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ORIGINAL ARTICLE
Year : 2015  |  Volume : 15  |  Issue : 1  |  Page : 51-55

Effect of exercise on undergraduate health care students


1 Department of Physiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
2 Department of Surgery, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Date of Web Publication19-Jan-2015

Correspondence Address:
Arunima Chaudhuri
Department of Physiology, Burdwan Medical College and Hospital, Burdwan, West Bengal
India
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DOI: 10.4103/1319-6308.149539

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  Abstract 

Background: Various cardio-respiratory parameters are markedly better in youths who undertake couple of hours of exercise. This better cardio-respiratory fitness is known to translate into a lower cardiac disease risk in future. Aims: To study the effects of physical exercise on cardiovascular profile in young undergraduate males in health sector. Materials and Methods: This pilot study was undertaken in a tertiary care hospital of eastern India after taking Institutional ethical clearance and informed consent of the subjects in a time span of 2 years. One hundred male subjects in the age group of 18-25 years with no regular exercise habit, were selected as study group and 100 males otherwise comparable anthropometrically with a physically active lifestyle were selected as control. Blood pressure, pulse rate, and spirometric parameters were measured. Then, the subjects were made to exercise with bicycle ergometer. After cessation of exercise, the previous parameters were again recorded. Data obtained was analyzed using SPSS software. Results: Pre- (71.16 ± 1.98 vs 77.76 ± 4.59) and post-exercise (114.52 ± 5.55 vs 120.05 ± 4.79) heart rate and systolic BP (119.8 ± 7.05 vs 125.3 ± 5.72 and 140.80 ± 7.60 vs 147.84 ± 6.07) were significantly less in control as compared to study group. Post-exercise FEV1% was significantly less in study group. Pre- (4.1 ± 0.56 vs 4.05 ± 0.54) and post-exercise values of FVC (3.94 ± 0.55 vs. 3.77 ± 0.47) was significantly less (P value: 0.037*) in study group as compared to controls. Conclusions: Early lifestyle modification by regular exercises may improve not only quality of life in general but patient care in particular in students of healthcare services.

  Abstract in Arabic 

تأثير ممارسة الرياضة على طلاب الرعبة الصحية الجامعيي
خلفية: تعد معدلات أداء القلب والجهاز التنفسي الأفضل عند الشباب الذين يمارسون الرياضة البدنية لمدة ساعتين في اليوم. وتعد هذه اللياقة القلبية التنفسية سببا رئيسا في الحماية من مخاطر أمراض القلب في المستقبل.
أهداف الدراسة: دراسة تأثيرات الرياضة البدنية في القلب والأوعية الدموية لدى طلاب القطاع الصحي الجامعيين
منهج الدراسة : أجريت هذه الدراسة التجريبية في أحد مستشفيات الرعاية الصحية التعليمية في شرقي الهند بعد اتخاذ الإجاءات الأخلاقية وأخذ موافقة أفراد العين
ة, وكانت مدة الدراسة عامين.
عينة الدراسة: تم اختيار 100 من الذكور الذين ليست لديهم عادة ممارسة الرياضة ترواحت أعمارهم بين 18 - 25 كما تم اختيار 100 من الذكور يمارسون الرياضة البدنية كعينة ضابطة للمقارنة. تم قياس ضغط الدم ومعدل النبض، ومعدلات التنفس, وأخضع أفراد العينة لممارسة الرياضة على دراجة مقياس العمل ، وممارسة التمارين الرياضية سجلت المعدلات السابقة مرة أخرى , ثم تم تحليل البيانات السابقة باستخدام برنامح الحاسوبي. SPSS
النتائج: كانت معدلات ضربات القلب و ضغط الدم الانقباضي قبل ممارسة التدريب ( 71.16± 1.98 مقابل 77.67 4.59± (وبعد التدريب 114.52± 5.55مقابل 120.05± 4.79 , 119.8±7.05 مقابل 147.84 ± 6.07 كانت أقل بشكل ملحوظ في المجموعة الضابطة مقارنة بمجموعة الدراسة بعد التدريب في مجموعة الدراسة . كانت أقل FEV1% قبل التدريب 4.1± 0.56 مقابل 4.05± 0.54 وبعد التدريب كانت أقل بشكل ملحوظ 3.94±0.55 مقابل 3.77± 0. FVC قيم
الاستنتاجات: ممارسة الرياضة البدنية بانتظام في وقت مبكر يمكن أن تحسن نوعية الحياة بشكل عام والرعاية الصحية لدى طلاب الرعاية الصحية بشكل خاص.




Keywords: Cardiopulmonary efficiency, exercise, heath care students


How to cite this article:
Banerjee S, Chaudhuri A, Roy PS, Sarkar SK. Effect of exercise on undergraduate health care students. Saudi J Sports Med 2015;15:51-5

How to cite this URL:
Banerjee S, Chaudhuri A, Roy PS, Sarkar SK. Effect of exercise on undergraduate health care students. Saudi J Sports Med [serial online] 2015 [cited 2019 Jun 19];15:51-5. Available from: http://www.sjosm.org/text.asp?2015/15/1/51/149539


  Introduction Top


Physical activity is known to improve physical fitness and reduce morbidity and mortality from numerous chronic ailments. [1],[2],[3] Physical activity and non-smoking or smoking cessation is associated with maintenance of cardiorespiratory fitness. Change in physical activity habits is associated with change in cardiorespiratory fitness, but respiratory function contributed little to this association during a long-term follow-up. [1],[2],[3],[4],[5] Autonomic nervous system activity contributes to the regulation of cardiac output during rest, exercise, and cardiovascular disease. Studies have revealed that parasympathetic tone dominates the resting state, while exercise is associated with prompt withdrawal of vagal tone and subsequent sympathetic activation. Conversely, recovery is characterized by parasympathetic activation followed by sympathetic withdrawal, although clarification of the normal trajectory and autonomic basis of heart rate decay following exercise is needed. Abnormalities in autonomic physiology-especially increased sympathetic activity, attenuated vagal tone, and delayed heart rate recovery-have been associated with increased mortality. Exercise training is associated with a relative enhancement of vagal tone, improved heart rate recovery after exercise, and reduced morbidity in patients with cardiovascular disease. [6]

Heart rate provides an index of the net effects of autonomic tone on the sinus node, and carries prognostic significance. Heart rate recovery after exercise represents the changes in autonomic tone that occur immediately after cessation of exercise. This index has also been shown to have prognostic significance. Autonomic evaluation during exercise and recovery may be important prognostically, because these are high-risk periods for sudden death, and the autonomic changes that occur with exercise could modulate this high risk. [7],[8]

There are few studies on aerobic exercise and cardiorespiratory function in students of health sector. So this pilot project was conducted among students of various medical and paramedical courses to assess cardiopulmonary efficiency, its impact on health, so that exercise programs may be implemented for improvement in positive coping skills. The medical students of today will be doctors of tomorrow and if more attention is paid in early days in medical schools this will improve the quality of their life and most important patient care in future. This will benefit the population at a large. As changes in cardiorespiratory mechanics due to inactivity may be reversible, early intervention in life will ensure lesser chance of complications later in life.


  Materials and methods Top


This pilot study was undertaken in a tertiary care hospital of eastern India after taking Institutional ethical clearance and informed consent of the subjects in a time span of 2 years. One hundred male subjects in the age group of 18-25 years with no regular exercise habit, with no history of diabetes and hypertension, non-smokers were selected as study group and 100 males otherwise comparable anthropometrically with a physically active lifestyle were selected as control.

Inclusion criteria

Physically inactive males in the age group of 18-25 years who were willing to participate in the study were included in the study group and 100 males (age, BMI matched) with a physically active lifestyle like a morning walk for at least 1 hour were randomly selected as control. Young males were only included as premenopausal females are usually protected from cardiovascular diseases due to presence of female sex hormones.

Exclusion criteria

The individuals taking any type of regular medication that may affect autonomic reflexes were excluded. Subjects with past history of prolonged medication or prolonged hospitalization, major surgery, any chronic illness of cardiovascular system, hypertension, respiratory diseases, and neuromuscular disorders were excluded from the study. Tobacco addicts, smokers, and alcoholics were also excluded. Subjects having resting systolic blood pressure more than 140 mm of Hg or diastolic more than 90 mm of Hg were not included in the study as blood pressure above this may be indicative of hypertension. Subjects undertaking any yoga or meditation practices, or engaged in sports activity were excluded.

The study was conducted on undergraduate males undergoing medical and different paramedical courses. There are 100 medical students in each MBBS batch in Burdwan Medical College and 100 students come from dental college and 50 are physiotherapy students. Sampling was performed using multistage and random cluster method. The first stage of sampling included simple random selection of 310 students from all the batches (excluding females) using an online randomizer. In the second stage of sampling, all of them were administered questionnaires to elicit history. Two-hundred and sixty who met the inclusion and exclusion criteria were recruited for the study.

They were clinically examined thoroughly and subjects having resting systolic blood pressure more than 140 mm of Hg or diastolic more than 90 mm of Hg were not included in the study. In sixteen subjects blood pressure recorded was above normal level. So the sample size came down to 244. Fourteen refused to participate. Thirty subjects did not finally turn up. The height and weight were recorded as per standard procedures. Body mass index (BMI) was calculated.

Most of the medical students were sedentary, whereas paramedical students were mostly practicing some sort of exercise. Ninety medical students were included in the study group and 12 in control group. Eighty-eight students in control group were paramedical students and 10 paramedical students were included in study group. The subjects were age, BMI, stress level matched to rule out confounding variables.

All the subjects were then administered Perceived Stress Scale (PSS). PSS is the most widely used psychological instrument for measuring the perception of stress. The questions in the PSS are of general nature, relatively free of content specific to any sub-population group and enquire about feelings and thoughts to measure the "degree to which situations in one's life is appraised as stressful" especially, over last 1 month. The items are easy to understand and response alternatives are simple to grasp. Items are designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives. It comprises of 10 items, four of which are reverse-scored, measured on a 5-point scale from 0 to 4. PSS scores are obtained by reversing responses (e.g, 0 = 4, 1 = 3, 2 = 2, 3 = 1 and 4 = 0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items. [9] Total score ranges from 0 to 40. Study group had stress score of 21 ± 1.58 and controls had stress score of 18.8 ± 1.92 and the difference was not statistically significant (P-value: 0.084).

Subjects had light breakfast at least 3 h prior to exercise testing and at least 24 h of abstinence from any form of alcohol, tobacco, tea, and coffee. It was ensured that they had not undergone any strenuous work or exercises 3 h prior to the tests. The testing was carried out between 11 a.m. and 1 p.m. in a well-ventilated room. In the resting condition, blood pressure, pulse rate, and spirometric (Helios Spirometer 401) parameters, forced vital capacity (FVC), and forced expiratory volume in 1 sec (FEV 1 %) were measured.

Then, the subjects were made to do moderate exercise with bicycle ergometer. (Flywheel circumference = 6 m, pedaling at 90 revolution/min (fixed by metronome); Work done = 4 Χ 540 = 2160 kg-m or kpm; 426.8 kpm equivalents to 1 kcal energy burn. So 2160 kpm equivalents to 2160/426.8 = 5 kcal energy burn. All participants burnt 5 kcal/min. 1 MET (Multiple of resting oxygen consumption) = 3.5 ml/kg/min O 2 consumption. Average weight of the students = 60 kg, so (3.5 Χ 60) 210 ml/min O 2 consumed. One liter O 2 consumption produces 5 kcal energy, equivalents to 1000/210 = 4.8 MET). After cessation of exercise, the previous parameters were again recorded.

Data obtained was analyzed using SPSS software version 16. Unpaired T-Test was used to analyze the data. The data were considered significant and highly significant if the analyzed probability values (P values) were <0.05* and <0.01**, respectively.


  Results Top


The subjects were age and BMI matched. Pre (71.16 ± 1.98 vs 77.76 ± 4.59) and Post-exercise (114.52 ± 5.55 vs 120.05 ± 4.79) heart rate and Systolic BP (119.8 ± 7.05 vs 125.3 ± 5.72 and 140.80 ± 7.60 vs 147.84 ± 6.07) were significantly less in control as compared to study group. No significant difference in Diastolic BP and FEV 1 % was noted in both Pre -exercise values. Post- exercise FEV 1 % was significantly less in study group. Pre (4.1 ± 0.56 vs 4.05 ± 0.54) and post-exercise values of FVC (3.94 ± 0.55 vs 3.77 ± 0.47) was significantly less (P value: 0.037*) in study group as compared to controls. Pre and post-exercise values of R-R interval was significantly less in control as compared to study group [Table 1] and [Table 2].
Table 1: Comparison of study and control group (Before
exercise values)


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Table 2: Comparison of study and control group (After
exercise values)


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  Discussion Top


It is generally accepted that people with higher levels of physical activity tend to have higher levels of fitness and that physical activity can improve cardiorespiratory fitness. Sedentary life-style is a burning problem of modern civilization. Various physiological parameters are likely to be affected due to physical inactivity. Pulmonary function tests and autonomic nervous system activity are likely to be compromised to varying degrees in these individuals. It is essential to study cardiorespiratory efficiencies in these subjects as compared with physically active individuals. This study was conducted to compare these two groups of people in order to find out the importance of physical activity in the cardiorespiratory functions in students of health sector of a developing country.

Pakkala et al., in 2014 [1] studied 30 male subjects between 45 and 60 years of age with a desk job and no regular exercise habit and a similar number of male subjects otherwise comparable anthropometrically with a physically active lifestyle like a morning walk for at least 1 h as controls. Flow-volume loop, forced expiratory volume in the first second (FEV 1 ), forced vital capacity (FVC) and FEV 1 /FVC were recorded using the computerized spirometer. FEV 1 , FVC and FEV 1 /FVC ratio measured in sedentary subjects were significantly reduced when compared with physically active individuals. Our study also demonstrated similar results. We studied individuals in age group of 18-25 years, while in the above study the population was in the age group of 45-60 years. We did not find any significant difference in FEV 1 % in pre-exercise session, the difference in age and body composition of the subjects may be a cause of this difference. Age is an unmodifiable risk factor for decreased cardiorespiratory function. During childhood and adolescence there is a natural rise in lung function, after which it declines annually. [2] Higher values in post-exercise FEV 1 % in controls could be explained due to better strengthening of respiratory muscles as a result of physical training. Skeletal muscle control many crucial elements of aerobic conditioning including lung ventilation. There might be increase in the maximal shortening of the inspiratory muscles as an effect of training, which has been shown to improve the lung function parameters. [3],[4]

To explore the role of physical activity in maintaining cardiac and respiratory function in healthy people Cheng et al., in 2003 [2] conducted a study. Cardiorespiratory fitness was measured by a maximal treadmill test (MTT), and respiratory function was tested by spirometry. The cross-sectional study included data from 24, 536 healthy persons who were examined at the Cooper Clinic between 1971 and 1995; the longitudinal study included data from 5707 healthy persons who had an initial visit between 1971 and 1995 and a subsequent visit during the next 5 years. All participants were aged 25-55 years and completed a cardiorespiratory test and a medical questionnaire. In the cross-sectional study, after controlling for covariates, being active and not being a recent smoker were associated with better cardiorespiratory fitness and respiratory function in both men and women. In the follow-up study, persons who remained or became active had better MTT than persons who remained or became sedentary. Men who remained active had higher forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC) than the other groups. We only conducted a cross-sectional study, so we failed to demonstrate long-term results.

Pulmonary function tests (PFTs) of Border Security Force (BSF) trainees were compared with controls. PFTs in 100 healthy BSF trainees before and after their rigorous physical training of 9-months duration was evaluated by Thaman et al., in 2010, [3] and compared the values so obtained with 100 healthy medical students who were chosen as controls. Both were in the age group of 18-23 years. Higher lung volumes and flow rates were achieved in BSF trainees after their training period, as compared to their own values obtained before their training period and to those of controls. Better mechanical factors and lower airway resistance influenced during the training period might have benefited in improving lung volumes and flow rates. We also noted higher lung volumes and flow rates in the control group in the present study. Medical students had sedentary lifestyles and lower pulmonary function parameters in the study of Thaman et al., similar sedentary habits among medical students were also noted in the present study.

A study was carried by Chitra et al., in 2011 [5] to explore the effect of aerobics on pulmonary function in general population. Eighty, apparently healthy medical students of either sex, aged 17-20 years were recruited. Randomizations into experimental and control groups (40 each), was carried out with a table of random numbers. Experimental group participated in a 16 weeks aerobic exercise plan (five 20-minute sessions of jogging in a week), while control group had no plan of exercise during that period of time. PEFR was recorded by computerized spirometer, before the commencement of training and at the end of 16 weeks in both the groups. At baseline, PEFR (L/min) values of experimental and control group were 437.8 64 (mean S.D.) and 429.7 53, respectively. After 4 months of aerobics training, the PEFR values in experimental and control groups were 512.9 62 (P = 0.007), and 431.5 59 (P = 0.491) respectively. There was 17% improvement in PEFR in experimental group after the training. We also observed improved PFT in physically active individuals in the present study.

Interventions to increase Heart Rate Variability (HRV), such as exercise therapy, have been examined in different studies. [6],[7],[8] Exercise therapy may improve HRV in myocardial infarction, chronic heart failure and revascularization patients by increasing vagal tone and decreasing sympathetic activity. One hypothesis is that a shift toward greater vagal modulation may positively affect the prognosis of these individuals. While the underlying mechanisms by which exercise training improves vagal modulation are speculative at present, angiotensin II and nitric oxide may be potential mediators. [8] Our study also demonstrated increased in cardiac vagal activities in physically active individuals.

The main objective of a study by Nikolaidis et al., in 2013 [10] was to examine the relationship between elevated Body Mass Index (BMI) and selected physical fitness variables in male handball players. In addition, they investigated whether this relationship is age-dependent, i.e. whether a higher BMI has the same implications for physical fitness in adolescents as in adult players. Therefore, adolescent (n = 57, aged 14.9 ± 1.4 yr) and adult (n = 39, 26.6 ± 5.7 yr) participants performed a series of anthropometric and physical fitness measures. In adolescent players, BMI was inversely related with countermovement jump (r = −0.26, P < 0.05), mean power during a 30-s Bosco test (r = −0.30, P < 0.001) and handgrip muscle strength (r = −0.52, P < 0.001). Further, BMI was in direct relationship with fatigue index of the Wingate anerobic test (r = 0.29, P < 0.05). Correspondingly lower and non-significant correlations were found in adult players. Also, in the latter players, there was an inverse association between BMI and maximal anerobic power dur ing the force-velocity test (r = −0.34, P < 0.05). The findings indicated that elevated BMI is more strongly inversely related to physical fitness in adolescent compared to adult team handball players. So it may be concluded that early lifestyle modifications with exercise programed should be implemented for better results.

Limitations and future scope of the study

Most of our healthy adult participants were from mid to upper socioeconomic strata. Assessment of physical activity is difficult. Leisure time physical activity, miles of walking and jogging as an index of physical activity were all considered in this study. This was a cross-sectional study, longitudinal studies with population at a large to see efficacy of different programs could have provided better conclusions.


  Conclusions Top


Early lifestyle modification by regular exercises may improve not only quality of life in general but patient care in particular in students of healthcare services.

 
  References Top

1.
Pakkala A, Ganashree CP, Raghavendra T. An Indian study of computerized pulmonary function tests in sedentary versus physically active individuals. Saudi J Sports Med 2014;14:48-51.  Back to cited text no. 1
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2.
Cheng YJ, Macera CA, Addy CL, Sy FS, Weiland D, Blair SN. Effects of physical activity on exercise tests and respiratory function. Br J Sports Med 2003;37:521-8.  Back to cited text no. 2
    
3.
Thaman RG, Arora A, Bachhel R. Effect of physical training on pulmonary function tests in border security force trainees of india. J Life Sci 2010;2:11-5.  Back to cited text no. 3
    
4.
Enright SJ, Unnithan VB, Heward C, Winthall L, Davies DH. Effect of high intensity inspiratory muscle training on lung volumes, diaphragm thickness and exercise capacity in subjects who are healthy. Phys Ther 2006;86:345-54.  Back to cited text no. 4
    
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Chaitra B, Maitri V. Effect of aerobic exercise training on peak expiratory flow rate: A pragmatic randomized controlled trial. Int J Biol Med Res 2011;2:789-92.  Back to cited text no. 5
    
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Rosenwinkel ET, Bloomfield DM, Arwady MA, Goldsmith RL. Exercise and autonomic function in health and cardiovascular disease. Cardiol Clin 2001;19:369-87.  Back to cited text no. 6
    
7.
Lahiri MK, Kannankeril PJ, Goldberger JJ. Assessment of autonomic function in cardiovascular disease: Physiological basis and prognostic implications. J Am Coll Cardiol 2008;51:1725-33.  Back to cited text no. 7
    
8.
Routledge FS, Campbell TS, McFetridge-Durdle JA, Bacon SL. Improvements in heart rate variability with exercise therapy. Can J Cardiol 2010;26:303-12.  Back to cited text no. 8
    
9.
Kane PP. Stress causing psychosomatic illness among nurses. Indian J Occup Environ Med 2009;13:28-32.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.
Nikolaidis PT, Ingebrigtsen J. The relationship between body mass index and physical fitness in adolescent and adult male team handball players. Indian J Physiol Pharmacol 2013;57:361-71.  Back to cited text no. 10
    



 
 
    Tables

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