Manuscript accepted on :14-Nov-2018
Published online on: 22-01-2019
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Second Review by: Akshat Pandey
Final Approval by: Dr. Josphert Ngui Kimatu
Quality of Life in Relation to the Level of Physical Activity Among Healthy Young Adults at Saudi Arabia
Amal A. Kokandi1, Jafar Salman Alkhalaf2 and Asmaa Mohammedsaleh3
1Department of Dermatology, Faculty of Medicine, King Abdulaziz University, Saudi Arabia.
2Faculty of Medicine in Rabigh, King abdulaziz University (student), Saudi Arabia.
3Faculty of Medicine, King abdulaziz University (student), Saudi Arabia.
Corresponding Author E-mail: email@example.com
Physical activity is known to have benefits on health and well-being. The aim of this study was to assess the quality of life domains (using WHOQOL-Bref) in relation to the level of physical activity in young healthy adults at Saudi Arabia. An online questionnaire (WHOQOL-BREF and IPAQ) was sent to adults without special needs in Saudi Arabia aged 18 years and more. In total 1026 completed the questionnaire. Females were 767 and males were 250 (9 were missing). Results of this study showed that IPAQ total score was significantly correlated with WHOQOL-BREF physical, psychological and social relationships health scores. Additionally, the high PA group had a significantly higher WHOQOL-BREF for all domains (physical, psychological, social relationships and environmental health scores) compared to the low PA group. Male subjects had a significantly higher physical health score than female subjects, however, female subjects had a significantly higher social relationships score. In conclusion, high physical activity is linked with high better quality of life in all domains.
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Kokandi A. A, Alkhalaf J. S, Mohammedsaleh A. Quality of Life in Relation to the Level of Physical Activity Among Healthy Young Adults at Saudi Arabia. Biomed Pharmacol J 2019;12(1).
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Kokandi A. A, Alkhalaf J. S, Mohammedsaleh A. Quality of Life in Relation to the Level of Physical Activity Among Healthy Young Adults at Saudi Arabia. Biomed Pharmacol J 2019;12(1). Available from: http://biomedpharmajournal.org/?p=25744
The benefits of physical activity on health and mental wellbeing is well known. A number of studies have found that exercise helps depression. There are many views as to how exercise helps people with depression. Evidence suggests that even some physical activity might be protective against depression (1).
WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” and defines Quality of Life as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person’s physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment” (2).
A systematic review showed that there is a positive correlation between physical activity and quality of life that varied according to the analyzed domains. Of note that no studies from Saudi were included in the final step to be analyzed (3). Even in disease states in adults, several studies have shown an effect of level of physical activity and health related quality of life like type 2 diabetes (4), cancer survivals (5), head and neck cancer (6) and others.
The WHO recommendation on physical activity for adults (aged 18-64 years) in order to improve cardiopulmonary and muscular fitness, bone health, reduce the risk of depression they should: “Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity” (7).
The aim of this study was to assess the quality of life domains (using WHOQOL-BREF) in relation to the level of physical activity in young healthy adults at Saudi Arabia.
A link to a questionnaire was sent through the Deanship of Graduate studies to King Abdulaziz University students. The link was was sent by social media (WhatsApp application) as well. The letter stated that the questionnaire is directed to adults without special needs in Saudi Arabia aged 18 years and more. The questionnaire was filled through a Surveymonkey program.
The questionnaire was anonymous and contained demographic data including gender, age, marital state, occupation and educational level (with choices for each question). This was followed by questions of the Arabic IPAQ and questions of WHOQOL-BREF.
The purpose of the International Physical Activity Questionnaires (IPAQ) is to provide a set of well-developed instruments that can be used internationally to obtain comparable estimates of physical activity. The questionnaire is considered a feasible instrument for measuring physical activity in large groups (8). The official Arabic short version of the international Physical Activity Questionnaire was used in this study (9). The Arabic version has been validated and used in Saudi Arabia adult population studies (9-10). The short form of IPAQ used in the present study has 7 items providing information on time spent walking, in vigorous- and moderate-intensity physical activities and in sedentary activity during the previous 7 days. IPAQ defines moderate physical activities as those that produce a moderate increase in respiration rate, heart rate and sweating for at least 10 min duration. Vigorous physical activities are defined as those producing vigorous increases in respiration rate, heart rate and sweating for at least 10 min duration. They were asked to think about all the vigorous and moderate activities that they had done in the previous 7 days during work, transport, household, yard/garden and leisure/sports.
The World Health Organization Quality of Life (WHOQOL) assesses the individual’s perceptions in the context of their culture and value systems, and their personal goals, standards and concerns. The WHOQOL instruments were developed collaboratively in a number of centers worldwide and have been widely field-tested. The WHOQOL instrument comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. The WHOQOL-BREF is a shorter version of the original instrument that may be more convenient for use in large research studies (11). This is especially important because another set of questions needed to be answered (IPAQ).
This study protocol was approved by the unit of biomedical ethics research committee at King Abdulaziz university Hospital (Reference No 425-17).
Data were analyzed using SPSS software (version 21). A one-way ANOVA was performed to test the difference in WHOQOL-BREF domain scores between subjects with low, moderate and high physical activity. The association between IPAQ total score and WHOQOL-BREF domain scores was determined by Pearson correlation. A Two sided P values of 0.05 or less were considered statistically significant. Data were represented as mean ± SE. All missing data were classed as missing at random and only available data were analyzed.
In total 1026 completed the questionnaire. Females were 767 and males were 250 (9 were missing). Demographic data for study subjects are reported in 1. Most of the study population were in the age group of 18-20 years (61%), followed by the age group of 21-30 years (31.2%). More than 84% were single and 87.9% were students. Undergraduate and postgraduate students were 78.7% of the total population. Demographic data for study subjects are reported in table 1.
Table 1: Subjects descriptive statistics. n=1026.
|Divorced or widow||14||1.4%|
|Private sector employee||34||3.3%|
|Lower than primary||0||0.0%|
|Undergraduate or postgraduate||807||78.7%|
Physical Activity (PA) is Study Subjects
Nearly half of the study population (49.5%) of the subjects in this study had a high PA, 31% of the subjects had a moderate PA and 19.5% had a low PA (Table 2).
Table 2: The frequency of IPAQ categories in study subjects.
|IPAQ category||n||N %|
Physical Activity Differences Between Age and Gender Groups
Young adults aging 18-20 years had the highest IPAQ score compared to other age groups; however, the differences in IPAQ score between age groups were not statistically significant (Table 3).
Table 3: IPAQ score in age groups. n= 1026. Data are mean ± SE.
|Mean ± SE|
|18-20||5128.85 ± 347.56|
|21-30||3919.53 ± 318.91|
|31-40||2665.83 ± 358.36|
|41+||3021.19 ± 832.47|
There were no differences in the frequency of subjects who have low, moderate and high PA between male and female subjects (Table 4).
Table 4: Physical activity categories in gender groups.
The Relationship Between Physical Activity and Quality of Life
The high PA group had a significantly higher WHOQOL-BREF physical, psychological, social relationships and environmental health scores compared to the low PA group (p < 0.001, p < 0.001, p < 0.001, p < 0.02 respectively; Table 5, Figure 1). The psychological score significantly differed between all groups as it was significantly higher in high PA group than moderate PA group and significantly higher in moderate PA group than low PA group (p < 0.001 and p < 0.05 respectively; Table 5, Figure 1).
Table 5: The difference in WHOQOF-BREF domain scores between subjects with low, moderate and high physical activity.
|WHOQOF-BREF domains||IPAQ score category|
|Low (n= 200)||Moderate (n= 318)||High (n= 508)|
|Mean ± SE||Mean ± SE||Mean ± SE|
|Physical health score||14.06 ± 0.19 a||14.95 ± 0.14 a,b||15.37 ± 0.11 b|
|Psychological score||12.62 ± 0.21 a||13.61 ± 0.15 b||14.16 ± 0.12 c|
|Social relationships score||13.47 ± 0.25 a||13.96 ± 0.19 a||14.56 ± 0.15 b|
|Environment score||12.74 ± 0.19 a||13.29 ± 0.15 a,b||13.44 ± 0.12 b|
n= 1026. Data are mean ± SE. a denotes significantly different than b. b denotes significantly different than c using One-way ANOVA with Benferroni correction.
|Figure 1: WHOQOF-BREF domain scores between subjects with low, moderate and high physical activity.
n= 1026 Data are mean ± SE. * denotes significantly different at the p< 0.05 level. ** denotes significantly different at the p< 0.01 level. *** denotes significantly different at the p< 0.001 level using 004Fne-way ANOVA with Benferroni correction.
Male subjects had a significantly higher physical health score than female subjects (p < 0.001, Table 6). However, female subjects had a significantly higher social relationships score (p < 0.01, Table 6).
Table 6: WHOQOF-BREF domain scores in gender groups.
|Male (n= 250)||Female (n=767)|
|Mean ± SE||Mean ± SE|
|Physical health score||15.48 ± 0.16***||14.82 ± 0.09|
|Psychological score||13.8 ± 0.18||13.65 ± 0.1|
|Social relationships score||13.8 ± 0.22*||14.29 ± 0.12|
|Environment score||13.43 ± 0.16||13.21 ± 0.1|
Data are mean ± SE. * denotes significantly different than female at the p < 0.05 level (student’s t-test). *** denotes significantly different than female at the p < 0.001 level (student’s t-test).
IPAQ total score was significantly correlated with WHOQOL-BREF physical, psychological and social relationships health scores (r=0.073, p <0.02), (r= 0.098, p <0.01) and (r= 0.068, p <0.05) respectively.
Results of this study showed that IPAQ total score was significantly correlated with WHOQOL-BREF physical, psychological and social relationships health scores. Additionally, the high PA group had a significantly higher WHOQOL-BREF for all domains (physical, psychological, social relationships and environmental health scores) compared to the low PA group. Male subjects had a significantly higher physical health score than female subjects, however, female subjects had a significantly higher social relationships score.
A positive correlation between different domains of quality of life and physical activity were reported in different areas of the world (3,12). Different methods of assessments were used.
A small study (55 subjects) which included 55 older age group (60-90 years) in Saudi showed that activities of daily living was significantly correlated with anxiety, memory problems and sleep disturbances (13).
Health behaviors in the form of daily activity are associated with health beliefs particularly self-efficacy (beliefs about one’s ability to cope with stressors and health locus of control (beliefs about what controls one’s health) (14).
Results of recent survey in another University involving health college students showed different results to ours (15). They studied similar study population and showed that using IPAQ tool that only 12.9% performed high level of physical activity, 29.1% performed moderate level and 58% performed low level of physical activity. Although we had wider range of ages in our study but 90% of our study population were students. They were of different colleges unlike Awadalla study were the students were only from health colleges which could explain their results. They attributed the barriers to physical activity to time limitation, lack of suitable sports places, other important priorities, lack of friends to encourage, lack of support and encouragement from others, lack of safe sporting places, lack of motivation, high cost, not being interested in sports, lack of sport skills, feeling tired on physical activity and lastly ignorance about the benefits of sports.
A school-based study for secondary schools aged 14-19 years involving 2908 students showed high prevalence of physical inactivity. Nearly half of the male students and quarter of female students did at least 1 hour of daily of moderate-intensity physical activity (16). Females were reported to be significantly less active than males (17). The same authors compared the Saudi secondary school students to those of Britain and showed that British adolescents demonstrated higher total physical activity energy expenditure than Saudi adolescents (18).
In another study of national survey of 4758 participants aged 15 years and older reported low, moderate and high levels of physical activity by 66.6%, 16.8% and 16.6% of the entire sample (19).
In a study involving 420 Saudi women working in office-based jobs in Riyadh city, more than 50% were overweight or obese and more than 50% of the sample were insufficiently physically active (20). In a study of university female students, revealed higher physical activity levels among married students, those with high educated mothers and those who lived far from parks, and lower activity levels among underweight students (21).
In a small study involving 100 participants (aged 18-70 years) found a positive relationship with health-related quality of life as measured by the short form Health Status survey (SF-36) in 4 domains including physical functioning, role limitations caused by physical health problems, vitality and general health (22). A larger study using IPAQ and SF-36 enrolled 400 Saudi adults (aged 18-60 years), found that more than half of the study population had a low level of physical activity, while 13% had high grade and 30% had a moderate level of activity. Their health-related quality of life is significantly associated with their physical activity levels. The main domains associated with physical activity are physical functioning, role of limitations due to physical health and the general health (23).
Limitations of our study is related to the sampling technique as we used the online method. Some may made threads to others and the response rate could not be calculated. Some skipped important questions which did not allow for calculation for IPAQ so they were not considered in the statistical analysis. But the main objective of this study was not to find the prevalence of levels of physical activity. Indeed, it was aimed at correlating the level of physical activity to the domains of quality of life.
High physical activity levels are linked with better quality of life in all domains in Saudi Arabia. This adds to the well-known physical activity benefits.
The authors would like to acknowledge Mrs Sumiah Anany for her valuable work in statistical analysis of the data.
Conflict of Interest
There is no conflict of interest.
- Teychenne. M, Ball. K and Salmon. J. Physical activity and likelihood of depression in adults: A review. Preventive Medicine. 2008; 46: 397-411.
- WHO website: Health statistics and information systems. http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/ (accessed on 15-11-2017)
- Pucci GC, Rech CR, Fermino RC, Reis RS. Association between physical activity and quality of life in adults. Rev Saude Publica. 2012 Feb;46(1):166-79. Review. English, Portuguese
- Thiel DM, Al Sayah F, Vallance JK, Johnson ST, Johnson JA. Association between Physical Activity and Health-Related Quality of Life in Adults with Type 2 Diabetes. Can J Diabetes. 2017 Feb;41(1):58-63.
- Murnane A, Gough K, Thompson K, Holland L, Conyers R. Adolescents and young adult cancer survivors: exercise habits, quality of life and physical activity preferences. Support Care Cancer. 2015 Feb;23(2):501-10.
- Capozzi LC, Nishimura KC, McNeely ML, Lau H, Culos-Reed SN. The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review. Br J Sports Med. 2016 Mar;50(6):325-38.
- Global strategy on Diet, physical activity and health http://www.who.int/dietphysicalactivity/factsheet_adults/en/ (acced on 14-11-2017).
- International physical activity questionnaire website: https://sites.google.com/site/theipaq/ (accessed on 19/7/2017)
- Arabic short version of International Physical Activity Questionnaire [Internet]. Stockholm: Karolinska Institutet (http://www.ipaq.ki.se/questionnaires/ArabicIQShtel_coverpage.pdf, accessed 2 July 2014).
- Al-Hazzaa HM. The public health burden of physical inactivity in Saudi Arabia. J Family Community Med. 2004 May;11(2):45–51. PMID:23012048
- World health organization website. (WHOQOL-Bref): http://www.who.int/substance_abuse/research_tools/whoqolbref/en/ (accessed on 19/7/2017)
- Anokye. NK, Trueman. P, Green. C, Pavey. TG and Taylor. RS. Physical activity and health related quality of life. BMC Public Health. 2012; 12: 624-629
- Al Senany. S, Al Saif A. Assessment of physical health status and quality of life among Saudi older adults. J Phys Ther Sci. 2015 Jun;27(6):1691-5.
- Al-Eisa ES, Al-Sobayel HI. Physical activity and health beliefs among Saudi women. J Nutr Metab. 2012; Article ID 642187:1-6
- Awadalla N J, Aboelyazed A E, Hassanein M A, Khalil S N, Aftab R, Gaballa I I, Mahfouz A A. Assessment of physical inactivity and perceived barriers to physical activity among health college students, south-western Saudi Arabia. Eastern Mediterranean Health Journal. 2014; 20(10): 597-604
- Al-Hazzaa HM, Abahussain NA, Al-Sobayel HI, Qahwaji DM, Musaiger AO. Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region. Int J Behav Nutr Phys Act. 2011 Dec 21;8:140.
- Al-Hazzaa HM, Al-Sobayel HI, Abahussain NA, Qahwaji DM, Alahmadi MA, Musaiger AO. Association of dietary habits with levels of physical activity and screen time among adolescents living in Saudi Arabia. J Hum Nutr Diet. 2014 Apr;27 Suppl 2:204-13.
- Al-Hazzaa HM, Al-Nakeeb Y, Duncan MJ, Al-Sobayel HI, Abahussain NA, Musaiger AO, Lyons M, Collins P, Nevill A. A cross-cultural comparison of health behaviors between Saudi and British adolescents living in urban areas: gender by country analyses. Int J Environ Res Public Health. 2013 Dec 3;10(12):6701-20.
- Abdulmohsen H. Al-Zalabani, ABCMa, Nasser A. Al-Hamdan, FFCMb and Abdalla A. Saeed, MFPHb. The prevalence of physical activity and its socioeconomic correlates in Kingdom of Saudi Arabia: A cross-sectional population-based national survey. Journal of Taibah University Medical Sciences. 2015; 10(2): 208-215
- Albawardi NM, Jradi H, Al-Hazzaa HM. Levels and correlates of physical activity, inactivity and body mass index among Saudi women working in office jobs in Riyadh city. BMC Womens Health. 2016 Jun 20;16:33.
- Khalaf A, Ekblom Ö, Kowalski J, Berggren V, Westergren A, Al-Hazzaa H. Female university students’ physical activity levels and associated factors–a cross-sectional study in southwestern Saudi Arabia. Int J Environ Res Public Health. 2013 Aug 9;10(8):3502-17.
- Sobkey S B. Physical activity level and adult Saudi health related quality of life. Open Journal of Therapy and Rehabilitation. 2014; 2: 106-113.
- Moshibah A M, Almazarigeh SD, Al-Dowan A A, Assiri H M, Al-Shahrani S F, And Assiri I M. Physical activity and quality of life among Saudi Adults. Al-Azhar Assiut Medical Journal. 2015; 13(3): 126-131