GULF MEDICAL JOURNAL
GMJ, ASM 2012;1(S1):S169-S173
Relationship between physical activity, BMI and waist
hip ratio among middle aged women in a multiethnic
population: A descriptive study
Annamma Mathew1*, Shanti Fernandes2, Jayadevan Sreedharan3, Mehzabin Ahmed4
1
College of Allied Health Sciences, 3Research Division, 4Deptarment of Pathology, Gulf Medical
University, Ajman, UAE
2
Department of Obstetrics and Gynaecology, Gulf Medical College Hospital and Research Centre,
Ajman, UAE
*Presenting Author
ABSTRACT
Objective: This study was conducted to assess the relationship between physical activity and
Body Mass Index (BMI) and Waist Hip Ratio of middle aged women in a multiethnic population
in Ajman, UAE.
Materials and Methods: A descriptive methodology was adopted. 150 women of age group
35-59 years attending GMC Hospital, Ajman participated in this research. A self-administered
questionnaire was used for subjective and objective assessment, and the waist and hip
circumferences were measured using a measuring tape. BMI and waist hip ratio were calculated
by standard formulas. Analysis was performed on SPSS 19 version.
Results: It was observed that 96% women were involved in some kind of moderate physically
activity, 8.6% were involved in vigorous activity, and4% did not perform any physical activity.
There is a significant difference in BMI of subjects who participated in vigorous activity but
WHR did not show much variation.
Conclusion: This study demonstrates that among the middle aged women there is a relationship
between physical activity, BMI and waist hip ratio.
Key words: waist Hip ratio, BMI, physical activity, middle aged women.
INTRODUCTION
Sedentary lifestyle is a type of lifestyle
with no or irregular physical activity. A
Body Mass Index (BMI) of >30 and a waist
hip ratio (WHR) above 0.90 for males and
above 0.85 for females are important
indicators of lifestyle-related health
problems throughout the world1. In 2009,
almost a quarter of adults (24% of men
and 25% of women aged 16 or over) in
England were classified as obese (BMI
30kg/m2 or above). Thirty-nine per cent of
adults had a raised waist circumference in
2009 compared to 23% in 1993. Women
were more likely than men (44% and 34%
respectively) to have an increased waist
circumference (over 88cm for women
and over 102cm for men)2. According to
several studies3,4, women are less active
than men, and this has been related to
reproductive as well as social factors.
World Health Organization (WHO)
predicted that there will be about 2.3
billion overweight people aged 15 years and
above, and over 700 million obese people
worldwide in 20155. Physical inactivity is
one of the five leading global risk factors
for mortality and is estimated to cause
two million deaths per year6. Physical
activity has been defined as any bodily
movement produced by the contraction
of skeletal muscle that increases energy
expenditure above a basal level7. The
World Health Organization has agreed on
an international standard for identifying
overweight and obesity in the adult
populations using the Body Mass Index
(weight/height2) and waist hip ratio8.
The relationship between physical
activity and body fat or weight is derived
from the assumption that a normal-weight
person’s energy intake is equal or nearly
equal to his/her energy expenditure9.
That is, a person becomes overweight or
obese if his/her energy intake is greater
than his/her energy expenditure, and one
way of maintaining the energy balance
is by getting rid of the extra calories by
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performing physical activity10. It has
been found that the association between
physical activity and Body Mass Index
(BMI) is stronger in obese individuals than
in non-obese persons. Waist circumference
and Waist Hip ratio is a measure of
relative overall body fat distribution
and has been widely used in adults to
identify the physical status. Although
some decrease in function, strength and
stamina are unavoidable with age, the
rate of decline can be diminished through
supportive environments that promote
better health through healthy levels of
physical activity11,12.
A large body of research has established
that in elderly women regular physical
activity reduces the risk of premature
death and disability from a variety of health
conditions, including Coronary Heart
Disease, Hypertension, Type II Diabetes
Mellitus, Colon Cancer, Osteoarthritis
and Osteoporosis13. Research published
on women 40 years and older (middle
aged) who are at increased risk of both
physical inactivity and chronic disease
is limited14. The prevalence of inactivity
and obesity, and their negative health
consequences, are rapidly increasing in
both the developed and the developing
countries15.
During the middle age period one
faces the downhill slope of life, or an
ageing process. During this period women
start to experience changes in their body
as they near menopause and might
begin to experience pre-menopausaltype symptoms. Sometimes a few may
have already attained menopause which
can affect their quality of life. The other
noticeable sign of aging is an increase in
the fat layer which starts at about the
age of 35. Women gain an average of a
pound and a half (600g) of fat each year
during this phase due to the tendency of
fat moving in because muscle moves out.
After 35 years of age, women start to lose
muscle and fat gets stored in the body,
especially in the abdominal area.
In middle-aged women, genetic factors
and environmental factors have a strong
influence on the amount and distribution
of body fat. Among the environmental
factors leading to total and central obesity
is decreased physical activity16. Physical
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activity is more important than energy
intake and dietary composition. Women
should be encouraged to maintain
physical activity even if there are some
limitations. Australia’s national physical
activity guidelines recommend that
adults should have at least 30 minutes
of moderate intensity activity seven days
a week. Sedentary women with waist
circumference of more than 85cm had
almost doubled mortality risk compared
to active women with waist circumference
below 80cm. Physical inactivity and obesity
seem to increase the total mortality risk
independently and additively. There is
limited research in the Arabian region on
physical activity in middle aged women.
This present study is an effort to find the
relationship of physical activity and BMI,
waist circumference and waist hip ratio in
middle aged women in Ajman.
MATERIALS AND METHODS
150 women in the age group 35-59
year age group attending GMC Hospital,
Ajman, participated in this study. A selfadministered questionnaire was given to
the participants, and participants who
found it difficult to understand were
provided with assistance. The questionnaire
included
questions
about
sociodemographic details including height,
weight, waist
and hip circumference,
medical history of chronic diseases,
physical activities that were carried out
during the past one month, perception on
their own physically activity level and the
reason for being physically active or being
inactive. Questions on physical activity
included both of moderate level activity
to vigorous level physical activity which
ranged from leisure activity to house hold
activity. Activities like walking, cycling,
stair climbing, light gardening and house
hold chores at moderate intensity were
classified as moderate physical activity
and those such as running, jogging,
swimming and heavy gardening, climbing
stairs briskly were classified as vigorous
physical activity.
BMI was calculated as weight in
kilograms divided by the square of the
height in meters. The effect of BMI was
presented in four categories according
to WHO recommendations13:<18.5kg/
m2
(lean);18.5–24.9kg/m2
(normal
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GMJ, ASM 2012;1(S1):S169-S173
weight);25–29.9kg/m2 (overweight) and
≥30 kg/m2. The waist to hip ratio was
calculated as waist girth divided by the
hip girth. It is statistically proved that men
with WHR of more than 0.90 and women
with 0.85 are at greatest risk of health
complications14,15. The data were entered
into Microsoft Excel and transferred to
SPSS version 19 for statistical analysis.
The student’s t-test was used to find the
difference in mean between those with
physical activity and of those without.
RESULTS
The relation between moderate and
vigorous level of physical activity to BMI
and waist hip ratio was assessed. Out
of 150 women, 144 were engaged in
moderate physical activity, ranging from
walking at a moderate pace to moderate
household chores, and six of the women
did not perform any form of physical
activity. Out of 144 women who were
involved in moderate physical activity, 13
also performed vigorous physical activity
like jogging/running and stair climbing at
fast pace.
BMI, WHR were calculated from the
given data and compared with those
performing moderate physical activity
and those without moderate physical
activity, and with and without vigorous
physical activity. Although it is generally
expected that physically active persons
would have significantly lower BMI and
WHR than those without, the analysis
in this study showed that there was no
major significant difference in the BMI
of women engaged in moderate physical
activity and those who were not involved
in any physical activity. Details are given
in Table 1. A significant difference in the
BMI of women involved in vigorous level
of physical activity when compared to
those involved in moderate activity was
also observed. Details are given in Table
2. WHR showed no significant difference
between women involved in moderate or
vigorous activity.
Further analysis was done to find out
which type of moderate/vigorous activity
had greater impact on BMI and WHR.
It was observed that walking and stair
climbing at moderate speed and vigorous
physical activity like brisk jogging, stair
climbing helped reduce BMI but had no
impact on WHR, whereas brisk walking
and stair climbing showed lower WHR,
and brisk walking had no effect on BMI.
Light aerobics, performing yoga, dancing,
gardening and doing household chores
was not associated with any significant
difference in BMI and WHR. Details are
given in Tables1 and 2.
DISCUSSION
In this study we examined the relationship
of physical activity with BMI and WHR
and the mean change in level of physical
activity and its impact on BMI and WHR.
Physical activity and BMI are associated,
Table1. Mean BMI of subjects with and without moderate and vigorous physical activity
Activity
Yes
No.
Mean
126
26.75
SD
No
No
Mean
SD
p
17
31.21
6.62266
<0.001
Moderate intensity
Walking moderate
speed
Walking brisk pace
Static cycle
Light aerobics
Lightcallisthenic
Yoga
Stair climbing
Dancing
Gardening
Household chores
Vigorous intensity
Running /jogging
Static cycle
4.03
120
134
134
133
129
51
131
128
17
27.44
27.27
27.31
27.36
27.33
29.77
27.38
27.48
29.27
4.61
27.27
4.62
4.61
4.60
29.77
4.64
4.65
29.26
16
2
3
2
6
84
5
7
125
25.68
26.07
26.58
23.32
26.55
25.80
26.11
24.04
27.07
4.43
26.07
4.96
1.42
4.91
25.79
3.76
1.15
27.06
NS
NS
NS
NS
NS
<0.001
NS
NS
NS
132
128
27.43
27.55
4.57
4.60
3
8
21.72
23.19
1.81
1.06
<0.05
<0.01
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Table 2. Mean WHR of subjects with and without moderate and vigorous physical activity
Activity
Yes
No.
Mean
No
No
SD
p
Mean
SD
Moderate intensity
Walking moderate speed
Walking brisk pace
Static cycle
Light aerobics
Lightcallisthenic
Yoga
Stair climbing
Dancing
Gardening
Household chores
Vigorous intensity
Running /jogging
Static cycle
127
120
134
134
133
129
51
131
128
17
0.89
0.89
0.89
0.89
0.89
0.89
0.91
0.89
0.89
0.90
.05409
0.06
0.89
0.06
0.06
0.06
0.90
0.06
0.06
0.90
16
17
2
3
2
6
84
5
7
126
0.91
0.86
0.82
0.85
0.89
0.88
0.88
0.85
0.89
0.89
.12111
0.07
0.82
0.05
0.03
0.02
0.87
0.03
0.04
0.88
132
128
0.89
0.89
0.06
0.06
3
8
0.91
0.87
0.03
0.02
and the type or the intensity of physical
activity is the major factor that affects
BMI. Many studies16-18 have evaluated the
relation between physical activity and
diseases like CVD, diabetes, cancer and
mortality. Individuals who perform regular
physical activity are less likely to have
chronic diseases compared to those who
lead a sedentary life-style. Wannamethee
et al17, report that moderate or high level
of cardio-respiratory fitness may protect
against the excess mortality among
the overweight and obese individuals18.
In this study there was no significant
difference in the BMI between women who
had moderate physical activity and those
who had asedentary life-style, whereas
women with physical activity of vigorous
type showed significant difference in the
BMI when compared to those performing
moderate activity. Studies have proved
that regular physical activity of any type
(work-related or leisure-time) is inversely
related to all measures of obesity, viz.
BMI, WHR. Thus, the higher the intensity
of exercise the lower the BMI.
Weight gain reduces the overall
metabolic energy expenditure in middle
aged women, and the increase in body fat
percentage (without weight gain) causes
no reduction in WHR in spite of physical
activity.
Moderate activity such as walking
for pleasure, doing household chores(3.55 MET) have no effect on the BMI. In
addition to the above, 30 minutes per
week of a 6-MET activity such as brisk
walking, jogging and brisk stair climbing
are needed to have a beneficial effect.
172
NS
<0.05
NS
NS
NS
NS
<0.01
NS
NS
NS
NS
NS
In this study we found that physical
activity was positively related to BMI but
showed no significant difference in the
WHR. More studies on the similar topic
are recommended with large sample and
taking into consideration the duration of
activity, body type, and metabolic index.
CONCLUSION
There was a significant reduction in BMI
of middle aged women who performed
vigorous activity but no changes were
noted in WHR. Additionally, moderate
physical activity did not change either
BMI or WHR among the participants.
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