Hrev_master Healthcare in Low-resource Settings 2023; volume 11(s1):11197 Physical activity, exercise habits, and body mass index of adults Ratna Candra Dewi,1,2 Bambang Wirjatmadi3 1Doctoral Program of Public Health Faculty, Universitas Airlangga, Surabaya, Indonesia; 2Faculty of Sport Science, Universitas Negeri Surabaya, Surabaya, Indonesia; 3Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia Abstract Introduction: The risk of degenerative diseases begins to appear in adulthood. Physical activity and exercise habits prevent the incidence of obesity which is a risk factor for degenerative dis- eases’ emergence. Therefore, this study aims to examine the rela- tionship between physical activity, exercise habits, body mass index, and fat mass percentage. Design and Methods: This study used an analytic observa- tional cross-sectional design and 32 office workers in Surabaya aged 28-56 years were selected by simple random sampling tech- nique. The data collected included measurements of physical activity, exercise habits, anthropometry, and body composition, which were analyzed using Spearman’s rank correlation test. Results: The results showed that 46.9% of participants had moderate activity, 43.8% exercised 1-2x a week, 56.3% exercised for 20-60 minutes, 56.30% had a low exercise intensity, 62.50% had an overweight body mass index, and 71.9% had overfat mass percentage. Spearman’s rank test showed a significant relationship between energy intake, physical activity, exercise frequency, dura- tion and intensity, and body mass index as well as between energy intake, physical activity, exercise intensity, and body fat percent- age. Conclusions: Increased physical activity and exercise habits were associated with decreased BMI and body fat percentage. Introduction Physical Activity (PA) and exercise habits help to prevent and manage chronic disease, due to their beneficial effects on clinical endpoints in various diseases.1 High levels of PA show a relation- ship with better health and life quality.2,3 In contrast, low PA is associated with negative health outcomes, including obesity, type 2 diabetes mellitus, and death.4 Physical activity, exercise, and nutrition work together to maintain body weight at the desired level.2 Although diet contributes more to short-term weight loss, exercise appears to be important in maintaining the desired body weight.3 Decreased PA due to Lifestyle changes initiates obesity, while light PA performed during leisure time such as sitting relaxed, watching television, and playing computer, decreases bodily-pro- duced energy, causing an imbalance between energy generated from food and the amount expended for physical activity. This leads to fatty tissue accumulation that increases the risk of obesity, especially in adulthood.5 Obesity in adulthood (26-45 years) which has the highest level of productivity compared to other age groups, directly increases the economic burden. Hence, elevation in medical expenses and absenteeism at work due to diseases caused by obesity is used to measure a country’s productivity decline. Obese employees require more time to complete tasks and have limited ability to work physically. Their counterparts with a normal body weight lack or only have a few related health disorders.6 Physical activity that prevents obesity can be conducted with moderate intensity for at least 150-250 minutes per day. Additionally, there is a need to limit excess food, rest sufficiently (6-8 hours in adults) and reduce stress.7 Moderate-intensity PA done regularly maintains a balance of expended and consumed energy.8 PA in adulthood includes sports or planned exercises, as well as leisure activities (such as walking, dancing, gardening, swimming), household chores (such as washing, cooking, sweep- ing), on-site work, and play which are carried out routinely. Body Mass Index (BMI) is a method that uses height and weight data to determine whether a person is healthy, overweight, or obese, but its disadvantage is the inability to provide accurate information about body composition. This aspect led some authors to define “the obesity paradox” as a situation in which obese indi- viduals do not appear to be at a higher risk for hypertension, dys- lipidemia, type II diabetes, or cardiovascular disease compared to their lean counterparts.2 A recent study on total body fat shows that adiposity is a sig- nificant risk marker for evaluating unhealthy weight. Furthermore, body fat is a more accurate indicator than BMI for predicting obe- sity.3 There is ample evidence regarding the importance of physi- cal activity in weight loss programs to maintain a healthy weight and prevent long-term weight gain. Increased PA has also been reported to provide comprehensive health benefits and reduce mortality associated with any cause, regardless of BMI. Specifically, this study aims to analyze the relationship between physical activity, exercise habits, body mass index, and body fat percentage. Article Significance for public health An unbalanced diet and lack of physical activity increase the risk of non-communicable diseases. Meanwhile physical activity has several benefits including reducing the risk of coronary heart disease, stroke, diabetes, hypertension, colon cancer, breast cancer, and depression. It is also the key to energy expenditure which balances energy and controls body weight to facilitate a normal BMI and body fat percentage. [Healthcare in Low-resource Settings 2023; 11(s1):11197] [page 111] No n- co mm er cia l u se on ly Design and Methods An analytic observational cross-sectional design was used, while the population selected by simple random sampling technique were 32 office workers in Surabaya aged 25-55 years. Anthropometric measurements included the assessment of height using a microtoise. Bodyweight, body fat percentage, and BMI were measured by bioimpedance using a Tanitamulti frequency analyzer (Tanita Corporation, Tokyo, Japan). Furthermore, con- sumption intake was determined with a 2x24 hour recall method and analyzed using NutriSurveysoftware, while the GPAQ (Global Physical Activity Questionnaire) method was used for PA. In this study, exercise habits were divided into frequency, duration, and intensity of exercise. All data were analyzed with SPSS version 22 and descriptive statistics were calculated to determine consumption intake percentage, body fat percentage, BMI, physical activity, and exercise habits. Rank Spearman Correlation Test was used to ana- lyze relationships between variables, where α (two-sided) = 0.05 and Power of study = 95%. Before data collection, all participants were provided with information about the study and the right to withdraw at any time, then they filled out informed consent. Results and Discussions Characteristics of participants Table 1 shows that most of the participants were male (78.1%), 46.9% had an energy intake of 2500-2999 kcal, 46.9% did a mod- erate physical activity, 62.5% had overweight BMI, 71.9% had excess body fat percentage, 43.8% exercised at a frequency of 1-2 times/week, 56.3% had an exercise duration of 20-60 minutes, and 56.3% did low-intensity exercise. Table 2 shows a significant relationship (<0.05) between ener- gy intake, physical activity, exercise frequency, duration and inten- sity, and BMI, as well as between energy intake, physical activity, exercise intensity, and body fat percentage. The energy intake coefficient is positive, meaning a greater coefficient value tends to increase BMI and body fat percentage. On the other hand, the coef- ficients of exercise frequency, duration and intensity, and physical activity are negative, meaning a greater value reduces BMI and body fat percentage. This study aimed to analyze the relationship between energy intake, physical activity, exercise frequency, duration and intensity, BMI, and percentage body fat in adults aged 28-56 years. Bodyweight and composition are the sums of many factors that regulate and influence the “intake” and “output” sides of the ener- gy balance equation.1 In weight management and obesity preven- tion, the role of diet and PA is not simply ‘eat less’ or ‘exercise more’, but understanding the synergies and interrelated nature of both factors.9 Diet influences energy balance and health more than just providing energy. For example, daily energy expenditure is affected by total energy intake (e.g., kcal or kJ consumed), plus food macronutrient composition (percentage of energy from pro- tein, fat, carbohydrates, and alcohol),4,10 its energy density (kcal or kJ per g of food),10,11 and timing of intake.12 These dietary factors also change the food’s thermic effect and the type of substrate stored or used for fuel during PA.13-15 Physical activity and exercise affect the balance of energy more than just its expenditure. The energy amount expended and Article Table 1. Variables of the participant’s characteristics. Characteristics N % Sex Male 25 78.1 Female 7 21.9 Energy Intake 2000 – 2499 kcal 4 12.5 2500 – 2999 kcal 15 46.9 3000 – 3499 kcal 10 31.2 >3500 3 9.4 Minimum: 2000 Maximum: 3500 Mean: 2787.50 SD: 421.02 Physical Activity Low (< 600 MET-minutes a day) 13 40.6 Moderate (600 - <1500 MET-minutes a day) 15 46.9 High (1500 - <3000 MET-minutes a day) 4 12.5 Body Mass Index Underweight (BMI ≤ 18.4) 1 3.1 Normal (BMI 18.5-25) 11 34.4 Overweight (BMI ≥ 25.1) 32 62.5 Body Fat Percentage Lean 0 0 Optimal 9 28.1 Overfat 23 71.9 Exercise frequency No exercise 5 15.6 1-2x/week 14 43.8 3-5x/week 8 25.0 >5x/week 5 15.6 Exercise duration <20 minutes 7 21.9 20-60 minutes 18 56.3 >60 minutes 7 21.9 Exercise intensity Low 18 56.3 Moderate 13 40.6 High 1 3.1 Remark: MET= Metabolic equivalents; BMI= Body Mass Index. Table 2. The relationship between explanatory variables, body mass index, and body fat percentage. Variables BMI Body Fat Percentage R Sig. r Sig. Energy Intake 0.522 0.002 0.479 0.006 Physical Activity -0.415 0.018 -0.418 0.017 Exercise Frequency -0.396 0.025 -0.255 0.159 Exercise Duration -0.375 0.034 -0.315 0.079 Exercise Intensity -0.628 0.000 -0.528 0.002 [page 112] [Healthcare in Low-resource Settings 2023; 11(s1):11197] No n- co mm er cia l u se on ly the fuel used are affected by the type, intensity, and duration of PA. For example, 30 minutes of running consumes more energy than walking at that same time. PA also alters appetite and its-regulating hormones by promoting appetite suppression or hunger, which in turn changes total energy intake.16-19 This in addition to regular and frequent exercise jointly increases energy flux, namely energy con- version rate after absorption from food into body tissues for use in metabolism or the conversion into energy stores.20 Higher energy flux levels augment the body’s ability to match energy intake with expenditure thereby making weight management easier.20,21 PA and proper exercise increase muscle mass and strength,22,23 as well as elevate or maintain bone mass.23 These factors improve body com- position and health as well as increase an individual’s ability to maintain an active lifestyle and reduce the risk of obesity and chronic disease.11,24 According to Shook et al., the group with low activity levels had high body weight and BMI. They also discovered that weight differences were entirely attributable to differences in fat mass, with the low PA group having the highest fat mass (30.9 kg or 68 lb) versus the greatest PA group (14.2 kg or 32 lb).25 One year later, another study reported that the two lowest PA groups had a 1.82 to 3.80 times greater risk of gaining >3% body fat than the group par- ticipating in medium or higher PA, meaning a low PA level is a risk factor for weight gain. Physical activity reduces energy intake by changing appetite, and its effect on appetite is influenced by PA type and intensity, environmental temperature, and characteristics of the exerciser. PA tends to create a negative energy balance, depending not only on its direct effect on the ability to increase expenditure but also indi- rectly on the potential to modulate appetite and/or energy intake. Based on a study, the type and intensity of exercise or PA affect changes in appetite. High-intensity exercise has a greater propen- sity to suppress hunger or food intake after being performed than moderate or light exercise.26,27 Appetite is suppressed for 15-60 minutes after exercise and potentially delays the next meal. The type of exercise also affects appetite suppression. Another study shows that running, rope jumping, or high-intensity exercise inter- val workouts tend to suppress appetite than swimming and walking which rather stimulate appetite and/or food intake. Additionally, running has a stronger effect on appetite suppression than strength training.28-33 The environmental temperature during or after exercise also affects appetite. Increased hunger and/or food intake can be caused by a cold environment while hunger is suppressed by hotness. It was reported that exercising for 45 minutes in 20◦C water elevates food intake by an average of 44% more after 1 hour of exercise compared to 32◦C.(34,35) Differences in environmental or body temperature show that swimming increases hunger compared to other types of exercise.35 The limitations of this study are related to body composition measurements that only BMI and body fat per- centage. There need to be other measurements such as muscle mass and bone mass. This is to determine the role of physical activ- ity, exercise habits and diet on body composition. Conclusions Based on the results, increased physical activity and exercise habits were associated with decreased BMI and body fat percent- age. Regular physical activity and exercise, as well as a healthy and balanced diet will create a healthy body composition. References 1. Sparling PB, Franklin BA, Hill JO. Energy balance: the key to a unified message on diet and physical activity. J Cardiopulm Rehabil Prev 2013;33:12–5. 2. Hall KD, Heymsfield SB, Kemnitz et al. Energy balance and its components: implications for body weight regulation 1-3. Am J Clin Nutr 2012;95:989–94. 3. Shook RP, Hand GA, Blair SN. Top 10 research questions related to energy balance. Res Q Exerc Sport 2014;85:49–58. 4. Galgani J, Ravussin E. REVIEW Energy metabolism, fuel selection and body weight regulation. Int J Obes 2008;32:109– 19. 5. Elder BL, Ammar EM, Pile D. Sleep Duration, Activity Levels, and Measures of Obesity in Adults. Public Health Nurs 2016;33:200–5. 6. Sanchez Bustillos A, Gregory Vargas III K, Gomero-Cuadra R. Journal of Epidemiology and Global Health Work productivity among adults with varied Body Mass Index: Results from a Canadian population-based survey Work productivity among adults with varied Body Mass Index: Results from a Canadian Article Correspondence: Ratna Candra Dewi, Faculty of Public Health, Universitas Airlangga, Jl. Dr. Ir. H. Soekarno, Mulyorejo, Surabaya, Indonesia 60115, Tel.: +62315920948, Fax: +62315924618, E-mail: ratna.can.dewi-2017@fkm.unair.ac.id Key words: Physical activity, exercise habits, Body Mass Index, body fat percentage Acknowledgment: The authors are grateful to the Faculty of Public Health Universitas Airlangga for the support and encouragement pro- vided during this study. Contributions: All authors read and approved the final manuscript. Conflict of interest: The authors declare no conflict of interest. Funding: This study was funded by the Faculty of Public Health, Universitas Airlangga. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Informed consent: Written informed consent was obtained from a legal- ly authorized representative(s) for anonymized patient information to be published in this article. Conference presentation: Part of this paper was presented at the 2nd International Nursing and Health Sciences Symposium that took place at the Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia. Received for publication: 3 December 2021. Accepted for publication: 10 May 2022. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2023; 11(s1):11197 doi:10.4081/hls.2023.11197 Publisher's note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any prod- uct that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. 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Postexercise Water Immersion Increases Short-Term Food Intake in Trained Men. Med Sci Sport Exerc 2011;43:632–8. Article [page 114] [Healthcare in Low-resource Settings 2023; 11(s1):11197] No n- co mm er cia l u se on ly