PERCEIVED BENEFITS AND BARRIERS OF EXERCISE AMONG FEMALE UNIVERSITY STUDENTS

Nanees A. Gad 1, 3 , Mervat M. Arrab 2, 3 and Shmookh M. Alsayed 3 . 1. Community Medicine Department, Faculty of Medicine, Ain Shams University, Egypt. 2. Community Health Nursing, Faculty of Nursing, Menoufia University. 3. Public Health department, College of Applied Medical Sciences, King Khalid University Khamis Mushait, Kindom of Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

A contributing factor for obesity, weight gain, coronary heart disease, and other life-threatening illnesses mainly physical inactivity (Munford, 2011). A critical period of adolescence is the transition between high school and university that physical activity level turns down during adolescence and activity behavior starts to decreased as adults (Bray, 2007).
The global mortality 4 th leading risk factor is physical inactivity and it is a contributing factor in the development of various chronic diseases such as hypertension, cancer and heart diseases causing 3.2 million deaths worldwide. The World Health Organization reports that about 60% of the global population do not meet the recommended daily minimum of physical activity (WHO, 2010).
In Saudi Arabia (KSA) The economic growth surge in recent years responsible of facing challenges to combat chronic health problems related to sedentary lifestyles, diet and other behavior changes associated with riches of the country. In addition, developments in city planning that require the use of automobiles for all trips (Al-Hazzaa et al., 2011), may be leading to physical inactivity and a low down level of physical fitness. Studies conducted in Saudi Arabia suggests a high prevalence 43.3-99.5% of physical inactivity among Saudi children and among adults (Khalaf et al., 2013). The southwestern region college students of Saudi Arabia suffered from high prevalence of physical inactivity and inactive leisure time among (Awadalla et al., 2016).
Analyzing university students 'barriers to physical activity is a cornerstone to address needs and promote physical activity among college students by health officials . The reasons why university students do not participate in sufficient physical activity (personal, interpersonal, environmental, and social and policy factors) are essential, perceived barriers to being active are the main predictor of health behavior change. (Lovell et al., 2010).
To assess the perceived benefits and barriers to physical activity: A descriptive analysis performed. Possible scores of Likert scale ranged from one to four; four represented the highest perception of benefit and perception of barrier. The scores were computed for both the total benefits, total barriers and total score. Scores on the total instrument can range from 43 to 172. The higher the score, the more positively the individual perceives exercise. The score range of benefits is between 29 and 116 and score range of barrier is ranged between 14 and 56. The means of the individual EBBS items as well as the mean total of all benefits and barriers items was calculated. For each scale and subscale, the items were added then divided by number of items included in that scale to calculate the mean score.
To describe the level of physical activity status. The physical activity status was classified according to Godin Leisure Time Exercise Questionnaire Scoring for health contribution. Weekly frequencies of strenuous and moderate, activities are multiplied by 9 and 5, respectively. Total weekly leisure activity was calculated in by summing the products of the separate components 1-24 units or more: Active, 2-23 units or less: Insufficiently active. This cut point (24 units or more) is more near of the «basic» public health recommendations (Minimal weekly volume with strenuous and/or moderate physical activity).
To study the relation between physical activity status and perceived exercise benefits and barriers by using independent t test.
To study the relation between BMI groups and perceived exercise benefits and barriers, ANOVA test was used.

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Results:- Table (1) demonstrates Socio-demographic characteristics of the study sample. It was clear that, 97.3% of females university students were Saudi, the majority of student's residence 84.3 % were urban. Slightly more than one third of students were married.  Table (4) shows the mean benefit, barrier and total score among study sample. It shows that the mean benefit score was 3.29, while mean barrier score was 2.69.

Table (5) and figure (3) show Comparison between mean benefit score and mean barrier score.
Which revealed that there is significant difference between mean benefit score and mean barrier score. Figure 4 shows places where students practice sports. This figure revealed that 47% of students practice sports at their home while 22.5% practice sport at Gym.

Figure 5 presents Students physical activity.
It was clear that about 35% of students were active, While 65% were inactive. The relation between Activity behaviour and socio-demographic factors: The mother and father"s level of education, the students" marital status and residence all had no significant impact on the students" physical activity.

Table (7) shows the relation between activity status and benefits and barrier scores.
The table shows that, Inactive students had higher score than active students as regards barriers scores and the difference was significant.

Table (8) shows relation between BMI groups and benefits and barrier scores.
It was clear that, obese students and overweight had higher mean barrier score than normal weight students and the difference was statistically significant.

Table (9) shows the relation between activity status and benefits subscales score.
It was obvious that, active students had higher mean social subscale than inactive students did. The difference was statistically significant. Table (10) shows the relation between activity status and barriers subscales score. It was clear that inactive students had higher mean score as regards all barriers subscales except Mean time expenditure score. The difference was statistically significant.

Discussion:-
A university setting is vital in promoting health-enhancing behaviours. This age group is thought to be flexible and can be readily influenced to make positive changes. This is also a time whereby individuals can set habits, which then persist into adult life.

(Dalibalta & Davison, 2016)
For the exercise benefits in this work, either female university students "agreed" or "strongly agreed" with most of the benefits items, with a total benefit mean value was 3.29. The mean scores of subscale items were greater than 3, indicating that the majority of our sample were perceived as benefits. While they were being neutral or nearly with an agreement with many of the barriers items, with a total barrier mean value was 2.69. Mean scores for all four barriers subscales were between 2 and 3 which we interpreted to mean neutral. The perceived benefits among studied sample were significantly greater than the perceived barriers to exercise.
In this work, the highest mean was of the psychological outlook ( Our results suggested that the female"s university students agreed with the perceptions that exercise can improve psychological wellbeing, physical fitness and physical appearance and provide preventative health benefits. Our student sample perceived higher benefits from exercise associated with life enhancement and social interaction, with mean subscale values of 3.30 and 3.12 respectively. These in opposition with previous research on university students in the United Kingdom (UK) by (Lovell et al, 2010 This finding came in agreement with another study in Kuwaiti university students (Alsahli, 2016) who studied Female university students perceived barriers "lack of motivation", " lack of energy", "pain when I exercise", and "how " I see my body" significantly greater than male university students . In addition, revealed that "Lack of motivation" is significant barrier of females because they are not encouraged to engage in physical activity due to Kuwaiti society. Females cited more barriers to physical activity than males and overall had more internal and external barriers. The most commonly cited internal barriers to physical activity were "lack of motivation", "lack or low physical power", and "fear of injury". The most commonly cited external barriers were "lack of time", "unsuitable weather", and "lack of access to opportunities such as nearby facilities".
Another study on (Daskapan et al, 2006) at Turkish university students revealed that The total score of the external barriers was significantly higher than the score of the internal barriers Lack of time was the most important external barrier. Lack of energy was the most important internal barrier. "Lack of time due to responsibilities related to the family and social environment" and "I have never any energy to able to do any exercise". In Spanish University Students, (Lemos et al,. 2014) stated that the higher scores corresponded to "too much work"; "laziness"; "place for exercise are too far away", and "lack of time for exercise". Self-perceived health was associated with barriers to PA.

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Study on Kuwaiti students, "not having time to be physically active", was one of the main barriers reported (Musaiger et al, 2014). Furthermore, a survey on Saudi adolescents showed that lack of time was the primary reason for inactivity for both males and females (Al-Hazzaa et al, 2014).
(Alsahli M, 2016) cited barriers for both the USA and KSA university groups were "I am too embarrassed to exercise" and "I think people in exercise clothes look funny". The strongest endorsement from both the KSA and USA participants, reflected by a mean score > 3.6, was for the item: Exercise improves the way my body looks. This finding was consistent with the last surveys, among undergraduate students in the USA and UK, that suggesting the most important perceived benefits were concerned with physical appearance (Lovell, et al., 2010). It was also consistent with those reported by Samara, et al. (2015) conducted with female students in the KSA, which revealed that participants had good knowledge of the benefits of physical activity. (Alsahli M, 2016) concluded that female Saudi students attend universities in the KSA or USA, they both appear to similarly perceive the strength of their Exercise Benefits to physical activity. The reason is cultural, females tend to be less social with strangers, especially in public areas. For example, Saudi females in sports clubs are less likely to approach and engage in conversation with other females they do not know.
Regarding Mean benefit, barrier and total score among study sample, the current study revealed that higher total mean benefits score 3.29 compared to a total Mean barrier score 2.69 . The current study finding was consistent with (Dalibalta & Davison , 2016) who demonstrated that university students perceive higher levels of benefits than barriers to exercise with a total benefits mean value of 3.09, compared to a total barriers mean value of 2.16.
Regarding physical activity among studied students. The current study revealed that about 35% of students were active, While 65% were inactive this means that the benefit/barrier ratio of 1.22 was not enough to motivate these students to be active. The present study findings were supported by a study that was carried out by (Daskapan et al, 2006) at Turkish university students who stated that the prevalence of physical inactivity increased in the 15-18year-old age group in both sexes.

Conclusions:-
The female university students perceive higher levels of benefits than barriers to exercise. The highest mean of benefits was the psychological outlook then followed by Physical performance, Life Enhancement, Preventive health, Social interreaction subscale respectively. The highest mean of barriers was the Time expenditure subscale then followed by the Exercise milieu, Physical exertion), Family discouragement subscale respectively. Applied interventions need to assist female university students to overcome their barrier to participate in physical activity.

Recommendations:-
For future studies, young population provision of good physical activity health promotion program early in life to overcome any perceived barriers and to avoid future risk of chronic disease. Appropriate places should be available for females to encourage them to participate in physical activity, a larger number of public facilities for sports and exercise should established specifically for women and adolescent girls.