Level of physical activity , cardiorespiratory fitness and nutritional status of higher education institution servers

Objective: to evaluate the level of physical activity, cardiorespiratory fitness and nutritional status of Brazilian higher education institution servers. Method: 134 public servants (80 men and 54 women) were evaluated to estimate body mass index (BMI), waist circumference (WC), waist/hip ratio (WHR), aerobic fitness and blood pressure at rest. Results: most of the servers were classified as insufficiently active (62%). BMI results show a high prevalence of obesity (39% mild and 33% moderate). WC showed a prevalence of high (30%) and very high risk (27%), and WHR showed a prevalence of high (28%) or very high risk (12%). The ergometric test showed that 41% of the servers presented very poor (17%) or poor (24%) aerobic fitness and 23%, regular aerobic fitness. Considering blood pressure, 15% of the servers presented blood pressure considered as borderline and 30% considered as hypertension. No associations were found between physical condition (active or inactive) with WC (χ2 = 3.4, p = 0.179), WHR (χ2 = 7.0, p = 0.073), aerobic fitness (χ2 = 4.3, p = 0.368) and blood pressure (χ2 = 2.9, p = 0.734). Although no association was observed between physical activity and BMI (χ2 = 7.6, p = 0.062), significance values (p < 0.07) suggested an association trend, with worse ratings for the sedentary group. Closing remarks: among higher education institution servers, there is high prevalence of physical inactivity, obesity and risk factors, and the majority of the sample had aerobic fitness below recommended levels.


Level of physical activity, cardiorespiratory fitness and nutritional status of higher education institution servers
Nível de atividade física, aptidão cardiorrespiratória e estado nutricional de servidores de instituição de ensino superior

INTRODUCTION
Cardiovascular diseases are one of the leading causes of death worldwide. 1In Brazil these diseases are the main cause of death. 2 Risk factors more evident in the panorama of cardiovascular health in Brazil are smoking, arterial hypertension systemic, diabetes mellitus, obesity, dyslipidaemia and sedentary lifestyle. 3,4mong these risk factors for cardiovascular disease sedentary lifestyle appears to be one of the most important. 5Physical inactivity can be considered as the cause of 5.3 million deaths per year worldwide, representing approximately 10% of deaths. 6ccording to some studies 7,8 changes in lifestyle, such as regular physical activity, represent a beneficial effect on major cardiovascular risk factors.Thus, small increases in the levels of physical activity in sedentary populations could represent a significant improvement with respect to reducing the incidence of diseases, especially cardiovascular diseases. 1However, the prevalence of physical inactivity is very high, even with the proven benefits of regular exercise.It is estimated that 31% of adults and 80% of adolescents worldwide do not meet the recommendations for physical activity. 9In Brazil about 80% of the population is sedentary. 10iven this reality, incentive programs to promote physical activity for health reasons should be encouraged.In this scenario government institutions and particularly public universities play an important role in this process of awareness and combating physical inactivity.
In this context, it is relevant to check the level of physical activity, cardiorespiratory fitness and nutritional status of public servants at higher education institutions.It is hypothesized that these people are physically active with a good aerobic power associated with a low cardiovascular risk because they have greater access to information on the adoption of a healthy lifestyle.To test this hypothesis, the aim of this study was to evaluate the level of physical activity, cardiorespiratory fitness and nutritional status of higher education institution workers.

Participants
This is a descriptive, cross-sectional study with non-probability sampling.The study sample consisted of 134 Brazilian higher education institution servers (80 men and 54 women), with an average age of 46.1 ± 9.3 years old.Public servants were considered active if they reported being engaged in some systematized program of physical activity (e.g., walking, fitness, cycling, soccer) with a frequency less than or equal to twice a week.Participants were considered insufficiently active if they did not reach the established criteria.All servers were selected after outpatient screening at the university's medical clinic.Informed consent was obtained from all individual participants included in the study.All participants were informed about the study procedures, and all signed consent forms.This study was approved by the local ethics committee.

Anamnesis
A semi-structured questionnaire was used, with questions on aspects relating to personal data (e.g., age, sex), cardiovascular risk factors (e.g., arterial hypertension systemic, diabetes, dyslipidaemia, obesity, smoking), medical diagnosis (any disease), referent to the practice of regular physical activity (i.e., type, frequency, duration), knowledge of the benefits of exercise and, if not practiced, the reasons for not exercising.

Anthropometry
Body mass was measured using a commercial scale (Fillizola ® ) with a precision of 0.1 kg, and height determined by a stadiometer (Seca ® ) with an accuracy of 0.1 cm, according to the protocol described by Lohman et al. 11 .The circumference of the waist and hip were estimated using a tape measure Seca ® with a precision of 0.1 cm, following descriptions of Lohman et al. 11 The Body Mass Index (BMI-weight/height 2 -kg/m 2 ) was determined according to the WHO classification. 12he waist/hip ratio (WHR = waist circumference (cm)/ hip circumference (cm)); and the waist circumference (WC) were rated according to the WHO classification. 12

Blood pressure and ergometric test
Blood pressure was checked using the auscultation method, following the parameters set by the VI Brazilian Guidelines on Hypertension. 13Aerobic power (VO 2máx ml/kg/min) was determined individually using an ergometric test on a treadmill (Inbrasport, Classic I, Porto Alegre-RS, Brazil), monitored by electrocardiogram (Ergo PC 3, Micromed, Brasília-DF, Brazil), following the protocol most appropriate for the assessed subject; the Bruce protocol and modified Bruce protocol were used.The classification of aerobic power was performed using reference values of the American Heart Association. 14

Statistical analysis
Data are presented as mean, standard deviation, frequency and 95% confidence interval (95% CI).To analyse the association between variables, we used the chi-square test or Fisher's exact test when the conditions for the use of chi-square test were not checked.The level of significance was set at 5%.Statistical analysis was carried out using the Statistical Package for the Social Sciences -SPSS software, version 20.0.

RESULTS
Anthropometric characteristics, cardiovascular risk factors and physical fitness of higher education institution servers are presented in table 1.
Considering the mean values, male and female participants presented BMIs classified as light obesity, 12 WC classified as elevated risk 12 and blood pressure rated as normal. 13The WHR was classified as moderate risk for men and high risk for women. 12able 2 shows that no significant association was found between sexes and physical activity level (χ 2 = 2.7, p = 0.099).
Table 3 shows the values of the associations between physical activity level (insufficiently active or active) and BMI, WHR, VO 2max and blood pressure.
Additionally, it must be stressed that when individuals were asked in the interview if they knew the benefits of regular physical activity, the majority (99%) answered in the affirmative and the main reasons for not participating in a systematic program was the limitation of time, followed by a lack of motivation/laziness.

DISCUSSION
In modern societies inactivity levels have increased significantly in recent years due to technological advances.This prevalence of lifestyle becomes harmful to health because physical inactivity is considered a primary risk factor for several diseases, including cardiovascular diseases, which is the main cause of death in Brazil. 2 In the present study we observed the presence of physical inactivity in 62% of participants, without noting a significant difference between the sexes.
In previous studies, similar results were observed among Brazilian college students, with studies finding that 51% of students did not perform physical activities at leisure in 2010. 15These findings in the university community do not differ from other populations.In 2013 it was observed that only 38% of adults in the capital of southern Brazil were considered active during leisure. 16his pattern of physical inactivity does not seem to be improving.In 2012 it was observed that, in a Brazilian city (Pelotas-RS), the prevalence of physical inactivity was 54%, significantly higher than ten years ago. 17his pattern of behaviour deserves attention because today a sedentary lifestyle can be considered to be the   during exercise for the production of energy because during exercise there is an integration of the respiratory, cardiovascular and neuromuscular systems. 30n the present study 41% of participants presented aerobic power classified as very poor or poor, 23% as regular and 36% as good or excellent.There was no association between physical condition and aerobic power.In this sense, it may be suggested that the activities performed by the active group might not be enough quantitatively or qualitatively to generate benefits to its practitioners.In this sense, it is known that variables such as intensity, volume, frequency and type of exercise are important to tracking the changes in cardiorespiratory capacity; however, as a limitation of the study, these variables were not controlled.
Another cardiovascular risk factor is high blood pressure, which can be described as a clinical condition characterized by high and sustained blood pressure, 13 representing a risk factor for many diseases, particularly those that affect the heart. 18Using the classification table of the VI Brazilian Guidelines on Hypertension, 13 the group analysed in this research was not classified as hypertensive.When values were analysed as a percentage, however, 15% had blood pressure considered as limitrophe and 30% as hypertensive.In this sense, studies such as those of Fagard, 5 have shown the importance of having a more active lifestyle as a method of prophylaxis of cardiovascular diseases, particularly hypertension.Also according Fagard, active individuals present a risk of developing hypertension approximately 30% lower than sedentary individuals.
In the current study most participants (99%) reported knowing the benefits of regular physical activity.However, although the evaluated individuals were aware of the importance of regular physical activity, this knowledge did not cause them to change their physical condition from insufficiently active to active.Thus, the results obtained in this study refute the initial hypothesis, which predicted that the participants being in an environment that encourages the adoption of a healthy lifestyle, would be physically active, with good aerobic power associated with a low cardiovascular risk.This hypothesis was formulated especially for public servants at a state university which, at the time of data collection, had six campuses with 52 undergraduate courses, 93 specialization, and 28 master's degree and 12 doctoral degree programmes.Of these, six graduate courses, several specializations, and six master's and two doctoral degree programmes are related to health sciences.

CLOSING REMARKS
In summary, the findings might suggest that the universities have much to be desired in respect to physical activity of its employees.Primarily, universities are supported by the idea of a so-called tripod system, which should work in teaching, research and extension.The fact that the university community does not have better prevalence rates of physical activity and/or cardiovascular risk factors, per se, should be cause for reflection.It is essential that universities adopt strategies that would not only raise awareness about the benefits of regular physical activity but also awareness of the cause of millions of deaths worldwide at a rate similar to deaths resulting from smoking. 69][20] However, even with constant disclosure of this information, there is a high prevalence of obesity and overweight rates.
In the present study only 26.1% of participants were classified as having a normal nutritional status.Most participants presented as obese (38.8% with light obesity levels and 32.8% with moderate obesity) based on evaluation of the BMI.These results are similar to those of the Brazilian population; in 2013 it was estimated that in the population older than 20 about 52.5% of men and 58.4% of women presented as overweight or obese. 21Moreover, findings in the current study suggest an association trend with worse classifications for the insufficiently active group.Although use of BMI has its limitations, such as not differentiating the constituent tissues of body composition which is an important factor in determining health risk, it is effective for epidemiological studies and has been widely used in the evaluation and diagnosis of the nutritional status of people in worldwide. 22In fact, the literature has identified the relationship between the relative risk of total mortality and BMI, with the two extremes of the index (< 20 kg/m 2 and > 30kg/m 2 ) being associated with increased risk of morbidity and mortality. 22,23Lower BMI values are associated with tuberculosis, lung cancer and chronic obstructive pulmonary disease, while higher values are associated mainly with cardiovascular diseases, hypertension, diabetes, stroke, and in men, colon cancer. 23esides BMI, waist circumference is another low-cost, easy-to-use parameter for predicting risk for cardiovascular and metabolic disorders. 24This method is an indicator of central obesity and is associated with other risk factors such as increase of insulin resistance. 25In this study 42% of the sample showed normal risk while 30% showed high risk and 27% very high risk.The major concern of the evaluation is high fat deposits in the abdominal area (abdominal or visceral obesity) because this type of obesity is a more serious cardiovascular risk factor and disturbance in glucose-insulin homeostasis than generalized obesity. 19entral obesity verified by the WC also can be evaluated by WHR, which is an easy and useful tool for diagnosing risk factors for developing of health problems such as endocrine-metabolic, 26 neoplastic 27 and especially cardiovascular 28 disorders.In the present research most participants showed a WHR rated as low and moderate.However, 40% presented with a WHR classified as high (28%) or very high (12%).
In addition to the anthropometric measurements, the evaluation of cardiorespiratory fitness is important in cardiovascular evaluation because low VO 2max values are correlated with mortality. 29Maximum oxygen consumption is a reproducible measure which expresses the maximum amount of oxygen that the body can use

Table 1 -
Anthropometric characteristics, cardiovascular risk factors and physical fitness of higher education institution servers (n = 134).

Table 2 -
Associations between sex and physical activity level in higher education institution servers.

Table 2 -
Associations between sex and physical activity level in higher education institution servers.LEVEL OF PHYSICAL ACTIVITY, CARDIORESPIRATORY FITNESS AND NUTRITIONAL STATUS OF HIGHER EDUCATION INSTITUTION SERVERS Leonardo Vidal Andreato, João Victor Del Conti Esteves, Tales de Carvalho, Sabrina Weiss Sties, Daiane Pereira Lima, Solange Marta Franzói De Moraes.