Physical Activity, Sedentary Behaviour and Psychological Wellbeing in Emirati University Students

Abstract

The university years often overlap with young adulthood which is a key life stage when health behaviours and wellbeing may be compromised. To inform culturally appropriate interventions to address this, there is a need for more research in Arabic speaking populations as research with university students in Western countries may not be generalizable in the Arab world due to socio cultural differences. The aim of this thesis was to understand physical activity, sedentary behaviour and psychological wellbeing in Emirati university students. Study one was a psychometric study of a self-administered version of the Global Physical Activity Questionnaire-Arabic (GPAQ-Arabic). A total of 93 Emirati university students completed the instrument on two occasions 7 days apart, and 48 also wore an accelerometer for 7 days. Test-retest reliability and criterion validity were assessed using Spearman’s rho and Bland-Altman plots. Test-retest reliability was acceptable for moderate to vigorous physical activity (MVPA), but fair for sedentary behaviour. Criterion validity of the MVPA measure was fair. Study two involved the development and psychometric assessment of a domain specific, self-administered, Arabic language, sedentary behaviour questionnaire (The Sitting and Reclining Time Questionnaire-Arabic [SART-A]). A total of 61 Emirati university students completed the instrument on two occasions 7 days apart, and 26 also wore an accelerometer for 7 days. Test-retest reliability and criterion validity were assessed using Spearman’s rho and Bland-Altman plots. Test-retest reliability of the SART-A was acceptable for weekday, weekend day and usual day sedentary behaviour, however the criterion validity of the instrument was less promising. Studies three, four and five used data from a cross-sectional survey study of Emirati university students. A total of 628 participants completed Arabic language questionnaires assessing physical activity; sedentary behaviour; psychological wellbeing; knowledge of physical activity guidelines and mental health benefits, and preferences for activity type and context. Generalised linear modelling was used to assess potential differences in prevalence by gender. Bivariate associations using explanatory variables of age, gender and BMI were also explored for knowledge of physical activity guidelines and mental health benefits, and preferences for activity type and contexts. Almost three-quarters (74%) of students met guidelines of >150 minutes of MVPA/week. Median time spent in sedentary behaviour was 10 hours/day on a usual day, weekday, and weekend day. A total of 69% reported high or very high satisfaction with life. However, 65% also reported depressive symptoms, 69% reported anxiety symptoms, and 46% reported stress. No significant gender differences were found. Only 3% of respondents correctly identified activity guidelines as 150 mins/week MVPA. Most respondents believed that exercise could improve wellbeing (69%), and help manage depression (71%) and anxiety/stress (74%). Women were more likely than men to view exercise as a way to manage depression (p=0.003) and anxiety/stress (p=0.002). A fun element was the most preferred context for physical activities (87.1%). Walking (66.7%) and swimming (61.7%) were the most preferred activity types. Men had significantly higher odds to prefer competitive activities; and football, weights, and jogging. Women had significantly higher odds to prefer activities with people of the same gender, with supervision and done at home; and walking, aerobics, cycling, squash, and yoga. Study six involved five focus groups with female Emirati university students (n=25) to explore barriers to and enablers of physical activity. Emergent themes were identified and analysed using Nvivo software. The main barriers were lack of family support, gender roles associated with family responsibilities, social media use, lack of convenient access to female only facilities, and hot weather. The main enablers were low cost and convenient female only gyms; support via friends, family and social media; and physical activity timetabled within the academic schedule. Study seven was a systematic review and meta-analysis study to assess the efficacy of physical activity interventions to promote wellbeing in university students. Five databases were systematically searched to identify randomised controlled trials. Methodological quality of studies was assessed using Downs and Black scale and quantitative analysis was performed using Revman 5.3 software. A total of 6,138 studies were identified and 11 were included in the final review. Overall, there was a small significant effect of physical activity for depression (standardised mean difference (SMD) 0.47), and anxiety (SMD 0.28). There was no significant effect of physical activity for quality of life. This research program indicates that Emirati university students have high levels of sedentary behaviour, depression and anxiety. Physical activity interventions could be an acceptable and effective way to manage depression and anxiety, however, the majority of students lack knowledge of physical activity guidelines. Interventions should be tailored by gender for context and type and should also consider specific socio-cultural barriers and enablers related to female students’ participation. More research is needed to identify valid self-report measures of MVPA for this population.