Research Article
The health and fitness profiles of nurses in
KwaZulu-N atal
R. Naidoo,
Sport Science Department, University of KwaZulu-Natal, Edgewood Campus
Prof. Y. Coopoo
Centre for Exercise Science and Sports Medicine, University of Witwatersrand
Keywords:
nurses health fitn ess profiles, lower back
pain
Abstract: Curationis 30(2): 66-73
Back pain has been recognized as a problem in hospitals, with up to 50% ofhealthcare
s ta ff reporting sym ptom s (Smedlv, Egger, Cooper and Coggon, 1997 and Engels, van
der Guilden, Senden and v a n ’t Hof, 1996). The general purpose o f this study was to
determ ine the health andfitness profiles o f nurses working in a public hospital. It was
hypothesized that there is a correlation between the prevalence o f lower back pain and
being overweight or obese am ongst nurses. One hundred and seven nurses fro m a
local hospital in KwaZulu Natal participated in this study. Responses fro m a health
questionnaire exam ining m edical histoiy, dietary, exercise and lifestyle patterns were
analyzed. Fitness tests determ inedflexibility (sit and reach), m uscular strength (back
and grip strength), aerobic capacity (Astrand-Rhym ing cycle) and anthropom etrical
data (percent body f a t and BMI). Results suggested overall p o o r health and fitn e ss
pro files and a high incidence o f back pain correlating with increased body fa t
percentages, thus accepting the hypothesis. The need f o r health a n d wellness
intervention strategies in hospitals f o r the nurses was emphasized.
Introduction
Correspondence address:
Ms. R. N aidoo
U niversity O f K w azulu N atal
E dgew ood Campus
Sport Science D epartm ent
Private B a g X 0 3
A sh w o o d
3605
Tel : (031) 260-3676
F ax : (031) 260-3595
E -m ail : naidoor3@ ukzn.ac.za
O p tim u m h e a lth is s o m e th in g each
individual and em ployee w ould want.
Ideally, optim um health im plies living a
relatively disease-free life. M inim ising
disease development, especially lifestylerelated diseases such as cardiovascular
disease, diabetes, cancer or obesity is
v e ry p o ssib le . H e a lth ca re in d u stry
employees are certainly not immune from
lifestyle-related diseases or work-related
injury (McAllister andBroeder, 1993:50).
With this statem ent in mind, the general
purpose o f this study was to determine
the health and fitn e ss profiles o f nurses
working in a public hospital. A tertiary
p u r p o s e w as to d ev elo p h e a lth a n d
wellness program m es f o r the nurses as a
resu lt o f the testing program m e. The
r e s e a r c h e r s o f th is s tu d y a lso
hypothesised that there is an association
between obesity and the prevalence o f
low er back pain am ong nurses.
L o w e r b a ck p a in is th o u g h t to be a
66
Curationis June 2007
p a rtic u la r h a za rd o f n u rsin g (C ust,
Pearson andMair, 1972:169). In the United
States o f Am erica, nursing p e rso n n e l
have one o f the highestjob related injury
rates o f any occupation. The rate f o r
hospitals (approximately nine in every
100 fu ll-tim e workers) was the fo u rth
highest (US Department o f Labour, 2002).
Similarly, according to the F aculty o f
Occupational Medicine (2001), backpain
is a m ajor cause o f m o rb id ity in the
w o r k in g p o p u la tio n in th e U n ite d
K ingdom , with a p re v a le n c e o f 40%
overall and accountingfor 50 million lost
working days each year. B ack pain has
b een r e c o g n is e d as a p r o b le m in
hospitals, with up to 50% o f healthcare
sta ff reporting symptoms (Smedly, Egger,
C ooperand Coggon, 1997:1226). This is
an indicator that the back injury problem
in n u r s in g p e r s o n n e l is im p o rta n t,
however, in South Africa fe w studies have
r e p o r te d on w o rk p la c e p r e v e n tio n
programmes.
Similarly, Yassi, Khokhar, Tate, Cooper,
Snow, and Vallentyne (1995) fo u n d that
51% o f nurses com plained o f back pain
a n d m o re r e c e n tly . M a u l, L a u b li,
Klipstein, and K rueger (2003) concluded
that low er back pain was prevalent in
nurses with an increase o f 73% - 76%
annually. These statistics emphasize the
need fo r wellness programmes that would
a d v ise n u r s e s on p r e v e n ta tiv e a n d
treatment interventions fo r back pain.
Such program m es should comprise o f an
educational program m e, physical fitness
in te r v e n tio n a n d o f b a c k in ju r y
rehabilitation.
Methodology
Research Design
The research design was a quantitative
su rvey th a t re q u ire d p a rtic ip a n ts to
complete a questionnaire and perform a
series o f fitn e ss tests.
Instruments and Tests
The H e a lth a n d P h y s ic a l A c tiv ity
questionnaire was designed by Corbin
and Lindsey (1985), which consisted o f a
to ta l o f fo r t y - s e v e n c lo s e - e n d e d
questions. A ll participants completed the
q u e s tio n n a ir e . The q u e s tio n n a ir e
c o n s is te d o f th r e e s e c tio n s . The
injoim ation obtained fro m the various
sections included, personal and fa m ily
m edical history, sm oking and drinking
habits; dieta ry p a tte rn s and p h y sic a l
activity profiles.
The fitn e ss test b a tteiy com prised o f the
f o llo w in g c o m p o n e n ts : a n th r o p o metrical, flexibility, aerobic and strength.
Anthropometry
The a n th r o p o m e tr ic a l c o m p o n e n t
consisted o f height, weight, waist-to-hip
ratio and skin fo ld m easurements. The
height and weight measurem ents were
u sed to d eterm in e p a rtic ip a n ts Body
Mass Indexes. The purpose o f this test
w as to p r o v id e an indica tio n o f the
relationship o f an individual’s weight in
relation to their height. (Bray, 1993) while
the purpose o f the waist-to-hip ratio was
to determine abdom inal and hip obesity
patterns f o r each participant (van Itallie,
1988). The last m easurement was the
skin fo ld test. S k in fo ld m easurem ents
were taken fro m three sites on the body
to determine the percentage o f fa t ofeach
su b ject (Jackson, P o llo ck a nd Ward,
1980).
Flexibility
The
fle x ib ility
com ponent
w as
determined by the modified sit-and-reach
test. This test was designed to measure
hip and trunk flexio n and the ability to
stretch the ham string and lower back
muscles. The participant sat on the flo o r
with bare fe e t fla t against the side o f the
test box a nd with their entire back in
contact with the wall fo rm ing a 90 degree
angle between the lower and upper trunk.
The knees were kept straight throughout
the test, with the tester holding the knees
down to the floor.
To perform the test the subject extended
their arms forw ard with hands placed on
top ofeach other, palms fa cin g down. The
participant m ust be m easured fro m the
zero starting position on the m easuring
scale. Once in the starting position the
participant slides their hands along the
m easuring scale on the top o f the box.
The fu rth est position that was reached
by the subject and held for at least three
seco n d s was re c o rd e d (H o eg er and
Hopkins, 1992).
Aerobic fitness
According to Baum gartner et al. (2003),
aerobic fitn ess can be m easured in the
laboratory with eith er a m axim al or
subm axim al test. A t m axim al exercise,
oxygen uptake can be m easured from
expired gases, estim ated from maximal
treadm ill time, or estim ated fro m pow er
output. F or subm axim al tests, the heart
rate response to a given pow er output
on a treadmill or cycle ergometer is used
to estimate aerobicfitness. A submaximal
cycle test was used in this study. The
A s tr a n d -R y h m in g (1954) c y c le test
measured the participant’s aerobicfitness
or submaximal oxygen uptake (VO,max).
VO ,m ax is d e fin e d as the m axim um
volume o f oxygen that is consum ed by
the body in each minute during exercise,
while breathing air at sea level. Since
oxygen consumption is linearly related
to e n e r g y e x p e n d itu r e , w hen one
measures the oxygen consumption, one
is indirectly m easuring an individual's
maximum capacity to do work aerobically.
Therefore, the higher the participants
VO,max, the higher the aerobic fitness o f
the participant.
Strength
The grip strength and back strength tests
were used fo r this component.
The purpose o f the grip strength test was
to determine the isometric strength o f the
upper lim b m usculature. A handgrip
67
Curationis June 2007
dynamometer was used. The handgrip o f
the dynamometer was adjusted to f i t the
s u b je c t’s hand. The subject holds the
dynamom eter in one hand in line with
forearm and hanging at the thigh. The
dynamometer was squeezed as hard as
possible and the score recorded. The arm
remained locked and straight at the elbow
throughout the grip manoeuvre. The hand
o f the participant was not allow ed to
touch the body or object while the test is
a d m in iste re d (S to e lin g , 1970). The
participants were allow ed two attempts
fo r each hand. The sum o f the maximal
scores fo r each hand was recorded and
expressed in kilograms.
The second test was to determ ine the
stre n g th o f the lo w er b a c k m u scles
w ithout any involvem ent o f the arms,
legs or body mass. A back dynamometer
d e te r m in e d th e b a c k s tr e n g th f o r
participants. Participants bent forw ard to
approximately 90 degrees and held onto
a chain that was attached to a handlebar
that was then ho o ked onto the back
strength dynamometer. The participant
placed theirfe e t shoulder width apart, ju st
b e h in d the a tta c h m e n t o f the
d y n a m o m e te r to th e p la tfo r m .
Throughout the test, the p a rtic ip a n t
looked up and kept their eyes fix e d on a
sp o t in fr o n t o f them (T his is very
important so as to assure that the subject
will p u ll the dynamometer with a straight
back and thus avoid injury). Two attempts
were allow ed and the best result was
recorded in kilograms Clarke, 1959; Schell
and Leelarthaepin, 1994).
A ll tests were standardized, valid and
reliable and m ethods o f testing were
em ployed conforming to criteria set by
the American College o f Sports Medicine
(1991).
Population and sampling
One hundred and ten nurses above the
age o f 22 years volunteered to participate
in this study. The nurses were employees
at a provincial hospital in KwaZulu -Natal.
The subjects had to be nurses working
f o r at le a st tw o y e a r s b efo re b ein g
included in this study.
The 110 participants were divided into
smaller groups were they were briefed at
prelim inary meetings on various days on
the research project at the hospital. The
health questionnaire and the components
f o r the fitn ess testing were discussed.
A fter the briefings, three participants
withdrew, after realising that they will be
unable to perform m ost o f the tests. Each
o f the remaining 107 nurses participated
in all fitn e s s tests a nd com pleted the
health questionnaire.
Data collection
The researchers and their assistants were
post-graduates in the fie ld o f Biokinetics
were responsible f o r the data collection.
The r e s e a r c h e r s e n s u r e d th a t th e
assistants fa m ilia rized themselves with
test procedures and scoring and that all
results were accurately recorded. Testing
p ro c e d u re s w ere c a r r ie d o u t a t the
hospital in an appropriate environment.
E ach te st was s ta n d a r d iz e d a n d a ll
equipm ent was calibrated before tests
were performed. The researchers ensured
th a t th e te s t p r o c e d u r e s a n d
administration were alike throughout the
testing to prom ote validity and reliability.
The sam e m easuring instrum ents were
used throughout the testing programme.
It was recommended that the participants
wore suitable clothing and training shoes
during testing. Participants com pleted a
circuit com prising o f various stations,
with each station m easuring a particular
fitn ess component. P rior to the testing,
the fitn e ss tests w ere d isc u sse d a nd
demonstrations were held at each station.
Participants were fa m ilia rized with the
equipm ent u sed fo r testing. The purpose
fo r perform ing each test a nd the correct
te c h n iq u e w as e x p la in e d to th e
participants to ensure test reliability.
Statistical analysis
Data was analyzed by a com puterized
statistical program m e known as SP SS
Version 11. Means, standard deviations,
t-tests a n d fr e q u e n c ie s w ere used to
a n a ly ze da ta . D iffe r e n c e s b e tw e e n
g ro u p s w ere e s ta b lis h e d a n d in te r­
variable correlations were calculated
using the Pearson M om ent Correlation
C oefficient technique a nd ANOVA fo r
baseline variables.
u n d e r s ta n d in g o f th e d o c u m e n t
exp la in ing the research pro ject. The
d o c u m e n t o u tlin e d th e te s tin g
program m e, the length and duration o f
testing procedures and the possible risks
a n d d is c o m fo r ts th a t m ig h t be
experienced during testing procedures.
The freedom o f a subject to withdraw
consent and to discontinue participation
was also explained. The pa rticip a n ts
were assured that all the data gathered
w o u ld be tr e a te d as c o n fid e n tia l.
T h erea fter all p a rtic ip a n ts p ro v id e d
w ritten co nsent to p a rtic ip a te in the
fitn e ss tests.
Results and discussion
A sum m ary o f the results according to
responses fro m the health questionnaire
is presented as well as the results fo r the
fitn e s s com ponents. The average age
was 3 7years old with height and weight
been 1.58m and 74kg respectively. The
researchers divided the sample o f nurses
into f o u r g ro u p s a c c o rd in g to th eir
responses fr o m the p e rso n a l m edical
h isto ry se c tio n o f the h e a lth sta tu s
questionnaire. These groups were the
apparently healthy group (n=48) which
c o n siste d o f n u rse s th a t sh o w e d no
symptoms ofdisease. The lower back pain
group (n -2 7 ) were nurses who had a
m edical diagnosis o f lower back pain.
Nurses that were diagnosed with lower
b a c k p a in a n d h a d o n e o r m o re
hypokinetic disease, fo rm e d the lower
back pain and hypokinetic disease group
(n -1 6 ). H ypokinetic diseases, are also
re fe rre d to as lifesty le diseases, f o r
example, heart disease, diabetes, lower
back pain and hypertension, which are
p r im a r ily d u e to in a c tiv ity . The
h y p o k in e tic d is e a s e g r o u p (n = 16)
con sisted o f nurses with only one or
m ore hypokinetic disease. The results
were divided into the fo u r categories as
shown in table 1.
Table 1 indicates that 55% o f the nurses
te ste d h a d so m e fo r m o f p a th o lo g y,
including lower back pain, hypertension,
asthma and diabetes. Approximately onethird (30%) o fth e sample presented with
one or more hypokinetic disease. The
m o st co m m o n h y p o k in e tic d is e a s e
am ongst the nurses was hypertension
and diabetes. Incidentally, alm ost onequarter o f the sa m p le ’s m others were
treated or suspected o f hypertension.
Table 2 reflects responses to selected
sm oking and exercise physical activity
questions.
A positive fa c t o f the study is that 93%
o f the nurses did not sm oke while the
remaining seven percent o f smokers were
fro m the hypokinetic disease group and
the apparently healthy group. Sm oking
is a major riskfa cto rfo r coronary artery
d isea se a n d the h yp o k in etic d isea se
group h a d the highest p ercen ta g e o f
smokers (12.5%). The participants fro m
th is g r o u p a re o v e r w e ig h t. B e in g
overweight and heavy sm oking can be
u s e d to p r e d ic t h o sp ita liz a tio n f o r
interverteb ra l disc disorders (K ailaK a n g a s, L e o n o -A r ja s , R iih im a k i,
Luukkonen andKirjonen, 2003:1860). A t
present, this group does not experience
sy m p to m s o f b a c k p a in , b u t i f the
participants continue to sm oke and be
overweight, then they are at an increased
r is k f o r d e v e lo p in g b a c k p a in a n d
possible hospitalization.
E ighty p e rc e n t o f the nurses d id not
exercise at all. The m ost common fo rm o f
exercise f o r those who exercised was
walking fo r an average o f 38 minutes.
T h ir ty -e ig h t m in u te s o f w a lk in g is
acceptable however, a higher duration will
a s s is t in the re d u c tio n o f th e high
Table 1 Division of cohort
Ethical considerations
CATEGORY
n
PERCENTAGE
The study design was accepted by the
Ethics com m ittee o f the U niversity o f
K w a Z u lu -N a ta l, W e stv ille cam pus.
Subsequently, a letter was written by the
researchers to the hospital administrator
requesting perm ission to undertake this
study. Permission was granted.
Apparently H ealthy (Group One)
48
45%
Low er Back Pain (Group Two)
27
25%
Low er B ack Pain and Hypokinetic Disease
(Group Three)
16
15%
Hypokinetic Disease (Group Four)
16
15%
Prior to the data collection process, all
p a rticip a n ts read a n d indicated their
68
Curationis June 2007
Table 2 The percentage responses to selected questions
MEASURED COMPONENTS
prevalence o f low er back pain am ong
nurses in E ngland and fo u n d that the
m ostfrequent reports o f lower back pain
was by nurses with a body mass index
equal to or greater that 30 kg/m 2. This
fin d in g was sim ilar to that o f this study
were the lower back pain groups had B M l
ratios greater than 30 kg/m2.
\V E R \G E PERCENTAGE
D o not sm oke
93%
Exercised on a regular basis
20%
Engaged in som e fo rm o f weight loss
52%
Would prefer a walking program m e
73%
Would p refer an aerobic dance program m e
35%
The p ercen t body f a t values fro m the
individual groups are very high and in
an unhealthy range. Percent body fa t in
the low er back p a in a n d hypokinetic
disease group is the highest at 38.7%.
p e rc e n ta g e o f b o d y f a t a m o n g st the
nurses.
pressure exerted against the artery walls,
and in turn lowers blood pressure.
A s ig n ific a n t p e r c e n ta g e o f th e
participants appear to be enthusiastic to
p a r tic ip a te in p r e fe r r e d e x e r c is e
p ro g ra m m e s. S e v e n ty -th r e e p e r c e n t
would participate in a walking programme
and thirty-five p ercen t would participate
in an aerobic dance programme. Garber,
McKinney, R ichard and Carleton (1992)
stated that aerobic dance program m es
result in sim ilar improvements in aerobic
f itn e s s a s c o m p a r e d to a jo g /w a lk
p rogram m es. H ence, these p re fe rre d
program m es will help the nurses improve
their health a nd p h ysica l status, as well
as serve as a m otivational tool.
S e v e ra l stu d ie s h a ve u n d e rlin e d the
importance o f exercise in lowering chronic
d is e a s e s su c h a s h y p e r te n s io n
(American College o f Sports Medicine,
1991; Hagbeig, Park and Brown, 2000:193206; Chiriac, Dima-Coznta, Georgescu,
Turcanu a n d P andel, 2002:258-263;
Thiele, P ohlink a nd Schuler, 2004:401405). When an individual exercises, the
blood vessels dilate to increase blood
supply. This vasodilation reduces the
Table 3 reflects the mean percent body
fa t and body mass index (BMl) and waistto hip ratio (WHR) results
A ccording to M iller (2002), B M l values
greater than 27.3forfem ales are indicators
o f e x c e s s iv e w e ig h t a n d h a ve been
a s s o c ia te d w ith in c re a se d risks f o r
s e v e r a l h e a lth p ro b le m s, in c lu d in g
hypertension, coronary a rte iy disease
and diabetes. Individuals with a B M l
greater than 30 are considered obese, and
those with a B M l greater than 40 are
considered morbidly obese and are in the
need o f m edical attention.
The researchers agree with M iller (2002)
due the results presented in this study.
Alm ost all the groups had a B M l o f over
30. Particularly, the hypokinetic disease
groups had a body m ass indexes that are
higher than the other two groups.
P art o f a study by Smedley, Trevelyan,
Inskip, Buckle, Cooper, an d Coggon,
(2 0 0 3 ) o b s e r v e d th e o n e -m o n th
Individuals with central, visceral types
o f o b esity (in crea sed f a t tissue th a t
accumulates beneath the muscle wall that
s u r r o u n d s the o r g a n s a n d o th e r
structures within the abdom inal cavity)
are particularly at risk f o r developing
c a r d io v a s c u la r d is e a s e a n d o th e r
illnesses associated with p o o r metabolic
profiles (Bouchard, 2000). This central
visceral obesity is m easured by the waistto-hip ratio. W aist-to-hip ratios were
above 0.86cm in all groups, hence an
unhealthy range.
Leboeuf-Yde, Kyvik, and Bruun, (1999)
and Berner, Alwash, Gaber, an dL ovasz
(2 0 0 3 ) b e lie v e d th a t th e r e w as a
relationship between the prevalence o f
lower back pain and being overweight or
obese. With regard to this statem ent it is
clear that i f the nurses decrease excessive
body fa t, there m ay be a sig n ific a n t
reduction in the incidence o f lower back
pain.
Modified Sit-and Reach Test
Table 4 represents the m odified sit-andre a c h te s ts m e a n s a n d s ta n d a r d
deviations.
The m odified sit-and-reach test proved
Table 3 Mean percentage body fat, body mass index and waist-to hip ratio
Group
Mean Body Fat (%)
Mean B M l (kg/m2)
Mean W HR (cm)
Apparently H ealthy (n -4 8 )
30.4*
28.7**
0.89
Lower Back Pain Only (n =2 7)
34.3*
30.6**
0.89
Low er B ack Pain and Hypokinetic
Disease (n -1 6 )
38.7*
34.9**
0.93
Hypokinetic D isease Only (n=16)
37.0*
32.6**
0.93
*p<0.05 Significant differences between groups
**p<0.05 Significant differences between groups
69
Curationis June 2007
Table 4 Modified sit and reach test means and standard deviations (SD)
for the nurses
SAMPLE SIZE
MEAN (cm)
SD
Total Sample (n=106)
34
8.15
Apparently H ealthy (n—48)
35
8.53
Lower Back Pain Only (n—26)
35
7.62
Low er Back Pain and Hypokinetic Disease (n —16)
33
8.53
Hypokinetic D isease Only (n —16)
32
6.10
to be a good indicator o f poor hamstring
and lower backflexibility. The mean score
fo r the sample was 34cm. The hypokinetic
disease group p resented with the lowest
flexibility score o f 32cm. The lower back
pain group had the highest score o f 35cm,
togeth er with the a p p a ren tly healthy
g ro u p . H o w e v e r, a c c o r d in g to the
American A lliancefo r Physical Education,
Recreation and Dance (1980) modified sitand reach test noim s, the average score
fo r women is 46cm (SD = ±9.99). A study
conducted by Andrew s (1990) on South
African women, had a mean flexibility
score o f 41cm. This shows that the nurses
in this study when com pared to the South
African fem a le population are still below
population norms.
There was a moderately high correlation
(r = 0.76) between incidence o f lower back
pain in the lower back pain group and
the group's flexib ility scores. The lower
back pain and hypokinetic disease group
presented with a m oderate correlation o f
0.65.
f l e x o r a n d lo w e r b a c k m u sc le s is
n e c e ssa ry f o r a h ea lth y lo w er b a ck
(F o ste r a n d F u lto n , 1 9 9 1 :1 8 7 -2 0 9 ;
Plowman, 1992:221-242). Theflexibility’o f
the sp in e p r o v id e s f o r a fu n c tio n a l
m echanical advantage, while tight or
shortened back m uscles adversely affect
spinal mechanics (Fatfan, 1975:135-144;
Kravitz and Andrews, 1995:45). A lack o f
pelvic mobility, due to tightness in the
hip flexors, could limit pelvic mobility and
cause strain on the lum bar spine. In
a d d itio n , tig h t h a m s tr in g a n d h ip
e x te n s o r m u sc le s c o u ld r e d u c e the
lordotic curve, which may im pair spinal
loading and consequently result in lower
back pain.
Grip Strength and Muscular Back
Strength Tests
T a b le 5 re p r e s e n ts th e m e a n s a n d
standard deviations (SD) o f the cohort
f o r both grip strength and back strength
tests.
Studies have sug g ested that adequate
flexib ility o f the oblique, hamstring, hip
The g rip stren g th test is a com m on
isometric strength test. Grip strength is a
com bined value o f both left and right
hand values. Results fro m the com bined
grip strength tests show that the nurses
have fa irly strong forearm flexors. The
lower back pain and hypokinetic disease
group presented with the lowest mean
grip strength result o f 56kg, while the
lower back pain group scored the highest
s c o r e o f 61kg, to g e th e r w ith th e
apparently healthy group.
B a c k s tr e n g th is h ig h e s t in th e
hypokinetic disease group with a mean
o f 60kg. The lowest means were in the
lo w er b a ck p a in gro u p s. These low
values m ay be due to the incidence o f
lower back pain hence decreasing lower
back strength in the groups with lower
back pain pathology. The lower back
pain g ro u p ’s result was a mean o f 52kg
and the lower back pain and hypokinetic
disease group was lower at 49kg.
According to Addison (1980), it should
be em phasized that the greatest losses
in back strength have been fo u n d in the
trunk extensors. Workers with high levels
o f m uscular strength are less prone to
back injury. The researchers support
Addison (1980), as similar findings in this
study show ed that strength o f the back
extensors in the nurses was poor, hence,
increasing the risk o f back injuty.
Submaximal Aerobic Cycle Test
This test was used to assess the subject's
fu n c tio n a l w o rking ca p a city/a ero b ic
fitness. (Table 6)
The number o f participants in each group
is reduced. This is due to the reason that
many participants had excessive bodyfat
and the bicycle seat was uncomfortable
and that som e participants were unable
to complete the test due to extremely low
aerobic fitness.
Table 5 Means (standard deviations) obtained from combined grip strength and back strength tests
SAMPLE
n
GRIP STRENGTH (KG)
BACK STRENGTH (KG)
Total Sample
107
60(12.21)
54(18.61)
Apparently healthy
48
61 (14.41)
53(16.87)
Lower Back Pain Only
27
61 (12.47)
52(19.53)
Low er Back Pain and H ypokinetic Disease
16
56(8.19)
49(21.45)
Hypokinetic D isease Only
16
60(6.93)
60(19.09)
70
Curationis June 2007
Table 6 Means (standard deviations) of predicted maximal oxygen
consumption (ml/kg/min) levels
SAMPLE
M EAN (SD) (ml/kg/min)
Total Sample (n=68)
33(10.72)
Apparently H ealthy (n -3 6 )
37(10.77)
Lower Back Pain Only (n=16)
28(9.50)
Lower Back Pain and Hypokinetic Disease (n =8)
29(8.22)
Hypokinetic D isease Only (n=8)
29(7.19)
The results from this study show that
the m ean p r e d ic te d m a xim a l oxygen
consumption (VO,max) o f the sample is
3 3 m l/kg /m in . The h ig h e st p r e d ic te d
VO,max score is in the apparently healthy
group with a score o f 3 7ml/kg/min and
the low est sco re was recorded in the
lo w e r b a c k p a th o lo g y g ro u p . The
remaining g ro u p ’s scores were also very
low.
The aerobic capacity o f the nurses is
below average or p o o r f o r m ost o f the
sample. A ccording to Blair (1995), p o o r
a ero b ic c a p a c ity is a sso c ia te d with
in c r e a s e d
r is k
of
m o r ta lity .
Cardiorespiratory fitness indicates a high
state o f efficiency o f the circulatory and
respiratory system s in supplying oxygen
to the working muscles. The more oxygen
an individual is able to inhale and utilize,
the longer an individual is able to work
or exercise, before fa tig u e or exhaustion
occurs (Miller, 2002).
N u rse s s h o u ld h a v e g o o d c a r d io ­
respiratory’fitn e ss due to the nature o f
th e ir o c c u p a tio n s . N u r s e s a re
c o n tin u o u s ly w a lk in g , liftin g a n d
transferring patients and need to move
q u ic k ly to a id p a tie n ts d u r in g an
emergency situation. Being aerobically
unfit, inflexible and decreased muscular
strength w ill decrease their quality o f
work and in turn, affect the well-being o f
the p a tie n t. T h ese e ffo r ts a re a lso
supported by B lue (1996), where it was
b e lie v e d th a t e x e r c is e , in c r e a s e d
flexibility, muscle strength and endurance
are e n c o u r a g e d to re d u c e th e g a p
b etw een j o b p h y s ic a l d e m a n d s a n d
human capabilities.
Since aerobic fitn ess is highly associated
w ith o v e r a ll f i t n e s s a n d w e ig h t
management, the im portance o f aerobic
fitn e s s to red u ce lo w er b a c k p a in is
signified. This association is not as strong
o f a cause-effect relation that is seen with
decreased levels o f m uscular strength,
flexib ility and m uscular endurance with
lower back pain. The exact mechanism
f o r reduced pain with aerobic exercise is
n o t clear, sin c e the in te n sity o f the
m uscular contractions is not considered
in te n s e en o u g h to s tr e n g th e n the
muscles (Kravitz and Andrews, 1995:4452).
Beliefs by Kravitz and Andrews (1995)
a re s u p p o r te d b y W ittin k, M ic h e l,
Sukiennik, Gascon and Rogers (2002)
w h ere the a sso c ia tio n o f p a in w ith
aerobic fitn ess in patients with chronic
lower back pain was investigated. Wittink
et al. (2002) concluded that low aerobic
fitn ess levels do not contribute to pain
intensity in patients with chronic lower
back pain.
Various hypokinetic diseases such as
diabetes, coronary artery disease and
hypertension are associated with poor
aerobic fitness. Good aerobic capacity is
a ssociated with an increase in highdensity lipoprotein (HDL) cholesterol
(Uusitupa, 1996:445-449). An increase o f
HDL in the body has a positive effect on
an individual's health status, m ore so in
a coronary artery disease patient.
Conclusions
Lower back pain was prevalent in 40% o f
the sample, prim arily due to weak back
strength and high percentages o f body
fa t. In all the groups the percentage body
f a t was above the norm (25%). A high
p e rc e n ta g e o f b o d y f a t is re la te d to
coronary heart disease, hypertension
and diabetes. A lready there is a 30%
prevalence o f these diseases. Ivanov and
Ivanov (2000) believed that an increase
o f body mass increases the frequency o f
71
Curationis June 2007
hypertension and fu rth e r increases the
b lo o d p r e s s u r e in an a lr e a d y
hypertensive subject.
The spine is designed to c a n y the b o d y’s
w e ig h t a n d d is tr ib u te th e lo a d s
encountered during rest an d activity.
When excessive weight is carried, the
spine is fo rc e d to assimilate the burden,
which may lead to structural compromise
and damage, especially to the lower back.
Obesity may aggravate an existing lower
b a ck p ro b le m a n d c o n trib u te to the
recurrence o f the condition (Silveri and
Spinasanta, 2003).
A high negative correlation (r = -0.85)
between back strength and percent body
f a t w as d e te r m in e d i.e. in c r e a s e d
percentages o f body fa t correlated with
decreased back strength and hence the
increased risk to lower back pain. Thus
the h y p o th e sis is a c c e p te d . This is
su p p o rte d by a stu d y c o n d u c te d by
Bayramoglu, Akman, Kilinc, Cetin, Yavuz
and Ozker (2001), where it was concluded
that o b e sity to g e th er w ith low back
muscle strength are im portant fa cto rs
influencing the risk o f chronic lower back
pain.
In general, flexib ility was fo u n d to be
poor. This inflexibility m ay give rise to
shortened hamstring muscles as well as
lower back muscles. Therefore decreased
flexibility could be a m ajor contributing
fa cto r to lower back pain.
Back strength was below the norm fo r
the population due to the lack o f exercise.
Weak back muscles increases the risk o f
lower back pain. This is supported by a
stud}’conducted by Yip (2001:803), where
it was concluded that education aimed at
the prevention o f lower back pain should
include fitn e s s tra in in g p a rtic u la rly
perform ed to increase m uscle strength
andflexibility o f the back.
Aerobic capacity was fo u n d to be poor.
This is due to the lack o f physical activity
and exercise.
Recommendations
Based on the results and the conclusions
derived fro m the study, the fo llo w in g
r e c o m m e n d a tio n s a p p e a r to be
warranted:
Exercise is safe fo r individuals with back
pain because it does not increase the risk
o f fu tu re back injuries i f the program m e
is w ell-designed (Rainville, Hartigan,
M a rtin ez, L im ke, J o u v e a n d F inno,
2004:106-115). The value o f exercise as a
measure in the m anagem ent o f lifestyle
disease and work related injury should
be fo r m a ll y r e c o g n iz e d in th e
developm ent o f a p rim a ry health care
strategy in South Africa.
The im portance o f health and fitn e ss
education sh o u ld be em phasized as a
p r im a r y h e a lth c a re m e c h a n ism in
h o s p ita ls a n d n u r s in g tr a in in g
institutions, not only to patients but as
well as employees.
The results indicate that the walking that
the nursing do on a daily basis in the
wards and around the hospital is not
sufficient to derive an aerobic benefit.
Hence, a structured program m e o f fitness
is required f o r a ll nursin g staff. It is
therefore necessary to em bark on the
p ro c e ss o f im p le m e n tin g health a nd
w ellness centres in hospital. Lifestyle
a n d r e h a b ilita tio n
m anagem ent
program m es, have been successful in
improving the wellness o f patients with
chronic diseases and p o o r fitn ess levels
in the corporate environm ent (Coopoo,
Patterson and van Seim, 2000:19). Similar
centres w ill help the nurses to overcome
specific fitn ess problem s a nd in turn will
help improve worker efficiency.
Similarly, according to Proper, Koning,
van derBeek, Hildebrandt, Bosscher and
van Mechelen (2003), the implementation
o f w o r k p la c e p h y s ic a l a c tiv ity
program m es is supported to increases
the level o f health a n d fitn e ss a nd to
re d u c e th e r is k o f m u s c u lo s k e le ta l
disorders. H ospitals should therefore
consider having a fitn ess centre where a
b iokineticist/physical therapist w ould
provide assistance f o r nurses concerning
w e ig h t
m a n a g e m e n t;
h e a lth
assessments; education f o r the reduction
o f the risks o f hypokinetic diseases and
p r o v id e an e x e r c is e p r o g r a m m e to
rehabilitate lower back problems.
A lifting team should be established in
hospitals in order to lift and transfer
patien ts. The liftin g team is a m u lti­
f a c to r i a l
e r g o n o m ic
a p p ro a c h ,
e n c o m p a ssin g e n g in e e rin g c o n tro ls
( liftin g d e v ic e s a n d e q u ip m e n t),
a d m in is tr a tiv e c o n tr o ls (p o lic ie s
mandating the use o f lifting teams and
devices) and responsibility f o r personal
practices (calling the lifting team instead
o f lifting alone). The dram atic reduction
in back injuries to nurses and other health
care p ersonnel dem onstrated in these
program m e evaluations is encouraging
(Haiduven, 2003:217).
Further research, exploring the role o f
e x e r c is e a n d v a r io u s e r g o n o m ic
interventions in the prevention o f lower
back pain appears justified.
In the nursing training curriculum, the
valu e o f exercise, fitn e s s a n d liftin g
te c h n iq u e s s h o u ld b e ta u g h t a n d
emphasized.
A dietary modification plan is also needed
in o rd er to co m p lim en t the exercise
p r o g r a m m e . P o s s ib le b e h a v io u r
m o d ific a tio n c o u n s e lin g is fu r th e r
su g g e s te d in o rd e r to su c c e e d w ith
weight loss programmes.
It is suggested that employers strive to
d evelo p to o ls to b e tte r q u a n tify the
value produced by employees. One such
tool is the introduction o f incentives.
S u c c e s s fu l in c e n tiv e s to in flu e n c e
participation in a workplace health and
wellness program m e include: throwing
parties; increasing insurance coverage;
cash bonuses; and days o f f fo r m eeting
w e ig h t a n d o r e x e r c is e g o a ls
(D e M o ra n v ille , S c h o e n b a c h le r a n d
Przvtulski, 1998).
References
ADDISON, R 1980: Trunk strength in
p a tie n ts se e k in g h o sp ita lisa tio n f o r
chronic low-back disorders. Spine. 5:539544.
AMERICAN ALLIANCE FOR HEALTH,
P H Y S IC A L
E D U C A T IO N ,
RECREATION & DANCE 19S0. HealthR elated Physical Fitness Test Manual.
Reston, VA: Author.
ASTRAND, PO & RHYMING, 11954:/!
nom ogram f o r calculation o f aerobic
capacityfor pulse rate during submaximal
work. Journal o f A pplied Physiology. 7:
218-221.
AMERICAN COLLEGE OF SPORTS
MEDICINE 1991: Guidelinesfo r Exercise
Testing and Prescription. Philadelphia:
LeaandFebiger.
BAYRAM OGLU, M; A K M AN , MN;
KILINC, S; CETIN, N; YA V U Z, N &
OZKER,
R
2001:
I s o k in e tic
m easurem ent o f trunk muscle strength in
w om en with ch ro n ic lo w -b a c k pain.
American Journal for Physical M edicine
72
Curationis June 2007
and Rehabilitation. 80(9): 650-655.
BENER, A; ALWASH, R; GABER, T &
LOVASZ, G 2003: Obesity and low back
pain. Collegium Anthropologicum. 27:95104.
BLAIR, SN 1997: Effects o f Physical
A c tiv ity on C a rd io va sc u la r D isea se
M ortality Independent o f R isk Factors.
In: Leon, A.S, Eds. Physical Activity and
C ardiovascular H ealth. C ham paign:
Human Kinetics.
BLUE, CL 1996: Preventing back injury
am ong nurses. O rthopaedic Nursing.
15(6): 9-20.
C H IR IA C , S; D IM A -C O Z M A , C;
G EO RG ESCU, T; TURCANU, D &
PANDELE, G I2002: The beneficial effect
o f physical training in hypertension. Rev
M ed ChirSoc Nat Iasa. 107(2): 258-263.
C L A R K E , HH 1959: A pplication o f
m easurem ent to health a n d p h y sic a l
education. Prentice-Hall: United States o f
America.
COOPOO, Y; PATTERSON, D; VAN
SELM , C & BUNN, C 2000: Chronic
diseases rehabilitation p ro g ra m m e M ondi p a p e r D urban. O c cu p a tio n a l
Health South Africa. 6(4): 15-19.
CUST, G; PEARSON, JCG & MAIR, A
1972: The prevalence o f low back pain
in nurses. International Nursing Review.
19:169-179.
D E M O R A N V IL L E ,
C .W ;
SC H O EN BA C H LER ,
DD
&
PR ZY TU LSK I, J 1998: W ellness at
work: M arketing Health Services. 18(2)
Summer 1998:14-24.
F A C U L T Y OF O C C U P A T IO N A L
MEDICINE 2001: Good Medical Practice
f o r O ccupational Physicians. London:
Faculty o f Occupational Medicine.
F A R F A N , H F 1975: M u s c u la r
mechanism o f the lumbar spine and the
p o s itio n o f p o w e r a n d e ffic a c y .
Orthopeadic Clinics o f North America. 6:
135-144.
FOSTER, DN & FULTON, M N 1991
B ack pain a n d exercise prescription.
Clinics in Sports Medicine. 10:187-209.
G A R B E R , C E; M C K IN N E Y , JS;
RICHARD, MS & CARLETON, A 1992:
Is aerobic dance an effective alternative
to walk/jog exercise training? Journal o f
Sports M edicine a n d Physical Fitness.
32(2): 136-141.
HAGBERG, JM; PARK, JJ & BROWN,
M D 2000: The role o f exercise in the
treatm ent o f hypertension: An update.
Journal o f Sports M edicine. 30(3): 193206.
H AIDUVEN, D 2003: Lifting teams in
health care fa c ilitie s . J o u rn a l o f the
American Association o f O ccupational
Health Nurses. 51(5): 210-218.
IV A N O V , Z & IV A N O V , M 2000:
Obesity, hypertension, a nd the lum bar
syndrome in workers a t the Neoplante
M e p lant in N ovi Sad. M ed Pregl. 53(56): 297-300.
JA C K SO N , AS; P O L L O C K , MI &
W ARD, A 1980: Generalized equations
fo r predicting body density o f women.
M edicine A n d Scien ce In Sports A n d
Exercise. 12:175-182.
KAILA-KANGAS, L; LEONO-ARJAS,
P; RIIHIMAKI, H; LUUKKONEN, R &
K IR JO N E N , J 2 0 0 3 : S m o kin g a n d
o v e r w e ig h t
as
p r e d ic to r s
of
hospitalization f o r back disorders. Spine.
28(16): 1860-1868.
KRAVITZ, L & ANDREW S, M S 1995:
Fitness and low back pain. IDEA Today.
13(4): 44-52.
LEBOEUF-YDE, C; K YVIK , K O &
BRUUN, NH 1999: L ow back pain and
lifestyle. Spine. 24(8): 779-783.
CORBIN, CB & LINDSEY, R 1990:
Concepts o f physicalfitness. (7"' Edition).
Dubuque, IA: Wm. C. Brown Co.
MAUL, I; LA IBLI,T; KLIPSTEIN, A &
KRUEGER, H 2003: Course o f low back
pain am ong nurses: a longitudinal study
a c ro ss e ig h t y e a r s . J o u r n a l O f
Occupational Environm ental Medicine.
60(7): 497-503.
M CALLISTER, R & BRO EDER, CE
1993: Wellness strategies help workers
adopt healthy habits in lifestyles. Journal
O f O ccu p a tio n a l H ealth A n d Safety.
August: 50-59.
MILLER, DK 2002: Measurement by the
physical educator: Why a n d how. (4,h
Edition). New York: M cGraw Hill.
PLOWMAN, S A 1992: Physical activity,
physical fitness, and low back pain. In:
Holloszy, J.O. (Eds), Exercise and Sport
S c ie n c e s R e v ie w s (pp. 2 2 1 -2 4 2 .).
Baltimore: Williams and Wilkins.
PROPER, KI; KONING, M; VAN DER
B EE K , AJ; H IL D E B R A N D T , VH;
BOSSCHER, RJ & VAN MECHELEN,
W 2003: The effectiveness o f worksite
physical activity program s on physical
a c tiv ity p h y s ic a l fitn e s s a n d health.
Clinical Journal o f Sports Medicine. 13(2):
106-117.
R A IN V IL L E , J; H A R T IG A N , C;
MARTINEZ, E; LIMKE, J; JOUVE,C&
FINNO, M 2004: Exercise as a treatment
fo r chronic low backpain. Spine. 4(1): 106115.
SILVERI, CP & SPIN AS ANTA, S 2003:
C o n n e c tio n to B a c k P a in a n d
D evelopm ent o f Obesity.
In: h ttp : //w w w .s p in e u n iv e r s e .c o m /
displa.yarticle.php/article2391.html.
SMEDLY, J; EGGER, P; COOPER, C &
COGGON, D 1997: Prospective cohort
study o fp redictors o f incident low back
pain in nurses. British M edical Journal.
314:1225-1228.
TATE, RB; YASSI, A & COOPER, J
1999: Predictors o f time loss after back
in jw y in nurses. Spine 15. 24(18): 19301935.
THIELE, H; POHLINK, C & SCHULER,
G 2004: H ypertension a n d exercise:
Exercise regim es fo r the hypertension
patient. Herz. 29(4): 401-405.
U. S. D E P A R T M E N T OF L A B O R
BUREAU OF LABO R STATISTICS
2002: L o s t-w o r k tim e in ju r ie s a n d
illnesses: Characteristics and resulting
time away fro m work.
UUSITUPA, MI 1996: Early lifestyle
intervention in patients with non-insulindependent mellitus and impaired glucose
tolerance. Annals o f Medicine. 28(5): 445449.
YASSI, A; K H O K H A R, J; TATE, R;
C O O P E R , J;
SNO W ,
C
&
V A L L E N T Y N E , S 1995:
The
epidem iology o f back injuries in nurses
at a large Canadian tertiary care hospital:
implicationsfor prevention. Occupational
Medicine. 45(4): 215-220.
YIP, Y 2001: A stu d y o f work stress
73
Curationis June 2007
patient handling activities and the risk o f
low back pain am ong nurses in Hong
Kong. Journal o f Advance Nursine. 36(6):
794-804.