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THE CARDIORESPIRATORY FITNESS AND CARDIOVASCULAR RISK AMONG SECURITY OFFICERS WITHIN A UNIVERSITY
Dr Jackson Wong
QM 178 W872 2013 Master of Public Health
2013
Pus t Kbidmat Maklumat A demik UNlVERSm lALAVSIA ARAWAK
PKHIDMAT MAKLUMAT AKAOEMIK
111111111 rli~iillllllill 1000246996
U tv I
Faculty of Medicine and Health Sciences
THE CARDIORESPIRATORY FITNESS AND CARDIOVASCULAR RISK AMONG SECURITY OFFICERS WITHIN A UNIVERSITY
Dr Jackson Wong
Master of Public Health
2013
ACKNOWLEDGEMENTS
I thank the Lord God Almighty that with His presence and loving grace despite the imperfection
of the flesh made this life and this day at all possible
This study would not have been completed if not for the support of my principal and coshy
supervisors friends and colleagues Therefore I would ~ike to extend my gratitude and special
thanks to Associate Professor Dr Kamaludin Bakar for his understanding guidance and
constructive criticism and support Dr Cheah Whye Lian for her utmost dedication patience
relentless effort and professionalism throughout this study
Through working with them I had gained much knowledge and assistance in completing my
research work and am more prepared for future challenges in this field
This study also could not have been completed without the support from the survey respondents
and unconditional support from the University Head of Security Mr Yam an and the many staff
of Unimas Security Kota Samarahan I would also like to thank UNIMAS lecturers and staff for
supporting me throughout this study
Last but not least I would like to thank Dr Deburra Peak Ngadan for spending the time to share
research knowledge and experience whilst maintaining utmost professionalism as well as
friendship
To my family no amount of word can describe how grateful and thankful I am
ABSTRACT
0 hysical fitness is important in most high physically demanding jobs especially in the armed forces and
security services However physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand when needed This research
used a cross-sectional survey to explore cardiorespiratory fitness cardiovascular risk factors and the
relationships that exist between physical activity cardiorespiratory fitness and cardiovascular risk factors
among security officers in UNIMAS using the International Physical Activity Questionnaire Short-fonn
(lPAQ-S) the YMCA 3 minutes physical fitness test and blood test for fasting sugar and cholesterol
levels In particular this study aimed to determine the socio-demographic characteristics cardiovascular
risk factors level of cardiorespiratory fitness and the relationship between cardiorespiratory fitness
cardjovascular risk factors and sociodemographic characteristics among the university security officers A
total of 100 respondents participated in this study The rate percentage of the respondents who were found
to be smokers was 531 high blood pressure was 347 deranged cholesterol levels was 378
deranged blood glucose was 378 and abnormal BMI was 765 There were 744 respondents
(n=73) with more than two risk factors 235 respondents (n=23) with one risk factor and 2 (n=21) had no
risk factors Two cardiovascular risk factors which were found to have statistically significant associated
with cardiorespiratory fitness were fasting blood glucose (X2 = 6082 df= 2 P lt 005) and physical
activity (X2 =9337 df= 1 P lt 005) In conclusion physical inactivity and the risk of hypertension
diabetes and high cholesterol levels were existing problems among the security officers where all except
for high BP were above the figures reported by NHMS III Mo-st of the security officers were also found
to have poor cardiorespiratory fitness Both employee and employers should take an active role in
planning a healthy working environment and schedule with compulsory regular annual medical
examination and full gymnasium university utilization to monitor and maintain physical fitness and high
physical activity amongst the security officers
11
ABSTRAK
Kesihatan jizikal penting dalam pekerjaan yang memerlllkan kekuatan jizikal tinggi seperti perkhidmatan
pasukan bersenjata dan perkhidmatan keselamatan Bagaimanaplln kesihatan jizikal dalam pekejaan seperti
ini selalunya diabaikan disebabkan jangka selang lama antara keperluan kekuatan jizikal rendah diikuti oleh
permintaan jizikal yang Linggi apabia diperlukan Penyelidikan ini menggllnakan satu kajiselidik keratan
rentas meneroka perhubungan yang wujud di antara aktiviti jizikal kesihatan kardiorespiratori dan faktorshy
faktor risiko kardiovaskular an tara pengawal keselamatan di UNIA1AS dengan menggunakan International
Physical Activity Questionnaire Short-form (IP AQ-S) ujian kesihatan jizikal YMCA (3 minit ujian langkahan)
dan ujian darah seperli gula dan kolestesterol Khususnya kajian ini bertujuan untuk menentukan ciri-ciri
sosiodemografi faklor-faklor risiko kardiovaskular tahap kesihatan kardiorespiratori dan hubungan an tara
kesihatan kardiorespiratori faklor-faklor risiko kardiovaskular dan ciri-eiri sosiodemografik antara pegmvaishy
pegawai keselamatan universiti Sejumlah 100 responden telah menyertai kajian ini Di kalangan responden
tersebut Kadar peratusan yang merokok adalah 531 tekanan darah tinggi adalah 347 tahap kolesterol
tinggi adalah 378 tahap glllkos darah tinggi adalah 3 7 8 dan BMI yang tinggi adalah 765 Terdapat
73 respond en dengan lebih dua faktor risiko 23 responden dengan satll faktor risiko dan 2 responden yang
tiada faktor risiko Dua faktor risiko kardiovasklilar yang ditemui mempunyai perhubungan slatistik yang
signifikan di antara kesihatan kardiorespiratori adalah tahap glukos darah (X2 = 6082 df= 2 P lt 005) dan
aktiviti jizikal (X2 =9337 df= 1 P lt 005) Kesimplilannya aktiviti fizikal dan risiko tekanan darah til1ggi
kencing manis dan paras kolesterol yang tinggi merupakan masalah perubatan di kalangan pegmvai-pegawai
keselamatan di mana semlla keeuali tekanan darah tinggi berada di atas tahap yang dilaporkan oleh NHMS p
III Kebanyakan pegmiQi-pegawai keselamatan juga didapati Inempunyai kecergasan kardiorespiralori
rendah Kedua-dua pihak pekerja dan majikan perlu mengambil peranan aklifdalam meraneang persekitaran
pekerjaan yang sihal dan penjadualan pemeriksaan perubatan tahunan yang wajib penggunaan gimnasilltn
universili sepenuhnya dalam memanlau serta mengekalkan kesihalan fizikal dan kegiatan fizikal yang tinggi
di kalangan pengawal keselamalan
III
Uamp~d Kbidmal Mlktumat Aklldemik UNIVERSlll MALAVSIA SARAWAK
TABLE OF CONTENTS
Acknowledgement i
Abstract (English) ii
Abstract (Bahasa Melayu) iii
Table of Contents iv
List of Tables vii
List of Figures vii
List of Abbreviations viii
CHAPTER 1
INTRODUCTION
10 Introduction 1
11 Problem Statement 5
12 Conceptual and Theoretical Framework 9
13 Purpose of study 11
14 Hypothesis 1 1
15 Objectives 12
151 Specific objectives 12
16 Operational Detinition 12
CHAPTER 2 14
LITERATURE REVIEW 14
20 Introduction 14
21 Physical activity and its measurement 14
22 Cardiorespiratory fitness and its measurements 15
24 Job fitness injuries and ill-health retirement 23
25 Conclusion 26
CHAPTER 3 27
IV
27 METHODOLOGY
30 Introduction 27
31 Research design and setting 27
311 Location 27
32 Population and sampling method 28
33 Research Instmments and Data Collection 29
34 Pilot study 32
35 Data analysis 33
36 Ethical issues 34
CHAPTER 4 35
RESULTS 35
40 Introduction 35
41 Sociodemographic Characteristics 35
42 Cardiovascular Risk Factors 37
43 Cardiorespiratory fitness level 41
44 Cardiorespiratory Fitness and Cardiovascular Risk Factor 42
CHAPTER 5 44
DISCUSSION LIMITATION AND CONCLUSION 44
50 Introduction 44
51 Respondents Socio-demographic Characteristics 44 52 Cardiovascular Risk Factors and Cardiorespiratory Fitness 45
521 Smoking 45
522 Alcohol 46
523 Cholesterol level 46
524 Fasting blood sugar 47
v
525 Blood pressure 47
526 Body Mass Index (BMI) 48
527 Waist circumference 49
528 Physical activity level 50
53 Summary of the major findings of this study 51
54 Limitation 51
55 Conclusion 53
56 Recommendation 53
REFERENCES 55
APPENDIX 72
Appendix I Questionnaire (English) 72
Appendix II QuestiOlmaire (Malay) 76
Appendix III Ethics committee letter 80
Appendix IV Information respondent sheet (English) 81
Appendix V Consent form (English) 83
Appendix VI PAR Q (English) 84
Appendix VII Information respondent sheet (Malay) 85
Appendix VIII Consent Form (Malay) 87
Appendix XI PAR Q (Malay) 88
VI
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
Pus t Kbidmat Maklumat A demik UNlVERSm lALAVSIA ARAWAK
PKHIDMAT MAKLUMAT AKAOEMIK
111111111 rli~iillllllill 1000246996
U tv I
Faculty of Medicine and Health Sciences
THE CARDIORESPIRATORY FITNESS AND CARDIOVASCULAR RISK AMONG SECURITY OFFICERS WITHIN A UNIVERSITY
Dr Jackson Wong
Master of Public Health
2013
ACKNOWLEDGEMENTS
I thank the Lord God Almighty that with His presence and loving grace despite the imperfection
of the flesh made this life and this day at all possible
This study would not have been completed if not for the support of my principal and coshy
supervisors friends and colleagues Therefore I would ~ike to extend my gratitude and special
thanks to Associate Professor Dr Kamaludin Bakar for his understanding guidance and
constructive criticism and support Dr Cheah Whye Lian for her utmost dedication patience
relentless effort and professionalism throughout this study
Through working with them I had gained much knowledge and assistance in completing my
research work and am more prepared for future challenges in this field
This study also could not have been completed without the support from the survey respondents
and unconditional support from the University Head of Security Mr Yam an and the many staff
of Unimas Security Kota Samarahan I would also like to thank UNIMAS lecturers and staff for
supporting me throughout this study
Last but not least I would like to thank Dr Deburra Peak Ngadan for spending the time to share
research knowledge and experience whilst maintaining utmost professionalism as well as
friendship
To my family no amount of word can describe how grateful and thankful I am
ABSTRACT
0 hysical fitness is important in most high physically demanding jobs especially in the armed forces and
security services However physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand when needed This research
used a cross-sectional survey to explore cardiorespiratory fitness cardiovascular risk factors and the
relationships that exist between physical activity cardiorespiratory fitness and cardiovascular risk factors
among security officers in UNIMAS using the International Physical Activity Questionnaire Short-fonn
(lPAQ-S) the YMCA 3 minutes physical fitness test and blood test for fasting sugar and cholesterol
levels In particular this study aimed to determine the socio-demographic characteristics cardiovascular
risk factors level of cardiorespiratory fitness and the relationship between cardiorespiratory fitness
cardjovascular risk factors and sociodemographic characteristics among the university security officers A
total of 100 respondents participated in this study The rate percentage of the respondents who were found
to be smokers was 531 high blood pressure was 347 deranged cholesterol levels was 378
deranged blood glucose was 378 and abnormal BMI was 765 There were 744 respondents
(n=73) with more than two risk factors 235 respondents (n=23) with one risk factor and 2 (n=21) had no
risk factors Two cardiovascular risk factors which were found to have statistically significant associated
with cardiorespiratory fitness were fasting blood glucose (X2 = 6082 df= 2 P lt 005) and physical
activity (X2 =9337 df= 1 P lt 005) In conclusion physical inactivity and the risk of hypertension
diabetes and high cholesterol levels were existing problems among the security officers where all except
for high BP were above the figures reported by NHMS III Mo-st of the security officers were also found
to have poor cardiorespiratory fitness Both employee and employers should take an active role in
planning a healthy working environment and schedule with compulsory regular annual medical
examination and full gymnasium university utilization to monitor and maintain physical fitness and high
physical activity amongst the security officers
11
ABSTRAK
Kesihatan jizikal penting dalam pekerjaan yang memerlllkan kekuatan jizikal tinggi seperti perkhidmatan
pasukan bersenjata dan perkhidmatan keselamatan Bagaimanaplln kesihatan jizikal dalam pekejaan seperti
ini selalunya diabaikan disebabkan jangka selang lama antara keperluan kekuatan jizikal rendah diikuti oleh
permintaan jizikal yang Linggi apabia diperlukan Penyelidikan ini menggllnakan satu kajiselidik keratan
rentas meneroka perhubungan yang wujud di antara aktiviti jizikal kesihatan kardiorespiratori dan faktorshy
faktor risiko kardiovaskular an tara pengawal keselamatan di UNIA1AS dengan menggunakan International
Physical Activity Questionnaire Short-form (IP AQ-S) ujian kesihatan jizikal YMCA (3 minit ujian langkahan)
dan ujian darah seperli gula dan kolestesterol Khususnya kajian ini bertujuan untuk menentukan ciri-ciri
sosiodemografi faklor-faklor risiko kardiovaskular tahap kesihatan kardiorespiratori dan hubungan an tara
kesihatan kardiorespiratori faklor-faklor risiko kardiovaskular dan ciri-eiri sosiodemografik antara pegmvaishy
pegawai keselamatan universiti Sejumlah 100 responden telah menyertai kajian ini Di kalangan responden
tersebut Kadar peratusan yang merokok adalah 531 tekanan darah tinggi adalah 347 tahap kolesterol
tinggi adalah 378 tahap glllkos darah tinggi adalah 3 7 8 dan BMI yang tinggi adalah 765 Terdapat
73 respond en dengan lebih dua faktor risiko 23 responden dengan satll faktor risiko dan 2 responden yang
tiada faktor risiko Dua faktor risiko kardiovasklilar yang ditemui mempunyai perhubungan slatistik yang
signifikan di antara kesihatan kardiorespiratori adalah tahap glukos darah (X2 = 6082 df= 2 P lt 005) dan
aktiviti jizikal (X2 =9337 df= 1 P lt 005) Kesimplilannya aktiviti fizikal dan risiko tekanan darah til1ggi
kencing manis dan paras kolesterol yang tinggi merupakan masalah perubatan di kalangan pegmvai-pegawai
keselamatan di mana semlla keeuali tekanan darah tinggi berada di atas tahap yang dilaporkan oleh NHMS p
III Kebanyakan pegmiQi-pegawai keselamatan juga didapati Inempunyai kecergasan kardiorespiralori
rendah Kedua-dua pihak pekerja dan majikan perlu mengambil peranan aklifdalam meraneang persekitaran
pekerjaan yang sihal dan penjadualan pemeriksaan perubatan tahunan yang wajib penggunaan gimnasilltn
universili sepenuhnya dalam memanlau serta mengekalkan kesihalan fizikal dan kegiatan fizikal yang tinggi
di kalangan pengawal keselamalan
III
Uamp~d Kbidmal Mlktumat Aklldemik UNIVERSlll MALAVSIA SARAWAK
TABLE OF CONTENTS
Acknowledgement i
Abstract (English) ii
Abstract (Bahasa Melayu) iii
Table of Contents iv
List of Tables vii
List of Figures vii
List of Abbreviations viii
CHAPTER 1
INTRODUCTION
10 Introduction 1
11 Problem Statement 5
12 Conceptual and Theoretical Framework 9
13 Purpose of study 11
14 Hypothesis 1 1
15 Objectives 12
151 Specific objectives 12
16 Operational Detinition 12
CHAPTER 2 14
LITERATURE REVIEW 14
20 Introduction 14
21 Physical activity and its measurement 14
22 Cardiorespiratory fitness and its measurements 15
24 Job fitness injuries and ill-health retirement 23
25 Conclusion 26
CHAPTER 3 27
IV
27 METHODOLOGY
30 Introduction 27
31 Research design and setting 27
311 Location 27
32 Population and sampling method 28
33 Research Instmments and Data Collection 29
34 Pilot study 32
35 Data analysis 33
36 Ethical issues 34
CHAPTER 4 35
RESULTS 35
40 Introduction 35
41 Sociodemographic Characteristics 35
42 Cardiovascular Risk Factors 37
43 Cardiorespiratory fitness level 41
44 Cardiorespiratory Fitness and Cardiovascular Risk Factor 42
CHAPTER 5 44
DISCUSSION LIMITATION AND CONCLUSION 44
50 Introduction 44
51 Respondents Socio-demographic Characteristics 44 52 Cardiovascular Risk Factors and Cardiorespiratory Fitness 45
521 Smoking 45
522 Alcohol 46
523 Cholesterol level 46
524 Fasting blood sugar 47
v
525 Blood pressure 47
526 Body Mass Index (BMI) 48
527 Waist circumference 49
528 Physical activity level 50
53 Summary of the major findings of this study 51
54 Limitation 51
55 Conclusion 53
56 Recommendation 53
REFERENCES 55
APPENDIX 72
Appendix I Questionnaire (English) 72
Appendix II QuestiOlmaire (Malay) 76
Appendix III Ethics committee letter 80
Appendix IV Information respondent sheet (English) 81
Appendix V Consent form (English) 83
Appendix VI PAR Q (English) 84
Appendix VII Information respondent sheet (Malay) 85
Appendix VIII Consent Form (Malay) 87
Appendix XI PAR Q (Malay) 88
VI
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
ACKNOWLEDGEMENTS
I thank the Lord God Almighty that with His presence and loving grace despite the imperfection
of the flesh made this life and this day at all possible
This study would not have been completed if not for the support of my principal and coshy
supervisors friends and colleagues Therefore I would ~ike to extend my gratitude and special
thanks to Associate Professor Dr Kamaludin Bakar for his understanding guidance and
constructive criticism and support Dr Cheah Whye Lian for her utmost dedication patience
relentless effort and professionalism throughout this study
Through working with them I had gained much knowledge and assistance in completing my
research work and am more prepared for future challenges in this field
This study also could not have been completed without the support from the survey respondents
and unconditional support from the University Head of Security Mr Yam an and the many staff
of Unimas Security Kota Samarahan I would also like to thank UNIMAS lecturers and staff for
supporting me throughout this study
Last but not least I would like to thank Dr Deburra Peak Ngadan for spending the time to share
research knowledge and experience whilst maintaining utmost professionalism as well as
friendship
To my family no amount of word can describe how grateful and thankful I am
ABSTRACT
0 hysical fitness is important in most high physically demanding jobs especially in the armed forces and
security services However physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand when needed This research
used a cross-sectional survey to explore cardiorespiratory fitness cardiovascular risk factors and the
relationships that exist between physical activity cardiorespiratory fitness and cardiovascular risk factors
among security officers in UNIMAS using the International Physical Activity Questionnaire Short-fonn
(lPAQ-S) the YMCA 3 minutes physical fitness test and blood test for fasting sugar and cholesterol
levels In particular this study aimed to determine the socio-demographic characteristics cardiovascular
risk factors level of cardiorespiratory fitness and the relationship between cardiorespiratory fitness
cardjovascular risk factors and sociodemographic characteristics among the university security officers A
total of 100 respondents participated in this study The rate percentage of the respondents who were found
to be smokers was 531 high blood pressure was 347 deranged cholesterol levels was 378
deranged blood glucose was 378 and abnormal BMI was 765 There were 744 respondents
(n=73) with more than two risk factors 235 respondents (n=23) with one risk factor and 2 (n=21) had no
risk factors Two cardiovascular risk factors which were found to have statistically significant associated
with cardiorespiratory fitness were fasting blood glucose (X2 = 6082 df= 2 P lt 005) and physical
activity (X2 =9337 df= 1 P lt 005) In conclusion physical inactivity and the risk of hypertension
diabetes and high cholesterol levels were existing problems among the security officers where all except
for high BP were above the figures reported by NHMS III Mo-st of the security officers were also found
to have poor cardiorespiratory fitness Both employee and employers should take an active role in
planning a healthy working environment and schedule with compulsory regular annual medical
examination and full gymnasium university utilization to monitor and maintain physical fitness and high
physical activity amongst the security officers
11
ABSTRAK
Kesihatan jizikal penting dalam pekerjaan yang memerlllkan kekuatan jizikal tinggi seperti perkhidmatan
pasukan bersenjata dan perkhidmatan keselamatan Bagaimanaplln kesihatan jizikal dalam pekejaan seperti
ini selalunya diabaikan disebabkan jangka selang lama antara keperluan kekuatan jizikal rendah diikuti oleh
permintaan jizikal yang Linggi apabia diperlukan Penyelidikan ini menggllnakan satu kajiselidik keratan
rentas meneroka perhubungan yang wujud di antara aktiviti jizikal kesihatan kardiorespiratori dan faktorshy
faktor risiko kardiovaskular an tara pengawal keselamatan di UNIA1AS dengan menggunakan International
Physical Activity Questionnaire Short-form (IP AQ-S) ujian kesihatan jizikal YMCA (3 minit ujian langkahan)
dan ujian darah seperli gula dan kolestesterol Khususnya kajian ini bertujuan untuk menentukan ciri-ciri
sosiodemografi faklor-faklor risiko kardiovaskular tahap kesihatan kardiorespiratori dan hubungan an tara
kesihatan kardiorespiratori faklor-faklor risiko kardiovaskular dan ciri-eiri sosiodemografik antara pegmvaishy
pegawai keselamatan universiti Sejumlah 100 responden telah menyertai kajian ini Di kalangan responden
tersebut Kadar peratusan yang merokok adalah 531 tekanan darah tinggi adalah 347 tahap kolesterol
tinggi adalah 378 tahap glllkos darah tinggi adalah 3 7 8 dan BMI yang tinggi adalah 765 Terdapat
73 respond en dengan lebih dua faktor risiko 23 responden dengan satll faktor risiko dan 2 responden yang
tiada faktor risiko Dua faktor risiko kardiovasklilar yang ditemui mempunyai perhubungan slatistik yang
signifikan di antara kesihatan kardiorespiratori adalah tahap glukos darah (X2 = 6082 df= 2 P lt 005) dan
aktiviti jizikal (X2 =9337 df= 1 P lt 005) Kesimplilannya aktiviti fizikal dan risiko tekanan darah til1ggi
kencing manis dan paras kolesterol yang tinggi merupakan masalah perubatan di kalangan pegmvai-pegawai
keselamatan di mana semlla keeuali tekanan darah tinggi berada di atas tahap yang dilaporkan oleh NHMS p
III Kebanyakan pegmiQi-pegawai keselamatan juga didapati Inempunyai kecergasan kardiorespiralori
rendah Kedua-dua pihak pekerja dan majikan perlu mengambil peranan aklifdalam meraneang persekitaran
pekerjaan yang sihal dan penjadualan pemeriksaan perubatan tahunan yang wajib penggunaan gimnasilltn
universili sepenuhnya dalam memanlau serta mengekalkan kesihalan fizikal dan kegiatan fizikal yang tinggi
di kalangan pengawal keselamalan
III
Uamp~d Kbidmal Mlktumat Aklldemik UNIVERSlll MALAVSIA SARAWAK
TABLE OF CONTENTS
Acknowledgement i
Abstract (English) ii
Abstract (Bahasa Melayu) iii
Table of Contents iv
List of Tables vii
List of Figures vii
List of Abbreviations viii
CHAPTER 1
INTRODUCTION
10 Introduction 1
11 Problem Statement 5
12 Conceptual and Theoretical Framework 9
13 Purpose of study 11
14 Hypothesis 1 1
15 Objectives 12
151 Specific objectives 12
16 Operational Detinition 12
CHAPTER 2 14
LITERATURE REVIEW 14
20 Introduction 14
21 Physical activity and its measurement 14
22 Cardiorespiratory fitness and its measurements 15
24 Job fitness injuries and ill-health retirement 23
25 Conclusion 26
CHAPTER 3 27
IV
27 METHODOLOGY
30 Introduction 27
31 Research design and setting 27
311 Location 27
32 Population and sampling method 28
33 Research Instmments and Data Collection 29
34 Pilot study 32
35 Data analysis 33
36 Ethical issues 34
CHAPTER 4 35
RESULTS 35
40 Introduction 35
41 Sociodemographic Characteristics 35
42 Cardiovascular Risk Factors 37
43 Cardiorespiratory fitness level 41
44 Cardiorespiratory Fitness and Cardiovascular Risk Factor 42
CHAPTER 5 44
DISCUSSION LIMITATION AND CONCLUSION 44
50 Introduction 44
51 Respondents Socio-demographic Characteristics 44 52 Cardiovascular Risk Factors and Cardiorespiratory Fitness 45
521 Smoking 45
522 Alcohol 46
523 Cholesterol level 46
524 Fasting blood sugar 47
v
525 Blood pressure 47
526 Body Mass Index (BMI) 48
527 Waist circumference 49
528 Physical activity level 50
53 Summary of the major findings of this study 51
54 Limitation 51
55 Conclusion 53
56 Recommendation 53
REFERENCES 55
APPENDIX 72
Appendix I Questionnaire (English) 72
Appendix II QuestiOlmaire (Malay) 76
Appendix III Ethics committee letter 80
Appendix IV Information respondent sheet (English) 81
Appendix V Consent form (English) 83
Appendix VI PAR Q (English) 84
Appendix VII Information respondent sheet (Malay) 85
Appendix VIII Consent Form (Malay) 87
Appendix XI PAR Q (Malay) 88
VI
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
ABSTRACT
0 hysical fitness is important in most high physically demanding jobs especially in the armed forces and
security services However physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand when needed This research
used a cross-sectional survey to explore cardiorespiratory fitness cardiovascular risk factors and the
relationships that exist between physical activity cardiorespiratory fitness and cardiovascular risk factors
among security officers in UNIMAS using the International Physical Activity Questionnaire Short-fonn
(lPAQ-S) the YMCA 3 minutes physical fitness test and blood test for fasting sugar and cholesterol
levels In particular this study aimed to determine the socio-demographic characteristics cardiovascular
risk factors level of cardiorespiratory fitness and the relationship between cardiorespiratory fitness
cardjovascular risk factors and sociodemographic characteristics among the university security officers A
total of 100 respondents participated in this study The rate percentage of the respondents who were found
to be smokers was 531 high blood pressure was 347 deranged cholesterol levels was 378
deranged blood glucose was 378 and abnormal BMI was 765 There were 744 respondents
(n=73) with more than two risk factors 235 respondents (n=23) with one risk factor and 2 (n=21) had no
risk factors Two cardiovascular risk factors which were found to have statistically significant associated
with cardiorespiratory fitness were fasting blood glucose (X2 = 6082 df= 2 P lt 005) and physical
activity (X2 =9337 df= 1 P lt 005) In conclusion physical inactivity and the risk of hypertension
diabetes and high cholesterol levels were existing problems among the security officers where all except
for high BP were above the figures reported by NHMS III Mo-st of the security officers were also found
to have poor cardiorespiratory fitness Both employee and employers should take an active role in
planning a healthy working environment and schedule with compulsory regular annual medical
examination and full gymnasium university utilization to monitor and maintain physical fitness and high
physical activity amongst the security officers
11
ABSTRAK
Kesihatan jizikal penting dalam pekerjaan yang memerlllkan kekuatan jizikal tinggi seperti perkhidmatan
pasukan bersenjata dan perkhidmatan keselamatan Bagaimanaplln kesihatan jizikal dalam pekejaan seperti
ini selalunya diabaikan disebabkan jangka selang lama antara keperluan kekuatan jizikal rendah diikuti oleh
permintaan jizikal yang Linggi apabia diperlukan Penyelidikan ini menggllnakan satu kajiselidik keratan
rentas meneroka perhubungan yang wujud di antara aktiviti jizikal kesihatan kardiorespiratori dan faktorshy
faktor risiko kardiovaskular an tara pengawal keselamatan di UNIA1AS dengan menggunakan International
Physical Activity Questionnaire Short-form (IP AQ-S) ujian kesihatan jizikal YMCA (3 minit ujian langkahan)
dan ujian darah seperli gula dan kolestesterol Khususnya kajian ini bertujuan untuk menentukan ciri-ciri
sosiodemografi faklor-faklor risiko kardiovaskular tahap kesihatan kardiorespiratori dan hubungan an tara
kesihatan kardiorespiratori faklor-faklor risiko kardiovaskular dan ciri-eiri sosiodemografik antara pegmvaishy
pegawai keselamatan universiti Sejumlah 100 responden telah menyertai kajian ini Di kalangan responden
tersebut Kadar peratusan yang merokok adalah 531 tekanan darah tinggi adalah 347 tahap kolesterol
tinggi adalah 378 tahap glllkos darah tinggi adalah 3 7 8 dan BMI yang tinggi adalah 765 Terdapat
73 respond en dengan lebih dua faktor risiko 23 responden dengan satll faktor risiko dan 2 responden yang
tiada faktor risiko Dua faktor risiko kardiovasklilar yang ditemui mempunyai perhubungan slatistik yang
signifikan di antara kesihatan kardiorespiratori adalah tahap glukos darah (X2 = 6082 df= 2 P lt 005) dan
aktiviti jizikal (X2 =9337 df= 1 P lt 005) Kesimplilannya aktiviti fizikal dan risiko tekanan darah til1ggi
kencing manis dan paras kolesterol yang tinggi merupakan masalah perubatan di kalangan pegmvai-pegawai
keselamatan di mana semlla keeuali tekanan darah tinggi berada di atas tahap yang dilaporkan oleh NHMS p
III Kebanyakan pegmiQi-pegawai keselamatan juga didapati Inempunyai kecergasan kardiorespiralori
rendah Kedua-dua pihak pekerja dan majikan perlu mengambil peranan aklifdalam meraneang persekitaran
pekerjaan yang sihal dan penjadualan pemeriksaan perubatan tahunan yang wajib penggunaan gimnasilltn
universili sepenuhnya dalam memanlau serta mengekalkan kesihalan fizikal dan kegiatan fizikal yang tinggi
di kalangan pengawal keselamalan
III
Uamp~d Kbidmal Mlktumat Aklldemik UNIVERSlll MALAVSIA SARAWAK
TABLE OF CONTENTS
Acknowledgement i
Abstract (English) ii
Abstract (Bahasa Melayu) iii
Table of Contents iv
List of Tables vii
List of Figures vii
List of Abbreviations viii
CHAPTER 1
INTRODUCTION
10 Introduction 1
11 Problem Statement 5
12 Conceptual and Theoretical Framework 9
13 Purpose of study 11
14 Hypothesis 1 1
15 Objectives 12
151 Specific objectives 12
16 Operational Detinition 12
CHAPTER 2 14
LITERATURE REVIEW 14
20 Introduction 14
21 Physical activity and its measurement 14
22 Cardiorespiratory fitness and its measurements 15
24 Job fitness injuries and ill-health retirement 23
25 Conclusion 26
CHAPTER 3 27
IV
27 METHODOLOGY
30 Introduction 27
31 Research design and setting 27
311 Location 27
32 Population and sampling method 28
33 Research Instmments and Data Collection 29
34 Pilot study 32
35 Data analysis 33
36 Ethical issues 34
CHAPTER 4 35
RESULTS 35
40 Introduction 35
41 Sociodemographic Characteristics 35
42 Cardiovascular Risk Factors 37
43 Cardiorespiratory fitness level 41
44 Cardiorespiratory Fitness and Cardiovascular Risk Factor 42
CHAPTER 5 44
DISCUSSION LIMITATION AND CONCLUSION 44
50 Introduction 44
51 Respondents Socio-demographic Characteristics 44 52 Cardiovascular Risk Factors and Cardiorespiratory Fitness 45
521 Smoking 45
522 Alcohol 46
523 Cholesterol level 46
524 Fasting blood sugar 47
v
525 Blood pressure 47
526 Body Mass Index (BMI) 48
527 Waist circumference 49
528 Physical activity level 50
53 Summary of the major findings of this study 51
54 Limitation 51
55 Conclusion 53
56 Recommendation 53
REFERENCES 55
APPENDIX 72
Appendix I Questionnaire (English) 72
Appendix II QuestiOlmaire (Malay) 76
Appendix III Ethics committee letter 80
Appendix IV Information respondent sheet (English) 81
Appendix V Consent form (English) 83
Appendix VI PAR Q (English) 84
Appendix VII Information respondent sheet (Malay) 85
Appendix VIII Consent Form (Malay) 87
Appendix XI PAR Q (Malay) 88
VI
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
ABSTRAK
Kesihatan jizikal penting dalam pekerjaan yang memerlllkan kekuatan jizikal tinggi seperti perkhidmatan
pasukan bersenjata dan perkhidmatan keselamatan Bagaimanaplln kesihatan jizikal dalam pekejaan seperti
ini selalunya diabaikan disebabkan jangka selang lama antara keperluan kekuatan jizikal rendah diikuti oleh
permintaan jizikal yang Linggi apabia diperlukan Penyelidikan ini menggllnakan satu kajiselidik keratan
rentas meneroka perhubungan yang wujud di antara aktiviti jizikal kesihatan kardiorespiratori dan faktorshy
faktor risiko kardiovaskular an tara pengawal keselamatan di UNIA1AS dengan menggunakan International
Physical Activity Questionnaire Short-form (IP AQ-S) ujian kesihatan jizikal YMCA (3 minit ujian langkahan)
dan ujian darah seperli gula dan kolestesterol Khususnya kajian ini bertujuan untuk menentukan ciri-ciri
sosiodemografi faklor-faklor risiko kardiovaskular tahap kesihatan kardiorespiratori dan hubungan an tara
kesihatan kardiorespiratori faklor-faklor risiko kardiovaskular dan ciri-eiri sosiodemografik antara pegmvaishy
pegawai keselamatan universiti Sejumlah 100 responden telah menyertai kajian ini Di kalangan responden
tersebut Kadar peratusan yang merokok adalah 531 tekanan darah tinggi adalah 347 tahap kolesterol
tinggi adalah 378 tahap glllkos darah tinggi adalah 3 7 8 dan BMI yang tinggi adalah 765 Terdapat
73 respond en dengan lebih dua faktor risiko 23 responden dengan satll faktor risiko dan 2 responden yang
tiada faktor risiko Dua faktor risiko kardiovasklilar yang ditemui mempunyai perhubungan slatistik yang
signifikan di antara kesihatan kardiorespiratori adalah tahap glukos darah (X2 = 6082 df= 2 P lt 005) dan
aktiviti jizikal (X2 =9337 df= 1 P lt 005) Kesimplilannya aktiviti fizikal dan risiko tekanan darah til1ggi
kencing manis dan paras kolesterol yang tinggi merupakan masalah perubatan di kalangan pegmvai-pegawai
keselamatan di mana semlla keeuali tekanan darah tinggi berada di atas tahap yang dilaporkan oleh NHMS p
III Kebanyakan pegmiQi-pegawai keselamatan juga didapati Inempunyai kecergasan kardiorespiralori
rendah Kedua-dua pihak pekerja dan majikan perlu mengambil peranan aklifdalam meraneang persekitaran
pekerjaan yang sihal dan penjadualan pemeriksaan perubatan tahunan yang wajib penggunaan gimnasilltn
universili sepenuhnya dalam memanlau serta mengekalkan kesihalan fizikal dan kegiatan fizikal yang tinggi
di kalangan pengawal keselamalan
III
Uamp~d Kbidmal Mlktumat Aklldemik UNIVERSlll MALAVSIA SARAWAK
TABLE OF CONTENTS
Acknowledgement i
Abstract (English) ii
Abstract (Bahasa Melayu) iii
Table of Contents iv
List of Tables vii
List of Figures vii
List of Abbreviations viii
CHAPTER 1
INTRODUCTION
10 Introduction 1
11 Problem Statement 5
12 Conceptual and Theoretical Framework 9
13 Purpose of study 11
14 Hypothesis 1 1
15 Objectives 12
151 Specific objectives 12
16 Operational Detinition 12
CHAPTER 2 14
LITERATURE REVIEW 14
20 Introduction 14
21 Physical activity and its measurement 14
22 Cardiorespiratory fitness and its measurements 15
24 Job fitness injuries and ill-health retirement 23
25 Conclusion 26
CHAPTER 3 27
IV
27 METHODOLOGY
30 Introduction 27
31 Research design and setting 27
311 Location 27
32 Population and sampling method 28
33 Research Instmments and Data Collection 29
34 Pilot study 32
35 Data analysis 33
36 Ethical issues 34
CHAPTER 4 35
RESULTS 35
40 Introduction 35
41 Sociodemographic Characteristics 35
42 Cardiovascular Risk Factors 37
43 Cardiorespiratory fitness level 41
44 Cardiorespiratory Fitness and Cardiovascular Risk Factor 42
CHAPTER 5 44
DISCUSSION LIMITATION AND CONCLUSION 44
50 Introduction 44
51 Respondents Socio-demographic Characteristics 44 52 Cardiovascular Risk Factors and Cardiorespiratory Fitness 45
521 Smoking 45
522 Alcohol 46
523 Cholesterol level 46
524 Fasting blood sugar 47
v
525 Blood pressure 47
526 Body Mass Index (BMI) 48
527 Waist circumference 49
528 Physical activity level 50
53 Summary of the major findings of this study 51
54 Limitation 51
55 Conclusion 53
56 Recommendation 53
REFERENCES 55
APPENDIX 72
Appendix I Questionnaire (English) 72
Appendix II QuestiOlmaire (Malay) 76
Appendix III Ethics committee letter 80
Appendix IV Information respondent sheet (English) 81
Appendix V Consent form (English) 83
Appendix VI PAR Q (English) 84
Appendix VII Information respondent sheet (Malay) 85
Appendix VIII Consent Form (Malay) 87
Appendix XI PAR Q (Malay) 88
VI
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
Uamp~d Kbidmal Mlktumat Aklldemik UNIVERSlll MALAVSIA SARAWAK
TABLE OF CONTENTS
Acknowledgement i
Abstract (English) ii
Abstract (Bahasa Melayu) iii
Table of Contents iv
List of Tables vii
List of Figures vii
List of Abbreviations viii
CHAPTER 1
INTRODUCTION
10 Introduction 1
11 Problem Statement 5
12 Conceptual and Theoretical Framework 9
13 Purpose of study 11
14 Hypothesis 1 1
15 Objectives 12
151 Specific objectives 12
16 Operational Detinition 12
CHAPTER 2 14
LITERATURE REVIEW 14
20 Introduction 14
21 Physical activity and its measurement 14
22 Cardiorespiratory fitness and its measurements 15
24 Job fitness injuries and ill-health retirement 23
25 Conclusion 26
CHAPTER 3 27
IV
27 METHODOLOGY
30 Introduction 27
31 Research design and setting 27
311 Location 27
32 Population and sampling method 28
33 Research Instmments and Data Collection 29
34 Pilot study 32
35 Data analysis 33
36 Ethical issues 34
CHAPTER 4 35
RESULTS 35
40 Introduction 35
41 Sociodemographic Characteristics 35
42 Cardiovascular Risk Factors 37
43 Cardiorespiratory fitness level 41
44 Cardiorespiratory Fitness and Cardiovascular Risk Factor 42
CHAPTER 5 44
DISCUSSION LIMITATION AND CONCLUSION 44
50 Introduction 44
51 Respondents Socio-demographic Characteristics 44 52 Cardiovascular Risk Factors and Cardiorespiratory Fitness 45
521 Smoking 45
522 Alcohol 46
523 Cholesterol level 46
524 Fasting blood sugar 47
v
525 Blood pressure 47
526 Body Mass Index (BMI) 48
527 Waist circumference 49
528 Physical activity level 50
53 Summary of the major findings of this study 51
54 Limitation 51
55 Conclusion 53
56 Recommendation 53
REFERENCES 55
APPENDIX 72
Appendix I Questionnaire (English) 72
Appendix II QuestiOlmaire (Malay) 76
Appendix III Ethics committee letter 80
Appendix IV Information respondent sheet (English) 81
Appendix V Consent form (English) 83
Appendix VI PAR Q (English) 84
Appendix VII Information respondent sheet (Malay) 85
Appendix VIII Consent Form (Malay) 87
Appendix XI PAR Q (Malay) 88
VI
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
27 METHODOLOGY
30 Introduction 27
31 Research design and setting 27
311 Location 27
32 Population and sampling method 28
33 Research Instmments and Data Collection 29
34 Pilot study 32
35 Data analysis 33
36 Ethical issues 34
CHAPTER 4 35
RESULTS 35
40 Introduction 35
41 Sociodemographic Characteristics 35
42 Cardiovascular Risk Factors 37
43 Cardiorespiratory fitness level 41
44 Cardiorespiratory Fitness and Cardiovascular Risk Factor 42
CHAPTER 5 44
DISCUSSION LIMITATION AND CONCLUSION 44
50 Introduction 44
51 Respondents Socio-demographic Characteristics 44 52 Cardiovascular Risk Factors and Cardiorespiratory Fitness 45
521 Smoking 45
522 Alcohol 46
523 Cholesterol level 46
524 Fasting blood sugar 47
v
525 Blood pressure 47
526 Body Mass Index (BMI) 48
527 Waist circumference 49
528 Physical activity level 50
53 Summary of the major findings of this study 51
54 Limitation 51
55 Conclusion 53
56 Recommendation 53
REFERENCES 55
APPENDIX 72
Appendix I Questionnaire (English) 72
Appendix II QuestiOlmaire (Malay) 76
Appendix III Ethics committee letter 80
Appendix IV Information respondent sheet (English) 81
Appendix V Consent form (English) 83
Appendix VI PAR Q (English) 84
Appendix VII Information respondent sheet (Malay) 85
Appendix VIII Consent Form (Malay) 87
Appendix XI PAR Q (Malay) 88
VI
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
525 Blood pressure 47
526 Body Mass Index (BMI) 48
527 Waist circumference 49
528 Physical activity level 50
53 Summary of the major findings of this study 51
54 Limitation 51
55 Conclusion 53
56 Recommendation 53
REFERENCES 55
APPENDIX 72
Appendix I Questionnaire (English) 72
Appendix II QuestiOlmaire (Malay) 76
Appendix III Ethics committee letter 80
Appendix IV Information respondent sheet (English) 81
Appendix V Consent form (English) 83
Appendix VI PAR Q (English) 84
Appendix VII Information respondent sheet (Malay) 85
Appendix VIII Consent Form (Malay) 87
Appendix XI PAR Q (Malay) 88
VI
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
List of Tables
Table 41
Table 42
Table 43
Table 44
Table 45
Table 46
List of Figures
Figure 11
Figure 22
Sociodemographic Characteristics of the Respondents 36
(N=100)
Anthropometric measurements of respondents 38
Cardiovascular risk factors among the respondents 40
(N=100)
Number of risk factors which respondents are exposed to 41
(N=100)
Cardiorespiratory fitness level (V02max) (N=1 00) 42
Chi Square analysis of factors associated with V02 max 43
(mLlkg -1 min-I) (N=100)
Theoretical framework 9
Conceptual framework 11
VII
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
List of Abbreviations
ACSM American College of Sports Medicine
AO Abdominal obesity
BMI Body Mass Index
CC Calf circumference
CRF Cardiorespiratory fitness
CRP C-Reactive Protein
CVD Cardiovascular disease
HDL High density lipoprotein
IHR Ill-health retirement
IPAQ International Physical Activity Questionnaire
IPAQ-s Short form International Physical Activity Questionnaire
LDL Low density Hpoprotein
MANS Malaysian Adult Nutrition Survey
MET Metabolic equivalent task
NCD Non-comrnunicabe disease
NHMS National Health and Morbidity Survey
OR Odds ratio
PAL Physical activity level
V02max Maximum oxygen volume
WC Waist circumference
WHO World Health Organization
YMCA Young Man Christian Association
VIII
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
CHAPTERl
INTRODUCTION
10 Introduction
Physical fitness is important in most jobs dependent upon the nature of the job Jobs where
physical fitness is an essential requirement includes the armed forces civilian emergency
services some coast officer services security officer services life officer services and many
more The degree of physical demand on the job would vary depending on the job description
Having said that physical fitness in these jobs are often neglected due to the prolong interval of
low physical demand followed by a sudden spike of high physical demand whenever the need
arises This has been found in fire fighters and police officers Similarly in the University
security officers have a relatively higher demand on physical fitness Therefore it has become
one of the Universitys requirements that upon employment candidates for the post of security
ofticers be physically [rt
In addition physical fitness has a strong relationship with physical activity and has some
influence on the outcome of cardiovascular disease in terms of morbidity and mortality
Therefore because of the known fact that cardiovascular disease is dependent upon
1
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
cardiovascular risk factors and cardiovascular risk factors is influenced by unhealthy lifestyle
practices andor sedentary lifestyle practices The study aims to explore these relationships
In Malaysia there is an alarming trend where there is a tremendous increase in the prevalence of
cardiovascular risk factors and cardiovascular disease When little or no measures are taken by
the individual or the organization to maintain physical fitness and wellness among workers there
is a prone tendency towards the development of obesity and metabolic syndrome over time
(Aintsworth 1993) This is true in the UK as well as in Malaysia due to changes in lifestyle over
recent decades where relatively few people engage in the level of physical activity
commensurate with good health The Third National Morbidity Survey (NHMS-Ill) in 2006
demonstrated an overall national prevalence of overweight (BMIgt2Skgm2) of 291 and
obesity (BMIgt30kgm2) of 174 (Kee Jr et ai 2008)
In the UK studies conducted amongst firefighters have found that obese firefighters have the
tendency to experience a reduction in physical activity and cardiorespiratory titness which
would further worsen their obesity problem and that in turn is associated with unfavorable CVD
risk profiles as well as higher prevalence of metabolic syndrome (Baur 2012) Many of the
tiretighters had receive medical and physical abilities testing in the beginning of their
professional careers but without any subsequent follow up and formal reassessment over the next
20-30 year work span yet senior fire fighters are expected to perform the same essential job
functions as the young recruits The benetit of having a work crew that is fit-for-work as well as
fit-for-life is tremendous Ensuring fitness for work can lead to increased quality and quantity of
2
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
production decrease absenteeism and turnover lower medical costs improve personal lifestyle
and reduce incidence of injury (Knapik 2011) Spent efforts by organizations or companies to
promote physical-fitness and well-being among workers have proven to be economical in the
long run (Rayson 2000) In fact studies have shown that it pays $3 to $15 for every $1 spent on
promoting health
In the UK with the growing health costs sickness absence and ill-health retirement present an
immense and growing burden on the economy Estimated costs due to absence levels was on a
continuous upward trend where latest figures in 40 of organizations showed a staggering II
billion sterling per year (Rayson 2000) The number of ill-health retirement (IHR) in some
organization was shown to lbe crippling where the average cost was 60000 pounds sterling per
person per year not inclusive of the preceding period of absence and the recruitment and training
costs for replacement of persOlmel
It is not only sickness absence that causes absenteeism and IHR - musculo-skeletal injuries have
the dubious accolade of accounting for more days lost than any other cause (Merecz 2011) Such
injuries have long been shown to be related to the level of physical fitness Since Chaffins work
tI
in 1974 identified a link between muscle strength and low back pain in manual workers the
association between fitness and injury has been demonstrated across many sectors (Chaffin
1974) The military has been at the leading edge of research demonstrating an association
between aspects of body composition muscular strength muscular endurance aerobic fitness
and both injury and absence Equally there are examples from civilian sectors though the
3
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
-------
number of well-designed studies is few Examples come from the gas and electricity industries
where aerobic fitness has been shown to be related to work-related injury and in the airline
freight industry where low strength employees were found to have an eight fold increased risk of
sustaining workplace injury over high strength individuals (Gilliam 1999) Employers are
responsible for protecting employees against physical harm and disease that may reasonable be
expected to arise in connection with their employment which is reinforced by legislation
notably the Health and Safety at Work Act 1947 in the UK
Ensuring people are both physically fit for work by matching their capabilities with the physical
requirement of their job and physically fit for life by promoting health related physical
activities are important and underutilized tools in an organization or company in reducing
absence and IHR Fitness related strategies that can be employed include redesigning the most
demanding aspects of the job selecting and training personnel who possess the necessary
physical attributes and assessment and redeployment of personnel to jobs within their personal
capability (Chaffin 1974)
Therefore this research aims to survey and explore relationships that exist between physical
activity cardiorespiratory fitness and cardiovascular risk factors Results from this study would
be detrimental in future intervention decision making or act as a baseline for future research as
limited or no prior similar study was ever done in the University
4
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
Pusat Kbidmat Maklumat Almdemik UNTVERSm MALAYSIA SARAWAK
11 Problem Statement
It is without dispute that physical fitness and health plays an important role among security
officers in maintaining demanding job performances within the confines of their job description
In addition there should also be no doubt that the outcome in terms of public safety persona[
safety extent of property damage control as well as the welfare of the University can be at stake
given certain circumstances For that matter it is a requirement for the security officers to pass
the fitness test
Although emphasis on health screening was done during the initial selection of these candidates
upon employment there were no efforts undertaken to maintain the fitness level and well-being
of these fine individuals If the current situation were to be permitted to continue on without a
certain amount of monitoring or surveillance it may result in an insidious increase in the
prevalence of obesity and other cardiorespiratory risk factors if not already present And it is a
known fact that security officers that have low cardiorespiratory fitness would influence physical
activity levels which leads to obesity And it is a fact that obese security officers have a tendency
to have a reduction in cardiorespiratory and physical fitness thus further worsening their obesity
problem - and this in turn again may further reduce their cardiorespiratory and physical fitness shy
like a viscous cycle that if not interrupted may worsen to the extent of the inevitab[e
development of unfavorable CVD risk profiles
5
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
The University has now been in existence for more than 20 years And in the past 20 years or
more Malaysia has undergone a rapid pace of industrialization and urbanization bringing about
imminent changes to the lifestyle and behavior towards a more sedentary and physically inactive
lifestyle among Malaysians What is of the status of health and fitness of these fine individuals is
not known for no or limited studies have been conducted to ascertain their well-being The
potential benefits of detecting health problems early can be staggering Work productivity and
efficiency can be increased tremendously III health retirement can be reduced along with the risk
of injury at the work place The financial burden on the health system and of the country can be
reduced Musculoskeletal injuries accounts for more days lost than any other (Mercz 1999) and
this can put a tremendous burden on a countries economy (Rayson 2000) Low strength
individuals have been shown to have an 8 fold increase in the likelihood of workplace injury
(Gilliam 1999)
The Second National Health and Morbidity Survey (NHMS - II) in 1996 demonstrated an
overall national prevalence (among populationgt 18 years of age) of overweight (BMI gt
2Skgm2) of 166 and obesity of 44 laquoLetchuman et ai 2010) In urban areas it was revealed
that 19 males were overweight and 5 were obese while 26 of females were overweight and
8 obese Over weight and obesity results in the increase risks of premature deaths as well as
increase morbidities in h~alth conditions such as diabetes mellitus hypertension hyperlipidemia
atherosclerosis coronary heart disease gout gaU bladder disease respiratory diseases arthritis
and certain types of cancers The Third National Health and Morbidity Survey (NHMS III) was
conducted in 2006 to determine the nutritional status of a nationally representative sample of
Malaysian adults aged 18 years and above (Kee lr et aI 2008) Body weight height and waist
6
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
circumference measurements were taken by trained health nurses according to a standard
procedure (NHMS III) Body Mass Index (BMI) vas determined among 33055 eligible adults
while risk of abdominal obesity based on waist circumference (WC) was obtained from 32900
individuals In addition peripheral muscle wasting was determined using calf circumference
(CC) among 4282 older individuals aged 60 years and above
The national prevalence of normal BMI (BMI 185-249 kgm2) was 484 (477-490) The
prevalence of underweight (BMI lt185 kglm2) was 85 (82-89) being higher in rural areas
98 (92-104) than in urban areas 78 (74-83) Meanwhile 291 (286-297) of the adults
were overweight (BMI 250-299 kglm2) Among the ethnic groups Indians had the highest
prevalence of overweight followed by Malays and Chinese In addition 140 (136-145) of the
adults were obese (BMI gt300 kgm2) Women had higher obesity prevalence at 174 (167shy
180) than men at 100 (95-105) In terms of ethnic groups Indians and Malays had higher
obesity prevalence than other groups By occupation category housewives showed the highest
prevalence of obesity at 203 (194-213) The prevalence of abdominal obesity (WC for
women gt88 cm and men gt102 cm) was 174 (169-179) with women showing higher
prevalence 260 (252-268) than men 73 (67-7) The prevalence of older persons with
peripheral muscle wasting (calf circumference for women lt 273 cm and men lt 301 cm) was
199 (185-216) w~h a higher prevalence of men 237 (216-259) than women 168
(151-185) at risk of malnutrition according to this indicator In comparison the present national
prevalence of underweight of 85 was three times lower than that (252) reported in the
NHMS II in 1996 (Letchuman et aI 2010) In contrast the prevalence of overweight has of
140 in this study and 127 in the Malaysian Adult Nutrition Survey (MANS) were
7
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
approximately three times the level of 44 found in 1996 (NHMS II Letchuman et ai 2010)
This alarming trend calls for serious re-examination of public health programmers for more
effective reduction of obesity among Malaysian adults increased from 66 in the NHMS II to
291 in the NHMS III The latter is comparable with the finding of 274 reported in another
nationally representative sample involving over 5000 adults namely the Malaysian Adults
Nutrition Survey (MANS) conducted in 2003 (Poh et ai 2010) It is noted that obesity
prevalence of 140 in this study and 127 in the MANS were approximately three times the
level of 44 found in 1996 (NHMS II) This alanning trend calls for serious re-examination of
public health programmers for more effective reduction of obesity among Malaysian adults
In the advent of compelling evidence relating the complex relationship between lifestyle
obesity physical fitness and well-being with individual productivity and the rising costs and
burden of health care on the economics of a country it becomes a major public health challenge
to tackle these problems If one wishes to devise effective health promotion measures then it is
necessary to know which aspects of awareness and lifestyle practices is the root problem what
level of physical activity is being practiced and should be recommended and to recognize the
level of risk of obesity and CVD in the community In the advent of compelling evidence
relating the complex relationship between lifestyle obesity physical fitness and well-being with
individual productivity ~nd the rising costs and burden of health care on the economics of a
country it becomes a major public health challenge to tackle these problems If one wishes to
devise effective health promotion measures then it is necessary to know which aspects of
awareness and lifestyle practices is the root problem what level of physical activity is being
8
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
practiced and should be recommended and to recognize the level of risk of obesity and CVD in
the community
12 Conceptual and Theoretical Framework
Theoretical frame work for Health Related Physical Fitness adapted from the Helsinki National
Public Health Institute and modified for the purpose of the study (Katja Borodulin 2006) In the
above theoretical framework health related fitness would be the main focus Here health related
fitness is represented by muscular motor cardiorespiratory morphologic and metabolic health
Each of these components would be represented by surrogate markers that would reflect these
attributes with a certain amount of accuracy
PHYSICAL KTIYITY - Leisure - OccupatioDal Other chores
~
~
[HERIDITARY]
J
HEAlTH-RILUED FITh-rSS - Iorphological - luscular - Iotor - Cardiorespiratory - Ietabolic
OTHER FACTORS - Lifestyle behayior - PersoDal attributes - Physical eDyiroDmeol - Social eoiroomeot - Sociodemograpby -------_
Figure 11 Theoretical Framework
9
~ ~ HEAlTH
- Wellness - Iortality - [orbidity~
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
In the conceptual framework below (Figure 12) obesity lipid profile blood glucose as well as
smoking are all cardiovascular risk factors Risk factors such as obesity are acquired through
anthropometric measurements such as waist circumference and BMI whereas lipid profile and
blood glucose level would be acquired via blood investigations Smoking is also a cardiovascular
risk factor Obesity and lipid profile aside from being strong cardiovascular risk factors also act
as surrogate markers for food lifestyle practices such as diet and nutrition habits Physical
activity on the other hand IS represented by data taken via validated questionnaire
Cardiorespiratory fitness level IS one of the many ways to determine the fitness level of a
particular individual and is measured by converting clinical parameter findings into V02 max
readings This is then used as a rather accurate representation of cardiorespiratory fitness as well
as physical fitness A reduction of physical activity coupled with unhealthy lifestyle practices
would result in obesity Obesity reduces cardiorespiratory fitness and thus would result in further
physical inactivity These occurrences and events would result in a vicious cycle and without
intervention would result in cardiovascular disease Confounding factors such as socioshy
demographic factors would also play some role in influencing the risk factors cardiorespiratory
fitness as well as the level of physical activity Data regarding these would be gathered via
questiOlmaire
10
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
l
PHYSICAL ACTIVITY CARDIOVASCULAR
RISK FACTORS
r Obesitybull IPAQ CARDIORESPIRATORY ~lt===gt L UPldPomeJFITNESS Glucose
r- shySmokingn ~
Socia-demography~ CONCEPTUAL FRAME WORK ADAPTED AND MODIFIED FORTHIS STUDY
Figure 12 Conceptual Framework
13 Purpose of study
The purpose of the study was to detennine the cardiorespiratory fitness level and cardiovascular
risks and its relationship among the security officer and to make health and policy
recommendations on the most cost effective health intenention plan targeting root causes
14 Hypothesis
There is a relationship between cardiorespiratory fitness and the cardiovascular risk factors
among the security officers of a University
11
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
15 Objectives
The general objective of the research was to determine the cardiorespiratory fitness level and
cardiovascular risk factors among the security officers of UNIMAS
151 Specific objectives
The specific objectives were as follows
1 To determine the socio-demographic characteristics among the university security
officers
2 To determine the cardiovascular risk factors among the university security officers
3 To determine the leve1 of cardiorespiratory fitness among the university security officers
4 To determine the relationship between cardiorespiratory fitness cardiovascular risk
factors and sociodemographic characteristics among the university security officers
16 Operational Definition
Physical activity Physical activity is any physical activity that results in energy
expenditure
Health-related fitness A set of outcomes or traits that relate to the ability to perform
physical activity (Caspersen et aI 1985)
12
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
Cardiorespiratory fitness Refers primarily to the capacity of heart and lungs to deliver
oxygen to skeletal muscles and maximal aerobic power is an
indicator of the maximal capacity of oxygen delivery Individuals
with a high maximal aerobic power can undertake demanding
physical task without suffering fatigue (Bouchard and Shephard
1994) This is represented by V02 max and an assessment tool
widely used
V02max Quantitative representation of cardiorespiratory fitness in terms of
maximal capacity of oxygen delivery (Bouchard and Shephard
1994)
Job-related physical fitness Physical fitness is the physical fitness that is required to do all the
possible tasks that might come with the job (Caspersen et aI
1985)
13
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14
CHAPTER 2
LITERATURE REVIEW
20 Introduction
This chapter has five parts Part 21 describes physical activity and its measurement part 22
describes cardiorespiratory titness and its measurements whereas part 23 describes the
relationship between cardiorespiratory fitness cardiovascular risk factors and physical activity
Part 24 discuss upon job fitness injuries and ill-health retirement Lastly part 25 concludes the
chapter on literature review
21 Physical activity and its measurement
Physical activity is defined as any bodily movement produced by skeletal muscles resulting in
energy expenditure (Caspersen et al 1985) Physical activity behavior can also be approached
from a behavioral point of view in that individual behavior and lifestyle are governed by
personal choices together with biological limitations and physical and social environment
(Wankel and Sefton 1994) Physical activity is currently considered as a behavior that is a crucial
part of a healthy lifestyle (Pate et al 1995)
Different modes of physical activity refer to the context in which the activity takes place these
being typically divided into occupational and leisure time physical activity (Howley 2001)
Leisure time physical activity refers to any activity that an individual prefers to engage in and
14