Physical activity among Portuguese university students and its relation to knowledge and perceived barriers

Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 25 Physical activity among Portuguese university students and its relation to knowledge and perceived barriers La actividad física entre los universitarios portugueses y su relación con el conocimiento y las barreras percibidas Regina F. Alves 1 , José Precioso 1, Elisardo Becoña 2 1 CIEC – Research Centre Child Studies, Institute of Education – University of Minho, Braga, Portugal. 2 Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain. Contacto: [email protected] Cronograma editorial: Artículo recibido: 26/08/2020 Aceptado: 13/10/2020 Publicado: 01/01/2021 https://doi.org/10.17979/sportis.2021.7.1.6924 Funding sources This work is funded by National Funds through FCT - Foundation for Science and Technology, I.P., under the project SFRH / BD / 120758/2016. Conflicts of interest The authors declare that there is no conflict of interest. Ethical consideration approval code This study was approved by the Ethics Committee for Research in Social and Human Sciences (CEICSH), of the University of Minho Ethics Council, under the protocol CEICSH 009/2019. Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 26 Abstract University students, regardless of the country, have a very high prevalence of physical inactivity and health habits acquired during this period tend to remain throughout life, including those related to physical exercise. The purpose of this study was to analyse the relationship between knowledge about the recommendations on the practice of physical activity (PA), the perceived barriers towards PA and the practice of PA by higher education students. This cross-sectional study used a self-reported questionnaire with a stratified sample of university students (n = 840) from a university in Portugal. An ordinal logistic regression model was calculated to determine the predictive variables to the practice of PA. The results showed that 35.7% of the students surveyed were sedentary, the level of knowledge about PA was low, correctly answering 2.79 (SD = .090) questions in a total of 6, and lack of time was the most evident perceived barrier. The constructed model predicted that having more barriers to PA (β = -.750, p = .000) and being female decreased the likelihood of practising PA (β = .578, p = .000). The increase of PA levels of university students is a social necessity and, in this context, higher education institutions should undertake a key role in promoting student health, by implementing actions to reduce their students’ inactivity, developing the transmission of information about the health benefits related to the practice of PA. Key Words Physical exercise; knowledge; perceived barriers; recommendations; university students. Resumen Los estudiantes universitarios, independientemente del país, tienen una prevalencia muy alta de inactividad física y los hábitos de salud adquiridos durante este período tienden a permanecer a lo largo de la vida, incluidos los relacionados con el ejercicio físico. El propósito de este estudio fue analizar la relación entre el conocimiento sobre las recomendaciones sobre la práctica de AF, las barreras percibidas hacia AF y la práctica de AF por estudiantes de educación superior. Este estudio transversal utilizó un cuestionario auto informado con una muestra estratificada de estudiantes universitarios (n = 840) de una universidad de Portugal. Se calculó un modelo de regresión logística ordinal para determinar las variables predictivas para la práctica de AF. Los resultados mostraron que el 35,7% de los estudiantes encuestados eran sedentarios, el nivel de conocimiento sobre AF era bajo, respondiendo correctamente 2,79 (DE = .090) preguntas en un total de 6, y la falta de tiempo era la barrera percibida más evidente. El modelo construido predijo que tener más barreras a la AF (β = -.750, p = .000) y ser mujer disminuyó la probabilidad de practicar AF (β = .578, p = .000). El aumento de los niveles de AF de los estudiantes universitarios es una necesidad social y, en este contexto, las instituciones de educación superior deben asumir un papel clave en la promoción de la salud de los estudiantes, mediante la implementación de acciones para reducir la inactividad de sus estudiantes, desarrollando la transmisión de información sobre los beneficios para la salud. relacionados con la práctica de la AF. Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 27 Palabras clave Ejercicio físico; conocimientos; barreras percibidas; recomendaciones; estudiantes universitarios. Introduction The World Health Organization identified physical inactivity as the fourth major risk factor for global mortality (WHO, 2010) and other authors as the greatest public health problem of the 21 st Century (Trost, Blair, & Khan, 2014). In contrast, the practice of physical activity (PA) is considered a positive health measure. Scientific research has shown that the regular practice of PA contributes to physical health (Füzéki, Engeroff, & Banzer, 2017; Lear et al., 2017; Pandey et al., 2017), as well as to the reduction of mortality and cardiovascular and chronic diseases (Ekelund et al., 2016; Lear et al., 2017). In the same way, it contributes to psychological and emotional well-being (Álvarez Rivera, Cuevas Ferrera, Lara Pot, & González Hernández, 2015; Joseph, Royse, Benitez, & Pekmezi, 2014; Wu, Tao, Zhang, Zhang, & Tao, 2015). For example, Wu et al. (2015) found that the daily practice of PA contributed to the reduction of depression, anxiety and sleep problems. In recent years, several public health guidelines for the PA of the adult population were published, differing in the amount, intensity and frequency of PA (Haskell et al., 2007). The most recent recommends at least 150 minutes of moderate PA per week or 75 minutes of vigorous PA per week, allowing the combination of these two intensities and in episodes of at least 10 minutes (WHO, 2010). Despite the widespread recommendations and health benefits, in most developed countries there is a high proportion of adults who do not meet these recommendations for PA and show a low level of PA (Guthold, Stevens, Riley, & Bull, 2018), particularly in Portugal (Batista et al., 2012). The level of PA decreases from childhood to adolescence, as well as from adolescence to adulthood. University students, regardless of the country, have a very high prevalence of physical inactivity that is bigger (Arias-Palencia et al., 2015; Haase, Steptoe, Sallis, & Wardle, 2004; Keating, Guan, Piñero, & Bridges, 2005; Moreno-Arrebola, Fernández-Revelles, Linares-Manrique, & Espejo-Garcés, 2018; Pengpid et al., 2015) than Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 28 that of others age groups (Guthold et al., 2018). This evidence becomes relevant when stating that the transition to adulthood, matching it with starting higher education, is a critical and the most vulnerable life period. Health habits acquired during this period tend to remain throughout life, including those related to physical exercise (Curry, Jenkins, & Weatherford, 2015; Filla, Hays, Gonzales, & Hakkak, 2013; Rodriguez Rodriguez, Santibañez Miranda, Montupin Rozas, Chávez Ramírez, & Solis Urra, 2016). Several factors contribute to the decrease or absence of PA, which is why it is interesting to assess how predisposing factors include knowledge and attitudes towards PA (Ennis, 2010; Keating et al., 2009; WHO, 2012). Given the above, this article aims to analyse the relationship between knowledge on the recommendations for the practice of PA, the perceived barriers towards PA and the practice of PA by students in higher education. Material & methods Population and sample For the 2018/2019 academic year, 5447 students were registered in the 1 st and 3 rd year of integrated bachelors and masters degrees. Courses related to health sciences, undergraduate or postgraduate masters and those that did not have classes in the 1 st or 3 rd years were excluded from the sample. The minimum sample size needed for this study was 592 students (margin of error = 5%, confidence level = 99%, and response distribution = 50%). For this purpose, stratified probabilistic sampling of university students was performed according to the year of study and the scientific area. The different undergraduate and master’s degrees were divided into scientific areas (as defined by the Foundation for Science and Technology): Human and Social Sciences, Law and Economic Sciences, Exact and Natural Sciences and Engineering Sciences. In this cross-sectional study with a representative sample of university students (n = 840) in one university in Portugal, data were collected using a validated self-reported questionnaire without biochemical confirmation. The sample consists of 464 students in their first year of study (55.2%) and 376 students in their last year of study (44.8%). In what relates the scientific area, 302 (36.0%) students from Engineering Sciences, 270 (32.1%) students Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 29 from Human and Social Sciences, 136 (16.2%) students from Exact and Natural Sciences and 132 (15.7%) students in the area of Law and Economic Sciences. Most of the students surveyed were female (55.4%, n = 465), did not in a love relationship (58.3%, n = 486), were displaced from their usual residence (64.9%, n = 537), were full-time students (88.8%, n = 739) and had a BMI corresponding to a normal weight (73.1%, n = 599). The average age of the sample was 20.78 (SD = 4.221), ranging from 18 to 54, and only 3% of the students are 30 years old or older. Instruments Currently, there are several scientific instruments to monitor the prevalence of PA among young adults. Therefore, the development of the instruments present in this investigation was carried out in three stages: scale construction (1 st stage); content validity (2 nd stage); psychometric validity (3 rd stage), according to the procedures defined by Bowling (1998). For the scale construction (1 st stage), a systematic review of the literature was made to identify the questions and items commonly used to assess knowledge, attitudes and practices of PA in higher education (Alves, 2019). Based on this review, an analytical matrix was created for each of the dimensions to be analysed, and those with the same semantic similarities were eliminated. For the content validity (2 nd stage) 10 PhD researchers from several Portuguese universities with recognised work in the area of Health Education in Higher Education were invited, and the feedback received from 5 of them was considered as well as all the proposed semantic changes. Similarly, the instrument was applied to 12 university students, using the method “thinking aloud” (Bowling, 1998; Keszei, Novak, & Streiner, 2010) to identify items that might be confusing, to exclude less relevant or redundant items, and to verify that precoded response options were sufficient. After the suggested redrafting, the preliminary version of the questionnaire survey was presented to a sample of 32 students, not included in the final sample. The questionnaire included sociodemographic variables (sex, age, scientific area of study, academic year, weight and height (to calculate BMI), being in a love relationship, Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 30 professional situation e current residence) and specific questions to measure the following variables: - Prevalence of PA: the Godin Leisure-Time Exercise Questionnaire (Godin & Shephard, 1997) was used and one question about sedentary lifestyle (“On a normal day, how many hours do you spend seated?”); - PA knowledge: a 6-item scale with options for the answer - True, False, Don’t Know (e.g., “The practice of an intense physical activity is necessary to achieve health benefits.”) - Perceived barriers towards PA: a 5-item scale on a 5-point Likert scale (1 – I strongly disagree, 5 – I totally agree) concerning lack of energy, lack of motivation, lack of resources, lack of support and lack of time. Procedure and Statistical analysis The application of the instrument was carried out in classroom context and paper-andpencil format for all students in the sample, after giving informed consent. All ethical research procedures with humans were fulfilled, and the Ethics Committee for Research in Social and Human Sciences, of the University of Minho Ethics Council, under the protocol CEICSH 009/2019 approved the research. Data were analysed using the IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). For statistical analysis, frequencies and contingency tables were analysed, Pearson’s correlation was carried out, Chi-square test, independent t-test, and oneway variance (ANOVA) and Hochberg’s GT2 multiple comparison procedures. Ordinal logistic regression model with logit’s function was developed, only including variables with a significant bivariate association with PA, PA knowledge and perceived barriers. The nominal indicator of ‘sedentary’ was assigned as the reference category, and all covariates were entered into the model simultaneously. Variables that were found not to contribute to the prediction of the dependent variable were excluded from the final model. A significance level of 0.05 was considered. Activity counts were converted to metabolic equivalents (METS) by multiplying episodes of vigorous activity by 9, moderate activity by 6, and mild activity by 3. Total activity scores were calculated by adding the MET calculations for each PA intensity level Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 31 and were classified in three types: Insufficiently Active/Sedentary; Moderately Active and Active. For the knowledge scale, the number of correct responses was added to give an overall knowledge score, and the mean was calculated. This means that the higher the scale value, the higher the level of knowledge. The perceived barriers scale was subject to Cronbach’s alpha analysis to analyse its reliability (Bowling, 1998), and a good reliability index was obtained (α = .742). In addition, inter-item correlations ranging from .644 to .269. To read the results of this scale, the higher the average of the scale, the more will the barriers be towards PA. Results The results show that 35.7% (n = 298) of the students surveyed are sedentary, 17.5% (n = 146) moderately active and 46.8% were classified as active. It was also found that, on average, on a typical day, university students spend 7.44 ± 2,656 hours seated. There were no differences between the practice of PA and the number of hours that the students declared to spend seated (F (2, 798) = 1.617, p = .199). Table 1 shows that among all the sociodemographic variables analysed the practice of physical exercise was only associated with the sex of the respondents (χ 2 (2) = 22.554, p = .000). This indicates that female students are more sedentary and less active compared to male students. Table nº 1 – Frequencies and Chi Square test for sociodemographic variables and weekly leisure-time activity Weekly leisure - time Activity Chi Square test Sedentary Moderately Active Active n % n % n % χ 2 p Year of study 1 st year 156 52.3 82 56.2 221 56.7 1.364 .506 3 rd year 142 47. 7 64 43.8 169 43.3 Scientific area Engineering Sciences 93 31.2 50 34.2 159 40.8 7.572 .271 Exact and Natural Sciences 49 16.4 23 15.8 62 15.9 Law and Economic Sciences 51 17.1 24 16.4 56 14.4 Human and Social Sciences 105 35.2 49 33.6 113 29. 0 Sex Male 106 35.6 60 41.1 208 53.3 22.554 .000 Female 192 64.4 86 58.9 182 46.7 Age < 20 111 37.2 63 43.2 176 45.1 4.409 .110 Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 32 >= 20 187 62.8 83 56.8 214 54.9 Love relationship Yes 126 42.4 56 38.6 163 42.3 .694 .707 No 171 57.6 89 61.4 22 2 57.7 Current residence Displaced 110 37.5 45 31.3 133 34.5 1.756 .416 Not displaced 183 62.5 99 68.8 252 65.5 Professional situation Full time student 261 88.2 130 90.3 344 88.9 .433 .805 Worker / Student 35 11.8 14 9.7 43 11.1 BMI Low weigh t 22 7.6 14 9.9 21 5.5 5.175 .270 Normal weight 212 73.1 95 66.9 289 75.7 Overweight 56 19.3 33 23.2 72 18.8 Regarding the sedentary behaviour declared by the students, it was found that, on average, university students spend 7.44 ± 2.656 hours seated, according to their professional situation (t (795) = 3.693, p = .000) and scientific area (F (3, 799) = 12.380, p = .000). Thus, full-time and engineering students were the ones who declare to spend daily the most hours seated, compared with working students and students of other scientific areas, respectively. The level of knowledge about PA was low, presenting, on average, 2.79 ± 0.090 correct answers, in a total of 6 possible correct answers. Table 2 shows statistically significant differences between knowledge about PA and the scientific area (F (3,827) = 3.060, p = .028), indicating that students in the Exact and Natural Sciences area have more knowledge compared to students of the Human and Social Sciences area. Table nª 2 – Mean, one-way ANOVA and t-test for sociodemographic variables and PA knowledge PA K nowledge Mean (SD) ANOVA Z p Scientific area Engineering Sciences 2. 77 (.950) 3.060 .028 Exact and Natural Sciences 2. 91 (.740) Law and Economic Sciences 2. 78 (.868) Human and Social Sciences 2. 63 (.907) BMI Low weight 2.78 (.773) .040 .961 Normal weight 2.75 (.901) Overweight 2.74 (.872) Weekly leisuretime activity Insufficiently Active/Sedentary 2.69 (.950) 1.814 .164 Moderately Active 2.86 (.777) Active 2.75 (.892) t - student t p Year of study 1 st year 2.72 (.871) -.947 .344 3 rd year 2.78 (.925) Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 33 Sex Male 2.73 (.940) -.357 .721 Female 2.75 (.859) Age < 20 2.75 (.856) .101 .919 >= 20 2.74 (.924) Love relationship Yes 2.73 (.839) -517 .605 No 2.77 (.922) Current residence Displaced 2.76 (.901) .442 .659 Not displaced 2.74 (.888) Professional situation Full time student 2.75 (.908) .093 .926 Worker / Student 2.74 (.739) The scale of perceived barriers to the practice of PA obtained an average of 2.26 ± 0.037, in a range between 1 and 5, with the highest value corresponding to more barriers. The perceived barriers were ordered as follows, depending on the degree of agreement: lack of time (M = 2.78, SD = 1.353); lack of motivation (M = 2.45, SD = 1.230); lack of resources (M = 2.17, SD = 1.226); lack of energy (M = 2.06, SD = 1.092); lack of support (M = 1.86, SD = 1.041). Through the bivariate analysis, shown in table 3, there were statistically significant differences between perceived barriers and the scientific area (F (3,827) = 2.863, p = .036), BMI (F (2,807) = 3.318, p = .037), the practice of physical exercise (F (2,822) = 48.811, p = .000), sex (t (829) = -3.069, p = .002) and current residence (t (817) = 2.358, p = .019). Thus, it is possible to conclude that students of the Engineering Sciences area revealed fewer barriers to the practice of PA compared to students of the of Exact and Natural Sciences area; inactive students were those who revealed more barriers compared to students who practice PA (moderately and actively), with moderately active students showing more barriers compared to active students; female students and full-time students presented a higher score in the perceived barriers scale compared to male students and working students, respectively. Regarding BMI, Hochberg’s GT2 was not significant. Table nº 3 – Mean, one-way ANOVA and t-test for sociodemographic variables and perceived barriers towards PA Perceived barriers Mean (SD) ANOVA Z p Scientific area Engineering Sciences 2.18 (.816) 2.863 .036 Exact and Natural Sciences 2.43 (.858) Artículo Original. Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Vol. 7, n.º 1; p. 25-42, enero 2021. A Coruña. España ISSN 2386-8333 Para citar este artículo utilice la siguiente referencia: Alves, R.; Precioso, J.; Becoña, E. (2021) Physical activity among Portuguese university students and its relation to knowledge and perceived barriers. Sportis Sci J, 7 (1), 25-42 https://doi.org/10.17979/sportis.2021.7.1.6924 http://revistas.udc.es/ 40 with 1·9 million participants. The Lancet Global Health, 6(10), e1077–e1086. https://doi.org/10.1016/S2214-109X(18)30357-7 Haase, A., Steptoe, A., Sallis, J. F., & Wardle, J. (2004). Leisure-time physical activity in university students from 23 countries: Associations with health beliefs, risk awareness, and national economic development. Preventive Medicine, 39(1), 182–190. https://doi.org/10.1016/j.ypmed.2004.01.028 Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., … Bauman, A. (2007, August). 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