Effectiveness of a community based physical activity programme in changing the physical activity profile of the community: A feasibility study of an intervention

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“EFFECTIVENESS OF A COMMUNITY BASED

PHYSICAL ACTIVITY PROGRAMME IN

CHANGING THE PHYSICAL ACTIVITY

PROFILE OF THE COMMUNITY – A

FEASIBILITY STUDY OF AN INTERVENTION”

DISSERTATION SUBMITTED IN PARTIAL FULFILMENT OF

THE REQUIREMENT OF THE TAMILNADU

DR.M.G.R.MEDICAL UNIVERSITY, CHENNAI, FOR THE

DEGREE OF MD BRANCH XV (COMMUNITY MEDICINE)

EXAMINATION TO BE HELD IN MAY 2018

THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

CHENNAI

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CERTIFICATE

This is to certify that “Effectiveness of a community based

physical activity programme in changing the physical activity

profile of the community – a feasibility study of an intervention”

is a bona fide work of Dr. Anantharam.V in partial fulfilment of

the requirements for the M.D Community Medicine examination

(Branch-XV) of the Tamil Nadu Dr. M.G.R. Medical University,

Chennai, to be held in May 2018.

Dr. Jasmin Helan

(MD, Dip.NB, MPH)

Guide, Professor & Head

Department of Community Health

Christian Medical College, Vellore

Dr. Anna B Pulimood

(MD, Ph.D)

Principal

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DECLARATION

This is to certify that this dissertation titled “EFFECTIVENESS OF A

COMMUNITY BASED PHYSICAL ACTIVITY PROGRAMME IN

CHANGING THE PHYSICAL ACTIVITY PROFILE OF THE

COMMUNITY – A FEASIBILITY STUDY OF AN INTERVENTION” is a

bona fide work done by me, under the guidance of DR. JASMIN HELAN, in

partial fulfilment of the rules and regulations for the MD Branch XV

(Community Medicine) Degree examination of the Tamil Nadu Dr. M.G.R.

Medical University, Chennai, to be held in May 2018.

I have independently reviewed the literature, collected the data and carried out

the evaluation towards the completion of the thesis.

DR. ANANTHARAM.V P G REGISTRAR

DEPARTMENT OF COMMUNITY HEALTH CHRISTIAN MEDICAL COLLEGE

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CERTIFICATE – II

This is to certify that this dissertation work titled “Effectiveness of a

community based physical activity programme in changing the physical

activity profile of the community – a feasibility study of an intervention” of

the candidate Dr. Anantharam.V with registration number- 201525051

for the award of degree of M.D in the branch of Community Medicine (XV).

I personally verified the urkund.com website for the purpose of plagiarism

check. I found that the uploaded thesis file contains introduction to conclusion

pages and result shows two percentage of plagiarism in the dissertation.

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Acknowledgements

Firstly, I would like to thank the Almighty for placing me at this esteemed place

amidst wonderful people at the most opportune time to help realise my goals and

challenge myself while doing so, in spite of many obstacles, that were faced and

crossed.

My gratitude towards my guide knows no bounds. I thank Dr. Jasmin Prasad, my

mentor, guide and a perpetual source of inspiration during my tenure as a post

graduate resident.

I thank Dr. JP Muliyil, Dr. Kuryan George, and Dr. Anu Oommen for the time and

thought they put in for this work.

My gratefulness extends to Dr. Nihal Thomas and Dr. Riddhi Das Gupta from the

department of Endocrinology, Diabetes and Metabolism for their expert guidance.

I would like to thank Dr. Vinod Abraham, Dr. Shanthidani Minz, Dr. Venkata

Raghava, Dr. Jacob John, Dr. Anu Rose, Dr. Divya Muliyil, Dr, Sam Marconi, Dr.

Bhavya, Dr. Sindhu and all the faculty of the Community Health Department of

CMC, Vellore for the impetus provided. Special mention and gratitude to the

Department of Family medicine, LCECU.

I am much obliged to Mrs. Sarala, Mrs. Inthira, the health aides working in

Community Health and Development department of CMC. Special heartfelt

salutations to Mr.Vijaykumar and Mr. Sivashanmugam for everything that they have

done for this study selflessly at all times.

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Mrs. Salomi from the computer cell was helpful at all times.

Heartfelt thanks to the CHTC and CHAD office staff Mrs. Mary, Mrs. Sumi, Mr.

Suresh, Mr. William and Mr. Sudhesh.

A big thank you to the laboratory staff of CHAD, Mr. Balaji and team, who were

supportive at all times.

My sincere thanks goes to Peripheral Health nurses, Part Time Community Health

Workers (PTCHWS) and the local volunteers of the areas for their unstinting support.

It would be remiss of me if I do not thank my friends and colleagues, Drs., Charles,

Dolorosa, Kusum, Martina, Mohan, Sumanto, Anjali, Madhu Mohan, Nirmala,

Shalini, Swathi, Deepak, Jackwin, Kiran, Nirupama, Riya, Sandeep, Rachel, Sobers,

Tarun, Karthika, Bincy, Harsh, Ranjith, Krithika and many others.

I will be eternally grateful and indebted to my parents and my sister, Akhila, for their

abiding love that has seen me through the good times and the bad. Their support is

inestimable and their love unfathomable.

Last but definitely not the least, I would like to offer my gratitude to the people of

Edayansathu, Thuthipet, Sathumadurai, Kurumberpalyam, Pangalathan and Nelvoy,

the villages that were part of this study. Their geniality and large-heartedness with

which they invited me into their houses and treated me as one of their own was

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Glossary of Abbreviations

AO – Abdominal Obesity

BMI – Body Mass Index

BP – Blood Pressure

CHAD - Community Health and Development

CI – Confidence Interval

CO – Central Obesity

CVD – Cardio Vascular Diseases

FBS – Fasting Blood Sugar

GO – Generalised Obesity

GPAQ – Global Physical Activity Questionaaire

HDL-C – High Density Lipoprotein Cholesterol

ICMR – Indian Council of Medical Research

LDL-C – Low Density Lipoprotein Cholesterol

LSCS – Lower segment Caesarean section

MET – Metabolic Equivalent of Task

MNREGA – Mahatma Gandhi National Rural Employment Guarantee Act

NCD – Non Communicable disease/s

NFHS – National Family Health survey

NPCDCS – National Programme for Prevention and Control of Cancer,

Diabetes, Cardiovascular diseases and Stroke

OR – Odds ratio

PPBS – Post-prandial blood sugar

SDG – Sustainable Development Goals

SES – Socio-economic status

TTM – Trans-Theoretical Model of health education

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Index of Tables

Table 3.1 Risk factors and level of NCD prevention and management

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Table 4.1 List of villages in the study area 20

Table 4.2 Domains of physical activity. 28

Table 4.3 Categories of physical activity 33

Table 5.1 Description of socio-demographic characteristics in the 2 study areas – Pre intervention study

38

Table 5.2 Comparison of mean values of socio-demographic characteristics in the study areas – Pre intervention

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Table 5.3.1 Medical history of Non-Communicable diseases among participants:

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Table 5.3.2 Family history of Non-Communicable diseases among participants

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Table 5.4 Description of anthropometric characteristics in the 2 study areas – Pre intervention

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Table 5.5 Description of anthropometric characteristics in the study areas (Proportions) – Pre intervention

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Table 5.6 Description of Mean values of physiological and biochemical characteristics in the 2 study areas – Pre intervention

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Table 5.7 Prevalence of Non-Communicable Diseases and their risk factors among 30-40 year old women

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Table 5.8 Prevalence of Metabolic Syndrome 47

Table 5.9 Description of diet characteristics of the study areas (mean values)– Pre intervention

48

Table 5.10 Description of Physical activity profile of the 2 areas – Pre intervention

49

Table 5.11 Proportion of study population who are physically active

[image:12.595.125.549.100.768.2]

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[image:13.595.124.551.70.438.2]

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Table 5.12 Comparison of mean socio-demographic characteristics in both areas – Pre and Post Intervention surveys

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Table 5.13 Comparison of Proportions of socio-demographic characteristics in both areas – Pre and Post Intervention

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Table 5.14 Comparison of domains of physical activity of the two study areas – Pre and Post Intervention

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Table 5.15 Proportion of study population who are physically active post-Intervention

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Table 5.16 Association of Physical activity with Non-Communicable diseases and its risk factors

58

Table 5.17 Determinants of Physical activity level in the study populations

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Table 5.18 Multivariate analysis to study the association of each determinant adjusting for all other co-variables

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[image:13.595.124.551.476.705.2]

Index of Figures

Figure 4.1 Map of Kaniyambadi block 19

Figure 4.11 Detailed Diagrammatic algorithm of the study method and design

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Figure 5.1 Socio-economic status by B.G.Prasad classification

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Figure 5.2 Mode of delivery 40

Figure 5.3 Prevalence of Diabetes mellitus 45

Figure 5.4 Prevalence of hypertension 45

Figure 5.5 Utilisation of community gymnasium 57

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1.

Introduction and Justification

Physical activity is defined by WHO as any bodily movement that requires energy expenditure. It includes exercise as well as other activities done as part of playing, working, active transportation, house chores and recreational activities. Physical inactivity (lack of physical activity) is identified as the fourth leading risk factor for global mortality (1). Insufficient physical activity is one of the four primary risk factor for non-communicable diseases (NCDs). Physically active adults are also at a lower risk for depression and declines in cognitive function as one ages.(2)

People who are insufficiently active have a 20% to 30% increased risk of all-cause mortality compared to those who engage in at least 150 minutes of moderate intensity physical activity per week, or equivalent, as recommended by WHO.(3) According to WHO, global prevalence of insufficient physical activity among middle aged women in developing countries was 27%.(3)

NCDs are mainly cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes. They disproportionately affect people in low- and middle-income countries where more than 75% of global NCD deaths occur.(4)

NCDs cause more deaths in the world currently than all other causes combined and

(15)

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Approximately 42% of all NCD deaths globally occurred before the age of 70 years

which are called premature deaths which is preventable.(4)

In India, as of 2017, 61% of all deaths are due to non communicable diseases, with

total number of deaths being 58,17,000. 23% population have risk of premature death

by the four main NCDs.(5)

According to ICMR-INDIAB study done in 2014, prevalence of physical inactivity

among rural women was 62.3% which was one of the highest in India.(6)

A cross-sectional study with multi-stage cluster sampling design which was

conducted in a rural coastal Karnataka found that most participants did not perceive

a need to increase their physical activity level, though it was low and there was very

low awareness regarding chronic disease related health benefits of physical

activity.(7)

A study done in rural Vellore in 2012, showed prevalence of physical inactivity

among rural women to be 46.4% with high prevalence of most of the risk factors of

NCDs like overweight – 34.6%, central obesity - 55.3%, hypertension – 15.3%,

diabetes – 10.3%, metabolic syndrome – 34.5%.(8)

Most of these prevalence of NCDs and their risk factors were higher than Tamil Nadu

and India statistics. This prompted the need for a community based programme

focussing on improving physical activity profile, and also diet habits among the

general population, to prevent, reduce and postpone the incidence of risk factors of

(16)

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2. Aim and Objectives

Aim:

To evaluate the effectiveness of a community based physical activity programme in

changing the physical activity profile of the community.

Objectives:

1. To measure the change in level of physical activity among women in the age

group 30-40 years of the selected villages in Kaniyambadi block, Vellore

following community based physical activity intervention for prevention of

Non-Communicable diseases.

2. To measure the level of physical activity among women in the age group

30-40 years of the selected villages in Kaniyambadi block, Vellore.

3. To study the determinants of physical activity among women in the age group

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4.

Review of Literature

3.1 Non communicable diseases

Non communicable diseases are chronic diseases which are of long duration and generally slow progression. The four main types of non communicable diseases are cardiovascular diseases (includes heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease, asthma) and diabetes.(4)

3.1.1 Problem statement and Implications of NCDs:

Collectively, they are responsible for almost 70% of all deaths worldwide. Almost

three quarters of all NCD deaths, and 82% of the 16 million people who died

prematurely (before reaching 70 years of age), occur in low- and middle-income

countries. The rise of NCDs has been driven by four major risk factors: tobacco use,

physical inactivity, unhealthy diet and harmful alcohol use. (9)

Cardiovascular diseases (coronary heart disease, stroke, and hypertension) contribute

to 45% of all NCD deaths followed by chronic respiratory disease (22 %), cancers

(12 %) and diabetes (3%).(10)

(18)

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WHO is organizing the Global Conference on NCDs in October, 2017 to launch a set of new global initiatives to help countries accelerate progress in reducing premature mortality from NCDs and fast-tracking efforts to attain SDG target 3.4 by 2030.(11)

16 lakh deaths per year can be attributed to insufficient physical activity. Close to 40 lakh annual deaths have been attributed to excess salt/sodium intake(4). Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to stall poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products, such as tobacco, insufficient and unhealthy dietary practices, and have limited access to health services.

In low-resource settings like ours, health-care costs for NCDs quickly drain household resources. The exorbitant costs of NCDs, including often lengthy and expensive treatment and loss of breadwinners, force lakhs people into poverty annually and stifle development.(12)

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3.1.2 National Programme to prevent and control NCDs:

Government of India has instituted a National Programme for Prevention and

Control of Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), objectives of

which are:

 Awareness generation on lifestyle changes

 Early Detection of NCDs

 Capacity Building of health systems to tackle NCDs(14)

The following Interventions are planned in the programme: i) Health promotion

and health education for community, ii) Early Detection of Persons with High

Levels of Risk Factors (at the risk of developing disease) through screening iii)

Strengthening health systems at all levels to tackle NCDs and improvement of

quality of care(15)

[image:19.595.91.527.532.739.2]

3.1.3 Risk factors and Prevention of NCDs

:

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Risky lifestyle behaviours are responsible for the risk factors of NCDs. Risk factors

are cumulative and operate on a life course perspective. (i.e. they influence the risk

throughout the life course. For example, childhood obesity is a major risk factor for

adult obesity and consequently diabetes and CVD). Risk factors operate in a

continuum. This means that even within the normal ranges, people with higher

level have higher risks. For example, individuals with systolic blood pressure of

130 mmHg have a higher risk of CVD, stroke and future death than those with 120

mmHg even though both are within ‘normal’ range. The risk factors are additive.

This means cumulative small elevations of risk factors are much more harmful than

isolated elevation of a single risk factors. It is important to note that all these risk

factors are amenable to modification through lifestyle changes. (5)

In brief, today’s unhealthy practices and habits are tomorrow’s risk factors.

Today’s risk factors are tomorrow’s disease. Thus, primary and secondary

prevention of chronic diseases and their common risk factors provide the most

sustainable and cost-effective approach to chronic disease prevention and control. It

has been reported that a large waist circumference is significantly inversely

associated with HDL cholesterol levels and significantly positively associated with

LDL cholesterol levels and blood pressure. From various studies, exercise and

increased physical activity had a significant effect on LDL cholesterol levels. A

higher percentage of those who exercised for half an hour or more daily had LDL

cholesterol levels <130 mg/dL than those who did not exercise regularly. (16).

BMI, is consistently related to increased blood pressure and unfavourable lipid

(21)

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3.2 Physical activity:

3.2.1 Definition, Types and Measurement of physical activity:

Physical activity is defined by WHO as any bodily movement that requires energy expenditure. It includes exercise as well as other activities done as part of playing, working, active transportation, house chores and recreational activities. Physical inactivity (lack of physical activity) is identified as the fourth leading risk factor for global mortality (18).

Few terminologies while studying physical activity and health:

1. Exercise: A subcategory of physical activity that is planned, structured,

repetitive, and purposeful in the sense that the improvement or maintenance

of one or more components of physical fitness is the objective

2. MET: MET refers to metabolic equivalent of a task and 1 MET is the rate of

energy expenditure while sitting at rest. Physical activities frequently are

classified by their intensity, using the MET as a reference.

3. Moderate-intensity physical activity: On an absolute scale, moderate intensity

refers to the physical activity that is performed at 3.0–5.9 times the intensity

of rest. On a scale relative to an individual’s personal capacity,

moderate-intensity physical activity is usually a 5 or 6 on a scale of 0–10

4. Vigorous-intensity physical activity: On an absolute scale, vigorous intensity

refers to physical activity that is performed at 6.0 or more times the intensity

of rest for adults and typically 7.0 or more times for children and youth. On a

scale relative to an individual’s personal capacity, vigorous-intensity physical

(22)

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3.2.2 WHO Global Recommendations on physical activity for health:

WHO recommendations in order to improve cardiorespiratory and muscular fitness,

bone health, reduce the risk of NCDs and depression are:

1. 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 both

2. Aerobic activity should be performed in bouts of at least 10 minutes duration.

3. Adults should increase their moderate intensity aerobic physical activity to 300

minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical

activity per week, or an equivalent combination of both for additional health benefits.

4. Muscle-strengthening activities should be done involving major muscle groups on

2 or more days a week.(19)

3.2.3 Problem statement of insufficient physical activity:

The Global prevalence of Physical inactivity among adult women is 27% (20).

According to ICMR-INDIAB study done in 2014, physical inactivity among middle

aged rural women was 62.3% which was one of the highest in the country.(6) In a

study done in a similar setting in Vellore in 2012, prevalence of physical inactivity

among rural women was found to be 46.4% (8)

In a cross sectional study done in Kerala about risk factor profile for Chronic NCDs,

the relationship between Physical inactivity and diabetes, hypertension, overweight

was expressed as Odds ratios of 1.34, 1.64 and 2.5 respectively which showed

(23)

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3.2.4 Barriers of physical activity among middle aged Indian women :

In a qualitative study conducted in Kerala in 2016, Four focus group discussions were conducted among individuals between 25 and 60 years of age, in a few areas of Thiruvananthapuram. Women associated physical activity mostly with household activities. The majority of the women considered their activity level adequate, although they engaged in what the researchers concluded were quite low levels of activity. Commonly reported barriers were lack of time, motivation, and interest; stray dogs; narrow roads; and not being used to the culture of walking. Facilitators of activity were seeing others walking, walking in pairs, and pleasant walking routes. Walking was reported as the most feasible physical activity by women.(22)

A systematic review of published studies reporting physical activity among South

Asian adults residing in South Asia. In Indian females the inactivity prevalence was

17.0%-79.6%, while majority of the studies (n = 5, 62.5%) reported it to be >

39.5%.(23)

A cross-sectional study with multi-stage cluster sampling design was conducted in

a rural coastal Karnataka. Most participants did not perceive a need to increase

their physical activity level and there is very low awareness regarding chronic

disease related health benefits of physical activity.(7)

Another study done in similar rural setting showed individuals with low physical

activity levels had higher prevalence of metabolic syndrome as compared to their

counterparts. Moreover, individuals with low physical activity levels had

significantly higher BMI, waist circumference, waist height ratio than individuals

(24)

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higher among females in both the settings compared to males.(24)

While numerous studies suggest that lower levels of physical activity lead to obesity, there is also evidence for a reverse effect – that obesity leads to reduced levels of activity, and the association may be bi-directional, potentially to different degrees in different populations.(25)

The most common external barriers among the middle-aged respondents were 'not

enough time' (46.7%), 'no one to exercise with' (40.0%) and 'lack of facilities'

(33.4%). The most common internal barriers for middle-aged respondents were 'too

tired' (48.3%), 'already active enough' (38.3%), 'do not know how to do it' (36.7%)

and 'too lazy' (36.7%). These factors should be taken into account when healthcare

policies are being designed and when interventions such as the provision of facilities

to promote physical activity and exercise are being considered(26).

3.3 Physical activity and Metabolic Syndrome:

Metabolic syndrome is a cluster of metabolic disorders. When a patient presents with

these conditions together, the chances for future cardiovascular disease is greater

than any one factor presenting alone. Metabolic syndrome is a serious health

condition that affects about 23 percent of adults and places them at higher risk of

cardiovascular disease, diabetes, stroke and diseases related to fatty build-ups in

artery walls.

Metabolic syndrome occurs when a person has three or more of the following

(25)

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 Abdominal obesity (Waist circumference of greater than 40 inches in men,

and greater than 35 inches in women)

 Triglyceride level of 150 milligrams per deciliter of blood (mg/dL) or greater

 HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women

 Systolic blood pressure (top number) of 130 millimeters of mercury (mm Hg) or greater, or diastolic blood pressure (bottom number) of 85 mm Hg or

greater

 Fasting glucose of 100 mg/dL or greater

A study done by Deedwania et al showed Age adjusted prevalence (%, 95%

confidence intervals) of metabolic syndrome in men and women was 33.3 (31.7–

34.9) and 40.4 (38.6–42.2). Individual components of metabolic syndrome in men

and women, respectively, were: high waist circumference 35.7 (34.1–37.3) and 57.5

(55.6–59.3), high blood pressure 50.6 (48.9–52.3) and 46.3 (44.4–48.1), impaired

fasting glucose/diabetes 29.0 (27.5–30.5) and 28.0 (26.3–29.7), low HDL cholesterol

34.1 (32.5–35.7) and 52.8 (50.9–54.7) and high triglycerides 41.2 (39.5–42.8) and

31.5 (29.7–33.2) percent. Prevalence of metabolic syndrome was significantly

greater in subjects with highest vs. lowest categories of education (45 vs. 26%),

occupation (46 vs. 40%), fat intake (52 vs. 45%), sedentary lifestyle (47 vs. 38%)

and body mass index (66 vs. 29%) (p < 0.05)(27).

A community study consisting of 1178 adults in urban eastern India by D.S Prasad

et al showed that even in poor parts of India, the prevalence of metabolic syndrome

was as high as 33.5% overall, 24.9 % in males and 42.3% in females. Older age,

(26)

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middle-to-high socioeconomic status significantly contributed to increased risk of

metabolic syndrome(28)

A study was conducted to estimate prevalence of metabolic syndrome among 150

rural women in the age group of 30-50 years in a primary health centre area in Tamil

Nadu by I. Selvaraj et al and the prevalence was found to be 36%. The most

commonly observed components of metabolic syndrome in this study was increased

waist circumference (56.0%) followed by low HDL (45.3%), high triglyceride

(37.3%), high blood pressure 29.3%, and fasting blood sugar 12.7%.(29)

3.4 Physical activity and Obesity

WHO defines obesity as abnormal or excessive accumulation of fat that may impair

health. Body Mass Index (BMI) is used as an index of weight-for-height that is used

to classify obesity and overweight in adults.

BMI (kg/m2_{) = weight in kg}

(Height in meter)2

Classification :

BMI > 25 (overweight)

>25–29·9 kg/m2 (pre-obese)

>30 kg/m2 (obesity).

>30–39·9 kg/m2 (obese class I),

>35–39·9 kg/m2 (obese class II),

(27)

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WHO Asia Pacific guidelines to define obesity –

 generalized obesity (GO) - BMI≥25kg/m2,

 abdominal obesity (AO) - waist circumference ≥90 cm for men and ≥80cm for women) and

 combined obesity (CO) - GO plus AO

Phase I of the ICMR-INDIAB study, with 13,800 subjects, conducted in Tamil Nadu,

Maharashtra, Jharkhand and Chandigarh showed a high prevalence of GO, AO, and

CO(30). A study conducted in Salem, Tamil Nadu with 263 subjects found that 44.9%

respondents were found to be pre-obese and 19.0% were obese. The estimated risk

for the females to have an increased metabolic risk was 9.4 times that of the males.

60.8% persons had abdominal fat accumulation, based on the waist to hip ratio.(31)

Effects of Obesity :

 High blood pressure (Hypertension)

 High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)

 Type 2 diabetes

 Coronary heart disease

 Stroke

 Gallbladder disease

 Osteoarthritis (a breakdown of cartilage and bone within a joint)  Sleep apnoea and breathing problems

 Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)

 Low quality of life

(28)

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3.5 Physical activity and Dyslipidemia

It is defined as elevated total or low density lipoprotein (LDL) cholesterol and

decreased high density lipoprotein (HDL) cholesterol.

In a study conducted by Ambrish Mithal et al in 2014, a total of 5400 patients with

T2DM from 178 centers across India were screened and it was found that

dyslipidemia control in Indian T2DM patients is very poor with almost half of them

not reaching their LDL -C goal.(32). The ICMR-INDIAB study of 2014 conducted

by Shashank. R. Joshi et al, showed that 13.9% had hypercholesterolemia, 29.5%

had hypertriglyceridemia, 72.3% had low HDL-C, 11.8% had high LDL-C levels and

79% had abnormalities in one of the lipid parameters.(33)

3.6 Physical activity and Hypertension

High blood pressure is a common condition in which the long-term force of the blood

against your artery walls is high enough that it may eventually cause health problems,

such as heart disease(34)

Classification Systolic BP (mmHg) DiastolicBP (mmHg)

Normal <120 And <80

Prehypertension 120-139 Or 80-89

Stage 1 hypertension 140-159 Or 90-99

(29)

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A study conducted by Venkatachalam J et al in 2016 in Kancheepuram, TN with 3681

respondents aged 15 years and older showed 10.8% prevalence of hypertension,

which included the participants who are known hypertensive on treatment and/or

whose blood pressure was more than 140/90 mm Hg in sitting position for adult. The

prevalence of isolated systolic hypertension was 2.9%, 2.7% among male and 2.9%

among female subjects. The prevalence of hypertension increased proportionately

with increasing age. Hypertension was more prevalent among those who had the

habit of smoking tobacco (18.2%), alcohol consumption (17.4%), and those who

were obese (14.2%). (35)

3.7 Physical activity and Diabetes mellitus:

Diabetes is a group of metabolic disorders characterized by hyperglycemia resulting

from defects in insulin secretion, insulin action (hepatic and peripheral glucose

uptake), or both(36)

There are numerous studies to suggest that Physical activity prevents or postpones

incidence of Type 2 Diabetes mellitus in adults(37) (38)

3.8 Physiological health benefits of physical activity:

Health benefits of regular physical activity are plentiful and significant. As

mentioned by Center for Disease Control and Prevention, it improves body

composition, reduces risk of cardiovascular diseases, type 2 diabetes, metabolic

syndrome, few cancers. It also improves mental health and increases longevity.(39)

(30)

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usually used to refer to the relative percentage of fat and fat-free tissue(40) Physical

activity has shown to affect body composition and weight favourably by promoting

fat loss and maintaining mean tissue mass(41)

A randomized control trial done among adults aged 40-65 years with dyslipidaemia

in Durham and other surrounding countries experimented an exercise programme

with three different exercise intensities against a control group to study its effects on

body weight, body composition and central adiposity. There was a significant dose

response relationship seen between the amount of weekly exercise and the amount

of weight change in overweight adults(39) A cross sectional study in India also found

a similar inverse relationship between physical activity and body composition(42)

Physical inactivity is known to be an important lifestyle modifiable factor for

prevention of NCDs which includes cardiovascular diseases (stroke and heart

disease), diabetes, cancer and chronic respiratory diseases ( chronic obstructive

pulmonary disease and asthma).(6) In 2016, it was published in Lancet journal that

physical inactivity was the 4th_{leading risk factor for death worldwide stating that it}

as an urgent public health priority(43)

A study done analysing the effect of physical inactivity on the burden of non

communicable diseases worldwide estimated that physical inactivity causes 6% of

the burden due to coronary heart diseases, 7% of type 2 diabetes mellitus, 10% of

breast cancer and 10% of colon cancer. Interestingly it was also found that if the level

of inactivity decreased by 10% or 25%, more than 5 lakh to 13 lakh deaths could be

averted respectively and an increase in life expectancy of the world’s population

(31)

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Regular physical activity is also known to boost the immune response. It is known

to increase systemic concentrations of muscle derived interleukins and circulating

neutrophil counts. This response is known to assist in the clearance of glucose and

lipoproteins from the circulation and improve insulin sensitivity. Additionally it is

known to prevent the initiation and development of cardiovascular diseases since

both macronutrients are integral in the development of atherosclerotic plaque(45).

Physical activity has a beneficial effect to the neurological system of the body as

well. It is known to increase resilience to stress, increase energy and reduce fatigue,

slows down brain atrophy and promotes neurogenesis and improve self-esteem(46).

Studies have found that adults who engage in regular physical activity experience

fewer depressive and anxiety symptoms(47)

In spite of all these advantages lack of physical activity is still an emerging public

health issue. In India, physical activity, largely, is from work and transportation

domains. A cross sectional study done in South India highlights the participants not

feeling the need to improve their physical activity levels and having very low

(32)

19

4. Methodology

:

4.1 Study design: A feasibility study of a community based intervention.

4.2 Study Setting: The community health department of Christian Medical College,

Vellore has established an integral health and development programme in

Kaniyambadi block (CHAD). The CHAD project covers 82 villages and a population

[image:32.595.90.526.360.727.2]

of 1,15,505.

Figure 4.1

Intervention-A area

(33)

20

Following a multi-centric study about "Prevalence of Coronary Heart Disease and its

risk factors in urban and rural areas, Vellore”, sponsored by the ICMR done by the

Community health department and Cardiology department(49) ,the need for a

community based physical activity programme became a priority. The study was

conducted in 2 geographical areas in Kaniyambadi block of Vellore district, Tamil

[image:33.595.87.509.307.556.2]

Nadu. Each area consisted of many villages.

Table 4.1 : List of villages in the selected study areas:

Intervention

Areas

Villages Total

Population

Study population (Women

in age group 30-40 years)

Area-A Edayansathu

Kaligapuram Thuthipet

6366 528

Area-B Kurumberpalyam

Nelvoy Pangalathan Edigaithoppu Sathumadurai

4995 447

The suggestions and informal pleas of people from these villages to CHAD through

their village leaders and representatives, combined with the need for a

comprehensive programme to reduce risk factors of Non-Communicable diseases

prompted us to select these villages. The two areas were considerably far from each

(34)

21

4.3 Study Population: Women between 30-40 years of age who are Permanent

residents of the above mentioned villages, randomly selected from Census of

Kaniyambadi block maintained by CHAD Health Information system.

Exclusion Criteria:

 Pregnant women.

 Any musculo-skeletal or psychiatric conditions impairing cognition

contraindicating daily unsupervised moderate intense physical activity.

4.4 Sampling technique:

As mentioned above, the suggestions and informal pleas of villagers from

Edayansathu, Nelvoy and Sathumadurai prompted the respective village leaders to

propose an action plan to reduce Non-communicable diseases and its risk factors like

Obesity. This proposal combined with the need for a comprehensive programme to

reduce the risk factors of Non-Communicable diseases prompted us to select these

villages. The two areas were considerably far from each other i.e. around 8km apart,

on either side of a state highway (SH-38).

The participants for both the pre and post-Intervention studies were selected by

separate Simple random sampling from a list generated by Census of Kaniyambadi

block maintained by CHAD Health Information system.

4.5 Sample size Calculation:

According to the study, Diet and Physical Activity Among Women in Urban and

(35)

22

Jayamani, Vijayaprasad Gopichandran, Premila Lee, Greeda Alexander, Solomon

Christopher, Jasmin Helan Prasad, the proportion of population in rural Vellore with

adequate physical activity among middle aged women was found to be 50.7%.(50)

• To determine the increase in the proportion of women in the community who

are physically active from 50% to 70%, with 80% power, and considering

Cluster design effect to be 1.5 and relative precision being 20% of the

difference between actual and expected proportions (p-_{and q}-_{, the desired}

sample size will be,

• N = ((Zalpha + Zbeta)2_{2 p}-_q-_{) / d}2_{x Design Effect (1.5)}

N =

140

per arm.

4.6 Data collection:

4.6.1 Variables measured:

 Socio-demographic variables – Age, Education, Occupation, Family Income,

Marital status, Mode of delivery, Number of children, Housing details, Medical

and family history of Non-Communicable diseases.

 Physical activity profile of the study participant

 Diet profile

 Nutritional status -Weight and Height (BMI), Waist and hip circumferences

(Waist / Hip ratio)Blood pressure

 Blood glucose levels - Fasting venous blood glucose and post-prandial venous

blood glucose

(36)

23 4.6.2 Tools used:

 Structured questionnaire to collect information on socio-demographic

information

 Global Physical activity Questionnaire (GPAQ) to measure the physical activity

profile.

 24 hour diet recall and food frequency questionnaire to measure the diet profile.

 Calibrated mechanical weighing scale to measure weight.

 Stadiometer to measure height.

 Measuring tape to measure hip and waist circumferences.

 Electronic BP apparatus to measure Blood pressure

 Venous blood collection - Vacutainers, syringes, cotton, micropore tape, surgical

spirit for drawing blood for biochemical tests.

 Biochemical tests – Erba Mannheim EM-200 fully automated Biochemical

analyzer.

4.7 Intervention details:

Two types of intervention strategies were planned and executed for the two areas :

 Intervention-A included a planned community health education module, setting

up of an open-air Community gymnasium and identifying walking paths in the

villages.

(37)

24

Eight sessions of community health education were conducted in Intervention-A area

and five sessions were conducted in Intervention-B area. The number of sessions

depended on the geography and demography of the places. The health education

team consisted of the principal investigator, CHAD employed health educator,

village Health Aide and occasionally a social worker and local volunteers. Each

session in Intervention-A area lasted 60 minutes and in Intervention-B area lasted 50

minutes. People from all age groups and gender attended and participated in these

health education sessions.

The health education module consisted of 9 topics :

1. Non-Communicable diseases

 What are Non-communicable diseases(NCDs)?

 Types of NCDs

 Prevalence of major NCDs and seriousness of the problem

 Risk factors of NCDs – Modifiable and preventable

 Why is it better to prevent than treat?

2. Obesity

 What is considered as Obesity?

 Risk factors associated with Obesity

 Health and social problems associated with Obesity

 Different ways to prevent being obese – Physical activity, Diet.

(38)

25 3. Hypertension

 What is normal blood pressure and what is Hypertension?

 Risk factors of Hypertension

 Complications of Hypertension

 Prevention and management of Hypertension

4. Stroke

 What is a stoke and what are its effects?

 What are the risk factors of stroke?

 How to prevent Stroke?

5. Hypercholesterolaemia

 Types of Cholesterol in our body

 Normal ranges of cholesterol and what is considered as high cholesterol

 Foods to eat and foods to avoid to maintain normal cholesterol in our body

6. Diabetes mellitus

 What is Diabetes and how exactly does it affect our body? (Pathophysiology)

 Types of Diabetes and How do you diagnose Diabetes

 Risk factors of Diabetes

 Symptoms of Diabetes – early , late

(39)

26

7. Physical activity equivalents of common food items

 Common foods of Tamil Nadu and their common physical activity equivalents.

 Food items - Idli, Chapati, Dosai, Poori, Vegetarian meals

 Physical activity – Brisk walk, multiple light effort household chores, taking care

of cattle.

8. Mythbusters

 Myth 1: “Physical activity takes too much time.”

 Myth 2: “The older you are, the less physical activity you need.”

 Myth 3: “Taking medication interferes with physical activity.”

 Myth 4: “You have to be athletic to exercise.”

 Myth 5: “Getting in shape makes you tired.”

9. Orientation to Community gymnasium

 The health benefits of each equipment

 Whats the best way to use each equipment

 Air walker

 Hip turner

 Seated leg press

(40)

27 4.8 Method followed:

The list of eligible women was obtained from the health information system of the

Community Health Department of Christian Medical College, Vellore.

The study participants were approached individually by the principal investigator in

the setting of their house. The details of the study were explained to the study

participants in the local language in detail, and an Information sheet was provided

with contact number of the principal investigator and the base hospital. Thus, an

Informed consent was taken and each participant was allotted a unique ID number.

Socio-demographic details of each participant were collected by direct interview

using a structured questionnaire.

4.8.1 Assessment of physical activity:

GPAQ is a validated structured questionnaire developed by WHO for physical

activity surveillance. It collects information on physical activity participation in three

settings (or domains) and sedentary behavior. These domains are:

(a) Activity at work

(b) Travel to and from places

(c) Recreational activities and

(d) Sedentary activities.

Additional questions about home activities were asked which included

(a) Cleaning activities

(b) Kitchen activities

(41)

28

(d) Child Care and

(e) Self-care

Additional questions about usage of the community gymnasium were asked in the

post Intervention phase in Intervention-A area.

All the questions in GPAQ were asked in a uniform standardized template in local

language and the participants were given sufficient time to think and answer. What

activities constituted vigorous-intensity and moderate-intensity activity at work,

travel, vigorous-intensity and moderate-intensity recreational activities were

explained as per GPAQ guidelines with relevant generic showcards as examples for

ease of understanding.

[image:41.595.89.488.428.614.2]

The information collected about physical activity was converted to MET values by:

Table 4.2: Domains of physical activity.

Domain MET value

Work Vigorous = 8.0

Moderate = 4.0

Travel Walking and cycling = 4.0

Recreation Vigorous = 8.0

Moderate = 4.0

4.8.2 Assessment of Dietary intake:

A Semi-structured questionnaire for 24 hour Food Recall was used. Frequency of

fruits and fried food intake in a typical day/week was asked. Participant was asked

(42)

29

Standard measuring cups and spoons were used to assess the actual amount of food

consumed. If the participant had a feast or a fast due to ill-health, festival or any

reason, which was unlike her usual dietary habit, the previous 24 hour diet recall was

recorded. Using the database of ‘Nutritive Value of Indian Foods’ as given by the

National Institute of Nutrition, the total calorie, carbohydrate, protein and fat were

calculated.

4.8.3 Assessment of nutritional status:

– Height was measured by the Principal Investigator using standard Stadiometer

with the participant standing upright looking straight ahead without footwear,

with both their feet placed touching each other and knees extended.

– Weight was checked by the Principal Investigator using calibrated mechanical

weighing scale with participant standing upright without footwear.

– Waist circumference was measured by the Principal Investigator using

non-elastic measuring tape held at the midpoint between lower border of last rib and

anterior superior iliac spine in the Mid-axillary line. Hip circumference similarly

(43)

30 4.8.4 Measurement of Blood pressure:

– Blood Pressure was measured by the Principal Investigator twice 5 minutes

apart, using automated digital sphygmomanometer with the participant relaxed in

sitting position. If the difference between the 2 readings of either the systolic or

the diastolic BP was more than 10mm Hg, a third reading was taken. Closest of

the three readings to each other were considered in such cases.

4.8.5 Assessment of Biochemical parameters:

– Each participant was given a probable date and time of visit to their houses by

the Principal Investigator for collection of early morning blood samples for

biochemical tests (FBS, PPBS, Lipid profile). Most of the samples were collected in the early morning the next day of interview and almost all participants had

their bloods drawn within one week of interview. Participants whose blood

couldn’t be collected the next day were intimated by phone call too on the

previous day of blood collection to be fasting overnight and to have cooked food

ready so that post-prandial venous glucose could be collected on time and not too

late. A laboratory kit arranged by CHAD hospital lab was carried by the Principal

Investigator to each house. The kit contained vacutainers, disposable gloves,

syringes, vacutainer needles, clean cotton, micropore tape, surgical spirit, rubber

tourniquet and sharps disposing container. Blood was collected for Fasting

venous blood glucose and Lipid profile in the early morning and 2 hour

post-prandial venous blood glucose in the mid-morning with aseptic precautions by

(44)

31 4.9 Ethical issues:

– The biochemical results of the participants were followed up by the Principal

Investigator the same day, and in case of abnormal values, a referral letter was

given to the participant at the earliest and the concerned village Health aide who

is part of the CHAD healthcare system was intimated for further follow-ups. A

referral letter was given to people with high BP readings (>140/90 mm Hg) or

obesity (BMI >/=30) measured at the time of interview.

– Lifestyle modification advice was given either in person or over phone call to the

following participants :

o Blood sugars in pre-diabetes stage (FBS 100-125 and/or PPBS 140-199)

o Blood pressure in pre-hypertension phase (Systolic BP 120-139 mm Hg and/or

Diastolic BP 80-89 mm Hg)

o Any one of the parameters in Lipid profile outside the normal range.

o Overweight / Pre-Obese participants ( BMI 25 - 29.99)

o Waist circumference >/=80 cm

o Waist : Hip ratio > 0.85

Confidentiality:

Privacy and confidentiality was maintained during data collection. The results of the

biochemical tests and nutritional assessment were informed to the study participants

(45)

32 4.10 Data management and analysis:

Data collected was entered in Epidata 3.1 and analysis was done using SPSS version

20.

Descriptive statistics of the socio-demographic variables in intervention A and

intervention B villages were done. Chi-square tests and Student-t test were applied

to check whether the baseline characteristics of both villages were similar.

4.10.1 Physical activity:

MET score for most of the household activities were less than 4.0 according to widely

accepted Compendium of physical activities.(51) Thus, only three activities with

MET score of more than or equal to 4.0 were weighed in to the physical activity

calculation of that participant and MET score of 4 was given to each of these

activities:

o Heavy cleaning outside the house

o Washing clothes by hand

o Child care–vigorous activities (run, play with children – only active period)

Mean MET scores of vigorous-intensity and moderate-intensity activity at work,

travel, vigorous-intensity and moderate-intensity recreational activities of

participants were described for both the study areas and compared. Mean minutes of

sedentary activity per day of participants was also described for both the study areas

and compared.

The mean change in each of these activities was studied pre and post intervention in

(46)

33

Proportion of participants doing vigorous-intensity and moderate-intensity activity

at work, travel, vigorous-intensity and moderate-intensity recreational activities were

described and compared. Change in proportions of population doing each of these

activities was studied pre and post the intervention in both areas by Chi-Square test.

Physical activity profile of the areas was studied by categorizing participants as

‘Active’ and ‘Inactive’ by the WHO recommendations and criteria(52):

Throughout a typical week, including work activity, travel and recreation, adults

should do at least

• 150 minutes of moderate-intensity physical activity

OR

• 75 minutes of vigorous-intensity physical activity

OR

• An equivalent combination of moderate- and vigorous-intensity physical activity

[image:46.595.89.526.551.645.2]

achieving at least 600 MET-minutes

Table 4.3: Categories of physical activity

Categories of Physical activity Level of Physical activity

Active >/= 600 MET-minutes

Inactive < 600 MET-minutes

This was described in proportions for both study areas and compared. Change in

proportions of Active and Inactive population was studied pre and post the

(47)

34 4.10.2 Diet

Mean values of total calorie intake per day, protein and carbohydrate consumption;

servings of fruits per day and frequency of fried food consumption was described for

both the study areas and compared.

Bivariate and multivariate analysis was done to see the association between various

determinants and the level of physical activity.

Level of physical activity in both intervention areas were compared using difference

(48)

35

4.11

Detailed Diagrammatic algorithm of the study method and design:

2 geographical areas each consisting of many villages were selected based on informal requests and pleas by the village population to CHAD through their village leaders to propose an action plan to reduce Non-communicable diseases and its risk factors like Obesity

AREA-A

Edayansathu Kaligapuram

Thuthipet

AREA-B

Kurumberpalyam Pangalathan

Nelvoy Edigaithoppu Sathumadurai

Women between 30-40 years of age who are Permanent residents of the selected villages, excluding:

 Pregnant women.

 Any musculo-skeletal or psychiatric conditions impairing cognition contraindicating daily unsupervised moderate intense physical activity.

Simple random sampling of study participants from Census of Kaniyambadi block maintained by CHAD Health Information system

.

Sample Size

(49)

36

Informed consent Informed consent

Data Collection:

 Socio-demographic variables.

 Physical activity profile - GPAQ.

 Diet profile – 24 hour recall, food frequency

 Nutritional status -Weight and Height (BMI), Waist and hip circumferences (Waist / Hip ratio)

 Blood pressure

 Blood glucose levels - Fasting venous blood glucose and post-prandial venous blood glucose.

 Fasting lipid profile.

Intervention:

Community health education module – 5 sessions conducted

 Referral to base hospital (CHAD) if any of the variables measured were found abnormal.

 Lifestyle modification advice by P.I if any of the variables measured were slightly abnormal

Intervention Details:

 Setting up of an open-air Community gymnasium.

 Identifying walking paths in the villages.

 Community health education module – 8 sessions conducted

Approached subjects, if satisfied any exclusion criteria, were excluded during

data collection also.

Community Health Education Module

 8 topics

 5 Sessions, attended by people of all ages and gender.

 Each session was of duration 50 minutes.

 Tool - Flip Charts. Community Health Education Module

 9 topics

 8 Sessions conducted, attended by people of all ages and gender.

 Each session was of duration 60 minutes.

(50)

37

Post Intervention Data Collection – after 2 months

Sample size = 73 Post Intervention Data Collection-

after 2 months Sample size = 81

Data Collection:

 Physical activity profile.

 Diet profile Data Collection:

 Physical activity profile.

 Diet profile

Data Entry – Epidata version 3.1

Data Analysis – SPSS version 20 Data Entry – Epidata version 3.1 Data Analysis – SPSS version 20

Planned : Anthropometric, blood pressure and Biochemical assessment after 6 months.

Further continuation of the study planned – Periodic assessments

Planned – after 6 months

(51)

38

5. Results

Among the total 309 study participants in the Pre-intervention phase, 160 were from

the Intervention A areas and 149 were from the Intervention B areas.

5.1 Socio-Demographic characteristics:

Table 5.1: Description of socio-demographic characteristics in the 2 study areas – Pre intervention study

Characteristics Categories Intervention

A area (160) Intervention B area (149) Total (309)

No. (%) No. (%) No. %

Age (years) 30-35 86 53.8 74 49.7 160 51.8

36-40 74 46.2 75 50.3 149 48.2

Education Nil 4 2.5 9 6 13 4.2

Primary school 4 2.5 8 5.4 12 3.9

Middle school 24 15 25 16.8 49 15.9

High school 87 54.4 80 53.6 167 54.0

Intermediate / Diploma

23 14.4 22 14.8 45 14.6

Graduation 8 5 4 2.7 12 3.9

Post graduation or Professional

10 6.2 1 0.7 11 3.5

Occupation Homemaker 75 46.9 63 42.3 138 44.7 Unskilled /

Semi-skilled

66 41.2 74 49.7 140 45.3

Skilled worker 7 4.4 6 4 13 4.2

Clerical 4 2.5 3 2 7 2.3

Semi-profession

8 5 3 2 11 3.5

Marital Status Unmarried 9 5.6 4 2.7 13 4.2

Ever Married 151 94.4 145 97.3 296 95.8 Number of

children

0 8 5.3 6 4.1 14 4.7

1-2 102 67.5 106 73.1 208 70.3

>2 41 27.2 33 22.8 74 25

(52)

39

The two study areas were comparable in most of their socio-demographic

characteristics with no statistical differences except the socio-economic status (p

<0.0001). There were more participants who were of lower social classes in

Intervention-B area than Intervention-A area, as depicted in the bar diagram. (Figure

1)

6% of participants in Intervention-B area were illiterates as compared to 2.5% in

area-A, whereas 6.2% participants in area-A were postgraduates or had professional

degrees as compared to 0.7% in area B, although this was not statistically significant.

In Intervention-B area, 49.7% of participants were involved in unskilled and

semi-skilled work, most of whom (84%) were involved in the employment provided by

the MNREGA. On the other hand, 41.2% of participants in Intervention-A area were

engaged in unskilled and semi-skilled work, most of which included daily wage

labour in small factories.

Overall, occupation of study participants ranged from teachers (8; 4.7%), nurses (3;

1.8%), clerical jobs (5; 2.9%), tailors (12; 7%), salaried employees of small scale

industries (8; 4.7%), work at home like beedi rolling, incense sticks preparing,

garland making, packaging, shop attending, etc. (15; 8.8%), housemaids (7; 4.1%),

Anganwadi and ICDS workers (3; 1.8%), shop owners (2; 1.2%), Group-D workers

in schools and hospitals (8; 4.7%), animal rearing / tending to animals for income

(18; 10.5%), daily wage labourers, agricultural / construction labourers (82; 48%)

In Intervention-A area, 3 in 4 participants (73.8%) lived in a pucca house, as

compared to 5 in 6 participants (83.2%) in Intervention-B area, difference not being

(53)

[image:53.595.85.518.77.633.2]

40

Figure 5.1

Figure 5.2

The participants in the 2 study areas were similar except Mean number of years of

education (p= 0.003) and mean monthly family income (p= <0.0001), the difference

being statistically significant. Mean years of education in area A was significantly

higher (9.56 years) than area B (8.34 years) with p value <0.0001.

12.5%

38.1%

23.8%

19.4%

6.2% 30.9%

49.7%

9.4% _8%

2%

Lower Lower Middle Middle Upper Middle Upper

Socio-Economic Status

Modified BG Prasad classification

Intervention A area Intervention B area

Vaginal delivery; 239;

85% LSCS; 43;

15%

(54)

41

Likewise, mean per-capita monthly income was higher in area-A (Rs.2,637.65) than

area-B (Rs.1601.58), the difference of which was statistically significant with p value

[image:54.595.88.527.262.676.2]

<0.0001.

Table 5.2: Comparison of mean values of socio-demographic characteristics in

the study areas – Pre intervention

Mean values of Intervention A area

Intervention B area

Total

Mean Age (years) 35.12 (3.13) 35.31 (3.15) 35.3 (3.14)

Mean Years of education 9.56 (3.69) 8.34 (3.34) 9.0 (3.6)

Mean Per capita monthly income (Rupees)

2637.65 (2693.16)

1601.58 (1705.63)

2138.06 (2326.18) Mean Years of marriage 14.02 (5.68) 15.00 (5.91) 14.49 (5.47)

Mean Number of children 2.06 (0.78) 2.10 (0.70) 2.08 (0.74)

Mean Years since last child birth

9.09 (5.32) 9.84 (5.18) 9.45 (5.26)

Mean number of Rooms at home

3.40 (1.76) 3.05 (1.31) 3.23 (1.57)

Mean number of Household members

(55)

42

5.2 Medical and Family history of NCDs

Table 5.3.1: Medical history of Non-Communicable diseases among participants: Previously diagnosed NCD among participants Intervention-A area Intervention-B area Total

Number % Number % Number %

Diabetes mellitus 6 3.8 5 3.4 11 3.6

Hypertension 0 0 3 2.0 3 1

Heart diseases 1 0.6 0 0 1 0.3

Thyroid abnormalities 12 7.5 10 6.7 22 7.1

Bronchial Asthma 4 2.5 3 2.0 7 2.3

[image:55.595.87.526.145.359.2]

Psychiatric illnesses 3 1.9 0 0 3 1

Table 5.3.2: Family history of Non-Communicable diseases among participants: Family history of

NCD Intervention-A area Intervention-B area Total

Number % Number % Number %

Diabetes mellitus 57 35.6 39 26.2 96 31.1

Hypertension 41 25.6 29 19.5 70 22.7

Seizure disorder 3 1.9 2 1.3 5 1.6

Heart diseases 5 3.1 5 3.4 10 3.2

Thyroid abnormalities 10 6.3 2 1.3 12 3.9

Bronchial Asthma 20 12.5 7 4.7 27 8.7

Psychiatric illnesses 3 1.9 1 0.7 4 1.3

Both the study areas were similar in proportion of study participants with

self-reported non communicable diseases. In total, 3.6% participants had diabetes

[image:55.595.88.526.411.641.2]

(56)

43

and were on medications.

31.1% and 22.7% participants had a family history of diabetes mellitus and

hypertension respectively. 8.7% and 3.2% had a family history of bronchial asthma

and heart ailments.

5.3 Anthropometric characteristics:

Table 5.4: Description of anthropometric characteristics in the 2 study areas – Pre intervention

Mean values of Intervention A

area

Intervention B

area

Total

Height (cm) 153.46 (5.14) 153.44 (6.05) 153.45 (5.59)

Weight (kg) 63.45 (12.98) 61.41 (12.75) 62.47 (12.89)

BMI 26.93 (5.29) 26.01 (5.08) 26.48 (5.20)

Waist circumference (cm) 88.50 (11.41) 83.89 (11.54) 86.28 (11.68)

Waist : Hip ratio 0.856 (0.056) 0.828 (0.061) 0.842 (0.060)

The difference in mean waist circumference (p= <0.0001) and mean waist : hip ratio

(p= <0.0001) between the 2 study areas were found to be statistically significant.

Intervention-A area participants had higher waist circumference and waist/hip ratio

than area-B.

Effectiveness of a community based physical activity programme in changing the physical activity profile of the community: A feasibility study of an intervention