Studies on the quality of life and physical activity in Malaysia
Literature searches for studies on quality of life in relation to physical activity were
carried out and four studies published in English were found with one using the
WHOQOL-BREF questionnaire and the others using alternative instruments. Mat Ludin
et al. (2015) used the WHOQOL-BREF in their cross-sectional study to evaluate
physical activity and HRQOL among the non-academic staff of Faculty of Health
Sciences, National University of Malaysia. The 105 participants were aged between 18
and 60 years. The majority of the participants (72%) demonstrated high physical activity
of more than 3000 metabolic equivalent of task (MET) per week. However, the results
also showed that there were no significant correlations between physical activity and all
the domains of the WHOQOL. The authors suggested that the results were possibly due
to sample size, sampling method and response bias where respondents over-report
their physical activity level.
Three other studies were conducted using the 36-item Short Form Health Survey (SF-
36), 12-item Short Form Health Survey (SF-12) and Centers for Disease Control and
Prevention Quality of Life (CDC HRQOL-4) to assess quality of life. The SF-36 was
used by Ibrahim (2014) to examine the HRQOL among pre-diabetic patients and its
relationship with BMI. The SF-36 is a 36-items instrument which measures eight
domains: physical functioning, role-physical, bodily pain, general health, vitality, social
functioning, role-emotion and mental health. This cross-sectional study involved 268
patients recruited from two primary care clinics. The results of this study showed that
the prevalence of normal weight, overweight and obesity was 7.1%, 21.6% and 71.3%,
respectively. The study also found that 53.4% of the pre-diabetic patients had a family
history of diabetes, 15.7% were smokers and 60.8% were physically inactive. The pre-
diabetic patients with normal weight reported higher HRQOL compared to those
overweight and obese. The findings support previous literature that reported that higher
BMI was associated with lack of physical activity and poorer physical quality of life.
Another study which investigated the relationship between HRQOL scores and the
stages of change of adequate physical activity and fruit and vegetable intake was
conducted by Liau et al. (2013). The 144 participants were staff of Science University of
Malaysia. Data on physical activity and fruit and vegetable intake was collected using
the WHO STEP approach to surveillance (STEPS) instruments for chronic disease risk
factors surveillance. The SF-12 (Quality Metric, 2002) was used to gather information
on participants’ HRQOL. The SF-12 is a shorter alternative to SF-36 to evaluate
physical and mental health. The stages of change were measured using an instrument
developed by the Pro-Change Behaviour System Incorporation (©2008 Pro-Change
Behavior System Inc, Kingston, RI, USA). Findings showed that there was no statistical
significant difference in the SF-12 domains with the stages of change for both risk
factors. Analysis on the distribution of SF-12 and the stages of change of physical
activity showed an increasing trend for the domain of physical component scores,
physical functioning and general health as the intention to change increased. However,
the domain of mental component scores (MCS) showed a decreasing trend, which was
in contrast to other literature. The authors called for further studies with longitudinal
design and larger samples.
A cross-sectional study to determine the relationship between physical activity and
HRQOL among the staff of MARA University of Technology, Pahang was conducted by
Wan Norsyam, Muhammad Rafiai, and Ismail (2013). The study involved 65 participants
and used the General Practice Physical Activity Questionnaire (GPPAQ) to determine
the physical activity index and the CDC HRQOL-4. The study found that there were no
associations between physical activity index and health status measure and three
HRQOL domains, which were recent physical health, recent mental health and recent
activity limitation. Participants in this study also reported high HRQOL regardless of
physical activity index and in contrast with other literature which found higher HRQOL in
active individuals. Limitations included the use of self-reported questionnaires and
inaccuracy in estimating physical activity and recall bias which could have contributed to
the results of this study. The authors suggested that more studies investigating the
relationship between HRQOL and physical activity with body’s biochemical markers be
conducted.
Summary and research gap on quality of life in relation to physical activity
There is well-documented evidence of somatic benefits associated with physical activity
including the prevention and treatment of a range of medical conditions. However,
research on HRQOL in relation to physical activity has predominantly focussed on the
older population or populations with chronic disease (Bize et al., 2007). Even among
the existing literature on the relationship between physical activity and well-being,
studies use measures that are mainly of negative affect or focussed on clinical
outcomes such as anxiety, depression or stress (Stubbe et al., 2007). By using such
measures, any positive results from findings only provide support relating to
improvement of such conditions and not increased quality of life. The association
between physical activity and positive measures of well-being, such as happiness,
enjoyment or life satisfaction, among population-based samples remains unexplored
(Stubbe et al., 2007). As such, the present study will attempt to address the following
limitations of existing literature on quality of life and physical activity.
a) Relationship between quality of life and physical activity among the
general population
Evidence providing support for the relationship between physical activity and
HRQOL among disease-free general population and individuals younger than 65
years is limited (Bize et al., 2007; Blake, 2012; Scully et al., 1998). Elderly people
usually have poor physical function and strength while those with chronic
conditions, such as cardiovascular disease, arthritis and diabetes, require
tailored physical activity programmes (Bize et al., 2007). Due to the specific
conditions of both groups, elderly individuals and those with long-term conditions,
findings on the relationship between physical activity and HRQOL may not be
generalisable. The findings from the present study will contribute to the body of
knowledge on the relationship between quality of life and physical activity among
the general population. The results could benefit future research on the same
subjects and public health policy-makers.
b) Quality of life and physical activity using a repeated measures design
In the systematic review conducted by Bize et al. (2007), it was found that cross-
sectional studies showed moderate to strong associations between HRQOL and
physical activity. Higher physical activity level was consistently associated with
higher scores of HRQOL dimensions. However, studies using randomised
control trials and cohort design were scarce and insufficient to draw a conclusion
between physical activity and HRQOL changes over time. The present study
addresses this by employing a repeated measures design, which is
complemented by the addition of a qualitative interview study to gather a more
in-depth understanding of quality of life and physical activity.
