Definition of Physical Activity
This section discusses physical activity, the importance of physical activity to health
and, physical activity in Malaysia; Section 2.3 provides an overview of general theories
related to exercise behaviour. Physical activity is defined as bodily movement produced
by contraction of skeletal muscle that increases energy expenditure above the basal
level (U.S Department of Health and Human Services, 1996). The concept was also
defined more specifically as any bodily movement produced by the contraction of
skeletal muscle that results in a substantial increase in caloric requirement over resting
energy expenditure (Prescatello, Ross, Riebe, & Thompson, 2014). The WHO webpage
on physical activity (World Health Organization, 2015) provided a more concise
definition: any bodily movement produced by skeletal muscle that requires energy
expenditure. The definitions of physical activity are broad and allow the inclusion of any
kind of activity which involves movement that uses energy, not just sports or aerobic
exercise. The International Physical Activity Questionnaire (IPAQ) used in the
Malaysian National Health and Morbidity Survey (NHMS) 2011 covers activities
undertaken for work, transportation, leisure time, domestic work and gardening (Teh et
al., 2014).
The word “exercise” is used interchangeably with physical activity but the term is not
synonymous. Exercise is a type of physical activity consisting of planned, structured
and repetitive bodily movement to improve/or to maintain one or more components of
physical fitness (Prescatello et al., 2014). Exercise is part of physical activity and
training performed for the purpose of enhancing physical fitness (US Department of
Health and Human Services, 1996). However, in this thesis both terms are used
interchangeably as the respondents participated in the exercise programme organised
by their respective non-governmental organisation (NGO). As such, the participants
were performing physical activity in a stable, repetitive and consistent manner.
The definition of exercise introduces the term of physical fitness. Physical fitness refers
to the ability to carry out daily tasks with vigour and alertness, without undue fatigue and
with ample energy to enjoy leisure time pursuits and to meet unforeseen emergencies
(U.S Department of Health and Human Services, 1996). Physical fitness is also defined
as a set of attributes or characteristics individuals have or achieve that relates to their
ability to perform physical activity, and is separated into health-related and skill-related
components of physical fitness (Prescatello et al., 2014). The health-related
components of physical fitness include cardiorespiratory and muscular endurance, body
composition, muscular strength and flexibility; the skill-related components of physical
fitness comprise agility, coordination, balance, power, reaction time and speed
(Prescatello et al., 2014).
The opposite of being active is usually referred to as sedentary or inactive. Sedentary
behaviour refers to activities that do not increase energy expenditure substantially
above resting level, such as sleeping, sitting down, lying down or watching television
(Pate, O’Neill, & Lobelo, 2008). The addition of the “in” prefix to the term “activity”
suggests a lack of physical activity.
The importance of physical activity for health
Physical inactivity is associated with “disuse-syndrome” in humans which involves
premature ageing, obesity, cardiovascular disease, musculoskeletal fragility and
depression (Knight, 2012). Since these diseases and disorders occur in young adults as
well as the elderly, age per se is not completely responsible for all these diseases and
disorders (Knight, 2012). Physical activity is an important determinant of health and
there is evidence supporting the inverse relationship between regular physical activity
and the risk of developing cardiovascular disease, hypertension, stroke, type 2
diabetes, metabolic syndrome, obesity, colon cancer, breast cancer, depression and
falls (Prescatello et al., 2014). Cardiovascular diseases, diabetes and cancer accounted
for 50% of the global burden of disease and 80% of all non-communicable disease-
related deaths in low and middle income countries (Teh et al., 2014). Some of the
clinical conditions attributed to sedentary lifestyle were cardiovascular disease,
metabolic syndrome, obesity, type 2 diabetes and cancer.
Physical activity in Malaysia
Malaysia is a developing country and the rapid pace of economic and industrial growth
has led to an increase in sedentary lifestyles (Poh et al., 2010). To tackle the growing
problem of obesity and physical inactivity, the Ministry of Health Malaysia has
promoted physical activity through an annual Healthy Lifestyle campaign since 1991.
Similarly, physical activity and related areas have attracted the interest of researchers
in Malaysia. A selection of studies will be discussed below.
Findings from the NHMS 2015 (NHMS, 2015) showed that the prevalence of physical
activity was at 66.5% (Institute for Public Health, 2015). Even though the prevalence of
physical activity has improved from 64.3% during the NHMS 2011 (Cheah & Poh,
2014), the results from NHMS 2015 still indicate that at least one in three Malaysians
are physically inactive (Jeevananthan, Lim, Chan, Omar, & Khoo, 2015). In addition,
the prevalence of physical activity among Malaysians was lower than Singapore at
73.8% (Win et al., 2015).
The NHMS 2015 was conducted in 10,428 living quarters/homes and about 30,000
participants responded to the survey. Results showed that the rural population was
more physically active at 71.3% compared to the urban population at 65.0%. The
prevalence of physical activity among participants in the age group 18–19 years was
61% and it increased steadily to 73.4% for the age group 40-44 years. The prevalence
of physical activity remained fairly stable for the age group 45–54 years before
declining at the age group 55 years and above. The finding of NHMS 2015 is
comparable to the prevalence of physical activity among Singaporeans for age 40-59
years, which was 70% (Win et al., 2015). For adults in the age group 18–39 years, the
level of physical activity was reported at 66.9% for urban population and 73.3% for rural
population (Jeevananthan et al., 2015). The physical activity level for respondents in
the age group of 40–59 years was at 68.69% for urban and 78.7% for rural populations
(Jeevananthan et al., 2015). There was a reported decline in physical activity level for
the age group 60 years and above with respondents from urban areas at 49.9% and
rural areas at 54.6%.
A study on the physical activity pattern and energy expenditure of Malaysian adults
(Poh et al., 2010) discovered the prevalence of adequate exercise was at 14%.
Sufficiently active was defined as performing any moderate or vigorous-intensity
exercise for more than three times a week with each bout lasting more than 20 minutes
(Poh et al., 2010). The prevalence of adequate exercise was higher in urban areas at
15.7% compared to rural areas at 12%. When age was compared to the adequacy of
exercise, the data showed that Malaysians are most active between the ages of 18 and
19 years followed by 50 to 59 years. Data on physical activity adequacy was lower
during productive years, age 20 to 49 years. It was also found that about 75% of the
Malaysian adults travelled to work using passive transportation, such as cars or
motorcycles, and only 3% cycled and 18% walked to work. This cross-sectional study
was carried out from 2002 to 2003 on 7,349 Malaysian adults aged between 18 and 59
years. The study also revealed that only 9% of respondents used public transportation.
These findings also suggest that most Malaysians are inadequately active. The study
did not explore reasons for respondents’ choice of passive transportation but it
illustrated the choice of transportation and its link to physical inactivity in Malaysia. The
determinants of participation in physical activity were examined by Cheah and Poh
(2014) using data from the third NHMS 2006 of the Ministry of Health Malaysia which
consisted of 30,992 respondents. This study discovered older individuals were less
likely to be physically active due to greater difficulty in performing such activity. The
results also showed that those with higher income were less likely to be active. It was
suggested that high-income earners tended to substitute leisure-time physical activity
with working, which caused them to live a sedentary lifestyle. The study also found that
well-educated individuals were less active as they were doing less physically
demanding jobs in confined offices. Similar results were found for married respondents
where family responsibilities had taken over their opportunities to exercise.
The level of physical activity among the Malaysian population reportedly increased to
64.3% in the NHMS 2011 (Teh et al., 2014). The study also found the pattern of
decreasing physical activity with age where the prevalence of physical activity was at
60% for age category 16–24 years and its peak at 70.6% for age category 35–44 years.
However, the prevalence of physical activity decreased to 64.0% for age category of
55–64 years. The study suggested that this situation occurred due to older people
having less self-efficacy and perceiving less benefit from participating in physical activity
(Teh et al., 2014). Interpretation and comparison of findings between the third NHMS
2006 and the NHMS 2011 should be made with caution as different measurement tools
were used in both studies (Teh et al., 2014). The NHMS 2011 used IPAQ measures
which cover a wider range of daily activities including household chores (Teh et al.,
2014).
