Estimation of leisure time physical activity and sedentary behaviour among school adolescents in Nepal

Physical activity is an essential aspect of a healthy lifestyle [1, 2] and leisure-time physical activity (LTPA) is one of the most important components of total physical activity [3], others being occupation, transportation and home-based activities [4]. Regular LTPA controls diabetes mellitus and obesity, reduces hypertension, cardio-vascular diseases, some cancers and provides other health benefits [5]. LTPA are more common in developed countries while occupational, household and transport domains are the major contributors to total physical activity in developing countries [4].

The transition from childhood to adolescence has been identified as period of marked decline in physical activity, particularly amongst girls [6, 7], though this period is the most appropriate time for adoption of physical activity behaviors [8]. Studies from developing countries have reported gender difference in physical activity level and types of activities among adolescents. Girls appear to be less physically active than boys across all age groups and it associates with a number of individual, interpersonal and environmental covariates [9, 10]. On the other hand, time spent in sedentary activities like watching television, sitting either at school or home, reading, playing or working on computers is important as time spent in these activities limit the time available for physical activities [11]. These days, many young people are reluctant to do physical activities and instead choose sedentary activities for their leisure time [12].

In Nepal, adolescents comprise about 27% of total population and the proportion is in increasing trend [13]. About 17% of the Nepalese population lives in urban areas [14]. Average family size of the country is 4.9 with an average of 4.3 in urban, 5.0 in rural areas and in particular 5.3 members in the terai region. At national level, 51% of the households are within the reach to nearest paved road and 80% households are within the reach to nearest vehicle passable dirt road within 30 minutes. Overall, 72% of currently school/college enrolled Nepalese students attend public schools and 44% attend such schools in urban areas [15]. Literacy rate among 15–19 age group is 94% which is slightly higher for males (96%) than females (91%). Among the same age group, the dropout rate for higher education is 12% among males and 14% among females [13].

Limited studies are available on physical activity and its correlates in Nepal [16]. In addition, information on LTPA and sedentary behaviour among school adolescents is almost non-existent. This study was carried out to assess prevalence of LTPA and sedentary behaviour and their associated factors among high school adolescents.

Table 1 shows socio-demographic and environmental characteristics and sitting time among male and female students stratified by LTPA. Mean age of students was 17 ± 1.2 years. Among 405 respondents, 67% did at least some form of LTPA for more than 10 minutes at a time which was 80% and 50% among males and females respectively. Among 207 students who did at least some form of LTPA, average time spent was 49 minutes per day. It was higher among male students (55 minutes) compared to females (38 minutes). In contrast to this, mean time spent on sitting per day was comparably higher among females than males. Statistically significant difference was found between LTPA and No LTPA groups among both sexes in mode of transport to school and presence of playground or parks near home while significant difference was observed in economic status among females only.

LTPA scores and contribution of walking, moderate and vigorous activities among males and females is presented in Table 2. Median MET-minutes/week gained by the students from LTPA was 998 which was higher among males than females (1314 versus 678). Total LTPA score was contributed by walking (45%) followed by moderate (32%) and vigorous activities (23%). Engagement of males in vigorous activities was double than females (28% versus 14%) while engagement of females was higher in leisure time walking and moderate activities.

Association between LTPA and socio-demographic, environmental and sitting time related variables is shown in Table 3. For both males and females, logistic regression analysis revealed that students who walked to school and students having parks or playgrounds near home were more likely to be engaged in LTPA. Younger (15–17 years) females were 3 times more likely to be engaged in LTPA than their older counterparts (OR = 3.09, 95% CI: 1.18-8.08). Similarly, females living in nuclear families were twice likely to be involved in LTPA than those living in joint or extended families (OR: 2.16, 95% CI: 1.01-4.62). On the other hand, female students from poor families were less likely to be engaged in such activities (OR: 0.34, 95% CI: 0.12-0.98). In case of male students, those having provision of extra-curricular activities at schools were nearly 2.5 times (OR: 2.49, 95% CI: 1.04-5.97) more likely to do LTPA than students having no provision of such activities whereas no association existed among females. Cycling to school was also associated among males only (OR: 8.09, 95% CI: 2.35-27.80). Place of residence, type of school, playground in school, neighborhood walkability and sitting time were not associated with LTPA among both sexes.

Logistic regression analysis between sitting time and independent variables presented in Table 4 showed that students living in rural areas and students who did not have playground in school were likely to sit for more than 6 hours a day. Male students of private school were six times more likely to sit longer hours than those studying in public school (OR: 6.41, 95% CI: 2.89-14.21). Similarly, male students who used vehicles to reach school (OR: 5.90, 95% CI: 1.26-27.75) were also likely to sit for more than 6 hours per day but no such association existed for female students. Females who cycled to school were less likely to sit for longer hours (OR: 0.14, 95% CI: 0.04-0.45). No provision of extracurricular activities increased the likelihood of sitting for longer hours among male students by nearly 3 times (OR: 2.98, 95% CI: 1.09-8.07) but had no effect on females. Similarly, no significant association was found with age, family type, economic status, neighborhood walkability and presence of parks or playground near home for both male and female students.

This cross-sectional study carried out to assess LTPA and sedentary behaviour among high school adolescents in Banke district of Nepal found that only two-third of the adolescents were involved in some form of LTPA. This could possibly be due to unavailability of parks and playgrounds for leisure time activities in Nepal [16] which may be further aggravated by unsafe roads [24] and less friendly urban environment. Studies indicate absence of aesthetic appeal and green spaces discourage active commuting and participation in leisure time physical activities [4]. In Nepal, children are expected to help their parents in income generating activities like agriculture or business and in addition, daughters are expected to take care of household chores which decrease their leisure time. Since more than half of the students were either from families whose main source of income was agriculture or business, engagement of students from such families in LTPA might have been lower. Adolescent and youth survey in Nepal has found that every 4 in 10 adolescents of the age group 15–19 are economically active [13]. On average, students spent 49 minutes per day on LTPA which is higher than found by another study in Nepal [25].

While considering sex of the student, engagement of females in LTPA was much lower as compared to males and female students spend less time on physical activities during leisure which is also supported by other studies [25]. Non-communicable disease risk factor survey conducted in 2007/8 and 2013 in Nepal have shown that females were less engaged in LTPA than their male counterparts [25, 26]. Moreover, they were mostly engaged in leisure time walking and moderate activities which could possibly because in a country like Nepal, females tend to bear the burden of household works [16] and face greater restriction for outdoor movement while males mostly take responsibility of outdoor works which are supposed to be more vigorous. Daughters are expected to help their mothers with kitchen works while sons usually are allowed sufficient leisure time for playing with their friends [3, 16]. A study in Nepal has found that mobility rate for male is three times higher than for females [13]. Other studies have also shown greater engagement of males in leisure time and vigorous activities [27‐34].

In relation to sedentary behaviour, on average the students spent 7–8 hours per day on sitting while the NCD risk factor survey has shown average sitting time to be 2.5 hours among 15–29 age groups [25]. Students usually spent about 4–5 hours at school, mostly sitting, which might have contributed to longer sedentary time as found in this study. Furthermore, longer sitting time could also be attributed to increased use of modern technical gadgets among youths in urban areas of the country which are likely to replace physical activities during leisure [16].

Females in this study were not only just less engaged in LTPA, but also were likely to be more sedentary which indicated they spent their leisure time watching television, socializing or gossiping. Other studies have also shown females to be more sedentary [6, 28, 29, 35, 36] but Iranian females were less sedentary than their male counterparts [9]. Gender was not associated with sitting time in a study conducted among Polish students [37], these differences can be justified on grounds of social and cultural differences.

The study highlights gender difference in LTPA and sitting time. Females were found to spend less time in LTPA but more time on sitting. LTPA and sedentary behaviour were found to be two separate behaviours as no association existed between sitting time and LTPA in the study. Hence, specific interventions are needed not only to promote LTPA but also to reduce sedentary behaviour among school adolescents. Further studies using both subjective as well as objective measures for assessing LTPA and sedentary behaviour considering time spent on different domains and activities are recommended at school setting.

SP, RN, RB: MPH graduate, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal

NS: Program Manager, Nepal Public Health Foundation

RB: MA candidate, MA- Risk, Health and Public Policy, Department of Geography, Durham University, Durham, UK

AKP: Associate Professor, Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Nepal