FACULTY OF HEALTH SCIENCES

SEMESTER 1 SESSION 2019/2020

NDD 20103
NUTRITIONAL STATUS ASSESSMENT

NAME : NUR IZZAH ANIS BINTI ABU BAKAR (050128)

PRACTICAL : PHYSICAL ASSESSMENT
NAME OF : DR. WEE BEE SUAN
LECTURER
DATE OF : 9ST DECEMBER 2019
SUBMISSION

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TABLE OF CONTENTS

CONTENTS PAGE

1.0 INTRODUCTION 3

2.0 OBJECTIVES 4

3.0 METHOD 5

4.0 RESULTS 6

5.0 DISCUSSION 8

6.0 CONCLUSION 12

7.0 REFERENCES 13

8.0 APPENDICES 15

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1.0 INTRODUCTION

Physical activity is a behavior that involves bodily movements resulting in energy expenditure.
Physical activity assessment is an evaluation of physical activity level of individual per daily. The
purpose of measuring physical activity is to identify individual lifestyle index and understand the
relations between physical activity and health and determining the effectiveness of interventions.
It provides an estimation of the total daily energy expenditure. The purpose of this practical is to
assess the physical activity level of specific individuals and population. In this situation the
information on the usual daily activities is required. In this practical, the method available is
Pedometers where it is increasingly being used to measure physical activity in children and
adolescents. Starting in the mid-1900s, researchers became interested in using steps per day
to quantify ambulatory physical activity. Merriam-Webster defines a step as ‘‘a movement made
by lifting your foot and putting it down in a different place By counting the number of steps
accumulated in a day, both sedentary behaviors and indicators of insufficient activity can be
identified. Step counters are devices worn on the body that measure steps or distance travelled.
Measurement of steps has a number of other advantages which are can be measured easily and
accurately and can be used to place people into less active and more active categories.
Pedometers are a simple tool used to track daily physical activity, specifically walking. With its
ease of use, low cost and low participant burden, consideration should be given for implementing
a pedometer within and outside of the college and university physical education settings to
promote increases in daily physical activity.
By utilizing institutionalized assessment methods and aligned instruments, best quality body
measurement data can be obtained. Appropriation of standard profile and procedure enables
correlation to be made between sample groups.

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2.0 OBJECTIVES

a) To determine the physical activity level and activity energy expenditure of 2nd year
UniSZA Dietetics students.
b) To compare the achieved pedometer hand phone step counts with the step count
recommendation according to Tudor-Locke et al. 2011.
c) To compare the group achieved hand phone pedometer step counts with the step count
recommendation according to Tudor-Locke et al. 2011.

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3.0 METHODS

3.1 Instruments

a) Pedometer hand phone apps

b) Physical activity record

3.2 Procedures

3.2.1 Pedometer hand phone apps

1. The step count is recorded from morning when wake up till night before go to bed for 7
days.

3.2.2 Physical activity record

1. The daily activities is recorded for 1 day which is the same day with pedometer step
count measurement.
2. A comprehensive record of time spent is kept for performing all activities which is to the
nearest 5 minutes including sleeping, eating, sitting, standing, watching television,
occupational activity and household tasks as well as information on the duration and
intensity of all physical activities and structured exercise.
3. The energy expenditure is calculated by using an Excel spreadsheet for estimation of
energy expenditure.
4. The rate of EE (in kcal. h-1.kg-1 body mass) to each activity is allocated using
Compendium of Physical Activities (Ainsworth et al, 2000).
5. The time spent in each activity is also allocated. Then the time spent in activity (in
hours) is multiplied by corresponding rate of EE (kcal. h -1.kg-1 body mass).
6. The value of EE of each activity is added together and expressed in kcal.day-1.kg-1 body
mass.
7. The sum of EE (kcal. day-1.kg-1 body mass) then is multiplied by body mass (kg) to
obtain total daily energy expenditure (kcal/ 24 h).

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4.0 RESULTS

DAY STEP COUNT

Tuesday 1001
Wednesday 1053
Thursday 1103
Friday 896
Saturday 1037
Sunday 771
Monday 1167

Mean step count for weekday 1081

Mean step count for weekend 1037
Mean step count per daily 1578

Table 1 shows the step count recorded for seven days.

Activity Rate of EE Time EE of activity

(kcal/h/kg) Hours Kcal/kg
Sleeping 0.9 8.83 7.95
Washing/Dressing 2.5 0.17 0.43
Walking light 2.5 0.17 0.43
Sitting 1 8.50 8.50
Eating 1.5 0.50 0.75
Washing Dishes 2.3 0.17 0.39
washing clothes 2 0.25 0.50
Climbing stairs 5 0.08 0.40
Making Bed 2 0.08 0.16
Showering 4 0.50 2.00
Sitting while playing hand phone 1 1.00 1.00
Praying 1 0.83 0.83

Body mass (kg) 62

Total EE(kcal.day-1.kg-1) 23.33
Total (kcal/ day) 1446.46

Table 2 show the daily activities for Saturday.

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 STEP COUNT PER DAILY NUMBER OF STUDENTS
>1000 19
>2000 25
>3000 6
>4000 2
>5000 1

MEAN STEP COUNT PER DAILY 2380

Table 3 shows the number of students classified according to the range step count per daily.

LIFESTYLE INDEX FOR DIETETIC STUDENTS

ACTIVE

LOW ACTIVE

SEDENTARY

0 10 20 30 40 50 60

Graph 1 shows the lifestyle index for dietetics student classified in three type of lifestyles
which are sedentary, low active and active.

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5.0 DISCUSSION

5.1 The objective of the practical

Based on the practical, the determination of physical activity level and activity energy
expenditure of 2nd year UniSZA Dietetics students are measured by using standardized
examination procedure and calibrated equipment. This practical involved two main
methodology which are step count measurement by using Pedometer hand phone apps for
seven days and physical activity recorded for 1 day which is the same day with pedometer
step count measurement. In measuring the step count, it is recorded from morning when wake
up till night before go to bed for 7 days approximately 10 hours for each day. With all the
measurement, we were able to compare the achieved pedometer hand phone step counts
with the step count recommendation according to Tudor-Locke et al. 2011. One day is chosen
which correlate with the day with pedometer step count measurement by recording the daily
activities to determine the activity energy expenditure. The dietetic group students of step
count measurement is calculated to compare the group achieved hand phone pedometer step
counts with the step count recommendation according to Tudor-Locke et al. 2011. With all the
measurement data, we were able to identify the lifestyle index for dietetic students whether
they are in sedentary, low active, active, physically or very active lifestyles.
The mean step count per daily that I obtained for seven days is 1578 which is correlated
with the mean step count for weekday (1081) and the mean step count for weekend (1037).
Mean weekday step counts were higher than mean weekend steps. Saturday is chosen with
step count measurement is 1037 and the total daily energy expenditure is 1446.46 kcal/day.
For group, the mean step count per daily that obtained for seven days is 2380. Based on Table
3, it reveals that the majority of dietetic students which is 25 students are only achieved step
count in range >2000 per daily. Meanwhile 19 students are reached >1000, 6 students
obtained >3000 and 2 students got >4000 step count per daily. Last but not least, there is one
student who approximately obtained step count >5000 per daily. In 2011 Tudor-Locke and
Bassett introduced the concept of a graduated step index for healthy adults: 1) < 5,000
steps/day is sedentary, 2) 5,000-7,499 steps/day is low active, 3) 7,500-9,999 steps/day is
active, 4) ≥10,000 steps/day physically active and 5) ≥12,500 steps/day very active.
LIFESTYLE INDEX FOR ADULTS STEP COUNT PER DAY
Sedentary <5000
Low active 5000-7499
Active 7500-9999
Physically active ≥10000
Very active ≥12500
Table 4 shows the steps-per-day categories and classification system of Tudor-Locke et al.
2011.

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 In comparison with the 2011 Tudor-Locke and Bassett classification system, it shows my
individual lifestyle index is sedentary as the step count per daily is 1578. Meanwhile for the
group, according to Graph 1, it shows that 52 students are having sedentary behavior and
only 1 student has the low active lifestyle due to her step count is in range 5000-7499. This
happen because it is correlated with the group’s mean step count per daily which is <5000,
classified as sedentary.

5.2 Results obtained

In comparison with the 2011 Tudor-Locke and Bassett classification system, we found that
the majority (52) of the students including me were having inactive lifestyle behavior. Hence,
we examined the issue of inactivity among dietetic students. By counting the number of steps
accumulated in a day, both sedentary behaviors and indicators of insufficient activity can be
identified. A significant decline in physical activity among dietetic students as they are not
meet the minimum recommendations for physical activity and instead are leading highly
sedentary lifestyles. Researchers state that adults should accumulate at least 30 minutes or
more of moderate to intensity physical activity on most days of the week in order to be healthy.
In addition, a young, healthy population of college students should be expected to accumulate
between 7,000 and 13,000 steps per day.
Based on Journal of Instructional Pedagogies, it states that individual variations in daily
routines may have accounted for the fluctuation of steps taken between days of the week.
Academic and time demands may also play a significant role in the daily step fluctuation
between individuals. All students attended classes on campus from Tuesday to Thursday. The
variance between Thursday and weekend day (Friday and Saturday) in steps taken was
largely due to the weekend holiday. Although it may have been a limitation to this practical, a
holiday does not necessarily have to be a significant factor for activity performed in daily living.
My total values of energy expenditure (EE) of each activity is 23.33 kcal.day-1.kg-1. . From
this values, we are able to obtain the total daily energy expenditure which is 1446.46 kcal/day
by multiplying with the body mass. According to Recommended Nutrient Intake (RNI), energy
requirement for female adults aged 19 – 29 years with 60 kg is 1740 kcal/day. To maintain
body weight, it is necessary to balance the energy derived from food with that expended in
physical activity. To lose weight, energy expenditure must exceed intake and to gain weight,
energy intake must exceed expenditure. Basically my energy expenditure in this physical
activity is lower than energy requirement of RNI. This is because based on step count taken
on that day, I was having inactive lifestyle behavior.

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5.3 Journal reading
A number of studies have assessed the validity and reliability of pedometers. There is one
research published on 2016 by Digital Health entitled Validity of the Samsung Phone S Health
application for assessing steps and energy expenditure during walking and running: Does
phone placement matter? The purpose of this study examined the validity of the Samsung S
Health application in measuring steps and energy expenditure and also wanted to determine
if smartphone placement impacted the app’s measuring capabilities. According to the study,
advantages of smartphone use in physical activity research include increasing participant
recruitment and compliance, transmission of data wirelessly over long distances and an ability
to program smartphone software to the researcher’s specifications. The protocol of this study
is the participants were first asked to complete a 15 minutes 200-m walk around an indoor
track at self-selected pace with one pre-programmed Samsung smartphone being held in their
non-dominant hand and the other pre-programmed smartphone placed in their right pocket.
Smartphone placement did not impact the S Health app’s ability to estimate steps and energy
expenditure when compared with the criteria during self-selected pace walking. However
Smartphone placement had a negative impact on the S Health app’s ability to estimate energy
expenditure when compared with the criterion during treadmill running. Placement of the
phone impacts the S Health application accuracy in measuring physical activity variables
during treadmill running.
Based on journal Sports Medical, it states that the most accurate placement step counter
for walking is worn on the ankle because it is able to detect several signature movements
involved in stepping, ensuring that it has high sensitivity and specificity for recording steps.
Wrist step counters do not count steps when the wrist is stationary. Step counting has long
been used to quantify ambulatory physical activity. From these research, it can be concluded
step counter is valid in measuring steps and energy expenditure for ambulatory physical
activity only which is walking regardless the placement of it. However, placement of step
counter is highly impact the ability to estimate steps during running.
Another research written by H Kumahara, H Tanaka & Y Schutz published on 2009 by
European Journal of Clinical Nutrition entitled Are pedometers adequate instruments for
assessing energy expenditure? The purpose of this research is to determine whether the total
number of steps can estimate EE over a 24-h period. This research found that total number of
steps per day was not a meaningful predictor of the physical activity energy expenditure
(PAEE). When body weight was taken into account, it became a significant predictor. This
explain why we need to multiply the values of energy expenditure of each activity with body
mass to obtain total daily energy expenditure. Two recent studies reported no significant
correlation of the step counts with PAEE, however accelerometry is thus considered to be both
a more meaningful and better predictor of EE than step counts, particularly in sedentary

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individual. It can be concluded that the total number of steps per day does not provide accurate
information on the EE, instead it is only a rough predictor of the general PA in terms of
displacement (walking). Despite this limitation, if the overall walking activity index is the
outcome to be assessed, the pedometer remains a useful and relatively low-cost instrument
in comparison with the accelerometry technique.
Last but not least, pedometers have recently become popular as a tool for motivating
physical activity. There is one research published by Clinician’s Corner on 2007 entitled Using
Pedometers to Increase Physical Activity and Improve Health. Its purpose is to evaluate the
association of pedometer use with physical activity and health outcomes among outpatient
adults. The results suggest that the use of a pedometer is associated with significant increases
in physical activity and significant decreases in body mass index and blood pressure.
According to the Journal of Instructional Pedagogies, a pedometer was used as an
intervention strategy, to increase awareness of, and motivate college students to achieve the
minimum recommended amount of daily physical activity. McKercher et al. reported that
women who achieved ≥7,500 steps/day had a 50% lower prevalence of depression than
women taking <5,000 steps/day. Schmidt et al. reported that individuals taking <5,000
steps/day had a substantially higher prevalence of a number of adverse cardio metabolic risk
factors than those taking higher steps/day. Hence it can be summarized step-based
recommendations for physical activity might be more appropriate and better received by the
large population who do not regularly engage in any sport or other exercise apart from walking
as it is the most frequently reported leisure-time activity.

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6.0 CONCLUSION

In summary, results show that the dietetic students is classified as an individual that
have spent more time in sedentary behavior due to low step. However, inactivity behavior
influenced by several factors include social, natural or built environments and situational
factors for example mode of transport influences steps/day. The weather for example ambient
temperature and rainfall is another contextual factor related to pedometer-determined physical
activity. Walking is a very familiar and accessible type of physical activity that people
participate in on a regular basis. Most people walk during recreational activities, transportation,
occupational tasks and activities of daily living. However, for a large percentage of the
population, the amount of physical activity performed throughout the day fails for reaching the
minimum recommended guidelines for either health or fitness. Thus, simply performing the
basic activities of daily living is not sufficient to meet the minimum recommendations, improve
health and reduce the risk of chronic disease and premature death .Adults should accumulate
30 minutes or more of moderate to intensity physical activity on most days of the week. A
pedometer was used as an intervention strategy, to increase awareness of and motivate
college students to achieve the minimum recommended amount of daily physical activity. By
using pedometer method to measure physical assessment, the common sources of error are
over counting or undercounting of steps. In an effort to prevent these errors, pedometer
manufacturers have attempted to devise solutions to enhance pedometer accuracy.
Undercounting at slow speeds is a problem that afflicts most step counters. Double-counting
of steps is a common problem with less expensive step counters.
In general the accumulation of 10,000 steps/day is commonly promoted as a healthful
amount of physical activity. Individuals who accumulate at least 10,000 steps/day are more
likely to engage in at least 30 minutes of moderate-intensity physical activity than those who
do not accumulate 10,000 steps/day.

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7.0 REFERENCES

1. Bassett, D. R., Toth, L. P., LaMunion, S. R., & Crouter, S. E. (2017, July). Step Counting:
A Review of Measurement Considerations and Health-Related Applications. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488109/.
2. Bassett, D. R., Wyatt, H. R., Thompson, H., Peters, J. C., & Hill, J. O. (2010, October).
Pedometer measured physical activity and health behaviors in U.S. adults. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927728/.
3. Bravata, D. M. (2007, November 21). Using Pedometers to Increase Physical Activity and
Improve Health. Retrieved from https://jamanetwork.com/journals/jama/article-
abstract/209526.
4. Choi, P., Allred, A. T., Ryuh, Y., & Agiovlasitis, S. (2019, November 27). Prediction of
Energy Expenditure from Pedometer-Determined Step-Rate in Adults with and without
Down Syndrome. Retrieved from https://link.springer.com/article/10.1007/s10882-019-
09714-z.
5. Clemes, Stacy & Biddle, Stuart. (2013). The Use of Pedometers for Monitoring Physical
Activity in Children and Adolescents: Measurement Considerations. Journal of physical
activity & health. 10. 249-62. 10.1123/jpah.10.2.249.
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determined physical activity and active transport in girls. Retrieved from
https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-5-2.
7. Kumahara, H., Tanaka, H., & Schutz, Y. (2009, August 26). Are pedometers adequate
instruments for assessing energy expenditure? Retrieved from
https://www.nature.com/articles/ejcn2009108.
8. Oliver, Jennifer Lee, "Pedometer Estimated Step Rates and Energy Expenditure" (2004).
University of Tennessee Honors Thesis Projects.
https://trace.tennessee.edu/utk_chanhonoproj/780
9. Pillay, Tomaz, & Lambert. (n.d.). Steps that count: pedometer-measured physical activity,
self-reported physical activity and current physical guidelines - how do they relate?
Retrieved from http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1015-
51632014000100004.
10. Tudor-Locke, Catrine & Craig, Cora & Brown, Wendy & Clemes, Stacy & De Cocker,
Katrien & Giles-Corti, Billie & Hatano, Yoshiro & Inoue, Shigeru & Matsudo, Sandra &
Mutrie, Nanette & Oppert, Jean-Michel & Rowe, David & Schmidt, Michael & Schofield,
Grant & Spence, John & Teixeira, Pedro & Tully, Mark & Blair, Steven. (2011). How many
steps are enough? For adults. The international journal of behavioral nutrition and physical
activity. 8. 79. 10.1186/1479-5868-8-79.

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11. Tudor-Locke, Catrine & Craig, Cora & Thyfault, John & Spence, John. (2013). A step-
defined sedentary lifestyle index:. Applied physiology, nutrition, and metabolism =
Physiologie appliquée, nutrition et métabolisme. 38. 100-14. 10.1139/apnm-2012-0235.

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8.0 APPENDICES

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