QUALITY OF DIET, HEALTH BEHAVIOURS, AND LEVEL OF PHYSICAL ACTIVITY IN PHYSICAL EDUCATION STUDENTS FROM POLAND AND SPAIN

: Introduction: The aim of this study was to analyse the relationships of healthy diet indices (pHDI-10 and nHDI-14) with the level of physical activity and health behaviours among Polish and Spanish physical education students. Material and methods : Research was conducted among 499 students (219 from Poland and 280 from Spain). Three standardised research tools were used: the Dietary Habits and Nutrition Beliefs Questionnaire (Kom-PAN), the International Physical Activity Questionnaire (IPAQ), and the Health Behaviour Inventory (HBI) by Z. Juczy ń ski. Pearson’s r correlation coefficient and moderation analysis using IBM SPSS 21 software were used to determine relationships between variables. The level of significance was set at p = 0.05. Results: In the group of students studied, the healthy diet index (pHDI-10) evaluated on a scale of 0 to 100 was 23.23 points, while the unhealthy diet index (nHDI-14) was 14.47 points. Among the categories of health behaviours, students obtained the highest scores for a positive mental attitude, whereas among the domains of physical activity – for vigorous exercise. The analysis demonstrated a significant positive relationship between the pHDI-10 index and moderate physical activity ( p = 0.038), and between the nHDI-14 index and walking ( p < 0.001). Along with the increase in the pHDI-10 index, an increase was found in the level of preventive behaviours ( p = 0.001), proper eating habits ( p < 0.001), and the general index of health behaviours ( p < 0.001). Significant negative correlations were found between the nHDI-14 and: the level of positive mental attitudes ( p < 0.001), preventive behaviours ( p = 0.010), proper eating habits, health practices, and the general index of health behaviours ( p < 0.001). An increase in the healthy diet index along with a decrease in the general index of health behaviours (HBI Total) was also noted, but only in Polish students ( p < 0.001). Conclusions : Low levels of healthy (pHDI-10) and unhealthy diet (nHDI-14) indices, a high level of physical activity, differentiation of individual categories of health behaviours, significant relationships between healthy diet indices, and the level of certain domains of physical activity and health behaviours were demonstrated. A moderate effect of the country of residence on some relationships was also found.


Introduction
A holistic model of health, defined as the balance and integration of all dimensions constituting a human (physiological, mental, and social), assumes the complexity of factors determining health, with emphasis on the particular importance of lifestyles.The category of a healthy lifestyle, as a set of behavioural determinants of health, includes, among others, balanced nutrition and a highquality diet, regular physical activity, the use of effective Antropomotoryka coping strategies, avoiding psychoactive substances, and regular check-ups [1,2].A healthy lifestyle is an important factor in increasing health potential and early prevention of chronic diseases, and, in this regard, it affects every stage of ontogenesis.
A proper diet is based on variety and balance, consumption of foods with high nutritional value (vegetables and fruits, whole-grain cereal products, low-fat dairy products, fish, vegetable oils and nuts), limiting animal fats, red meat, processed meat, refined grain products, and confectionery and fast food [3].Various indices have been used to assess the health quality of diets, including healthy diet index (pHDI-10) and unhealthy diet index (nHDI-14) [4], used in previously published Polish studies on physical education students [5] and females [6,7].Various indices are also used to assess the health quality of diets in other countries, including Spain [8].
Another key aspect of a healthy lifestyle is regular engagement in physical activity adapted to individual exercise capacity, with the features of health training.The current WHO recommendations for adults suggest at least 150 minutes of moderate-intensity exercise or at least 60 minutes of high-intensity exercise, and strength training at least twice a week.Additionally, exercises to shape balance, coordination and flexibility are recommended [1].The group that stands out in terms of physical activity is physical education students, who are characterised by a higher level of physical activity than students of other faculties, which was confirmed both by studies conducted in Poland [9] and in other countries [10,11].
Various modifiable lifestyle factors were synthetically collected using the Health Behaviour Inventory by Z. Juczyński [12], which covers four categories of healthrelated behaviours, including proper eating habits, preventive behaviours, health practices, and mental attitude.This tool, concerning health beliefs, is part of a broad spectrum of determinants of holistic health.Despite the significance of a healthy lifestyle for health and quality of life, it is the prevalence of health behaviours in lifestyles of various social groups that have been indicated, including students of physical and health-oriented faculties [5,9,[13][14][15][16][17][18][19][20].

Purpose
Physical education students are a specific group, among others, due to their preparation for the future role of not only physical education (PE) teachers but also health educators.This has been emphasized in core curricula of general education and teacher training standards both in Poland and Spain.The effectiveness of teachers' work in the area of school health education depends, among others, on their attitudes towards behavioural determinants of health, including nutrition, exercise, and other health behaviours.Given the complexity of health deter-minants and the future professional role of PE students, research was conducted to analyse the relationships between health quality indices of diet and the level of physical activity, and other health behaviours of students.The moderating effect concerning country of residence of the students surveyed was also verified in terms of the correlation between health behaviours (HBI Total) and indices of healthy and unhealthy diets (pHDI-10 and nHDI-14) and the level of total physical activity (IPAQ Total).

Participants
The research was carried out in 2017-2019 among 499 physical education students, including 219 from Poland (the University of Physical Education in Kraków and Wrocław) and 280 from Spain (the University of Murcia and University of Granada).The group consisted of 310 men and 189 women aged 18 to 35 years (21.6 ± 2.4).

Measure
Three standardised research tools were used in the study.The Dietary Habits and Nutrition Beliefs Questionnaire (Kom-PAN), developed by the Human Nutrition Science Committee of the Polish Academy of Sciences, was used to assess diet quality in terms of frequency of consuming particular food groups [4].
Two indices of diet quality were calculated by summing the values of daily consumption frequency for specific product groups: the healthy diet index-10 (pHDI-10) for the consumption of foods with potentially beneficial health effects, and the unhealthy diet index-14 (nHDI-14), concerning the consumption of foods with potentially adverse health effects.The healthy diet index (pHDI-10) is determined by the frequency of consuming ten groups of products: wholemeal bread, other wholegrain cereal products, milk, fermented dairy beverages, fromage frais, white meat dishes, fish, dishes from legume seeds, and fruit and vegetables.The unhealthy diet index (nHDI-14) is determined by the frequency of consuming fourteen groups of products: white bread, other refined cereal products, fast food, fried foods, butter, lard, cheese and processed cheese, meat products, red meat dishes, sweets, canned meat, sweetened carbonated or non-carbonated beverages, energy and alcoholic drinks [4].
The daily frequency of consuming specific food products was described by real numbers according to the formula: never (0), 1-3 times a month (0.06), once a week (0.14), several times a week (0.5), once a day (1), and several times a day (2).The values of the indices, expressed as a daily frequency of consuming the 10 groups of products (times/day), range from 0 to 20

Journal of Kinesiology and Exercise Sciences
for pHDI-10 and 0 to 28 for nHDI-14.These values of the indices expressed as the sum of the daily frequency of consuming given products (in order to standardise their range), were then expressed on a point scale (from 0 to 100) by converting the values as follows: pHDI-10 = (100/20) × sum of daily consumption frequency regarding 10 food groups; nHDI-14 = (100/28) × sum of the daily consumption frequency of 14 food groups.Values of pHDI-10 and nHDI-14 indices within the range of 0-33 points are defined as low, between 34-66 as moderate, and within the range of 67-100 points -as high [4].
The level of physical activity was assessed based on the short version of the International Physical Activity Questionnaire (IPAQ), including four categories of physical activity: vigorous (above 1,500 or 3,000 MET-min/ week), moderate (600-1,500 or 600-3,000 MET-min/ week), walking (less than 600 MET-min/week), and sitting [21].
The Health Behaviour Inventory (HBI) by Z. Juczyński [12] was used to assess the scale of health behaviours.Based on the HBI, four categories of health behaviours (proper eating habits, preventive behaviours, health practices, and positive mental attitude), and the general index of health behaviours were assessed [12].
The research was carried out as part of the scientific project entitled "Health Behaviours Among Students of Teaching Faculties from Selected European Countries Within the Context of their Future Professional Role as Health Educators -Analysis of Selected Formal, Legal, Socio-cultural and Psychological Conditions" (the University of Physical Education in Kraków, project number: 136/BS/INS/2017) and in accordance with the principles of the Declaration of Helsinki, and the informed consent to participate in the survey was obtained from the respondents.

Statistical analysis
The IBM SPSS 21 program was used for statistical calculations.Basic statistics of the variables (percentages, means, standard deviations, minima, maxima) were calculated.Pearson's r correlation coefficient was applied to determine the relationships between the variables, and simple slope moderation analysis was used to determine differences in the relationships of the analysed variables depending on the physical education students' country of residence.The level of significance was set at p = 0.05.

Results
In the group of physical education students, the health diet index (pHDI-10) reached the value of 23.23, while the unhealthy diet index (nHDI-14) was 14.47 on a scale from 0 to 100 points (table 1).Among the categories of health-promoting behaviours included in the Health Behaviour Inventory (HBI), the students surveyed obtained the highest average results for positive mental attitudes (22.26), and the lowest for preventive behaviours (18.97) (table 1).Among the categories of physical activity included in the IPAQ questionnaire, the students obtained the highest values in terms of vigorous effort (4,036.51METs), and the lowest in terms of sitting (266.69METs) (table 1).
Correlation analysis demonstrated a weak but statistically significant positive relationship between the Antropomotoryka healthy diet index (pHDI-10) and moderate physical activity (p = 0.038) and between the unhealthy diet index (nHDI-14) and walking (p < 0.001).Furthermore, it was demonstrated that with the increase in the healthy diet index (pHDI-10), the level of preventive behaviours (p = 0.001), proper eating habits (p < 0.001), and the general index of health behaviours (p < 0.001) increased.Significant negative correlations were also found between the unhealthy diet index (nHDI-14), and the level of positive mental attitudes (p < 0.001), preventive behaviours (p = 0.010), proper eating habits (p < 0.001), health practices (p < 0.001), and the general index of health behaviours (p < 0.001) (table 2).An analysis was performed to verify whether the students' country of residence modifies the relationships of their own health beliefs (HBI Total) with the healthy and unhealthy diet indices and the level of physical activity (IPAQ Total), showing a moderating effect of the country in terms of the relationship between health behaviours and the unhealthy diet index -nHDI (p < 0.001).Among

Discussion
The present study showed low levels of the healthy (pHDI-10) and unhealthy diet (nHDI-14) indices, a high level of physical activity, differentiation of individual categories of health behaviours, and statistically significant relationships between indices of healthy diet quality and the level of some domains of physical activity and health behaviours among physical education students.The low levels of healthy diet index are caused by the low frequency of consuming products characterized by potentially beneficial health effects recommended in the diet, whereas low unhealthy diet index results from limited consumption of products with potentially adverse health effects.A moderating effect of the country of residence on some of the relationships examined was also demonstrated.Both positive and negative food choices demonstrated in the study were consistent with the findings of the research on physical education students from Biała Podlaska, Poland, which showed that these students did not consume products recommended in the diet with adequate frequency and limited the consumption of those not recommended [5].Furthermore, other studies of young women with different nutritional statuses have shown a low level of rational food choices, thus affecting the value of the health diet index (pHDI-10) [6].Another group of women from southern Poland was found to mostly follow a moderately healthy lifestyle, determined based on high and/or average physical activity and low-quality diet (according to the pHDI-10 index) [7].
The high level of physical activity demonstrated in physical education students, including the predominance of the domain of vigorous effort, is related to the educational profile of the study group.The high level of physical activity among physical education students, higher than students of other university faculties, was also confirmed in Polish [9], Romanian [10], Spanish [16,22], and other studies [20].
Our study showed that of the categories of health behaviours (positive mental attitude, proper eating habits, preventive behaviours, and health practices), Polish and Spanish physical education students obtained the highest scores for positive mental attitude (positive thinking, caring for good relationships with others, avoiding negative emotions and mental tension) and health practices (sleep and rest hygiene, physical activity, reducing the use of psychoactive substances).These results are consistent with the trends found in other groups of physical education students [9,20].Low levels of proper food choices have been also reported in other studies of university students from different countries and continents [13,[23][24][25][26].
The results of a statistical analysis of relationships between the variables used in our study are very interesting.It was shown that the healthy diet index (pHDI-10) was significantly positively correlated with other aspects of a healthy lifestyle, including moderate physical activity, preventive behaviours, proper eating habits and the general level of health behaviours.At the same time, it was confirmed that the unhealthy diet index (nHDI-14) was significantly negatively associated with positive mental attitude, preventive behaviours, proper eating habits, health practices, and the general index of health behaviours.The obtained relationships indicated that other elements of a healthy lifestyle are associated with a higher health quality of a diet, which may increase the health potential of physical education students, while other aspects of an unhealthy lifestyle are also associated with a lower health quality of a diet, likely to lead to a decrease in this potential.
The healthy diet index (pHDI-10) was most positively correlated with the level of proper eating habits from the HBI Inventory (r = 0.339) and to the general health behaviour index (HBI Total) (r = 0.221).On the other hand, the unhealthy diet index (nHDI-14) was most negatively associated with the level of health practices (sleep and rest hygiene, recreational physical activity, reducing stimulant use) (r = -0.200)and proper eating habits from the HBI Inventory (r = -0.224)and with the general index of health behaviours (HBI Total) (r = -0.240).The obtained data confirm the consistency of the results of the assessment of the diet using the HBI Inventory designed by Z. Juczyński and the Kom-PAN questionnaire [4,12], and thus to confirm their reliability and consistency.The results also demonstrated that students who eat more sensible diets care more for health in general, while students who follow a less healthy model of nutrition, are generally less concerned with health, as confirmed by correlations with the general index of health behaviours (HBI Total).These dependencies correspond to the subjectivity of health, which is one of the hallmarks of the holistic health model, assuming conscious and active care for health, in line with the belief that lifestyle plays a key role (approx.50%) in modern health.
The described regularities have also been reported in studies by other authors.In a Spanish study, a relationship between various aspects of lifestyle was found, indicating that physically active students consumed more fruit and smoked less tobacco than physically their inactive peers.Furthermore, physically inactive men spent more time in front of the computer, and physically inactive women spent more time in front of the TV, more Antropomotoryka frequently consuming alcoholic beverages.Therefore, the grouping of healthy or unhealthy aspects of lifestyle was confirmed [27], which is consistent with the results of the present study.The link between an unhealthy diet and low levels of health practices (including poor sleep hygiene, low physical activity, and the use of stimulants), shown in the discussed studies, was also reported in a study of Chilean university students which demonstrated the prevalence of unhealthy lifestyles, including eating disorders, smoking, drinking alcoholic beverages, low physical activity, and insufficient night sleep time [28].Also, in another Spanish study that aimed, among others, to examine the relationships between adherence to the principles of the Mediterranean diet and physical activity of university students, a significant relationship between high levels of physical activity and eating the Mediterranean diet was shown.The association of other health behaviours, including low physical activity, with limited compliance to medical recommendations, has also been confirmed [29].Furthermore, in a study of Spanish university students aimed to assess the relationships between smoking, alcohol consumption, physical activity, and diet quality, it was confirmed that health risk factors such as smoking, eating disorders, and physical inactivity tended to accumulate [30].Similarly, research in Argentina confirmed the association of positive nutritional status indices with healthy eating habits and high levels of physical activity in physical education students [31].Furthermore, in studies in Saudi Arabia, Bahrain and the Philippines, the coexistence of nutritional errors and low levels of physical activity in the lifestyles of university students was confirmed [32][33][34].In an American study, the exposure of academic youth to mistakes in eating behaviour, low levels of physical activity, and risky sexual contacts were also demonstrated [35].Another American study indicated the need to act towards increasing physical activity, promote sensible diets, and improve the nutritional knowledge of students [25].The coexistence of adverse health behaviours (smoking and alcohol abuse) was also found in the lifestyle of university students from the Eurocarpathian region (Poland, Slovakia, Romania, and Ukraine) [36].The coincidence of low responsibility for health with limited effectiveness of coping with stress, low quality of sleep, and low health self-assessment was also demonstrated among students of music schools in Great Britain [37].Relationships between nutrition and other aspects of a student lifestyle were also affected by the level of stress and ability to cope with it.In this research, it was confirmed that students who were less able to cope with stress skipped meals and smoked cigarettes more frequently [38].
Our research also showed a moderating effect of the country of residence on some of the correlations studied, confirming in particular the tendency to increase the unhealthy diet index (nHDI-14) along with the decrease in the general index of health behaviours (HBI Total) only in Polish students (p < 0.001).The demonstrated pattern is consistent with the results of another study which confirmed the moderating effect of the student's country of residence on the relationship between self-efficacy and the level of physical activity [39] and the general health behaviour index of Polish and Spanish physical education students [40].This confirms the importance of cultural determinants, traditions, and climatic factors (Northern vs.Southern Europe) and perhaps the effectiveness of broad health policy [16].
In light of the results of the present study, the significance of a sensible diet, recreational physical activity, and other aspects of a healthy lifestyle for maintaining and improving the health potential indicates the need for educational interventions among university students, including those from physical education faculties.The legitimacy of such initiatives was also emphasized by other authors [9,15,18,30,33,34,[41][42][43].
Given the limitation of this study, further research in this area should take the moderating effect of other variables into account, including students from other geographic and cultural regions.

Conclusions
1.A low level of healthy (pHDI-10) and unhealthy diet (nHDI-14) indices, a high level of physical activity, differentiation of individual categories concerning health behaviours and statistically significant relationships between indices of dietary health quality and the level of some domains of physical activity and health behaviours were found in physical education students from Poland and Spain.2. Higher health quality of the diet (pHDI-10) was significantly associated with other aspects of a healthy lifestyle, including moderate physical activity, preventive behaviours, proper eating habits, and the general level of health behaviours of physical education students.3. The lower health quality of the diet (nHDI-14) was significantly associated with other aspects of an unhealthy lifestyle, including a lower level of positive mental attitude, preventive behaviours, health practices, unhealthy eating habits, and a lower overall rate of health behaviours in physical education students.4.Among Polish and Spanish physical education students, a moderating effect of the country of residence on the relationships between health behaviour and diet quality was demonstrated, indicating an increase in the unhealthy diet index (nHDI-14) along with a decrease in the general index of health behaviours (HBI Total) in Polish students.

Institutional Review Board Statement:
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee

Table 1 .
Values of diet quality indices (pHDI-10 and nHDI-14) and the levels of physical activity and health behaviours among physical

Table 2 .
Correlations of the healthy (pHDI-10) and unhealthy (nHDI-14) diet indices with the level of physical activity (IPAQ) and health behaviours (HBI) among physical education students (N=499) (Pearson's r correlation coefficient) r -Pearson's r correlation coefficient, p -statistical significance

Table 3 .
Moderation analysis (moderating variable: country, independent variable: HBI Total) Spain students from Poland, the unhealthy diet index (nHDI) increased as the level of health behaviours decreased, while in Spanish students, this correlation was very weak and did not reach the level of statistical significance (see table3).