Risk assessment and level of physical activity of students in Poland

Purpose: The aim of the study was to determine the risks of activity by using Physical Activity Readiness Questionnaire (PAR-Q) and describe the PA profile using the short-version of the International Physical Activity Questionnaire (IPAQ-SF) among selected groups of sport science students. Material: The study covered 99 students – 61 females aged 21.08 ± 1.43 and 38 males aged 21.24 ± 1.22 y. In order to asses and stratify the risk of PA the Polish short version of the IPAQ-SF was used. Results: The total level of physical activity of the male students was 3460.039±2502.207 METmin/week and was higher than in the case of female students (3388,107±2204,290 METmin/week). The dominant type physical activity of female and male students was intensive effort. Among 22 men and 39 women, risk factors for cardiac events, pulmonary and musculoskeletal injuries were reported. The relationship between PAR-Q results and the on the IPAQ-SF results was no statistically significant. Conclusions: This study demonstrates that students achieve the level of physical activity recommended by experts for the prevention of chronic diseases. This research allows sports science students to understand their own health issues through self-assessments of personal risk factors for cardiac events, pulmonary and musculoskeletal injury.


Introduction 1
Globally, premature mortality from four main noncommunicable disease (NCDs) decreased by 15% between 2000 and 2012. This rate of decline is insufficient to meet the 2030 target of a one third reduction (WHO, 2016). The development of new technologies associated with professional work or communication progressing in the last several years is causing social restrain from Physical Activity (PA) and decreasing health. Then the lack of trained habits healthy life style and the disappearance of the natural need of the movement causes untimely aging and at the same time deteriorates health. Nieman (1998) showed that low fitness level has become the main indicator of all the risk factors for early death.
Physical activity is a biological human need, contributing to a healthy relationship status and should be a necessary component of human's lifestyle. Strategies to promote PA have become an important public health approach for the prevention of chronic diseases (Bonevski et al. 2014). In the past in Poland, less than 10% of all students took part in PA outside the statutory duty. In the same time in some European universities this percentage reached the limit of 50-60% (Korpak 2005).
Study of Glays Shuk-Fong Li et al. (2009), stressed that inactivity among students is prevalent. They conclude that participation in PA might be an effective way to improve the health of college students (their mental health, better social skills, higher levels of emotional intelligence). Thus, the importance of increasing exercise participation at the university level should be implemented and reinforced. The university students are considered prospective professionals with important roles in the future. For this reason, their attitudes in terms of PA level and health behaviors are of a higher importance (Varela-Mato et al. 2012). Active people live longer, are healthier and are more productive, more likely to avoid injury and illness.
The role of PA in maintaining health is undertaken for several decades (Pasek et al. 2006 Current recommendation of WHO, American Heart Association (AHM) and American College of Sport Medicine (ACSM) for adults 18-64 years old are that they should do at least 150 minutes of moderate-intensity aerobic PA or do at least 75 minutes of vigorousintensity PA throughout the week or an equivalent combination of moderate-and vigorous-intensity PA. Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week, and flexibility training every day (WHO 2010, ACSM 2011). The prevalence of achieving physical activity recommendations declines rapidly between the ages of 18 and 24 when many young people are undertaking tertiary education (Grim et al. 2011).
Scientists involved in the study of the level of PA of various socio-professional groups are faced with major methodological problem according to the nonunified research tools (Wareham et al. 1998). Several methods are available to measure level of PA eg. selfreported questionnaires, direct observation, indirect calorimetry, movement sensor and heart rate telemetry (Lee, 2011). This situation has prompted researchers to develop a unified tool, resulting in the development of the International Physical Activity Questionnaire (IPAQ). Initial pilot testing using IPAQ was performed during 1998-1999, and further method was developed resulting in the eight versions of the IPAQ, including four long and four short versions (Craig et al.,2003), and then IPAQ was used in different countries (Hagstromer et al. 2006, Biernat et al. 2007, Bauman et al. 2009). The IPAQ consists of various questions including times spent on walking and moderate-and vigorous-intensity PA of at least 10 min duration. During this study assess level of PA among selected groups of sport science students was used in the short form of International Physical Activity Questionnaire (IPAQ-SF).
To ensure an optimal benefit to health ratio before performing an exercise program the risk assessment should be carried out. Widely used tool for prescreening health assessment is the PAR-Q. The PAR-Q was developed by the Canadian (British Columbia) Ministry of Health to identify the number of adults for whom the PA might be inappropriate. The pre-participation of health screening is to provide information relevant to the safety of beginning physical exercise and to identify known diseases and risk factors for NCD by self-guide methods, so the appropriate lifestyle can be initiated (Allen, 2014). PAR-Q should be a first step before initiating an exercise program or planning to increase the amount of PA.
To measure pre-participation health hazard and risk assessment several instruments are available, eg. standardized forms are PAR-Q, and AHA/ACSM Health/ Fitness Facility Pre-participation Screening Questionnaire. These questionnaires can be completed in a few minutes and identifies moderate-and high-risk individuals. The American College of Sports Medicine (ACSM) exercise pre-participation health screening recommendations stipulates that persons at moderate risk for NCD should undergo a medical examination prior to starting a vigorous. ACSM also recommends that persons at high risk for CVD should undergo a medical examination and diagnostic exercise testing before beginning either a moderate-intensity (Pescatello et al. 2014). The ACSM recommendations are not a replacement for sound clinical judgment.
The aim of this article was to identify the types of risk factors associated with the PA among sport science university students, to assess their level of PA using the IPAQ-SF and guide the future efforts to minimize the health risk and improve PA level.
Therefore, we designed that study with a twofold aims. Firstly, we verified if the use of PAR-Q reduces the barriers to physical activity participation for physical exercise sport science students and the populations, which become more physically active. Secondly, we verified if sports science students understand their own health issues through self-assessments of personal risk factors for NCD.
This was the first examination of university students which associated types of risk factors with the level of PA carried out in Poland.

Materials and methods
Participants: The study was conducted at University of Physical Education and Sport in Gdansk, Poland. The research was done on a sample of voluntary 61 women (21.08±1.43 years old) and 38 men (21.24±1.22 years old). Before training all subjects were informed and gave consent for study procedures. Anthropometric parameters of the group at the beginning of the study are presented in Table 1.
Organization of the research: The research method was a diagnostic survey. The study used two validated research tools: PAR-Q and IPAQ-SF.  The purpose of preparticipation in risk assessment through the use PAR-Q is to provide information relevant to the safety of beginning exercise training, increase the intensity PA and to identify known diseases and risk factors for cardio-vascular diseases or musculoskeletal injury so that appropriate lifestyle interventions can be initiated. PAR-Q includes questions about diagnosed heart disease, stress and resting chest pain, dizziness, diseases of bones and joints, prescribed medications, elevated blood pressure or heart disease, and other causes which may be a contraindication to undertake PA. Statistical analysis. Completed questionnaires were analyzed statistically using the package SPSS 23 (IBM, USA). It established the characteristics of distributions response based on the Shapiro-Wilk and the significance of differences on the basis of a test Chi 2 , Mann-Whitney test and t-Student test. The probability values less than 0.05 (p<0.05) were considered as statistically significant.

Results
The IPAQ_SF allowed determining the number of days and the time devoted to intensive, moderate activity, walking, and the time spent in a sitting position during the previous 7 days among female and male sport sciences students. The distribution of vigorous, moderate and walking PA based on the number of MET-min/weeks is shown in Analyzing the relationships in test results in case of the level of activity no statistically significant difference in the range of questions from 1 to 7 was found. The most frequently observed response was the answer = 0. In the case of Question 6 all respondents gave this reply, hence the inability to quantify the statistical dependence (Table  3).
The assessment of correlation between age, weight, height, and BMI and the level of PA showed statistically significant relationship for activity level 1 to the second level of activity with the body mass and BMI. Body mass and BMI of about 2 activity were significantly higher than respondents declaring activity level 1 (respectively: 59.2 vs. 67.7, p= 0.027 and 20.4 vs. 22.1, p=0.040) ( Table 4).

Discussion
Physical activity is a basing biological human need, contributing to a health status and should be a necessary component of human's lifestyle. Plotnikow (2015) stressed that university students are ideal targets lifestyle interventions aimed at improving health behaviors. Sports executives possess higher than average knowledge about the importance of risk assessment in the prevention of NCD. Unfortunately, when they became trainers and instructors, they do not implement their theoretical knowledge to the practice of everyday life in a satisfactory manner. It is important to pay more attention and scope passed in the training of student's knowledge on risk assessment in the prevention of NCD.
The PAR-Q serves as a screening tool to quickly and easily identify adults for whom PA might not be appropriate (Pescatello et. al., 2014). PAR-Q can minimize barriers in adopting a physically active lifestyle (Balady et al., 1998; Thomas et al., 1992). The PAR-Q contains a 7-question battery designed to determine whether individuals are able to become more physically active (Allen et al, 2014, http://eparmedx.com/). When a person responds positively to 1 or more questions on the PAR-Q, he or she is advised to consult a physician for physical activity participation clearance. Risk assessment using the PAR-Q is undertaken to facilitate participation in regular physical activity by all, but should not replace sound clinical judgment. The process is easy to complete and administer and reduce the barriers to PA participation for asymptomatic and symptomatic populations which becoming more physically active. The PAR-Q tools are evidencebased, meeting the requirements recognized by the medical community. (Bredin, 2013). They simplify the prescreening process especially when low-to moderate intensity exercise is performed. This is implemented in some countries, e.g. allows for pre-exercise screening use the PAR-Q+. This was reducing the number of individuals seeking clearance by a physician (Israeli Ministry of Health, 2015).
It is estimated that 1% of people who fill out the questionnaire PAR-Q will require a further assessment by a physician before taking the systematic exercise (Bredin et al. 2013). However, in the near future, this number may increase as the diseases of civilization are more and more common. For example prevalence of prediabetes status is increasing worldwide and experts have projected that more than 470 million people will have pre-diabetics by 2030. On the other hand for pre-diabetic individuals, lifestyle modification is the cornerstone of diabetes prevention, with evidence of a 40-70% relativerisk reduction (Tabák et al., 2012), Declarations of our students filling the questionnaire PAR-Q indicate the incidence of symptoms memorialized at this relatively early stage of life. It should be noted, however, that the indications on individual symptoms were quite common, as concerned 22 men out of 39 tested. Among women, 60 respondents confirmed those 29 students. Efforts should be undertaken to facilitate participation in regular PA by university students and the hazards of exercise-related NCD events are likely to be reduced by careful attention to a reduce barrier and a safe and effective exercise prescription. Plotnikoff et al. (2015) stressed that the university students which are represents a significant proportion of our population are ideal targets improving health behaviors. They are still at an age where health behaviors that impact on health later in life can be improved that a variety of activities, designed to highlight PA and health factors with immediate feedback, is experience allows a hands-on approach to learning as it increases the students' understanding of their own health issues. The results of research conducted by Snetselaar et al. among 88 medical students whose aim was a self-assessment of their personal risk factors concluded that have succeeded in providing students with a valuable educational tools, which they can use in a future work. From international studies evaluating the level of PA residents 15 EU countries and 6 countries participating in the program CINDI WHO conducted in the late 90s it shows that the percentage of the guiding secondary amounted to between 40-80%. The largest percentage of women and men giving of a shallow PA was found in Portugal (Varo, 2003).
The Eurobarometer survey of the European Commission (http://europa.eu/rapid/press-release_IP-14-300_pl.htm) published in March 2014 indicate that 59% of European Union citizens never perform physical activity, play sport or do it only rarely, and while 41% take this kind of activity at least once a week. Residents of Northern Europe are more physically active than people in Southern and Eastern Europe. In Sweden, 70% of respondents said they practice or play sport at least once a week. Right behind Sweden the following countries are placed in the ranking: Denmark (68%) and Finland (66%), followed by the Netherlands (58%) and Luxembourg (54%). At the opposite end of the rankings were: Bulgaria (78% who never practice or play sport), followed by Malta (75%), Portugal (64%), Romania (60%) and Italy (60%). Nearly 35% of survey participants Multi-Centre Nationwide Health Survey Project -WOBASZ (37% of women and 32% men) do not perform any physical exercise lasting at least 30 minutes a day during free time from work or study. Among the people who perform this type of exercise, they do it irregularly or rarely (Dryglas et al, 2005).
Results from the Australian Bureau of Statistics of the Australian Health Survey 2011-2012 show that higher education students are more likely to meet recommended guidelines for exercise (58%) compared with 45% of nonhigher education students (ABS,2012).
Hasse et all (2004) stressed that 73% of male and 79% of female university students Reduce barriers to regular PA, by eliminating unnecessary medical evaluations which replace use of the PAR-Q. All adults should be encouraged to be physically active.
University students from UK do not meet physical activity guidelines. The same is the USA where nearly half of all university students are not achieving recommended levels of PA (Weinstock, 2010).
Our study confirms the assumption that students of physical education will be characterized by increased and high physical activity resulting from lead an active lifestyle. It demonstrates that the total level of PA of the male students was 3460.039±2502.207 MET-min/ week and was higher than in the case of female students (3388.107±2204.290 MET-min/week). The dominant type PA activity of female students was intensive effort male students was intensive effort (5246.917±2579.27 METmin/week) and moderate effort (1956.472±822.38METmin/week respectively). This data were higher than that of students from Bialystok Medical University where average total PA of students amounted to 3014.5 METmin/week ± 1564.8). Most of the students presented a moderate level of physical activity. Kościuczuk (2016) stressed that dietetics students were characterized by a higher average value of METmin/week 1304.37 ± 1082.32 compared with students of physiotherapy (MET-min/week 1016 75 ± 715.5).
In Poland another data from study done by Starościak (2016) stressed that Physical Education students undertake PA on a high and moderate level more often than students of other pedagogical sciences. Mrozik (2015) assessed the overall performance of PA of students from College of Physical Culture and Tourism in Pruszkow (Poland) showed that the level of PA is satisfactory. Sport science