Do psychological factors and sedentary activities influence physical activity level? Findings from Malaysian adolescents

ABSTRACT

Regular physical activity provides important health benefits. However, adolescents reduced their physical activity level as they grown up and eventually may develop chronic diseases. Psychological factors and sedentary activities influence physical activity level. A cross-sectional study using a clustered random sampling method was conducted to identify the association between sedentary activities and psychological factors on physical activity level among 1158 Malaysian adolescents (aged 16–17 years) in Selangor. Participants completed a self-administered questionnaire. The prevalence of physical activity level was 47.40%, 39.40% and 13.20% for high, moderate and low levels, respectively. The psychological factors of self-esteem (χ² = 17.927, df = 2, p < 0.001) and physical activity self-efficacy (F (2, 1155) = 43.570, p < 0.001) were significantly related to physical activity level but not for sedentary activities. The predictor variables for physical activity are suggesting that physical activity self-efficacy may take into consideration for future health programme implementation.

KEYWORDS:

• Physical activity
• adolescents
• self-esteem
• self-efficacy
• sedentary

Introduction

Malaysia is a multiracial country with various ethnics intermingle and live harmoniously. Malaysia has 13 states from both West Malaysia and East Malaysia. Selangor is one of the rapidly developing states that has the highest population density of adolescents in Malaysia. Urbanization and rapid development in the state of Selangor of Malaysia shape diverse physical activity level among adolescents.

Table 1. Prevalence of the physical activity by socio-demographic factors

Variables	High		Moderate		Low
	N	%	N	%	N	%	χ^2	p
Gender
Male	309	58.4	159	30.1	61	11.5	48.442	<0.001
Female	240	38.2	297	65.1	92	14.6
Ethnicity
Malay	303	51.0	222	37.4	69	45.1	6.932	0.031
Non-Malay	246	43.6	234	41.5	84	54.9
Number of siblings
≤3	294	44.3	280	42.2	89	13.4	6.335	0.042
>3	255	51.5	176	35.6	64	12.9
Father’s education
Below tertiary	435	45.0	394	40.7	138	14.3	15.022	0.001
Tertiary	114	59.7	62	32.5	15	7.9
Mother’s education
Below tertiary	468	46.0	408	40.1	141	13.9	7.259	0.027
Tertiary	81	57.4	48	34.0	12	8.5

Table 2. Multinomial logistic regression on predicting high physical activity

							95% CI
Model 1	Β	S.E.	Wald	df	sig.	Exp (β)	Lower	Upper
Intercept	1.029	0.590	3.039	1	0.081
PASE	0.053	0.008	47.005	1	0.000	1.054	1.039	1.071
Revision (≤2 h)	−0.775	0.308	6.332	1	0.012	0.461	0.252	0.843
Father’s education (below tertiary)	−0.646	0.303	4.558	1	0.033	0.524	0.289	0.948
Ethnicity (non-Malay)	−0.426	0.194	4.847	1	0.028	0.653	0.447	0.954
Gender (female)	−0.676	0.197	11.805	1	0.001	0.509	0.346	0.748
Reading (≤2 h)	−0.558	0.279	3.997	1	0.046	0.573	0.331	0.989

Table 3. Multinomial logistic regression on predicting moderate physical activity

							95% CI
	Β	S.E.	Wald	df	sig.	Exp (β)	Lower	Upper
Intercept	0.649	0.596	1.186	1	0.276
PASE	0.024	0.008	9.623	1	0.002	1.024	1.009	1.040
Revision (≤2 h)	−0.468	0.310	2.284	1	0.131	0.626	0.341	1.149
Father’s education (below tertiary)	−0.298	0.309	0.931	1	0.335	0.742	0.405	1.360
Ethnicity (Malay)	−0.110	0.191	0.333	1	0.564	0.896	0.616	1.302
Gender (female)	0.216	0.196	1.214	1	0.271	1.242	0845	1.824
Reading (≤2 h)	−0.012	0.283	0.002	1	0.966	0.988	0567	1.722

Adolescence is an important phase that marks notable changes in physical, biological, hormonal, cognitive and psychosocial development in an individual (Spear, 2002). The unhealthy lifestyle behaviour rooted from urbanization such as unhealthy eating habits and inactivity may subsequently develop chronic disease in adolescents. The growing evidence supported that inculcation of unhealthy and risky lifestyle deteriorates adolescents’ future health (Hallal, Victora, Azevedo, & Wells, 2006).

Physical activity

The modifiable health behaviour of being physically active is crucial to improve health status. Regular participation in physical activity will improve overall health (World Health Organization [WHO], 2010). Adolescents are recommended to perform 60 min of moderate-to-vigorous activity daily (WHO, 2010). However, the WHO (2018) reported that 81% of school-going adolescents from worldwide did not achieve the recommended level of physical activity daily. Although South-East Asia region had the lowest prevalence (74%) of insufficient physical activity, yet the prevalence of physically active is low.

In addition to that, findings from 2018 Active Healthy Kids report card from the countries in Asia region, children and youth in Hong Kong had a lower physical activity level with lower active play reported (Huang et al., 2019). Another evidence of low physical activity level on Overall Physical Activity of middle and high school students was reported with a drastically drop from 2016 to 2018 in South Korea (Oh et al., 2019). Taiwanese youth reported a poor Overall Physical Activity (Wu & Chang, 2019). Furthermore, 60% of Singaporean school students had active physical activity with more than 300 min/week of moderate activity or more than 120 min/week of vigorous activity (Wang, Koh, Biddle, Liu, & Chye, 2011).

Malaysia reported high prevalence on low physical activity level among adolescents in Kuantan (74.7%) (Farah Wahida, Mohd Nasir, & Hazizi, 2011), Kelantan (Hashim, Golok, & Ali, 2011) and Sarawak (65.9%) (Law, Mohd Nasir, & Hazizi, 2014). In view of adolescents who are at their most active age, they are expected to be physically active with a lower prevalence of physical inactivity. However, physical activity decreased when adolescents aged (Lee, Loprinzi, & Trost, 2010). The fundamental to identify the factors that affect their physical activity level on shaping their future health is extremely important and requires research attention.

Psychological factors

Psychological factors influence the engagement in physical activity among adolescents. The belief of one’s ability and values to embrace the significance of physically active in relation to health is important. The necessity to find the psychological factors that encourage adolescents to develop the habit of being physically active is tremendously important for their health. Self-esteem and self-efficacy are important psychological factors that support adolescents to engage in physical activity level.

Self-esteem is the general evaluation of an individual’s self-worth, confidence level and emotional response to the belief of trusting one’s ability (Mann, Hosman, Schaalma, & de Vries 2004). This belief relates to physical activity. A lower level of believing in one’s ability in health behaviour affects the engagement in physical activity. An individual with lower self-esteem on the negative perception of an individual’s appearance and negative body image had a low physical activity level (Kololo, Guszkowska, Mazur, & Dzielska, 2012).

Self-efficacy is the beliefs of one's capability to plan, organize and execute a series of actions to attain the anticipated outcome (Bandura, 1997). In the context of physical activity, self-efficacy is the intention to be active by the initiation to adopt and maintain a physically active lifestyle. Individuals with higher levels of self-efficacy were associated with greater physical activity (Biddle & Fuchs, 2009). Individuals with higher self-efficacy strongly believe in their ability to overcome the obstacles to be physically active (Wang et al., 2015).

Sedentary activities

Sedentariness in activities influences physical activity engagement. The postures or activities that require very little movement such as prolonged sitting, extended time spent on the television and the computer (surfing the Internet for study or work) and playing passive video computer game (Canadian Society for Exercise Physiology [CSEP], 2012) are termed as sedentary. Adolescents aged 12–17 years are recommended to reduce their screen time spent to less than 2 h per day and limit sedentary behaviour of extended sitting and spending time indoor for one whole day (CSEP, 2012). As adolescents spent most of their hours in school and the ease of accessibility to gadgets, e.g. smartphones, tablets and computers, youngsters spend their time sedentarily (Odiaga & Doucette, 2017). Physically active adolescents spent more time on ‘productive sedentary behaviour’ (reading or doing homework) were found positively associated with increased physical activity (Feldman et al., 2003).

Justification of study

There are many factors closely related to the physical activity level among adolescents. Numerous studies reported that older adolescents were having lower physical activity level as they grown up from young adolescence to young adulthood. This study targets on older adolescents and identifies the physical activity patterns. It is important to enhance the deficiency of literature since there are scarce studies on older adolescents.

Furthermore, psychological factors and sedentary activities are important factors in relation to physical activity level among adolescents. The identification of psychological factors would be an inspiring aspect to encourage adolescents to be physically active. The initiative inner willpower of staying physically active rooted from oneself would be more persuasive for adolescents to change their health behaviour. The uplift of health behaviour of being physically active among adolescents would have reverted the development of chronic disease in their future adulthood.

Likewise, sedentary activities may be an aspect to study in relation to physical activity level among adolescents. The identification of preferred sedentary activities that adolescents would likely to spend time on is important. The improvement in the variation of activities may improve the physical activity level in adolescents.

This study aims to investigate the association between physical activity level and socio-demographic factors, sedentary activities and psychological factors among Malaysian adolescents. This study hypothesized no association between physical activity level and socio-demographic factors, sedentary activities, self-esteem and physical activity self-efficacy among adolescents.

Methods

Study design and sampling

This was a cross-sectional study. Participants were selected by the clustered random sampling method. Upon granting the approval from the Ministry of Education, Department of Education of the state of Selangor, selection of schools and respondents that fulfilled the selection criteria was done using a random number table. A list of all secondary schools in Selangor was obtained from the Department of Education of the state of Selangor. All schools that fulfilled the selection criteria of national co-educational secondary schools were included in this study.

The schools as the primary unit in this cluster random sampling were selected randomly by using a random number table. All Form Four students from that randomly selected school were invited to participate in the study with the approval from the school principals. Students with given consent by their parents or guardians were participated in this study. The selection of schools using the random number table was repeated until the consented Form Four students to participate achieved the minimum sample size of at least 1084 based on the equation by Lwanga and Lemeshow (1991) to calculate the sample size after adjusted with the study design. There were 1158 students participated in the present study from the invited 1748 students.

Measurements

A self-administered questionnaire was used in this study. The questionnaire was translated into the national language of Malaysia and then translated back into English by two postgraduate students who are bilingual speakers. The questionnaire was checked for the reliability of internal consistency of Cronbach’s alpha, face validity and content validity prior data collection. The questionnaire used for data collection had a good test–retest reliability of 0.7 and above for each of the measurements taken.

Physical activity level

Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ, 2005) with the consideration of time consumption for answering the questionnaire. This questionnaire has seven items to measure physical activity on the number of days (frequency) and the number of minutes per day (duration) of participation in all kinds of vigorous and moderate activities as well as the sitting time for the past seven days (IPAQ, 2005). The frequency and duration of activities were computed and expressed in metabolic equivalent (MET)-min/week as suggested by the guidelines by IPAQ. The scoring was categorized into three levels of high, moderate and low with the score of total physical activity MET-min/week of at least 3000 MET-min/week, at least 600 MET-min/week and less than 600 MET-min/week, respectively.

Psychological factors

The psychological factors studied in this study were self-esteem and physical activity self-efficacy. Self-esteem was assessed using the Rosenberg Self-Esteem Scale (Rosenberg, 1965) with a Cronbach's alpha of 0.591. A cutoff point of 25 was used in this study (Isomaa et al., 2013). Physical activity self-efficacy was evaluated using the adapted physical activity self-efficacy (PASE) scale (Saunders et al., 1997) on a numerical scale with a Cronbach's alpha of 0.918.

Sedentary activities

Sedentary activities were measured on the time spent on the common activities among adolescents. The activities include (i) screen time activities (i.e. watching television/video, playing video games, using a computer not for study purpose and using electronic devices) (Kantomaa et al., 2016; McVeigh & Meiring, 2014; Wang et al., 2015) and (ii) extended sitting (Kantomaa et al., 2016; Wang et al., 2015), i.e. studying, reading, doing homework, attending after-school additional class and attending tuition class. The frequency (number of days) and duration (time spent) for each of the sedentary activities were recorded. Time spent on screen time activities or extended sitting of more than 2 h/day or equivalent to 14 h/week was grouped as sedentary and vice versa (CSEP, 2012). The questionnaire was modified from past studies (McVeigh & Meiring, 2014; Wang et al., 2015) with the selected activities which are common among adolescents.

Statistical analysis

The results were analysed using the Statistical Package for Social Science (SPSS) version 23.0. A descriptive analysis was used to summarize the level of physical activity, sedentary activities, level of self-esteem level and physical activity self-efficacy. An ANOVA and chi-square test were used to determine the relationship between physical activity level and socio-demographic factors, sedentary activities, self-esteem and physical activity self-efficacy. The predictor variables for physical activity level were assessed by multinomial logistic regression. The significance level was set at p < 0.05.

Results

A total of 1158 Form Four students (529 boys and 629 girls) with the mean age of 16.06 ± 0.24 years old were recruited in this study. The physical activity level was 47.40%, 39.40% and 13.20% for high, moderate and low levels, respectively. Male and Malay adolescents were more active. Respondents with more than three siblings and their father and mother with tertiary education significantly engaged in a higher level of physical activity (Table 1). The psychological factors significantly related to the level of physical activity were self-esteem (p < 0.001) and physical activity self-efficacy (p < 0.001).

All screen-related behaviours (watching television, browsing for social media, using electronic devices and using a computer not for study) were not significantly related to the level of physical activity. Similarly, study-related sedentary activities (attend school tuition, attend home tuition and doing homework) were not significantly related to the level of physical activity except reading (χ² = 9.041, p = 0.011) and doing revision (χ² = 11.058, p = 0.004).

Multinomial logistic regression was used to determine the set of predictor variables of physical activity level among respondents. Independent variables with p < 0.250 were included in the analysis, considering that the variables may have a reasonable association with the outcome (Bursac, Gauss, Williams, & Hosmers, 2008). The forward entry method in multinomial logistic reggression was used as more predictor variables were found significantly predicting physical activity level.

The addition of the predictors to a model significantly improved the fit between model and data, χ² (12) = 162.198, Nagelkerke R² = 0.152, p < 0.001. Goodness of fit was explored by Pearson test (p = 0.252) and deviance test (p = 0.991) which indicated that the model was at a good fit of the data. Although 12 predictor variables with p < 0.250 were included in the model, only 6 independent variables were found significantly predicted a high level of physical activity with reference to low level of physical activity. The significant predictor variables for high physical activity level were physical activity self-efficacy, time spent on revision, father’s education, ethnicity, gender and time spent on doing revision (Table 2), whereas the significant predictor variable for moderate level of physical activity level was physical activity self-efficacy (Table 3).

Discussion

Majority of the Form Four students (senior students in secondary school) in this study engaged in higher physical activity. Older adolescents spent a greater amount of their time in vigorous club sports had significant higher moderate-to-vigorous physical activity (Micklesfield et al., 2014). Boys were more active than girls in physical activity. Boys were frequently engaged in unstructured physical activity such as during recess and after school (Mota et al., 2005), school and club sports (Micklesfield et al., 2014), whereas girls were involved in passive activities. Despite boys were widely accepted socially as playful and physically active than girls, higher parental support encourages boys but not girls (Telford et al., 2016) to engage in physical activity. Furthermore, the girls felt a lack of competency of being physically active than boys (Telford et al., 2016) in participating in physical activity level.

Malay as the largest ethnic group (51.3%) participated in this study; they were significantly participated in high physical activity level. The differences in culture between Malay and non-Malay in Malaysia influence the engagement in physical activity among respondents. The culture of discouraging exercise but encouraging their children to focus on study by attending classes that benefits their future was found to be common among Malaysian Chinese (Lian et al., 2016). Malaysian Indian was the third major ethnic in this study, and they were more often engaged in light activity that involves less vigorous movement (Lian et al., 2016).

Consistent with past studies (McMinn et al., 2011; Silva et al., 2016), adolescents with more siblings were influenced and motivated by their siblings and subsequently encouraged to be active (Cheah, Lim, Kee, & Ghazali, 2016). Role modelling from siblings who were active in sports may foster active participation (Blazo & Smith, 2016) by influencing their younger siblings to be physically active (Rønbeck & Vikander, 2011). Parents with higher levels of education had more exposure to knowledge and information on health benefits and would be more compliant with the physical activity guideline (Butcher, Sallis, Mayer, & Woodruff, 2008). Mothers with a higher level of education may guide their children to develop a positive attitude on the adoption of health-related behaviours (Veselskla, Geckova, Reijneveld, & van Dijk, 2011). Well-educated individuals may have better understanding skills and more conscious about methods of staying physically active (Cheah, 2011).

Both psychological factors of self-esteem and physical activity self-efficacy significantly related to the level of physical activity. The engagement in physical activity among adolescents may relate to the perception of an individual of having the ability and confidence to be physically active (Sallis, Pinski, Grossman, Patterson, & Nader, 1988). An individual who strongly believe their ability to overcome the obstacles to be physically active would have stronger self-efficacy (Wang et al., 2015) and hence engage in a higher level of physical activity. Parallel with past studies, self-esteem was positively associated with physical activity level. Low self-esteem was found in adolescents with higher negative perception of their appearance (Kololo et al., 2012) and increases the risk of insufficient physical activity. Greater participation in physical activity rooted from higher self-esteem is related to greater enjoyment (Adachi & Willoughby, 2014). Adolescents with higher self-esteem believe in their ability and values to engage in health behaviours of participating in physical activity with greater enjoyment.

Consistent with Feldman et al. (2003), physical activity was positively associated with ‘productive sedentary behaviour’ (reading or doing homework). Although students spent most of their time in academic-related activities such as doing homework, studying, reading and doing revision, this may not necessarily displaced their physical activity level (Pearson et al., 2014). Individual spent a longer time on sedentary may not necessarily physically inactive (Kee et al., 2011). The present study findings showed that adolescents who engaged more time in reading and doing homework significantly engaged in moderate and higher physical activity. This would probably due to the capability of better time management of students (Feldman et al., 2003) to balance their time duration spent on study and engage in sports or exercises (Chen, Haase, & Fox, 2007). However, the allocation of time spent and physical activity engagement deem an interest to identify the discrepancies and need more research to fill this gap.

On the contrary, all screen-related sedentary activities were not significantly related to physical activity level. Along with emerging technology, television was replaced with streaming movies, and time spent on screen-related sedentary activities is increased (Odiaga & Doucette, 2017). More than half (54.1%) of Malaysian students spent more than 2 h per day on screen-related sedentary activities (Woon, Chin, & Nasir, 2015). Students are speculated to spend their time on academic-related activities rather than screen-related activities. Students spent their time in school by involved in co-curricular activities. This subsequently reduced screen-related sedentary activities on top of parents’ major concern of their children to focus on academic (Cheah et al., 2016).

The significant socio-demographic predictor variables for higher physical activity level were gender, ethnicity and father’s education level. Parallel with the findings, male was 1.96 times higher than female to engage in higher physical activity. Malay was 1.53 times higher than non-Malay to engage in higher physical activity. Adolescents with the father having tertiary education were 1.9 fold to have higher physical activity. Physical activity self-efficacy was significant predictors for both high and moderate physical activity levels. As speculated, the predictor variables were consistent with past studies (Dan, Mohd Nasir, & Zalilah, 2011) on the socio-demographic and psychological factors. Furthermore, sedentary activities that were found significantly predicting physical activity were time spent on doing revision and reading. The time spent on reading and revision of more than 2 h was 2.17 fold and 1.75 fold increase the physical activity level among the respondents. Although there were some studies found that sedentariness may coexist with physical activity level, the predictor variables of sedentariness activities deem more research interest to support the findings.

Findings from this study suggested that the psychological factors of self-efficacy and self-esteem would have influenced adolescents to be physically active leading to a healthy lifestyle. Self-efficacy and self-esteem were closely related to the internal motive and belief to participate in physical activity which would have influenced internally to improve physical activity level among adolescents. Furthermore, the deficiency of studies on psychological factor, particularly on older adolescents, is worth for research interest.

The inculcation of the habit of being physically active starts from younger age as in adolescence is important to be active in their future adulthood. These findings may practically provide some new insight into health professionals on modifying the activities or approaches in health promotion intervention. The concurrent efforts to improve the psychological factors internally among adolescents and the external efforts of health promotion intervention would be effective to instil the habit of being physically active.

Strengths and limitations

The present study documented the findings on socio-demographic factors, sedentary activities and psychological factors on the physical activity level among older adolescents. The randomization process of the sample was the strength of the study. Despite the cross-sectional study design which only able to collect the physical activity pattern at a certain point time, the shared limitation of epidemiological studies was the subjective measurement of physical activity and sedentary behaviour. Furthermore, the moderate response rate was another limitation. The incomplete questionnaires on the data provided by the students after several attempts have to be removed from the analysis and gave the moderate response rate.

Implications and future research

The findings from the present study on low physical activity level on non-Malay girls would provide some insight into health professionals to design intervention programmes and health promotion activities, particularly on adolescent girls to improve their future health. Furthermore, the intervention of health programme may target on increasing the self-esteem and physical activity self-efficacy when implementing a health programme for adolescents. This would encourage more participation in physical activity and hence reduce the prevalence of chronic diseases among adolescents by encouraging them to be physically active along with the health promotion intervention and activities by health professionals.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Geran Putra Inisiatif Putra Siswazah of Universiti Putra Malaysia [Grant number GP-IPS/2014/9433943].

Notes on contributors

Leong In Tyng

Leong In Tyng is currently a master degree student. Her research interest on adolescence health draws her to involve in research.

Nor Afiah Mohd Zulkefli

Nor Afiah Mohd Zulkefli, PhD, is an associate professor in the Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. Her research interests are in the field of public health medicine, family health, and adolescent health. She has published numerous articles in international journals.

Salmiah Md Said

Salmiah Md Said, Master in Community Medicine, is a senior lecturer in the Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia. Her involvement in research drives her to plentiful of publication in her research interest of public health.