Professional Documents
Culture Documents
Blinded Number
T3003
March 2014
ACKNOWLEDGEMENT
i
TABLE OF CONTENTS
Acknowledgement i
Table of contents ii
List of tables v
List of figures vi
Chapter 1: Introduction 1
2.1 Elderly 3
2.1.2.1World 4
2.1.2.2 Malaysia 4
2.3.1 Prevalence 10
ii
2.3.2 Associated factors 11
Chapter 4: Methodology 14
iii
4.14 Ethical approval 26
Chapter 5 : Result 28
sociodemographic group 36
Chapter 6 : Discussion 41
Chapter 7 : Conclusion 49
Chapter 9 : Recommendations 52
References 53
Appendix 57
iv
LIST OF TABLES
subjects
v
LIST OF FIGURES
version.
subjects
female subjects
occupational status
subjects
vi
LIST OF APPENDICES
vii
LIST OF ABBREVIATIONS
viii
ABSTRAK
Tajuk: Corak aktiviti fizikal dan factor berkaitan dengan aktiviti fizikal di kalangan warga
tua yang menghadiri klinik- klinik pesakit luar di Hospital Universiti Sains Malaysia
meningkatkan tahap kesihatan, di mana warga tua juga turut disarankan untuk sentiasa cergas
secara fizxikal. Di dalam situasi yang bersesuaian, warga tua disarankan untuk melakukan
aktiviti fizikal yang berintensiti sederhana selama 30 minit setiap hari dan 5 hari seminggu.
Objektif: mengenalpasti corak aktiviti fizikal dan faktor berkaitan dengan aktiviti fizikal di
Metodologi: satu kajian keratan rentas telah dijalankan di HUSM mulai ogos 2011 sehingga
disember 2011 yang melibatkan pesakit warga tua berumur 60 tahun dan ke atas. Soal selidik
ECAQ telah digunakan untuk menyaring keluar mereka yang mempunyai masalah
dayaingatan. Soalan selidik merangkumi soalan brkaitan latarbelakang social dan soal
kajiselidik Baecke yang telah dialih bahasa ke Bahasa Malaysia telah digunakan. Data
Keputusan: 374 peserta dikenalpasti dan 90.9% telah bekerjasama, di mana 142 (41.9%)
adalah lelaki dan 197 (58.1%) adalah perempuan dengan purata umur 67.7 (sisihan piawai
6.0) tahun. Markah purata aktiviti fizikal peserta berdasarkan soalselidik Baecke adalah 6.1.
kajian mendapati factor yang berkait rapat dengan aktiviti fizikal adalah factor umur, jantina,
mereka yang tidak menganggap berat badan mereka sebagai masalah kesihatan dan tidak
bekerja.
Kesimpulan: Terdapat kaitan yang rapat antara tahap aktiviti fizikal warga tua dengan
anggap mereka terhadap imej badan dan status pekerjaan. Didapati juga peningkatan umur
ix
ABSTRACT
Title: Pattern of physical activity and associated factors of physical activity among elderly
activity for health, in which the elderly are recommended to be physically active. Where
appropriate, older adults should engage in at least 30 minutes of moderate intensity physical
Objective: To determine the pattern of physical activity and associated factors of physical
activity among elderly attending the outpatient clinics Hospital Universiti Sains Malaysia.
Methodology: A cross-sectional study was conducted involving elderly patients age > 60
years attended outpatient clinics at Hospital University Sains Malaysia from August 2011 to
December 2011. ECAQ questionnaire is used to exclude patient with dementia. Structured
Baecke questionnaire are used to collect the data in face to face interviews.
Results: 372 subjects were recruited with respond rate 90.9%. Of these, 142 (41.9%) were
male and 197 (58.1%) were female with mean age of 67.7 (6.0). Median score for physical
activity according to Modified Baecke Questionnaire was 6.1 (SD 5.5). Base on this
questionnaire, there were statistical significant association between physical activity with age,
gender, patient perceive their weight not as health problem and patient not.
Conclusion: There were strong association between level of physical activity among elderly
with perceive body image and occupational status. Meanwhile increasing age and female
x
CHAPTER 1 : INTRODUCTION
Initially this global phenomenon started in the developed wealthy countries such as Europe
and America and currently it is growing more rapidly among developing countries such as
Cuba, the Islamic Republic of Iran and Mongolia (1). Malaysia as one of the developing
countries is experiencing the same trend of higher growth in number and proportion of the
elderly. It is expected our country will become an ageing population by the year 2021 (2).
Healthcare system in Malaysia should prepare to address the task of caring for the
elderly in view of the increasing numbers of elderly in our country. The main burden of health
care for the elder will lie within primary care where the elderly require long term care. The
concept of healthy ageing will be a challenge for primary care service in Malaysia. This
concept of healthy ageing depends on health promotion and disease prevention in order to
minimize the incidence of illnesses and disabilities in the later years and enhance their
independence in their daily living activities. Increased public awareness on being physically
active is one of the evidence-based intervention and is highly cost effective (1).
As generally known, there are association between physical inactivity with many
health problems such as coronary heart disease, diabetes, depression, obesity, osteoporosis
and cancer(3). In Malaysia, according to the Third National Health and Morbidity Survey
(NHMS III), chronic illnesses were reported to be most prevalent with about 48.8% amongst
the age 60 and above (4). Worldwide, non-communicable disease has become the main
burden of disease in high, middle and low income countries (1). Since physical inactivity is a
modifiable risk factor, there is a significant potential to increase the health and quality of life
of older adults, as well as to improve the economic health of the nation through physical
1
Although the benefits of regular physical activity are well known, a large proportion
of the elderly population remain inactive. There is paucity of information regarding pattern
of physical activity among the elderly in Malaysia. Understanding the factors that influence
physical activity behaviour in our local older adults is needed to develop effective
intervention strategies that will address the problem of physical inactivity in our population.
Most studies were done in western countries which have different socioeconomic
background, culture and ethnicity compare to our local population (5-9). This study aims to
contribute to the literature by describing the pattern of physical activity among the elderly in
our population. It also aims to analyse the possible associated factors that contribute to the
level of physical activity among this age group at our local set up. The findings could be used
for our intervention to motivate older persons to increase their level of physical activity, and
2
CHAPTER 2: LITERITURE REVIEW
2.1 Elderly:
Ageing process is of course a biological realities which has its own dynamic beyond
human control (10). Definition of elderly varies between countries where most of the time it
is a reflection of the current political and economic situation of that country. Generally,
Most of the developed countries such as the United States of America used
chronological age to refer their elderly population. Using this definition, elderly is commonly
defined as those person at the age of 60 or 65 year old which is roughly equivalent to
social role compared to chronological age. In these developing countries, elderly is beginning
at the point when active contribution is no longer possible and there is the loss of roles
According to the United Nations World Assembly on Ageing held in Vienna, 1982,
60 years and over is considered the cut-off point used for ageing (1). Different definition
for the elderly used in Africa, where the elderly persons correlate with chronological ages of
50 to 65 years, depending on the setting, region and country (10). In Malaysia, our
government has adopted cut-off point which has been used by WHO in formulating and
3
2.1.2 Demographic of the elderly
2.1.2.1 World
World Health Organization (WHO) statistic in 2010 showed that an estimated of 524
million people were 65 years or older, which comprises of 8% of the world population (12).
According to this report from U.S. Department of Health and Human Services and WHO, it is
expected that by 2050, this number will be nearly triple to about 1.5 billion, representing 16%
A statistic by WHO in 2012 shows about 14 million of the elderly aged 80 years or
older living in the whole world in the middle of 20th century (1). It was predicted that the
number will increase to 400 million people in this age group worldwide in the year 2050(1).
It is contributed by current more rapid speed of population aging. The shift to older
populations started in wealthy regions such as Europe and North America (1). However
currently low and middle-income countries are experiencing the greatest change (1). By
2050, it is expected that 80% of older people will live in these countries (1). Previously,
European countries such as French and Sweden took more than 100 years for their population
aged 65 and older to increase from 7 to 14% (12). Currently, these similar demographic are
experienced more rapidly by countries such as Brazil, China and Thailand (12). Based on
United Nations data, those aged 60 or over are expected to outnumber the population below
2.1.2.2.Malaysia:
In Malaysia, the numbers of the elderly have increased by 35% over 10 years period
of time (11). Based on this population projection, the number of the elderly is likely to be 3.4
4
It is estimated that Malaysia will be an ageing population by the year 2021 when the
population aged 65 years and above reaches 7.1% (2). It is also expected that old age
dependency ratio will double from 7.4 in year 2010 to 16.6 in the year 2040 (2). This means
that the working age population would have to bear the increasing number of old age
population.
In the year 2000, Chinese had the highest population of senior citizens among
Malaysia multi-ethic population at 8.8% (11). It was then followed by Bumiputera and Indian
which constituted to 5.7% and 5.6% of their respective groups (11). These contributed by low
Physical activity has been defined as any bodily movement produced by skeletal
Promoting Physical Activity Among Older Persons which was issued by WHO in 1996,
physical activity is operationally defined as all movement in everyday life including work,
recreation, exercise, and sporting activities (15). Meanwhile, inactivity is defined as doing
no or very little physical activities at work, at home, for transport or during discretionary
time .
Physical activities in daily life can be classified into a variety of ways including
occupational, sports, conditioning, household or other leisure time activities (14). Leisure
time activity is an activity that has been done out of freedom from time consuming duties,
5
activities. Example of transportation activities are walking or cycling. Household activity is
casual or organized participation, aim to use, maintain or improve physical fitness and
which serves to ensure fair competition, and allows consistent adjudication of the winner.
There is a different concept of sport between America and Europe(16). In North America,
sport is activity that involve competition meanwhile in Europe it may include recreational
and repetitive bodily movement done to improve or maintain one or more components of
There were various methods have been used to assess physical activities which
Calorimetry method of physical activity assessment had been used in earlier energy
balances studies. It could be sub classified into 2 which are direct and indirect calorimetry
(17). Direct calorimetry measured energy expenditure through production of heat in which it
limited to specific task only and it is deemed impractical (17). Meanwhile, indirect
calorimetry measures the consumption of oxygen that closely correlates with heat
production in which participants need to wear facemask or a mouthpiece with a nose clip,
6
and a container for the collection of expired air (17). Both techniques although accurate, but
max) and doubly labeled water technique (17). These methods had been used for validation
studies (18, 19) . VO2 max was used in validation and reliability study of Baecke
questionnaire for evaluation of habitual physical activities in Brazilian adult men where the
result showed this questionnaire is valid and reliable (20). Sabels et al in 2004 had done a
study on the effects of physical training on insulin sensitivity and how this relates to VO2
max (21). The result of this study showed VO2 max increased as a result of physical training
and the change in insulin sensitivity correlated positively with the change in VO2 max (21).
isotopically labeled hydrogen and oxygen atoms of negligible health risk. The excretion of
these isotopes in urine is measured to calculate the energy expenditure. It is costly for large
population study and cannot identify specific types or pattern of physical activities.
Measurements of energy expenditure using doubly labeled water are commonly accepted as
the optimum and gold standard in construct validation of questionnaire on physical activities
(16, 22).
Tools using specific objective monitoring such as heart rate, movement sensors and
doubly label water procedure are less practical as it is expensive and difficult to apply.
Questionnaires method is a popular and practical approach in large scale studies as their ease
of implementation, but it has a disadvantage as little is known about their reliability and
Most of questionnaire were validated using accelerometer, maximal oxygen uptake and
activity diaries (23) There was also the issue of limitation in the capacity of a person to
7
to compare self-administered questionnaire assessing physical activities among adult
concluded that no questionnaire for assessing physical activities was superior and therefore
There are questionnaires to measure the level of physical activities among the elderly
such as Physical Activity Scale for Elderly (PASE), Community Health Activity Model
Program for Senoirs (CHAMPS), Yale Physical Activity Survey (YPAS) and Modified
Baecke Questionnaire.
weeks (24). It assesses the types and intensity levels of physical activity that are appropriate
to the elderly people including lighter activities such as leisure walking, light housework,
light gardening, community or voluntary activities and light exercise, and also vigorous
activities such as heavy housework or gardening, swimming and sports. However it is not a
suitable questionnaire for Malaysian elder population because some of the questions
pertaining activities which are not popular in this country such as playing golf, dancing,
regarding how much time spent for housework, exercise, and recreational activities for past
one week (19). The second section is questions with categorical responses. It assesses several
different types of activities for past one months (19). There are also questions comparing
amount of physical activity level in each season of the year(19). This particular question
related to four seasons of the year; make this questionnaire not applicable to be used in
8
2.2.4 Global recommendations on physical activities for health.
included in a fitness plan (25, 26). F is for frequency, I for intensity, T for time and T for type
(25). It helps people determine how often, how hard, how long, and what kinds of activities
they should perform to build health and fitness. Frequency of activity is how many times per
week the person does physical activity (25). The intensity of physical activity is how hard
you exercise (25). Exercise intensity often quantified using heart rate (25). Other ways to
prescribe exercise intensity are by calculated VO2max or category-ratio scales for rating of
perceived exertion . The greater the intensity, the shorter the duration of exercise is necessary
long duration can yield results similar to those of higher intensity and shorter duration. Time
of physical activity is how long you perform the activity. Duration of exercise in excess of 45
minutes is associated with increased incidence of orthopedic injury (25). To avoid acute
injury, gradually increase frequency, duration, and intensity of activity over a period of
several weeks to months. Type of physical activity is what kind of activity is performed.
physically active as described for adults. However, particular attention must be put on the
intensity and type of physical activities appropriate for older people to avoid exercise related
injury or complication. WHO recommended that, if appropriate, older adults should engage
that every older adult should participate in moderate-intensity aerobic activity for at least 30
minutes on five days of the week, or vigorous-intensity aerobic activity for at least 20
minutes on three days a week(27, 28). A moderate physical activity is referred to an activity
9
performed at an intensity of 3 to 6 METs (work metabolic rate/ resting metabolic rate) which
is equal to brisk walking at 3 to 4 mile per hour. If in adult age group, the intensity of
physical activity is measured using METs (work metabolic rate/ resting metabolite rate) but
the intensity of activity is individualized in elderly group based on the increase in heart rate
and breathing. On the scale of 0 to 10, where sitting is 0 and all out effort is 10 to produce
noticeable increase in heart rate and breathing, the score 5 or 6 are considered moderate
activity and the score 7 or 8 is vigorous activity (29). For example, slow walk is considered
moderate activity in some elderly. The meanwhile in adult age group, it need brisk walk to
emphasizes on the benefits of moderate intensity physical activity that can be accumulated in
relatively short bouts (30). Accumulation of the daily dose of moderate-intensity physical
activities in relatively short, at least 8-10 min bouts, was offered as an alternative to one
continuous bout of the same total duration and intensity (30). Daily activities such as brisk
walking to work, gardening with shovel, carpentry which was performed in minimum bouts
2.4.1 Prevalence.
Most of the elderly in the United States did not meet the minimum amount of
recommended physical activity. Based on the data from Agency for Healthcare Research and
Quality, Centers for Disease Control and Prevention, 28 to 34% of adults age 65 to 74 years
The third National Health and Morbidity Survey 2006 (NHMS III) was published by
the Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia in
10
2008. It is a cross sectional population based household survey in Malaysia involving 33 933
subjects aged 18 years and above (31). According to this national survey, overall prevalence
of physical inactivity among Malaysian adults was 43.7% (31). It was more prevalent in
women, older adults, widow or widower and those who did not have formal education (31).
WHOs Global Strategy on Diet, Physical Activity, and Health encourages countries
Understanding the predictors factors of physical activity is important in developing our own
policy.
Previous studies have investigated factors that are associated with leisure time
physical activities among elderly. Among the factors that have correlated with physical
activities in this age group are sociological factors such as age (5-7, 32, 33), gender (5, 6,
32), marital status (6, 8), education status(6, 7, 9), smoking (6, 8, 9, 33) and economic status
(8, 33, 34) chronic illness(6, 32, 33) and body mass index (5, 6, 9, 32). Other factors are
psychosocial factors such as social support, self-efficacy and perceived barriers, and physical
environment factors such as access to sport or recreational facilities and neighborhood safety.
There is limited study focusing on the physical activity and the associated factors among
Physical activity is associated with a lower incidence of morbidity and mortality from
a number of major chronic illness and mortality. Previous studies had shown that physical
osteoporosis and cancer(3). There is evidence that regular activities lower the risk of
11
developing non-insulin dependent Diabetes Mellitus. Study by Bianchi et al shows physical
activity is inversely associated with insulin resistance and metabolic syndrome even in the
elderly age group (35). Physical inactivity was also predictive of mortality (36). Based on
WHO data in 2002, overall physical inactivity is estimated to cause 1.9 million deaths
globally.
Physical activity could help the elderly live in better quality of life. Study by Ferucci
et al in 1992 showed that physical activities in the elderly population prolonged active life,
decreases the percentage of remaining life that is spent in the state of disability chances and
period of disability in remaining life, and compared with people who die at the same age in
the general population, is associated with a shorter period of disability(37). This study also
showed that the negative effect of inactivity on survival and length of disabled life is
Physical activity also had effect on the cognitive function in the elderly. A prospective
study by Weuve et al suggests long term regular activity is associated with significant better
cognitive function and less cognitive decline in older women (38). Similar findings found in
another study that shows physical activities as a protective factor for dementia in elderly
person (39).
Other than reduced morbidity and mortality, and improved quality of life in the
elderly, physical activities also indirectly reduce the financial burden of the country as the
medical cost for inactive adults are higher than for active adults and increase with age. It may
be possible to significantly help to reduce health care cost by improving the level of physical
12
Conceptual framework
Figure 2.1 below shows the conceptual framework for this study.
PHYSICAL
ACTIVITY
13
CHAPTER 3: OBJECTIVES
To study the pattern of physical activity and its associated factors among elderly
1) age, sex, marital status, economic status and educational level are associated
CHAPTER 4: METHODOLOGY
Hospital Universiti Sains Malaysia is located in the district of Kubang Kerian, Kota
Keluarga, Obsteric and Gynecology clinic, Internal Medicine clinic, Pediatric clinic,
14
Psychiatric clinic. These clinics receive referral from surrounding health centers,
district hospitals, private hospitals, general practitioner as well as patients who come
Elderly patients at outpatients clinics HUSM that fulfill the inclusion and exclusion
criteria
Inclusion criteria:
15
Exclusion criteria:
HUSM.
The sample size calculation was done for each objective. However, only the one that
yielded the biggest sample size was taken as the study sample.
16
Reference for sample size calculation in this study was from pilot study on the
physical activity among elderly visitors in HUSM by Rahayu et al for her research
project as partial fulfillment of the requirement for the degree of master of Public
Health(40).
= 0.05
power = 0.8
m = 1
+ 20%
health problem
activity
17
From the above calculation, the biggest sample size was taken as sample size for this study.
2. Ex smoker: those who stop smoking for six months and above
4. Perceive weight as health problem: subjects perceive their body weight give
5. Perceive weight as disturb activity: subjects perceive their body weight give
8. Leisure time activity: activity done at freedom from time consuming duties,
responsibilities activities.
A. Questionnaires:
b. Sociodemographic data
18
B. Weight and height measurement:
Weight and height was measured using calibrated digital SECA scale machine.
Weight measured to the nearest1 decimal point in kilogram and height was measured
to 2 decimal point in meter. Body mass index was calculated as body weight divided
by height squared.
4.11.1 Questionnaires
The Malay version of the Elderly Cognitive Assessment Questionnaire (ECAQ) was
to screen for those who has memory problem. ECAQ questionnaire was initially
developed in Singapore and includes 10 items taken from the MMSE and the
Geriatric Mental State Schedule (41). The ECAQ assesses cognitive function by 3
categories which are memory, orientation and memory recall. It uses a 4 digit
number to test memory recall and the assessment of orientation is heavily reliant on
information such as age, birthday, and year of birth. It has a maximum score of 10
points. There is less bias on educational status and the questionnaire can be
completed in less than 10 min. The ECAQ reports a sensitivity of 85.3% and
specificity of 91.5% (42). Those who had score 5 or less was excluded from this
study.
On interview, participants were asked regarding general questions. The contents were
regarding age, sex, marital status, educational status, smoking status, income and co
19
morbid illness. They were also asked regarding how they perceive their body image
Baecke Questionnaire was initially created by Burema, and Frijters in 1982 (43). It is a
over the past year. It measures physical activity at work, sport during leisure time and
physical activity during leisure time exclude sport. Study by Ono et al in 2007 showed that
this questionnaire is a useful monitoring tools for assessing multiple domains of physical
activity with acceptable reliability and validity (44). Baecke Questionnaire was later modified
by Voorrips and co workers to capture habitual physical activity specific in the elderly by
deleting the employment items and replacing it with household activity item. Validation of
modified Baecke Questionnaire was done by comparison with energy expenditure according
to doubly labelled water method (18). The validation study showed spearman correlation
between the questionnaire score and physical activity level was 0.54(95% CI 0.22 0.66)
The modified Baecke Questionnaire was chosen for this study as it more suitable for
1. For the household activity, there are 10 questions with 4 to 5 possible response. The
specific activities in this domain include questions about light and heavy housework,
shopping, transportation and the number of rooms and stairs in the participants
house.
20
2. The sport activity section asks about participants most frequent sport activity for past
one year. For each activities reported, they are asked regarding frequency, duration of
time spent and the month of the year which the activity performed. Each activity is
scored by a formula multiplying the activity intensity code, time spent and months
3. The leisure time activity was also measured with similar formula with the sport
activity.
The total score is obtained by summing the score for all three domains in a continuous unit
less activity score; with the higher scores indicate higher level of physical activity. Tertiles
were computed to classify people as low, moderate and high physically active. The
The translation process was done by a group of experts consist of epidemiologist and
family physicians. Figure 4.2 outline the flow of translation process in order to preservations
The modified Baecke Questionnaire was translated into Malay by a bilingual master
student. Another forward translation was done by the research group. Following the
translation, another bilingual student who had never seen the questionnaire reviewed the
Malay items for backward translation into English. The Malay and back translated English
version was reviewed by research group and the translators. Final Malay version was
reproduced for pretesting. Pre-test was done to 10 subjects who were native speakers of
Malays. The review of the respondent testing and production of final consensus. (Appendix
D).
21
Figure 4.2: Forward and backward translation processes of the Modified Baecke
by
research
group
Final Malay
version
Pretesting
22
Validation
a) Face validation
Face validation was determine by interview 10 elderly persons and asked them to classify
scale 2 appropiate and scale 3most appropriate. All the respondents rated the question as
most appropriate.
b) Content validation
Content validity was determined by two experts in the field of research. In this study,
content validity was done by a Family Medicine Specialist and a Community Medicine
Specialist. After review the questionnaires, both of them agreed that the questionnaire
content was appropriate to assess the physical activity among elderly with some
Every 1 in 2 elderly patients attending outpatient clinics HUSM were asked for
informed consent. Those who consented for study will be screen for the inclusion and
exclusion criteria. Written consent was obtained from the subject. Face to face interviews
were done by trained investigator. Then, the weight and height measurement were done by
interviewer
Data was entered and analyzed using Statistical Program for Social Sciences (SPSS)
version 18.0 (SPSS Inc., 2003) and Stata Intercooled version 8.0 (Stata Corp., 2003). Data
23
Objective 1 was to describe pattern of physical activity among elderly. The proportion
of elderly involved in that particular activity was calculated. The proportions of involvement
Objective 2 was to identify the associated factors of physical activity among elderly
attending Outpatient Clinic, HUSM. The dependent variable was physical activity score. The
independent variables were age, sex, race, marital status, living arrangement, income,
educational level, smoking status, occupational, present of chronic illness, body mass index
1. Simple Linear Regression which was used to determine the potential associated
2. General Linear Regression which was used to determine the associated factors of
one numerical dependent variable and more than one independent variables. The goal is
to develop a best fitting, simple (parsimonious), biologically sound and easy model to
estimate the beta. General Linear Regression is a special name given when the
independent variables for Multiple Linear Regression consists of mixed numerical and
categorical variables.
The distribution and frequencies were examined. All continuous variables were expressed as
mean (SD) or median (IQR) depending on the data distribution. Categorical data were
presented as frequency and percentage. Categories with small sample size were noted and
24
Simple Linear Regression (SLR) was done on all independent variables at univariable level.
The analysis was continued with General Linear Regression (GLR). Variable selection was
done to get the preliminary main effect model by automatic backward and forward stepwise
procedure. A model with the significant variables chosen from those two procedures was
reconfirmed. Preliminary main effect model was obtained from the confirmed model.
Interaction and multicollinearity were checked in fine modeling. All possible 2-way-
interaction terms of the independent variables in the preliminary main effect model were
done. Multicollinearity was checked for the variables in the preliminary main effect model
and also for all the other variables excluded to ensure that they were not excluded due to
the variance inflation factor (VIF) is equal to or more than ten. Now the Preliminary final
Model assessment was done by checking the linearity assumptions (overall model linearity
and linearity of each independent numerical variable), equal variance assumption, normality
assumption and outliers by using standardized residual plots. Residual plots include scatter
plots and histogram of residuals. In scatter plot (residuals versus predicted), if the
standardized residuals were randomly scattered along the zero line (predicted value), the
model is considered fit and overall linearity assumption met. If the standardized residuals
were dispersed equally at any point of predicted value, equal variance assumption was
distributed, the normality assumption was met. In scatter plot (residuals versus independent
numerical variable), if the standardized residuals were randomly scattered along the zero line,
25
However, for objective 2, the model assumptions were not met and biostatistician was
consulted for remedial measures. Various transformation methods of the outcome variable
were attempted and it was found that log transformation of the outcome variable gave normal
distribution of the standardized residuals. Model assumptions were rechecked using the log
transformation of the outcome variable. Overall model fitness, equal variance assumption,
normality assumption and variable functional forms were satisfied after transformation.
The study proposal was presented to the academic lecturers in the Department of Family
Medicine USM, with the presence of lecturers from Community Medicine Department USM,
before being reviewed and approved by Ethics Committee of USM on 1st August 2011
26
Figure 4.1:Flow chart of the study.
Source of Population:
Patients attending outpatient clinics Hospital University Sains Malaysia.
Inclusion Criteria:
Age: 60 years old and above.
Systematic Sampling (1:2) Physically independent.
Exclusion Criteria:
Unable to walk independently.
Being advise by medical personel to
restrict physical activity.
Dementia (base on ECAQ score)
Research Tool:
Anonymous Questionnaires:
ECAQ (Malay version)
Socio demographic data.
Modified Baecke Questionnaire (Malay
version)
Data entry, analysis and interpretation by using SPSS Software (version 18)
27
CHAPTER 5:
RESULTS
A total of 372 elderly were recruited in this study. The recruitment of the subjects was
performed at the outpatients clinic HUSM. Thirty three elderly refused for interview or not
completed the interview. So, the drop out for this study was 9.1%. The response rate was
Table 1 showed the sociodemographic characteristics of study subjects. There were 142
(41.9%) male and 197 (58.1%) female. The mean age of the subjects is 67.7 (6.0). Majority
of the subjects were Malays (93.2%), stay with family members (92%) and not working
28
Table 5.1: Socio demographic and medical characteristics of subjects:
Gender
Male 142 (41.9)
Female 197 (58.1)
Race
Malay 316 (93.2)
Non Malay 23 (6.8)
Marital status
Married 229 (67.6)
Widow/unmarried 110 (32.5)
Living
Alone 27 (8.0)
With spouse 87 (25.7)
With family member 91 (26.9)
With both 134 (39.5)
Education level
No education 98 (28.9)
Primary 145 (42.8)
Secondary/tertiary 96 (28.3)
Smoking status
Smoker 48 (14.2)
Ex smoker 73 (21.5)
Non smoker 218 (64.3)
Chronic illness
Yes 244 (72.0)
No 95 (28.0)
Occupation:
Yes 92 (27.1)
No 247 (72.9)
29
5.2 BMI and perception of body weight among subjects:
Table 2 shows BMI and how the subjects perceived their body image. The Mean BMI for
these subjects was 25 4.28. Only 32.7% of subjects had normal body weight. Most of the
subjects (64%) are overweight and did not perceive their weight as a problem (87%) or
Figure 5.1 shows comparison of subjects BMI and how the subjects perceive their body
weight. Only 31.5% of subjects perceive their body weight correctly. Majority of overweight
subjects (83.9%) did not realise that their weight are a health problem.
30
perceive weight as problem perceive weight not a problem
93.7% 90.9%
83.9%
16.1%
6.3% 9.1%
Figure 5.1: Comparison of BMI and perception of body weight among subjects
Table 5.3 shows pattern of physical activity among the subjects. Most of the subjects were
involved in unstructured physical activity such as gardening. One third of subjects involved
in walking for leisure time activity. Only minority of them (1.7%) involve in structured
31
5.3.2 Physical activity score among subjects
The physical activity score is presented in Table 5.4. The maximum total score of physical
activity was 31.9 and the minimum total score was 0.9. The total physical activity score and
subscores were calculated for all subjects. The distribution of the total score and subscores
Min Max
The total score of physical activity are divided into tertile range (18). Those who score lowest
tertile, which is below 33th centile, is categorized to have low level of physical activity.
Between the 33th centile and 66th centile is categorized as moderate level of physical activity
and above 66th centile as high level of physical activity. The result is presented in Table 5.5.
32
5.3.3 Difference of physical activity score between gender
Figure 5.2 illustrates the physical activity score for each gender. Median total physical
activity score for male was higher compared to female with median score of 8.8(6.5).
Figure 5.3 showed the physical activity score according to type of physical activity in
female and male subjects. Male subjects were more involved in leisure time activity
6.75 (6.54)
7 5.51(4.33)
6
4 total score
3
0
male female
Figure 5.2: Total physical activity (median score) in male and female subjects.
33
6
5.44
4
3.48
3 male
2 female
2
1.3
1
0 0
0
household activity leisure activity sport activity
Figure 5.3: Physical activity (median score) according to the type of physical activity
Figure5. 4 and Figure 5.5 respectively show physical activity level among male and female
subjects. Percentage of male subjects who have high level of physical activity level was
34
low physical
activity
28.2%
high physical
activity
42.2%
moderate physical
activity
29.6%
high
27%
low
37%
moderate
36%
.
35
5.3.4 Comparison of physical activity level among different sociodemographic group:
Figure 5.6 shows median physical activity score according to the educational level of the
subjects. Group of subjects with higher educational level has higher median physical activity
8
7.27
7 6.58
6
5.02
5
3
Median physical
activity score
2
0
No education Primary education Secondary and
tertiary education
36
Figure 5.7 below shows level of median physical activity score according to subjects
occupational status. Not working subjects have high level of physical activity compare to
6.4 6.31
6.2
5.8
5.4
5.2
5
Working Not working
37
5.3.5 comparison of physical activity level and perceptions of bodyweight
Physical activity level among those who perceive and not perceive their weight as a health
problem is shown in figure 5.8. Surprisingly, those who do not perceived their body weight as
a health problem are more active compare to those who perceived their weight as a health
problem
7
6.40
5 4.59
0
perceive their weight as a not perceive their weight as a
health problem health problem
Simple Linear Regression showed that age, sex, educational status, occupational status and
those who did not perceive their weight as a problem and disturd activities were significant
associated factors of physical activity and General Linear Regression showed that only age,
sex, occupational status and those who did not perceive their weight as a problem were
38
Table 5.6: Associated factors for physical activity among elderly
Variables Simple linear regression Multiple linear regression
a b
b (95% CI) t stat P value b (95% CI) t stat P value
Age (year) -0.071(-0.16,0.02) -1.44 0.150 -0.10(-0.20,-0.01) -2.13 0.034
Gender:
Male
Female -2.12(-3.28,-0.96) -3.59 <0.001 -2.37(-3.52,-1.21) -4.03 <0.001
Race:
Malay
Non Malay 1.13(-1.17,3.45) 0.96 0.337
Marital status:
Married
Widow/unmarried -076(-2.00,0.48) -1.20 0.230
Living arrangement
Alone
With spouse 0.70 (-1.67,3.08) 0.58 0.560
With family members 0.23(-2.13,2.59) 0.20 0.483
With both 0.81(-1.46,3.08) 0.70 0.483
Education level
No education
Primary 1.49(0.11,2.89) 2.12 0.035
Secondary/tertiary 2.25(0.73,3.78) 2.90 0.004
Smoking status
Smoker
Ex-smoker 0.93(-1.05,2.90) 0.92 0.358
Non-smoker -0.98(-2.68,0.72) -1.13 0.258
Chronic illness:
Yes
No 0.66(-0.64,1.95) 0.99 0.322
Perceive weight
as problem:
Yes
No 2.28(0.54,4.02) 2.58 0.010 2.50(0.78,4.21) 2.65 0.004
Perceive weight as
disturb activity:
Yes
No 2.02(0.01,4.04) 1.98 0.049
Occupational status:
Working
Not working 0.96(-0.35,2.26) 1.44 0.151 1.76(0.46,3.06) 2.65 0.008
39
5.5 Final model of General Linear Regression
Table 5.6 showed the final model i.e. best fit, parsimonious and biologically plausible model
for the associated factors of physical activity. The significant associated factors for physical
activity were age, sex, occupational status and those who did not perceive their weight as a
1. For every 1 unit increased in age, there was a decreased of 0.1 unit in physical activity
score (95% CI: -0.20, -0.01), after adjusted for other variables.
2. Female have got 2.37 units of physical activity score (95% CI: -3.52,-1.21), lower
3. Those who did not perceive weight as a problem, there was an increased of 2.50 unit
in physical activity score (95% CI: 0.78, 4.21), when other variables are the same.
4. Those who were not working, there was an increased of 1.76 unit in physical activity
score (95% CI: 0.46, 3.06), after adjusted for other variables.
5. Regression equation:
Physical activity score = 6.45 0.1(age) 2.37 (sex) + 2.50 (perceive weight as a
R2= 0.08, meaning that only 8.4% of the variance in physical activity score in the sample
40
CHAPTER 6
DISCUSSION:
and morbidity from a number major chronic illness such as coronary heart disease, diabetes,
depression, obesity, osteoporosis and cancer (3). Despite well-known benefit of physical
activity, prevalence of those who are physically active are still low. Based on Malaysia
National Health and Morbidity survey III in 2006, about 40% of our adult Malaysian
population were inactive. We should assessed the factors that influence physical activity
especially among elderly in Malaysia in order to promote this healthy lifestyle and also to
prepare our health care system in managing the increasing burden of elderly people. There
were many literatures and study that showed socioeconomic factors such as age, gender,
marital status, education status, smoking, economic status, co morbid illness and body mass
index influenced level of physical activity (5-9, 32-34). These studies were conducted in
considered the most practical physical activity measure for large scale population studies
(17). However there was no standard questionnaires for physical activities. The Modified
Baecke questionnaire was used in this study as it measure physical activities involving
household activities, leisure time activities and sport activities. These activities are more
relevant to elderly as most of those in this age group are either pensioner or not working. In
our study 72% of subjects are not working. Besides, our country located in Khatulistiwa with
tropical climate. There are some questionnaires that specific to four seasons country. These
questionnaires are not applicable for population in tropical country such as Malaysia.
41
6.1Pattern of physical activity among elderly:
In this study, tertiles were computed from total physical active score that classified
participants as low, moderate or high physically active, which is similar method used in
validation study of the Modified Baecke Questionnaire done by Hertogh et al (18). Even
though in Hertogh study, the mean age of participants was 70.6 years which was higher than
mean age in this study (67.7 years), but their physical activity scores were higher (median for
total score was 11.9) comparing to this study (median score 6.10). In the study done by
Hertogh et al, the lowest tertile range from 2.3 to 7.94, the middle tertile range from 9.13 to
14.91 and the highest tertile range from 15.7 to 35.6 (18). These differences could be due to
the subjects in Hertogh et al study was recruited among participants in training programme on
several cardiovascular risk factors with strict exclusion criteria. Their exclusion criteria were
those with heart disease, diabetes, history of stroke in preceding 2 years and those taking beta
blocker or diuretics. Meanwhile in this study, participants were recruited from clinic setting
with less stringing exclusion criteria. Majority of participants of this study had co morbid
illness (71%) and the exclusion criteria were those cannot walk independently or advice by
Eventhough there is big different in total score between these two studies but if we
compare the contribution from each domain of physical activity, both studies show that
leisure activity score gave the most contribution for physical activity score. In current study,
we can see that elderly more prone to involve in leisure time activity (median score of 4.28)
compare to household activity (median score of 1.8) and worse in sport activity (median
score of 0). Median leisure score in study by Hertogh et al was 5.7 meanwhile household
median score and sport median were 1.6 and 2.2 respectively. It suggest that regardless the
42
socio demographic background, elderly people more involve in leisure activities compare to
In current study, if we compare between both gender, men had higher physical activity
score with median score 6.54 compare to female elder (median score 4.33). This finding also
corresponds with finding in study by Hertogh et al (18). Current study result also shows
nearly half of male subjects (42%) were classified in high physical activity. Contrast to
female elderly where percentage in all tertiles are similar, where percentage in each group of
Between gender, the finding similar with study by Hertogh et al (18), where female
gender show higher score on household activities compare to man. This could be due to most
culture, especially in Malay community in Malaysia, male spouse are the dominant character
in their house. They spent most of their time with outdoors activities. Meanwhile, it was
considered being female partner duty to do household chores and to take care of their
children. This could contribute higher leisure time activity among male participants compare
to female. If we compare between household activity score and leisure time activities score
among female participants, the median score for household activity are much lower. This
could be caused by the type of household activities such as sweeping floors, cooking and
washing require less intensity of energy compare to outdoors activities such as gardening and
walking.
Based on the results of this study, it shows that the elderly were more prone to
involved in unstructured physical activity such as household activity and leisure time activity.
Most of elderly were not active in sport. Only 6 out of 339 elderly (1.7%) participate in sport
43
activity and less than half of elderly involved in other type of exercise such as walking
Gardening is the most common forms of physical activity among the subjects. Other
common physical activity are walking and cycling. Only minority of the participants involve
in sport and exercise. Almost similar finding seen in study done in western country among
white elderly women by Walsh et al (9) . In that study, walking was the commonest form of
In Zutphen Elderly Study, similar pattern was seen where the most common activities
among elderly tend to be lower intensity but sustained activities such as walking, yard walk
or gardening, golf and cycling (19). This suggests that most elder tend to be involved in
more unstructured activities with lower intensity activities rather than sports. This could be
due to in activities such as gardening; they can suit it with their capability and energy. This
unstructured activities such as gardening also more flexible where they can chose the type
and the intensity of the gardening activity which is appropriate to them and they can
accumulate the duration of activities according to their free time or capability which as
competitive where they need to meet the standard of their opponents and need to comply to
certain rules of the sport. This type of activity could possible exposed the elderly to sport
injury if they push themselves too hard beyond their capacity to win the games. The type of
physical activities could also influence by the economical and geology of Kelantan state
where agriculture is one of the sources for economic income. Another possible factor could
be avalaibility of facilities for recreation. Subjects of this study came from all over Kelantan
and some of might came from rural area where there is not much facilities for sport available.
44
6.2 Associated factors of physical activity:
One of the purposes of this study is to determine the factors influence the physical
activity level among elderly. The results of this study show that age, female, working and
those who did not perceive their weight as a problem were significant associated factors of
Finding from previous study provide association between age and level of physical
activities (5-7, 9, 32, 33). In this study, increasing age influence the level of physical activity
measurement tools for physical activity used, many study showed reduce physical activity
level by increasing age (6, 32, 33, 45). A community based cross sectional study among
12611 elderly age 65 years old and above in Canada by Kaplan et al showed similar
association between physical activity and age (6). In that study, physically active was defined
as those who reported taking part in a physical activity lasting > 15 minutes at a rate of > 12
times per month (6). Another study with similar finding but with different method of
measuring physical activity level is a study done by Aslan et al in Ankara, Turki. It was a
community based study among 360 subjects age 65 years and above (median age 71.5 SD
5.4) (32). Aslan et al defined physical activity differently in their study in which subjects
were classified by asking whether they doing regular physical activity or not doing regular
In a national survey among 33 933 adult Malaysian population age 18 years and
above, WHO-stepwise questionnaire was used as measurement tools for physical activity.
Physical inactivity was defined as fewer than 150 minutes per week spent in moderate
physical activities, fewer than 60 minutes of vigorous physical activities and total MET
minutes per week lesser than 600 minutes (31). It finding showed prevalence of physical
45
inactivity among adult population in Malaysia decreased with age until the age group of 45
49, then it showed an increasing trend with age till age group of 80 years and above (31).
The finding of this national survey suggests that level of physical activity reduced earlier at
the age of 50 years, which is before elderly age group and correlate well with increasing age
Studies among female subjects also had correlated increasing age with lower level of
physical activity (7, 9, 33). One of the study with such finding was a community based study
done in south Carolina in United State by Wilcox et al (46). The subjects in this study were
102 women age 50 years and older. The researchers used Physical Activity Scale for Elderly
Another cross sectional study among 9704 ambulatory women aged 65 years and
above (mean age of 70 years) was done at clinic setting in United States using Modified
Paffenbarger scale questionnaire also showed similar result (9). Age related decreases in
physical activity was seen in all 4 most common types of activity among subjects of this
study, which are walking, gardening, swimming and bicycling (9). This study also showed
significant reduced participating in medium- or high intensity exercise with increasing age
(9).
From current study and previous literatures findings, we can conclude that increasing
measurement tools, gender and geographic factors. The finding also not influence by the fact
that either the study was done at the clinic setting or community base.
In current study, female gender (OR = -2.37, 95% CI = -3.52, -1.21; p = <0.001) is
associated with lower level of physical activity. This finding is consistent the result of our
46
National survey, NHMS III that showed gender factors contribute to low level of physical
activity among Malaysian adults (31). Based on NHMS III, prevalence of physical inactivity
higher among female in adult Malaysian population (77.5% (CI: 76.5- 78.4) than males
(66.8% CI 65.8-67.8) (31). These results were similar to those obtained by earlier researchers
(5, 6, 32). In the study by Aslan et al in Turki, the researchers postulate this finding with the
fact that their woman were historically less educated (32). In the past, older generation of
Islamic women in their country were usually did not go out from house unaccompanied and
did not gain employement (32). The same thing could also see among our elderly population
which majorities of them were Muslim. There could be others factors such as biological
factors which contribute to the lower physical activity among women other than religious
aspect, as study in the west countries such as Canada by Kaplan et al also showed similar
result (6).
Those who are not working were more physically active compared to those who are
still working. The most likely explanation is those who are working do not have enough time
to be involved in physical activity. There is possibility that they perceive that their activities
during working are enough for them to meet the recommendation of physical activity to
maintain healthy life. However due to cross sectional design of this study, we cannot
ascertain which one affect the other, either how they perceive weight not a problem and those
who are working affect the level of physical activity or otherwise. Further description on job
classification of participants may help in clarify the association between occupation status
and physical activity level of participants. Previous study on effect of leisure time physical
activity and strenuousness of work as predictors of physical functioning, found that high
physical strenuousness of work increased the risk of later poor functioning (47). Physical
activities at work and during leisure time differ in many aspects. The type, timing and
47
especially those in blue-collar strata usually of longer duration, more repetitive, monotonous
and less under control of the performer than exercise or housework. Jobs work demands may
exceed physical capacity of the worker that may lead they cannot perform much activity
In this study, those subjects who do not perceive their weight as a health problem had
significant higher level of physical activity. As this is a cross sectional study, we cannot
determine either their perception of body weight lead to higher physical activity level or the
higher physical lead to their current perception to body weight. Generally known that
physical activity help in reduction of weight and better health outcome. There is possibility
that those who already physically active are satisfied with their body image currently as a
result of their active lifestyle and think their current body weight reflecting their health status.
Unfortunately, the result of this study shows majority of subjects who are overweight
perceive their weight not a health problem (83.9%). We should give more education for this
group of people to correct their perception of body weight and to promote active lifestyle as a
48
CHAPTER 7: CONCLUSSION
This analysis supports that there are correlation between sociodemographic factors and level
of physical activity among elderly. The significant associated factors for physical activity
found in this study were age, sex, occupational status and those who did not perceive their
weight as a problem. However, only 8.4% of the variance in physical activity score in the
49
CHAPTER 8: LIMITATION OF STUDY
There are several limitations to this study. This study was conducted at outpatient
clinics Hospital Universiti Sains Malaysia. It was thus not a random, population based
sampling frame. It may influence the characteristics of the participants as 71% of them had
chronic illness.
There are possible response bias problem associated with self-report of physical
activity. The questionnaire used in this study need recall of 1 year physical activity and the
results based on self- report physical activity rather than an objective measure. This could
cause inaccurate data. The disadvantage of 1 year recall was minimized by using MMSE to
screen those who had memory problem. The interpretation of intensity of physical activity
was depend on the individual interviewer which could cause inconsistent interpretation
between interviewers. In this study, there was only one interviewer that interprets the
Besides, this questionnaire only allows us to assess level of physical activity in this
recommendations for physical activity. These also make difficulty to compare the results of
this study with other study populations that use different methods or different questionnaires
Although this study suggests there are significant associated factors for level of
physical activity among elderly, we cannot differentiate the associations because of the study
design. This is a cross sectional study, so we cannot be sure whether this significant
associated factors affected the level of physical activity or whether the level of physical
The results of this study showed that the associated factors that we analyze only
contribute 8.4% for the variance in physical activity score among elderly. This mean, there
50
are more factors need to be consider such as perceive barrier and environmental factors,
51
CHAPTER 9: RECOMMENDATION
This study was done at outpatient clinics setting. Another community base study
recommended as it could better represent elderly in general population. Although this study
show several significant associated factors for physical activity in elder, but these only
contribute 8.4%for the physical activity in elderly. Further study on other possible such as
perceive barrier and environmental factors should be done to determine other possible
Modified Baecke questionnaire which was used in this study need a one recall on physical
inaccurate data.
52
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56
APPENDICES:
APPENDIX A:
Elderly Cognitive Assessment Questionaire (ECAQ) Malay version
5. hari ______________
6. bulan _______________
7. tahun _______________
MENGINGAT KEMBALI
Jumlah _______________
57
APPENDIX B:
Sociodemographic questionnaire
1.2- Jantina:
0- Lelaki
1- Perempuan
1.3- Keturunan:
0 Melayu
1 Cina
2 India
3 Lain-lain
Jika lain lain,sila
nyatakan.
1.4- Taraf perkahwinan:
0- Berkahwin
1- Duda/ janda
2- Tidak berkahwin
1.5- Tinggal:
0- Bersendirian
1- Bersama pasangan sahaja
2- Bersama ahli keluarga
3- Bersama pasangan dan ahli keluarga
1.6- Status ekonomi:
0- Tidak bersekolah
1- Sekolah rendah
2- sekolah menengah
3- Institut pengajian tinggi
58
1.9- Status merokok:
0- Perokok
1- Sudah berhenti merokok (lebih daripada 6 bulan)
2- Tidak pernah merokok
1.12- Jika jawapan kepada soalan 1.12 adalah 'ya' sila nyatakan jenis penyakit anda
______________________________________________________________
______________________________________________________________
______________________________________________________________
1.15- Adakah berat badan anda merupakan satu masalah kesihatan bagi anda?
0- Ya
1- Tidak
59
APPENDIX C:
Modified Baecke Questionnaire for Older Adults
HOUSEHOLD ACTIVITIES
1) Do you do the light household work? (dusting, washing dishes, repairing clothes,
etc.)?
0- Never (< once a month) _____________
1- Sometimes (only when partner or help is not available)
2- Mostly (sometimes assisted by partner or help)
3- Always (alone or together with partner)
2) Do you do the heavy housework? (washing floors and windows, carrying trash
disposal bags, etc.)?
0- Never (< once a month) ____________
1- Sometimes (only when partner or help is not available)
2- Mostly (sometimes assisted by partner or help)
3- Always (alone or together with partner)
3) For how many persons do you keep house? (includimg yourself; fill in 0 if you
answered never in Q1 and Q2.)
______________
4) How many rooms do you keep clean, including kitchen, bedroom, garage, cellar,
bathroom, ceiling, etc? (fill in 0 if you answered never in Q1 and Q2.)
0- Never do housekeeping _____________
1- 1-6 rooms
2- 7-9 rooms
3- 10 or more rooms
5) If any room, on how many floors? (fill in 0 if you answered never in Q4.)
__________
7) How many flight of stairs do you walk up per day?( one flight of stairs is 10 steps)
0- I never walk stairs
_______________
1- 1 -5
2- 6 -10
3- More than 10
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4- Walking
10) If you go out for shopping, what kind of transport do you use?
0- I never go out _______________
1- Car
2- Public transport
3- Bicycle
4- walking
SPORT ACTIVITIES
Do you play sport?
Sport 1: name _________________
Intensity (code) _________________
Hours per week (code) _________________
Period of the the year (code) _________________
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Codes for the Modified Baecke Questionnaire
Intensity code:
0- lying, unloaded Code 0.028
1- sitting, unloaded Code 0.146
2- sitting, hand or arm movement Code 0.297
3- sitting, body movements Code 0.703
4- standing, unloaded Code 0.174
5- standing, hand or arm movement Code 0.307
6- standing, body movements, walking Code 0.890
7- walking, hand or arm movement Code 1.368
8- walking, body movements, cycling, swimming Code 1.890
Hours per week:
1- less than 1 hour/week Code 0.5
2- 1 - <2 h/w Code 1.5
3- 2 - <3 h/wk Code 2.5
4- 3 - <4 h/wk Code 3.5
5- 4 - <5 h/wk Code 4.5
6- 5 - <6 h/wk Code 5.5
7- 6 - <7 h/wk Code 6.5
8- 7 - <8 h/wk Code 7.5
9- 8 or more h/wk Code 8.5
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APPENDIX D:
4 Berapakah jumlah bilik di rumah anda yang anda kemaskan dalam sehari?
(termasuk dapur, bilik tidur, bilik air, ruang tamu dan sebagainya) Sila tandakan 0
jika jawapan pada soalan 1 dan 2 adalah tidak pernah
0- Tidak pernah mengemas.
1- Bilangan bilik: bilangan bilik tidur
Dapur
Ruang tamu
Lain-lain bilik
5 Jika ada bilik yang perlu dikemas, ditingkat berapakah? (Tandakan 0 jika jawapan untuk
soalan 4 adalah tidak pernah)
0- Tidak pernah
1- Tingkat bawah
63
2- Tingkat atas
3- kedua-dua tingkat
8 Jika anda keluar rumah menuju ke sesuatu tempat di daerah tempat tinggal anda, apakah jenis
kenderaan yang anda gunakan?
0- Tidak pernah keluar rumah
1- Kereta
2- Motosikal
3- Kenderaan awam
4- Basikal
5- Berjalan kaki
10 Jika anda keluar membeli belah, apakah jenis kenderaan yang anda gunakan?
0- Tidak pernah keluar membeli belah
1- Kereta
2- Motosikal
3- Kenderaan awam
4- Basikal
5- Berjalan kaki
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AKTIVITI SUKAN:
Adakah anda bersukan?
Sukan 1: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Sukan 2: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 1: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 2: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 3: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 4: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 5: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 6: Jenis
Tahap (kod)
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Tempoh jam/ seminggu
Tempoh dalam setahun
PENGIRAAN MARKAH:
= _____________
66
APPENDIX E:
BORANG SOALSELIDIK
LAMPIRAN A
Nama
Penyelidik: 1 Dr Hasmalaili Binti Husni
2 Dr Azidah Abdul Kadir
3 Dr Nani Draman
4 Prof Madya Dr. Nor Azwany Binti Yaacob
Sila isikan tempat kosong yang disediakan dan tanda pada kotak yang bersesuaian:
1.2- Jantina:
0- Lelaki
1- Perempuan
1.3- Keturunan:
0 Melayu
1 Cina
2 India
3 Lain-lain
Jika lain lain,sila
nyatakan.
1.4- Taraf perkahwinan:
0- Berkahwin
1- Duda/ janda
2- Tidak berkahwin
1.5- Tinggal:
0- Bersendirian
1- Bersama pasangan sahaja
2- Bersama ahli keluarga
3- Bersama pasangan dan ahli keluarga
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1.6- Status ekonomi:
0- Tidak bersekolah
1- Sekolah rendah
2- sekolah menengah
3- Institut pengajian tinggi
1.12- Jika jawapan kepada soalan 1.12 adalah 'ya' sila nyatakan jenis penyakit anda
______________________________________________________________
______________________________________________________________
______________________________________________________________
1.15- Adakah berat badan anda merupakan satu masalah kesihatan bagi anda?
0- Ya
1- Tidak
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1.16- Adakah berat badan anda mengganggu aktiviti harian anda?
0- Ya
1- Tidak
69
TERJEMAHAN ' MODIFIED BAECKE QUESTIONNAIRE'
TEMPOH MASA: sila jawab soalan berikut berdasarkan aktiviti anda dalam 1 tahun
kebelakangan ini.
4 Berapakah jumlah bilik di rumah anda yang anda kemaskan dalam sehari?
(termasuk dapur, bilik tidur, bilik air, ruang tamu dan sebagainya) Sila tandakan 0
jika jawapan pada soalan 1 dan 2 adalah tidak pernah
0- Tidak pernah mengemas.
1- Bilangan bilik: bilangan bilik tidur
Dapur
Ruang tamu
Lain-lain bilik
5 Jika ada bilik yang perlu dikemas, ditingkat berapakah? (Tandakan 0 jika jawapan untuk
soalan 4 adalah tidak pernah)
0- Tidak pernah
1- Tingkat bawah
2- Tingkat atas
3- kedua-dua tingkat
70
6 Adakah anda memasak sendiri atau membantu memasak di rumah?
0- Tidak pernah
1- Kadang kadang (1- 2 kali seminggu)
2- Kerap (3 5 kali seminggu)
3- Sentiasa (lebih daripada 5 kali seminggu)
8 Jika anda keluar rumah menuju ke sesuatu tempat di daerah tempat tinggal anda, apakah jenis
kenderaan yang anda gunakan?
0- Tidak pernah keluar rumah
1- Kereta
2- Motosikal
3- Kenderaan awam
4- Basikal
5- Berjalan kaki
10 Jika anda keluar membeli belah, apakah jenis kenderaan yang anda gunakan?
0- Tidak pernah keluar membeli belah
1- Kereta
2- Motosikal
3- Kenderaan awam
4- Basikal
5- Berjalan kaki
71
AKTIVITI SUKAN:
Sukan 1: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Sukan 2: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 1: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 2: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 3: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 4: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 5: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun
Aktiviti 6: Jenis
Tahap (kod)
Tempoh jam/ seminggu
72
Tempoh dalam setahun
PENGIRAAN MARKAH:
= _____________
73
APPENDIX F:
MAKLUMAT KAJIAN
Tajuk Kajian: Corak aktiviti fizikal dan faktor berkaitan aktiviti fizikal di kalangan warga emas yang
hadir ke klinik pesakit luar Hospital Universiti Sains Malaysia.
Pengenalan
Anda dipelawa untuk menyertai satu kajian penyelidikan secara sukarela. Sebelum menyertai kajian ini, anda
dikehendaki membaca dan memahami borang ini. Borang ini menerangkan tujuan kajian, prosedur, risiko dan
manfaat kajian. Ia juga menerangkan bahawa anda boleh menarik diri dari kajian ini pada bila-bila masa. Jika
anda bersetuju menyertai kajian ini anda akan menerima salinan borang ini untuk simpanan anda.
Set soal-selidik Pengubahsuaian Baecke secara amnya digunakan untuk menilai beberapa aspek berkaitan
dengan aktiviti fizikal di kalangan warga emas. Set soal-selidik itu adalah bertujuan untuk mengkaji aktiviti di
rumah, aktiviti sukan dan aktiviti semasa lapang warga emas. Sehubungan itu, anda diminta agar membaca dan
memahami segala keterangan di bawah yang akan memberi penerangan lanjut mengenai kajian ini.
Tujuan Kajian
Kajian ini bertujuan untuk mengenalpasti bentuk aktiviti fizikal atau senaman yang dilakukan oleh warga emas. Ia
juga untuk menilai faktor- faktor yang mempengaruhi tahap aktiviti fizikal di kalangan warga emas.
Kelayakan Penyertaan
Untuk membolehkan anda menyertai kajian ini, anda hendaklah memenuhi syarat-syarat di bawah:
74
Prosedur-prosedur Kajian
Sekiranya anda layak serta bersetuju untuk turut serta dalam kajian ini, anda perlulah memberi persetujuan
bertulis dengan cara menandatangani borang keizinan peserta yang dilampirkan. Anda juga diminta agar
memberi maklumat am tentang latar belakang diri anda.
Kemudian, anda akan diminta untuk menjawab soal-selidik tersebut yang akan disoal kepada anda. Tiada masa
yang ditetapkan atau dihadkan bagi anda menghabiskan soal-selidik tersebut, tetapi masa yang dianggarkan
untuk menjawab kesemua set soal-selidik adalah selama 20 minit. Anda diminta agar menjawab semua soalan
yang diajukan.
Jika anda mempunyai sebarang kemusykilan atau tidak memahami mana-mana bahagian di dalam soal-selidik
tersebut, anda bolehlah merujuk masalah tersebut kepada penyelidik yang akan sentiasa berada di situ bagi
membantu anda.
Risiko
Tiada risiko yang akan anda hadapi kerana kajian ini tidak melibatkan sebarang ubatan atau ujikaji.
Manfaat
Ganjaran
Penyertaan anda dalam kajian ini adalah secara sukarela. Anda boleh menolak penyertaan dalam kajian ini
atau anda boleh menamatkan penyertaan anda dalam kajian ini pada bila-bila masa, tanpa sebarang hukuman
atau kehilangan sebarang manfaat yang sepatutnya diperolehi oleh anda.
Penyertaan anda mungkin juga diberhentikan oleh penyelidik tanpa persetujuan anda sekiranya didapati anda
tidak layak sebagai peserta kajian.
Soalan
Sekiranya anda mempunyai sebarang soalan mengenai prosedur kajian ini atau hak-hak anda, sila hubungi;
Dr. Hasmalaili Binti Husni (NO.MMC: 39801)
75
Pusat Pengajian Sains Kesihatan
USM Kampus Kesihatan.
Tel: 019-4707871
Sekiranya anda mempunyai sebarang soalan berkaitan kelulusan Etika kajian ini, sila hubungi;
Puan Mazlita Zainal Abidin
Setiausaha Jawatankuasa Etika Penyelidikan (Manusia) USM
Pelantar Penyelidikan Sains Klinikal, USM Kampus Kesihatan.
No. Tel: 09-7663760 / 09-7663756
Kerahsiaan
Kajian ini adalah melibatkan isu-isu yang sensitif, semestinya identiti anda sebagai peserta kajian adalah
dirahsiakan. Segala maklumat yang bakal diperolehi dalam soal-selidik ini akan sentiasa dirahsiakan dan
hanya digunakan untuk tujuan kajian semata-mata. Ia juga tidak akan didedahkan kepada umum
melainkan atas perintah undang-undang.
Rekod anda yang asal mungkin akan dilihat oleh pihak universiti (Jabatan yang berkenaan), Lembaga Etika
kajian ini dan pihak berkuasa regulatori untuk tujuan mengesahkan prosedur dan/atau data kajian klinikal.
Maklumat anda mungkin akan disimpan dalam komputer dan diproses dengannya.
Dengan menandatangani borang persetujuan ini, anda membenarkan penelitian rekod, penyimpanan maklumat
dan pemindahan data seperti yang dihuraikan di atas.
Tandatangan
Untuk dimasukkan ke dalam kajian ini, anda mesti menandatangani serta mencatatkan tarikh halaman
tandatangan (Lihat contoh Borang Keizinan Peserta di LAMPIRAN 1 atau LAMPIRAN 2).
76
LAMPIRAN 1
Tajuk Kajian: Corak aktiviti fizikal dan faktor berkaitan aktiviti fizikal di kalangan warga emas yang
hadir ke klinik pesakit luar Hospital Universiti Sains Malaysia.
LAMPIRAN 2
77
Borang Keizinan bagi Penerbitan Bahan yang berkaitan dengan Peserta
(Halaman Tandatangan)
Tajuk Kajian: Corak aktiviti fizikal dan faktor berkaitan aktiviti fizikal di kalangan warga emas yang
hadir ke klinik pesakit luar Hospital Universiti Sains Malaysia.
Untuk menyertai kajian ini, anda atau wakil sah anda mesti menandatangani mukasurat ini.
Dengan menandatangani mukasurat ini, saya memahami yang berikut:
Bahan yang akan diterbitkan tanpa dilampirkan dengan nama saya. Saya memahami,
walaubagaimanapun, ketanpanamaan yang sempurna tidak dapat dijamin.
Bahan yang akan diterbitkan dalam penerbitan mingguan/bulanan/dwibulanan/suku tahunan/dwi
tahunan merupakan satu penyebaran yang luas dan tersebar ke seluruh dunia. Kebanyakan
penerbitan ini akan tersebar kepada doktor-doktor dan juga bukan doktor termasuk ahli sains dan
ahli jurnal.
Bahan tersebut juga akan dilampirkan pada laman web jurnal di seluruh dunia. Sesetengah laman
web ini bebas dikunjungi oleh semua orang.
Bahan tersebut juga akan digunakan sebagai penerbitan tempatan dan disampaikan oleh ramai
doktor dan ahli sains di seluruh dunia.
Bahan tersebut juga akan digunakan sebagai penerbitan buku oleh penerbit jurnal.
Bahan tersebut tidak akan digunakan untuk pengiklanan ataupun bahan untuk membungkus.
Saya juga memberi keizinan bahawa bahan tersebut boleh digunakan sebagai penerbitan lain yang diminta
oleh penerbit dengan kriteria berikut:
Bahan tersebut tidak akan digunakan untuk pengiklanan atau bahan untuk membungkus.
Bahan tersebut tidak akan digunakan di luar konteks contohnya: Gambar tidak akan digunakan
untuk menggambarkan sesuatu artikel yang tidak berkaitan dengan subjek dalam foto tersebut.
78
RESEARCH INFORMATION
Research Title: Pattern of physical activity and associated factors of physical activity among elderly
attending outpatient clinics Hospital University Sains Malaysia
Introduction
You are invited to take part voluntarily in a study on pattern of physical activity and associated factor of physical
activity among older adult. Before agreeing to participate in this research study, it is important that you read and
understand this form. It describes the purpose, procedures, risk and benefits of the study. It also describes
your right to withdraw from the study at anytime. If you participate, you will receive a copy of this form to keep
for your records.
The Modified Baecke Questionnaire was developed to measure habitual physical activity in the elderly. The
questionnaire includes items about household activities, sport, and leisure time activities. Thus you are adviced
to read the information given below for further understanding.
.
To describe pattern of physical activity among elderly and to determine factors associated with physical activity
among elderly.
Qualification to Participate
Study Procedures
If you fulfilled the criteria and agreed to participate in the study, you need to give your written consent on the
form attached. You are also required to give your background information.
79
Then you will be interviewed by a researcher. No time limit to answer all the questions but the estimated time to
finished all the questions are 20 minutes. You are required to answer all the questions asked. If you have any
doubt or do not understand any part of the questions, you can refer to the researcher who will always be there to
help you.
Risks
There is no risks if you participate in this study as it does not involve any medication or experiment.
Benefit
Gift
Your taking part in this study is entirely voluntary. You may refuse to take part in the study or you may stop
participation in the study at anytime, without a penalty or loss of benefits to which you are otherwise entitled.
Your participation also may be stopped by the researcher without your consent if you does not fulfill the criteria.
Questions
If you have any question about this study or your rights, please contact;
If you have any questions regarding the Ethical Approval, please contact;
80
Confidentiality
Your information will be kept confidential by the researcher and the research assistants and will not be made
publicly available unless disclosure is required by law.
Your original records may be reviewed by the supervisor in the department (involved in the research), the
Ethical Review Board for this study, and regulatory authorities for the purpose of verifying clinical trial
procedures and/or data. Your information may be held and processed on a computer.
By signing this consent form, you authorize the record review, information storage and data transfer described
above.
Signatures
To be entered into the study, you must sign and data the signature page (ATTACHMENT 1 or ATTACHMENT
2).
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ATTACHMENT 1
Research Title: Pattern of physical activity and associated factors of physical activity among elderly
attending outpatient clinics Hospital University Sains Malaysia
I have read all of the information in this Participant Information and Consent Form including any
information regarding the risk in this study and I have had time to think about it.
All of my questions have been answered to my satisfaction.
I voluntarily agree to be part of this research study, to follow the study procedures, and to provide
necessary information to the doctor, nurses, or other staff members, as requested.
I may freely choose to stop being a part of this study at anytime.
I have received a copy of this Participant Information and Consent Form to keep for myself.
82
Name of Individual
Conducting Consent Discussion (Print or Type)
83
ATTACHMENT 2
Research Title: Pattern of physical activity and associated factors of physical activity among elderly
attending outpatient clinics Hospital University Sains Malaysia
I understood that my name will not appear on the materials published and there have been efforts
to make sure that the privacy of my name is kept confidential although the confidentiality is not
completely guaranteed due to unexpected circumstances.
I have read the materials or general description of what the material contains and reviewed all
photographs and figures in which I am included that could be published.
I have been offered the opportunity to read the manuscript and to see all materials in which I am
included, but have waived my right to do so.
All the published materials will be shared among the medical practitioners, scientists and journalist
world wide.
The materials will also be used in local publications, book publications and accessed by many
local and international doctors world wide.
I hereby agree and allow the materials to be used in other publications required by other
publishers with these conditions:
The materials will not be used as advertisement purposes nor as packaging materials.
The materials will not be used out of contex i.e.: Sample pictures will not be used in an article
which is unrelated subject to the picture.
84
Participant Name (Print or type) Participant No (by researcher)
85
APPENDIX F
86
87
88