ABSTRACT
The aim of this study was to determine the physical activity and blood pressure of adults in Ikwuano local government area of Abia state. A cross sectional study was conducted among 439 adults from selected communities in Ikwuano Local Government Area using simple random sampling. A structured questionnaire was used to collect information on socio demographic characteristics. Anthropometry (weight and height) were measured following standard procedures. Blood pressure was recorded using a standard mercury sphygmomanometer, while the physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ). CHI-square was used to analyse the data. Significance was accepted at p>0.05. The Statistical Package for Service Solution (SPSS version 20) was used to analyze the data. The demographic/socio-economic characteristics of the participants showed that 49.9% of the participants reside in Amaoba, while 50.1% reside in Amawom. More than half (59.1%) of the participants were aged between 20-30 years. Slightly less than half (47.8%) of the population had a normal blood pressure (120/80mmHg). Very few (1.2%) of the participants had hypotension (<90/60mmHg), 24.2% of the participants had pre-hypertension (120-129/80-89mmHg). The overall prevalence of hypertension in this study was 26.8% (stage1 hypertension 15.4% and stage2 hypertension 11.4%). Less than half (23.8%) and 15.9% of the participants were overweight and obese, respectively. More than half (71.8%) of the participants did not meet WHO recommendation on physical activity for health, while 28.2% met the recommendation. In addition, the average time spent on sedentary behaviour was 5 hours, 26 minutes. From the study, there was no significant association found between physical activity status and blood pressure of the participants (p>0.05). The study showed that most of the participants were of normal blood pressure. Also, it was observed that majority of the participants were physically inactive. There is an urgent need for community-based interventions, to socially market the concept of a physically active lifestyle and to effectively control blood pressure in order to prevent hypertension due to unawareness.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEGEMENTS iv
TABLE OF CONTENTS v
LIST OF TABLES ix
ABSTRACT x
CHAPTER 1
INTRODUCTION
1.0 Background of the study 1
1.1 Statement of the problem 5
1.2 Objectives of the study 6
1.3 Sgnificance of study 7
CHAPTER 2
LITERATURE REVIEW
2.1 ADULTS 8
2.2 BLOOD PRESSURE 10
2.2.1 Types of Blood Pressure 11
2.2.2 Measurement of Blood Pressure 12
2.2.2.1 Auscultatory method 12
2.2.2.2 Oscillometric method 14
2.2.3 Hypotension 14
2.2.4 Hypertension 15
2.2.4.1 Types of Hypertension 15
2.2.4.2 Prevalence of Hypertension 16
2.2.4.3 Causes of Hypertension 18
2.2.4.4 Signs and symptoms 18
2.2.4.5 Risk factors of Hypertension 19
2.2.4.6 Diagnosis of Hypertension 19
2.2.4.7 Dietary management of Hypertension 20
2.3 PHYSICAL ACTIVITY 21
2.3.1 Types of Physical Activity 22
2.3.2 Classification of Physical Activity level 23
2.3.3 Prevalence of Physical Activity 25
2.3.4 Assessment of Physical Activity 26
2.3.4.1 Questionnaires 26
2.3.4.2 Direct observation 27
2.3.4.3 Pedometers 27
2.3.4.4 Accelerometers 28
2.3.4.5 Heart rate monitoring 29
2.3.4.6 Armbands 30
2.3.5 Factors affecting Physical activity 30
2.3.6 Risk factor and benefits of Physical inactivity 31
2.3.7 Prevalence of Physical Activity 32
2.3.8 Anthropometric methods 33
2.4 RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND BLOOD PRESSURE 34
CHAPTER 3
MATERIALS AND METHODS
3.1 STUDY DESIGN 36
3.2 AREA OF STUDY 36
3.3 POPULATION OF STUDY 37
3.4 SAMPLING AND SAMPLING TECHNIQUES 37
3.4.1 Sample size determination 37
3.4.2 Sampling Procedure 38
3.5 PRELIMINARY ACTIVITIES 39
3.5.1 Preliminary visits 39
3.5.2 Training of research assistants 39
3.5.3 Ethical approval 39
3.5.4 Informed Consent 40
3.6 DATA COLLECTION 40
3.6.1 Questionnaire administration 40
3.6.2 Anthropometric Measurements 40
3.6.2.1 Weight measurement 40
3.6.2.2. Height measurement 41
3.6.2.3 Body Mass Index (BMI) 41
3.6.2.4 Waist and Hip Circumference 41
3.6.3 Blood pressure measurement 42
3.6.4 Physical Activity Assessment 42
3.7 DATA ANALYSIS 43
3.8 STATISTICAL ANALYSIS 45
CHAPTER 4
RESULTS AND DISCUSSION
4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS 46
4.2 BLOOD PRESSURE CHARACTERISTICS OF THE PARTICIPANTS 50
4.2.1 Anthropometric characteristics of the participants 52
4.3 PHYSICAL ACTIVITY STATUS OF THE PARTICIPANTS 54
4.4 RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND BLOOD PRESSURE OF PARTICIPANTS 56
CHAPTER 5
CONCLUSION
5.1 Conclusion 58
5.2 Recommendations 58
REFERENCES 60
APPENDIX 1 77
APPENDIX 2 78
APPENDIX 3 79
APPENDIX 4 80
LIST OF TABLES
Table 3.1: Body Mass Index (BMI) Category 44
Table 3.2: Waist Hip Ratio (WHR) Classification 44
Table 3.3: Blood pressure classification 45
Table 3.4: Physical Activity Classification 45
Table 4.1a: Socio-demographic characteristics of the participants 47
Table 4.1b: Socio-demographic characteristics of the participants (Continuation) 48
Table 4.1c: Socio-demographic characteristics of the participants (Continuation) 49
Table 4.1d: Socio-demographic characteristics of the participants (Continuation) 50
Table 4.2: Blood pressure classification of the participants 51
Table 4.2.1: Anthropometric indices of the participants 53
Table 4.3: Physical activity classification of participants 55
Table 4.4: Relationship between physical activity and blood pressure of participants 56
CHAPTER 1
INTRODUCTION
1.0 BACKGROUND OF THE STUDY
Blood pressure is a measure of the force that the circulating blood exerts on the walls of the main arteries (WHO, 2006). The pressure wave transmitted along the arteries with each heartbeat is easily felt as the pulse (WHO, 2006). The pressure caused by the heart pumping blood to all parts of the body is called blood pressure (WHO, 2006).
Hypertension which is also called high blood pressure is raised pressure of the blood in the arteries (Cifkova et al., 2004). It is one of the most common worldwide disease affecting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge (Cifkova et al., 2004). Over the past several decades, extensive research, widespread patient education and a concerted effort on the part of the health care professionals have led to decreased mortality and morbidity rate from the multiple organ damage arising from years of untreated hypertension (Cifkova et al., 2004).
According to the World Health Organization (WHO), the prevalence of hypertension is highest in the African Region at 46% of adults aged 25 years and above while the lowest was found in the American region (WHO, 2011). The incidence of hypertension and cardiovascular mortality has been increasing in sub-Saharan Africa over the past few decades (Ataklte et al., 2015) and is expected to nearly double by the year 2030 (Damasceno et al., 2009). In a systematic review of articles published on hypertension between 2000 and 2013 in sub-Saharan Africa, Ataklte et al (2014) reported a pooled hypertension prevalence of 30% in adults and a range from 14.7 to 69.9% depending on the site and age.
In Nigeria, the prevalence of hypertension has been on the increase affecting a significant number of highly productive populations. A review of prevalence among adults from 1990 to 2017 showed combined prevalence of 22% and range from a minimum of 12.4% to a maximum of 34.8% (Ekwunife and Aguwa, 2011). It was estimated that there were about 20.8 million cases of hypertension in Nigeria among people aged at least 20 years, with a prevalence of 28.0% and projected increase to 39.1 million cases with a prevalence of 30.8% by 2030 (Adeloye et al., 2017). A review with wider coverage (1968 -2015) found overall crude prevalence of hypertension to range from 2.1 to 47.2% in adults and from 0.1 to 17.5% in children depending on the study site, target population, type of measurement and cut-off value used for defining hypertension (Akinlua, 2015).
Hypertension is the most important modifiable risk factor for coronary heart disease, stroke, congestive heart failure, end-stage renal disease and peripheral vascular disease (Lackland et al., 2015). Hypertension results from two major factors which can be presently independent or together which are; when the heart pumps blood with excessive force and if the body’s smaller blood vessels (known as the arterioles) narrow, so that blood flow exerts more pressure against the vessels ‘walls (WHO, 2003). Stress and other behavioral factors have been linked to a board range of cardiovascular disease outcome. Two numbers are used to describe blood pressure: the systolic pressure (the higher and first number) and the diastolic pressure (the lower and second number) (WHO, 2003).
Hypertension is strongly related to cardiovascular disease and all-cause mortality. Exercise reduces blood pressure but the response varies between individuals (Lackland et al., 2015). The mechanisms by which physical activity energy expenditure (PAEE) modifies blood pressure are not fully defined but include modulation of sympathetic tone (Wareham et al., 2014). In addition, like all complex diseases, it is probable that a variety of environmental and genetic factors cause hypertension. These factors may act in an additive or multiplicative manner. Epidemiological studies have demonstrated that hypertension segregates within families and its prevalence differs between ethnicities. Common variants in a number of genes are thought to explain some of this difference. Because the protective effect of physical activity on blood pressure varies greatly from one person to the next, it is probable that this relationship is also modified by genotype (Wareham et al., 2014).
Lifestyle modification is one of the cornerstones in the management of blood pressure. The recognition and management of elevated BP at an early age, and the identification of modifiable risk factors, may be an important strategy for limiting the overall public health disease burden caused by hypertension (Labarthe et al., 2009). According to WHO (2014), physical activity is defined as any bodily movement produced by skeletal muscles that requires energy expenditure – including activities undertaken while working, playing, carrying out household chores, travelling, and engaging in recreational activities. Physical inactivity is a major risk factor for cardiovascular health, including hypertension (Pescatello et al., 2004). Increasing awareness and simple preventive measures such as promotion of physical activity, reducing body weight and reduction of salt intake present the best hope for reducing the impact of hypertension on morbidity and mortality (Agyemang et al., 2005).
The prevalence rates of physical activity in studied African countries varied widely, although the reasons for these variations were not obvious. For example, the prevalence of physical inactivity was reported to be 52.6%, 49.1%, and 44.7% in Nigeria, Mauritania and Swaziland respectively, but was as low as 7.8%, 8.4%, and 8.8% in Burkina Faso, Malawi, and Ghana, respectively (Guthold et al., 2010). Similarly, Mozambique and Malawi, in southeastern Africa, had the highest reported prevalence of physical activity (around 95%), whereas Mali and Mauritania, sub-Saharan West African countries, were reported to have a prevalence of about 50% (Guthold et al., 2011). With a population of more than 140 million, Nigeria is the most populous country in Africa, and physical inactivity related NCDs are reported to be increasing.
Hence, physical activity is a key component of the therapeutic lifestyle changes recommended for preventing and treating elevated BP and hypertension in adults. It is therefore important to carry out the study on the relationship between physical activity and blood pressure to effectively devise ways to prevent several cardiovascular diseases relating to physical activity.
1.1 STATEMENT OF THE PROBLEM
There is a strong, continuous, and independent relationship between blood pressure and cardiovascular disease (Stamler et al., 1993). Physical inactivity is strongly and positively associated with hypertension (Wareham et al., 2000). Intervention studies have demonstrated that increased physical activity is effective in the treatment of high blood pressure in a variety of populations (Whelton et al., 2002).
It is estimated that hypertension affects 1 billion people over the world and is the main risk factor for many other cardiovascular diseases (Adeloye et al., 2015). The global burden of hypertension and other non-communicable diseases is rapidly increasing, and the African continent seems to be the most affected region in the world. With an increasing adult population and changing lifestyle of Nigerians, the burden of hypertension and physical inactivity may continue to increase as time unfolds. Due to the high rate mortality and morbidity of hypertension and physical inactivity, this project is worth carrying out to find a solution that will be effective in the reduction of this prevalence.
In addition, in Nigeria, the general prevalence of hypertension has been on the increase over the years affecting a significant number of highly productive populations in the country. A critical analysis of the prevalence among adults from 1990 to 2017 showed combined prevalence of 22% and range from a minimum of 12.4% to a maximum of 34.8% (Ekwunife and Aguwa, 2011). It was estimated that there were about 20.8 million cases of hypertension in Nigeria among people aged at least 20 years, with a prevalence of 28.0% and projected increase to 39.1 million cases with a prevalence of 30.8% by 2030 (Adeloye et al., 2017).
Finally, the potential value of long term approaches to hypertension control based on the prevention of high blood pressure in adult is increasingly recognised. However, understanding of the determinants of blood pressure in adult is incomplete and further research is needed to provide a basis for the development of effective prevention measures. With regards to all these findings from previous studies, it will be very essential to know the relationship between physical activity and blood pressure to promote ways of reducing the prevalence of physical inactivity and blood pressure.
1.2 OBJECTIVES OF THE STUDY
The general objective of this study is to determine the physical activity and blood pressure of adults in Ikwuano local government area of Abia state.
Specific objectives are to:
(i) assess the sociodemographic characteristics of adults.
(ii) measure blood pressure levels of adults.
(iii) determine the prevalence of hypertension in adults
(iv) determine the physical activity level of adults.
(v) determine the relationship between physical activity and blood pressure of adults.
1.3 SIGNIFICANCE OF STUDY
The essence of this study is to help adult individuals, health agencies, health practitioners, Ministries of Health (federal and state) understand the effect of hypertension on the human body and the impact of physical activity on blood pressure through promotion of physical activities, reduction of body weight and salt intake, regular checkups and healthy eating.
Furthermore, this study will enable health practitioners to carry out further research on blood pressure as it has shown that hypertension is the leading cause of mortality in the world and a major risk factor for cardiac disease and stroke.
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