INTRODUCTION
Overweight is a public health issue. According to the World Health Organization (WHO), in 2020, the global overweight prevalence was 38%. Future prevalence of overweight among adults (20-69 years of age) in India by 2040. (Shammi Luhar, et al., 2020). Overall, the overweight prevalence among Indian adults between the ages of 20-69 is expected to rise by approximately 2-fold from 2010 to 2040. Patients who are overweight and obese may have a better outcome than their peers with normal body mass index (BMI) after developing clinical cardiovascular disease (CVD). Fitness Fatness Index (FFI) is a recently developed index that is used to predict cardiovascular disease (CVD) risk. It is a measure of the ratio between an individual's cardiorespiratory fitness (CRF) and waist-to-height ratio (Daniel J. Leahy et al., 2022). Short bouts of Stair climbing increase Cardiorespiratory Fitness in young sedentary adults. Studies have shown that stair climbing is safe and beneficial. Minor alterations in physical activity levels (e.g., stair climbing) in sedentary populations (Valentino, Sydney E., et al) improve VO2max and improve weight loss in overweight adults (W. Daniel Schmidt, PhD, et al.,) (Ina Shaw et al.,2020).
Physical activity has long been recognized as an important part of maintaining good health and preventing illness (Shephard RJ). Despite this, a significant proportion of adults in most developed nations are not physically active enough to achieve any significant health and fitness outcomes (Blair SN). It has also been suggested that promoting physical activity among previously inactive individuals may be the most effective way to prevent cardiovascular disease on a population level(Caspersen CJ, Heath GW). According to current physical activity guidelines, every adult should do 30 minutes of moderate-intensity physical activity most, if not all, five days a week. (Blair SN, et al). Accumulating exercise in short bursts throughout the day is one of the strategies recommended to achieve this activity goal. This approach has been tested experimentally with 10-minute bouts of activity (Murphy MH., et al.,). However, so far only one study on stair climbing has demonstrated that accumulation of very short bursts of exercise lasting approximately 2 minutes can also provide health benefits.
Approximately 39% of the global adult population were classified as overweight (Body Mass Index (BMI) 25.0–29.9 kg/m2) or obese (BMI > 29.9kg/m2) in 2014; a doubling since 1975. Whereas the prevalence of obesity was 6.4% among women and 3.2% among men in 1975, it had risen to 14.9% and 10.8%, respectively by 2014[13]. In developing countries like India, the increasing prevalence of overweight and obesity has coincided with the demographic and epidemiological transitions, in which mortality and fertility have declined, and lifestyle-related diseases have become more common (Dandona L. et al.). The prevalence of overweight and obesity in India is increasing faster than the world average. For instance, the prevalence of overweight increased from 8.4% to 15.5% among women between 1998 and 2015, and the prevalence of obesity increased from 2.2% to 5.1% over the same period (WHO). This fast-paced growth has been accompanied by notable increases in the burden of non-communicable diseases (NCDs). Whereas in 1990 the number of life years lost to disability (DALYs) attributable to communicable, maternal, neonatal, and nutritional disorders exceeded that attributable to NCDs in virtually all of India’s states, currently the opposite is true. Given the extent of the increase in prevalence of overweight and obesity, and its relationships with NCDs (Kelly T.,et al.,), reliably predicting its future prevalence has become increasingly important.
A sedentary lifestyle which includes prolonged sitting time during waking hours and low energy expenditure, increases the risk of adverse health events, cardiovascular disease, and type two diabetes (T2DM) (Dempsey PC). This type of lifestyle leads to lower levels of cardiorespiratory fitness (CRF) and increased fatness, increasing cardiometabolic risk and mortality (Laukkanen JA). Improving CRF and lowering fatness with exercise promotes cardiovascular health and longevity. The Fitness-Fatness Index (FFI), developed in 2016, combines these two cardiometabolic risk factors and has been shown to be better at identifying those at risk of adverse cardiovascular events than either measure alone. FFI is calculated by measuring maximal CRF in metabolic equivalents (METs) divided by the waist to height ratio (WtHR). A 1-unit increase in FFI is clinically significant and has been found to reduce all-cause mortality (9%) and cardiovascular disease (CVD) specific mortality by 13% (Sloan RA et.,).
Establishment of Fitness Fatness Index (FFI) To establish FFI and changes in FFI, anthropometric measurements of waist (cm) and height (cm) and maximal CRF testing was required at baseline and 12-weeks post intervention. The FFI was calculated as maximal CRF expressed as metabolic equivalents (METs) divided by the waist-to-height ratio (WtHR). [FFI = CRF (METs) / WtHR] CRF was determined by the maximal oxygen uptake (VO2max mL∙kg-1∙min-1) via a graded maximal exercise test (GXT), in further detail below, converted to METs by dividing by 3.5 mL∙kg-1∙min-1. WtHR was calculated by dividing the anthropometric measurements of waist (cm) by height (cm). A higher number indicates a greater FFI.
Current physical activity guidelines recommend that every adult should engage in 30 minutes or more of moderate intensity physical activity on most, preferably all, days of the week (Blair SN, et al). One strategy advocated to meet this activity goal is to accumulate exercise in short bouts throughout the day. The efficacy of this approach has been shown experimentally using 10-minute bouts of activity (Murphy MH et al.,). However, to date only one stair climbing study has shown that accumulating very short bouts of exercise lasting about two minutes can also confer health benefits (Boreham C et al.,). In this study only one group has undergone exercise and control group didn’t receive any exercises, since to find out how much add on effective is the short bout of stair climbing when compared to the normal lifestyle.
MATERIALS & METHODOLOGY:
Pre and post experimental study design. This study was conducted at KG College of physiotherapy, KG pain relief center, Coimbatore, conducted over a period of 6 months. 50 participants enrolled and only 36 were selected based on inclusion and exclusion criteria. The experimental flow chart outlining the study design is shown in Figure 1. Only males age between 35 to 45 years. Males who are eligible as per BMI score >25 and <30 were included. Males under any medications, musculoskeletal disorders, using drugs, alcohol and cigarette, cardiovascular disease, hypertension, neurological deficit, any fractures, any recent surgeries, carcinoma were excluded. All the subjects have explained the purpose and test procedures and written informed consent and basic assessment were taken before their enrolment in the study. Participants were divided into two groups: Experimental Group A (n=18) and Group B Control Group (n=18). Group A underwent a short bout of stair climbing training for 3 times per day, 3 days a week, a total of 54 training sessions over 8 weeks. A single bout of the 3-flight staircase. 3 X 20s sprints with 2 minutes recovery. 58±4 stairs were climbed/ bout of 180±11 stairs /session. Group B is a control group was not Perform any kind of Exercise; Pre-Outcome Measures were taken on day 1 and Post Outcome Measures were taken after the end of the 8th week of intervention. Both groups underwent baseline anthropometric testing and a submaximal test to determine the baseline FFI. Anthropometric measures included waist circumference and height to calculate waist-to-height ratio. Height was measured on a stadiometer to the nearest 0.5cm. Waist circumference was measured at the top of the right iliac crest with a nonelastic tape measure to the nearest 0.1cm. WHtR was calculated by dividing waist in cm by height in cm.
Fitness-Fatness Index: To determine Fitness-fatness index (FFI), estimated VO2 max was used from the submaximal cardiorespiratory test, along with waist-to-height ratio. Estimated VO2 max was calculated using the Queens College Step test. From this metabolic equivalent (MET) was calculated (VO2/3.5), while WHtR was determined by dividing the participant’s recorded waist circumference in cm by their height in cm. These two values were then divided to obtain FFI.
PROCEDURE:
Sample size calculation:
Sample size, n= 4pq/L2
Where, P= 90% = 0.09, q= 1-q = 0.10, L= 10%= L2 = 0.01(al error), n= 36
Total 36 subjects were divided into two groups through simple random sampling method.
Ethical concern:
The study was approved by ethical committed of K.G hospital, Coimbatore
|
Characteristics |
Group |
N% |
|
Age |
35-45 years |
40 ± 3.06 |
|
BMI |
>25 - <30 |
27.02 ± 1.33 |
|
Educational |
Educated |
(22)60% |
|
Uneducated |
(14)40% |
|
|
Socio-economic level |
Low |
5 (13.3%) |
|
Moderate |
22 (60%) |
|
|
High |
9 (26.7%) |
Table 1: Demographic data
The participant’s demographic data were age, BMI, educational and socioeconomic level as shown in Table 1.
|
Groups |
Mean values |
N |
Mean difference |
SD |
t value |
P value |
|
Group A (pre-test) |
18.79 |
18 |
4.1 |
3.9209 |
8.2974 |
<0.0001 |
|
Group A (post-test) |
22.89 |
18 |
||||
|
Group B (pre-test) |
18.79 |
18 |
0.98 |
3.8214
|
4.4761 |
<0.0003 |
|
Group B (post-test) |
19.77 |
18 |
Table 2: Fitness-Fatness Index (pre and post-test mean scores)
The Mean values, mean difference, SD, t-value and P-value of Fitness Fatness Index scores of Group A and Group B are shown in Table 2.
Figure 1. Pre-Test and Post Test Mean Values for Fitness Fatness Index
RESULT
The purpose of the study was to find out the effects of short bouts of stair climbing exercise on Fitness Fatness Index among overweight individuals. Fitness Fatness Index was calculated by ratio of Cardiorespiratory fitness with waist-to-height ratio. Cardiorespiratory fitness is obtained by using Queens college step test (submaximal step test) and convert it into METs. Our current study results indicated that there is significant improvement in their cardiorespiratory fitness by short bouts of stair climbing exercise.
DISCUSSION
These findings show that an eight-week stair climbing programme characterized by multiple short bouts of vigorous activity can result in positive changes in important CVD risk factors. The substantial 17.1% improvement in VO2MAX reported in the present study provides evidence that just over 11 minutes a day of stair climbing is sufficient to elicit cardiovascular adaptations. Although genetic predisposition may account for about 40% of the variation in VO2MAX, 19 physical activity is the key determinant of the remaining 60%. Low levels of cardiorespiratory fitness have been found to be as strong a predictor of mortality as the conventional risk factors, such as cigarette smoking, and are a stronger predictor than hypercholesterolemia and hypertension.
It has also been observed that even small improvements in cardiorespiratory fitness can result in reduced risk of all-cause mortality. Improvement in cardiorespiratory fitness of the magnitude shown in this study should reduce risk of mortality by about 20%, Stair climbing is a vigorous activity because it requires participants to raise all their body mass against gravity. Energy expenditure is proportional to mass raised and speed of climbing is a relatively small contributor to metabolic cost.
Stair climbing is a vigorous physical activity, even at slow speeds, that can increase cardiorespiratory fitness with a lower time commitment than conventional physical activities. stair climbing interventions are one of the few physical activity initiatives that repeatedly change behavior. It has been estimated that the increased energy consumption from these interventions is six times more cost-effective than their nearest competitor. Repeated stair climbing at work, or in the home environment as reported here, would allow daily accumulation of stair climbing episodes. Unlike formal exercise sessions such as sport, stair climbing is a plausible behavior for most of the population. No particular skills are required, there is no competition, and there are few presentational concerns.
The exercising subjects in this investigation showed significant decreases in body weight, body mass index (kg/m2), sum of skinfolds and sum of circumference measures from baseline to post-treatment while the values for the non-exercising control subjects increased slightly over the same time frame. The fact that the control subjects in our study did not lose weight is perplexing and conflicts with other research that generally supports weight loss with caloric restriction. This could also explain the relatively small amount of weight lost by the exercising subjects as well, despite the significant calorie deficit they would have likely incurred with an increase in exercise induced energy expenditure.
CONCLUSION
In conclusion, based on the results of this study it appears that two or three short bouts of exercise have the same effect as one continuous bout of exercise with regard to aerobic fitness and weight loss in overweight individuals.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest about this manuscript.
ACKNOWLEDGEMENTS
The authors sincerely thank Dr. Manoj Abraham M, Professor / Principal, KG College of Physiotherapy, Coimbatore, India, for their support and logistical help to conduct this research.
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