Journal of Science and Medicine in Sport (2008) 11, 469—472

SHORT REPORT

The effect of a physical activity educationprogramme on physical activity, fitness, quality oflife and attitudes to exercise in obese females

Alison Quinna, Catherine Doodyb,∗, Donal O’Sheaa

a St. Columcille’s Hospital, Dublin, Irelandb School of Physiotherapy and Performance Science,University College Dublin, Ireland

Received 15 August 2006; received in revised form 26 July 2007; accepted 27 July 2007

KEYWORDSPhysical activity;Obesity;Exercise;Physical fitness;Weight loss

Summary Obesity has reached epidemic proportions worldwide. Decline in phys-ical activity has occurred simultaneously or before the increase in obesity. The aimof this pilot study was to investigate the effect of a physical activity group-basededucation programme delivered by a Physiotherapist on weight, physical activity,cardiovascular fitness, quality of life and attitudes to exercise in obese females. Asample of 18 obese Irish females (mean age 37.6 years, mean weight 117.9 kg), tookpart in this study. The participants attended four physical activity education ses-sions in groups of 6—8, 1 month apart. Outcome measures were Cardiorespiratoryfitness (CRF) measured by the Incremental Shuttle Walk test (ISWT) InternationalPhysical Activity Questionnaire-Short Form (IPAQ-Short) Impact of Weight on Qualityof Life Questionnaire-Short Form (IWQOL-Lite), and a questionnaire adapted fromthe EU survey on Consumer Attitudes to Physical Activity. There were no significantdecreases in participants’ weight (p = 0.444) and there were no significant improve-ments in IPAQ (p = 0.496) and IWQOL-Lite scores (p = 0.337). There were significantimprovements in CRF (p < 0.0002). Attitudes towards exercise improved as shown bydecreased barriers to exercise, i.e. decreased shyness (17%) and increased energy(22%) and increased enjoyment (22%). A group education programme focusing on

physical activity alone demonstrated a significant increase in CRF (ISWT) and had apositive influence on attitudes to exercise. Longer duration interventions may allow

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participants to make t© 2007 Sports Medicine

∗ Corresponding author.E-mail address: c.doody@ucd.ie (C. Doody).

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440-2440/$ — see front matter © 2007 Sports Medicine Australia. Publisheoi:10.1016/j.jsams.2007.07.011

cessary lifestyle changes to achieve weight loss.tralia. Published by Elsevier Ltd. All rights reserved.

ntroduction

he prevalence of overweight and obesity world-ide is increasing at such a dramatic rate that

t is now considered a global epidemic.1 Mortalityates rise with increasing levels of obesity, partic-

d by Elsevier Ltd. All rights reserved.

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470

ularly when body mass index (BMI) is ≥35 kg/m2.Psychosocial problems associated with obesityinclude social stigma, low self-esteem, isolationand humiliation.1

A review of obesity interventions concluded thatthe most effective interventions produce modestweight loss (i.e. 3—5 kg), with the exception ofsurgery.2 Physical activity alone has been shownto produce weight loss, however the optimumstructure in terms of the type and amount ofexercise for long-term weight loss has not beendefined.2 Increased physical activity attenuatesmany of the health risks associated with obesityand active obese individuals have lower morbid-ity and mortality than normal weight individualswho are sedentary.3 A recent Cochrane review con-cluded that it is still unclear as to what are the mostsuitable settings, outcomes measures, type and fre-quency of interventions and follow up needed inthe management of obesity.4 A meta-analysis ofthe efficacy of interventions for increasing physicalactivity in general showed that short interventionswhich included behaviour modification strategiesdelivered to healthy, targeted and unsupervisedgroups reported larger effects. Few studies werefound to measure increases in fitness. The reviewconcluded that the optimal ways to select phys-ical activity components require experimentalconfirmation.5

The aim of this pilot study was to inves-tigate the effect of a physical activity group-based education programme delivered by aChartered Physiotherapist on weight reduction,physical activity, cardiovascular fitness, qualityof life and attitudes to exercise in obese Irishfemales.

Participants

A sample of 21 obese females (mean age 37.6 years,S.D. = 10.7; mean weight 117.9 kg, S.D. = 17.5;mean BMI 43.5 kg/m2 S.D. = 4.8) were recruitedfrom the waiting list of the Weight ManagementService at St. Columcille’s Hospital, Loughlinstown,Co. Dublin, Ireland. Participants were excludedif they had significant psychiatric illness, muscu-loskeletal problems that would limit their abilityto exercise, ischemic heart disease and pre-vious bariatric surgery. Thirty-nine participantsout of a total of 108 met the inclusion crite-

ria and 21 (53%) agreed to participate. Threeparticipants failed to complete the study dueto moving abroad, family illness and unknownreasons. Eighteen participants completed thestudy.

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A. Quinn et al.

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thical approval was obtained from St. Vincent’sniversity Hospital Research Ethics Committee. Thearticipants attended four 1 h education sessionsn groups of 6—8, 1 month apart. The first sessionncluded factors that effect weight gain, energyalance, components of energy output, exerciserequency intensity and type, warm up, rating oferceived exertion and contraindications to exer-ise. The second session included set point theory,xercise progression, resistance, cardiovascular fit-ess classifications, BMI and heart rate, healthenefits of exercise and health problems of obesity.he third session included exercise progression,eight maintenance, motivation and relapse. The

ourth session included resistance exercise, tak-ng heart rate and examples of different wayso exercise. Participants were given a writtenandout following each session. A range of validnd reliable outcomes was completed at baselinend completion of the intervention (4 months).ardiorespiratory fitness (CRF) was measured byhe Incremental Shuttle Walk test (ISWT) whichs a standardised externally paced corridor walk-ng test that allows the highest level of oxygenonsumption VO2peak to be calculated from theistance walked.6 The International Physical Activ-ty Questionnaire-Short Form (IPAQ-Short) is a 7ay recall measure of physical activity and theolume of activity is converted to Metabolic Equiva-ents (MET min week−1).7 The Impact of Weight onuality of Life Questionnaire-Short Form (IWQOL-ite) is a 31 item self-report measure divided intove areas, physical function, self-esteem, sexual

ife, public distress and work.8 A questionnaire wasdapted from the EU survey on Consumer Attitudeso Physical Activity, Body-weight and Health. ‘‘Thisuropean survey with questions on attitudes to andarticipation in exercise including perceived bar-iers to exercise was conducted on over 15,000ubjects’’.9

SPSS version 12 was used to analyse the data.aired t-tests were used to analyse the results ofeight and ISWT and the Wilcoxon Signed Ranks Testas used to analyse IWQOL and IPAQ data.

esults

here were no significant decreases in participants’

eight. There were no significant improvements

n IPAQ and IWQOL-Lite scores (Table 1). The IPAQcores increased by 19 MET min week−1 from 1113S.D. = 974) at baseline to 1131 (S.D. = 1176) at8 weeks (p = 0.946). Cardiovascular fitness (CRF)

Physical activity in obesity 471

Table 1 Comparison of baseline and 16 weeks results for weight, Incremental Shuttle Walk Test (ISWT), Impact ofWeight on Quality of Life Questionnaire (IWQOL) and International Physical Activity Questionnaire (IPAQ)

N Outcome measure Baseline mean(S.D.)

16 Weeks mean(S.D.)

Change Mean(S.D.)

Statistic P value

18 Weight (kg) 117.9 (17.5) 117.2 (18.3) −0.7 (3.6) t = 0.783 0.44518 ISWT (mL kg−1 min−1) 18.00 (2.62) 19.87 (3.18) 1.88 (1.72) t = −4.614 0.0002

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18 IWQOL-Lite (0—155) 89.4 (25.3) 816 IPAQ (MET min week−1) Median 951 M

s measured by the ISWT improved significantlyp < 0.001).

The results of the questionnaire adapted fromhe EU survey on Consumer Attitudes to Physicalctivity, Body-weight and Health showed the impor-ance placed on physical activity by participantsncreased from 56% (n = 10) to 67% (n = 12) fromaseline to completion. The percentage of partici-ants who felt that physical activity /exercise wasmportant in their weight gain increased from 56%n = 10) to 67% (n = 12). The percentage who didot participate in any exercise decreased from 17%n = 3) to 6% (n = 1). There were decreased barrierso exercise, i.e. shyness decreased by 17% from 56%n = 10) to 39% (n = 7) and lack of energy decreasedy 23% from 67% (n = 12) to 44% (n = 8). The percent-ge of participants who enjoyed exercise increasedy 17% from 22% (n = 4) to 39% (n = 7). However, fac-ors such as health and fear of injury increased overhe course of the study by 11% (n = 2) each.

iscussion

group education programme focusing on physicalctivity alone demonstrated a significant increasen CRF (ISWT), which has been previously showno have considerable positive effects on morbiditynd mortality even in the absence of weight loss.3

RF improved in the majority of participants 83.3%n = 15) regardless of whether they lost or gainedeight. The improvement in CRF was equivalent

o a 10.4% increase in fitness. Using the McAr-le et al. (2001)10 classification of CRF a value of19.9 mL kg−1 min−1 for the age group of females

n this study (37.6 years) is considered ‘‘poor’’.‘Fair’’ is considered 20—27.9 mL kg−1 min−1. Whilehe CRF remained in the ‘‘poor’’ category thisas closely approaching the ‘‘fair’’ category at

he end of the study (i.e. a change from 18.00−1 −1

o 19.87 mL kg min ). It was hypothesised that

more intensive intervention including dietarydvice2 could lead to more significant improve-ents in CRF. Long term follow up, previously

dentified as lacking in physical activity interven-

(24.6) −4.9 (14.1) Z = −0.969 0.162n 891 Median 104 Z = −0.682 0.496

ions could investigate if the CRF increases wereaintained over time5. This study may have ben-

fited from an increased emphasis on behaviourodification which has been shown to increase the

ffects of physical interventions.5

There were not significant improvementsp = 0.496) in IPAQ scores (104 MET min week−1).he IPAQ has not been used extensively in obesity

ntervention studies and there is currently nobesity specific physical activity questionnaire.even day recall measures have been reported tover-estimate physical activity levels. The needor objective measures of physical activity in obesendividuals has previously been identified.4

The physical activity intervention included inhis study demonstrated a significant increase inRF (ISWT) and improved attitudes to exercise.imitations of the study include the small sampleize and lack of a control group in this feasibilitytudy. Further controlled studies of group educa-ion physical activity programmes could includeietary advice, behavioural modification strategiesith long-term follow up and objective measures ofhysical activity.

cknowledgments

e would like to thank the weight managementeam and participants at St. Columcille’s Hospi-al, Loughlinstown, Co. Dublin, Ireland. Catherinelake, UCD, for statistical advice. No financial assis-ance was received for this project.

eferences

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Attitudes to Physical Activity, Body-weight and Health. Lux-

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4. Harvey EL, Glenny AM, Kirk SFL, Summerbell CD., Improv-ing health professionals’ management and the organisationof care for overweight and obese people. The CochraneDatabase of Systematic Reviews 2001, Issue 2. Art. No.CD000984. doi:10.1002/14651858.CD000984.

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AE. Development of a shuttle walking test of disabil-ity in patients with chronic airways obstruction. Thorax1992;47:1019—24.

7. IPAQ. Guidelines for Data Processing and Analysis ofthe International Physical Activity Questionnaire (IPAQ)-

Available online at www.s

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Short Form. Version 2.0 April 2004. Available at:http://www.ipaq.ki.se. Accessed August 15, 2006.

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