International Journal of Physical Medicine & Rehabilitation
Open Access

Evaluation of a Physical Exercise Intervention Program in the Youth (PiPy) Among Chinese University Students Based Upon Body Compositions and Phase Angle

Juan Su¹, Haixu Hu¹, Chong Shen² and Harvest F. Gu^{3* *}Correspondence: Dr. Harvest F. Gu, School of Basic Medicine and Clinical Pharmacy, China Medical University, Nanjing, China, Email:

Author info »

Introduction

Physical Health Driven Teaching Model (PHDT) is used to adopt the concept and practice of body composition into the curriculum. Through physical health test- driven planning courses, teachers are needed to conduct body composition test training, and to interpret related indicators. Teachers are then required to master the bio-resistance of body composition [1]. The knowledge of resistance and other systems may help students to plan their daily Locomotive syndrome physical activity levels and to calculate the total energy consumption of each day. It also helps students to encounter the difficulties in practical operations and to achieve a healthy lifestyle. PHDT is a combination of sport planning and learning, effectively integrating physical education and physical health education. Teachers will incorporate the content of physical health indicators through the teaching activities of collective preparation and special seminars in the courses, and design the course content that addresses the physical health of each type of students in each class hour [2,3] Indeed, PHDT, as a teaching method for body composition recognition, is important for physical education. Bioelectrical Impedance Analysis (BIA) is used to check body composition, which can accurately reflect the body fat and skeletal muscle content [4,5], while Phase Angle (PA) depends on formulas and anthropometric measurements [6,7]. Recent research has demonstrated that higher PA implicates higher proportion of complete cell membrane corresponding to cytoplasm and skeletal muscle [8,9]. Therefore, PA, together with BIA, is important for judging malnutrition and has a very wide practical application for judging physical and nutritional status of body [10]. In term of physical education, PA, as an important indicator, is an important indicator for analysis of Body Mass Index (BMI), skeletal muscle and other body composition [11]. In school, students can learn and self-evaluate through modern body composition test such as PA to develop a physical exercise plan for the reasonable body composition goals [7,12,13]. In the mainland of China, almost 9 million of students from senior high schools participate in the national higher education entrance examination annually [14]. Due to the strong competition, the students are trapped by heavy homework and exams. Thereby, the inactivity of physical exercise among them is very common [15]. According to national student health standard in China, we have recently carried out a Physical exercise Intervention Program in the Youth (PiPy) in which the freshmen from high schools to a university were recruited [16]. In the present study, we have designed a PHDT model to evaluate the effectiveness of curriculum reform and the rationality of physical education teaching and learning. The main indicators of body composition, including BMI, skeletal muscle content, fat, PA, and physical performance were included for our analyses. Data from this study may provide with experiential practical information to change the ability of physical learning, to improve physical teaching and to solve intelligent sport learning with high initiative.

Materials and Methods

Subjects

From September 2016 to June 2018, a total of 446 subjects (371 males and 75 females) in experimental groups were selected from the freshman in Nanjing University of Aeronautics and Astronautics, China by using the cluster sampling method. In addition, the control groups of 326 subjects (238 males and 88 females) were included in the analysis. This study was approved by the Ethics Committee of Nanjing Medical University, and all subjects signed informed consent. According to the “Recommendations on Classification of Chinese Adult Body Mass Index”, the above subjects were divided into three groups, including lean (BMI <18.5 kg/m²), normal weight (18.5 ≤ BMI ≤ 23.9 kg/m²), and overweight (BMI ≤ 24.0 kg/m²) [17,18].

Physical health-driven teaching model

PHDT used in the present study was designed after reform and divided into five links: The first was to set a number of tasks precisely, such as the relationship between endurance, strength improvement and body composition. Teachers can provide students with their own test data. Students can reflect on and list the changes in the past week. The second was the planning trial link. In this link, teachers need to create communication and sharing situations to guide students to compare the results of their current tasks with other students. The third was the improvement link. Teachers randomly select the corresponding group members to report energy consumption and share with their peers. The teachers then evaluate the students’ understanding and understanding of body composition knowledge in physical exercise from a professional perspective. The fourth was the peer sharing. This kind of reporting member’s uncertainty can urge members of the group to actively participate in solving their own problems to a certain extent, so that it can be summarized by selfoperation and used outside of the classroom. The fifth was the summary link. It was to guide students to find the differences and gaps between them and other classmates. The students should be given targeted guidance, and consider their own shortcomings and how to improve them better. At the same time, teachers can also use this link as a basis to carry out a new round of capacitybuilding.

Data test method

The information was collected in the form of online questionnaires, which mainly include general information such as age, gender, eating habits, physical activity and physical education courses. The baseline data collection date was September 2016. Observation of the implementation of PHDT was ended in January 2017 as the first semester, the second semester ended in June 2017, the third semester ended in January 2018, and the fourth semester ended in June 2018. End statistics were compared with baseline surveys. Furthermore, the field composition data were tested on the spots, while Seca mBCA (model 5570021159, Germany) was used to measure body composition data such as PA, skeletal muscle content, and fat content.

Statistical analysis

Statistical analysis was performed using SPSS 20.0 software. Continuous variables are represented by mean standard deviation, while categorical variables are represented by frequency and corresponding percentages. Paired t test was used to analyse whether there was statistical difference before and after the intervention of the same indicator. Two independent sample t-tests and one-way ANOVA were used to compare the differences in each indicator before and after PHDT intervention between different groups. Chi-square test was used to compare the count data after each data change between groups. A two-sided test of P<0.05 was considered statistically significant.

Results

Implementation steps of control and experimental groups in PHDT

We first designed PHDT and applied this teaching model for the students in a university, China, for the period of two years. The implementation steps of control and experimental groups in PHDT are represented in Table 1. Reports on the development of PHDT in different semesters demonstrated that there was a large contrast between the control and experimental groups. In the experimental group, the majority of students had a great development relationship between the use of PHDT models and physical education curriculum.

Changes in all male and female subjects from baseline and after PHDT

We then analysed the changes in various indicators between control and experimental groups before and after PHDT. Comparative tests according to the baseline BMI were stratified for gender difference. Results of all male and female subjects between control and experimental groups are summarized in Tables 2A and 2B, respectively. Data demonstrated that along with levels of physical exercise were increased from semester 1 to 4; body fat was gradually decreased, while BMI and skeletal muscle were increased in both male and female subjects. Specifically, during the first semester, male subjects in the experimental group had an average body weight reduction of 1.16 kg from 14.49 kg to 13.33 kg, and females from 13.60 kg to 12.73kg. The mean reduction of body weight was 0.87 kg (both P<0.001). Consequently, BMI was increased mainly due to the skeletal muscle was increased while body fat decreased. The composition ratio of the experiment to control group had improved significantly (all P<0.001). Of all students, the subjects with normal weight were accounted for 473(61.3%), obese subjects were 179 (23.2%), and lean subjects were 117(15.2%). Thereby, we further analysed the data in the subgroups of subjects with normal body weight, over-weight and lean, and the results are attached in Supplemental Tables 1-3. According to the analysis of subgroups according to BMI and gender stratification, the changes of indicators between the control and experimental groups were consistent with the overall population (Tables 2A and 2B).

Table 1: Implementation steps of control and experimental groups in PHDT.

Table 2A: Changes in all male subjects from baseline and after PHDT.

Table 2B: Changes in all female subjects from baseline and after PHDT.

Evaluation of PDHT in comparison with traditional teaching model

We finally evaluated the effects with PDHT in comparison with traditional teaching model. Table 3 demonstrates the teaching content and action of students who achieve physical fitness and drive BMI in physical education course. Characteristics of BMI, skeletal muscle content, body fat, and PA of the four semester students from the baseline and after PHDT were analysed (Tables 2A and 2B). The muscle gain of students in the third semester was not as good as the second and fourth semester. Students lose a certain amount of muscle, so muscle development and content may have semester characteristics. For teachers, in order to avoid the effect of long distance running on muscle gain, the actual situation of students should be fully considered during the two semesters. On the one hand, teachers design more flexible strength exercises to increase muscle and guide Students focus on muscle gain. The achievement of exercise goals through extracurricular activities. In the classroom, students are provided with a scientific physical exercise experience, which enables students to harvest knowledge in a pleasant atmosphere to achieve teaching goals. According to the students’ physical fitness, body composition, and learning effects, it is feasible to implement the content-driven teaching model of physical fitness for college students. The traditional teaching model neglected the student’s subject status, neglected the students ‘healthy and coordinated development in the future, neglected the improvement of students’ personality and ability, neglected the use of modern instruments, and neglected the scientific development concept. Through the application of PHDT model, the learning atmosphere of the entire classroom is very lively, and the extracurricular participation rate is high. Survey statistics of effects with PDHT in comparison with traditional teaching model is summarized in Table 4. It can be seen that 72.4% of the students in the experimental group like physical activities, and 81.8% of the students like physical education. The number of students who like physical activities and lessons is low.

Table 3: Teaching content and action of students who achieve physical fitness and drive BMI in physical education course.

Table 4: Survey statistics of effects with PDHT in comparison with traditional teaching model.

Discussion

Su et al. [16] designed a PHDT model to evaluate the effectiveness of curriculum reform and the rationality of physical education teaching and learning, based upon an intervention program named as PiPy in China. Results demonstrated that BMI in subjects, after physical education with PHDT, was slightly increased, while fat weight and malnutrition rate were significantly decreased. Skeletal muscle content in male subjects was increased, while phase angle in females was relatively low. Furthermore, physical performance, learning performance, and nutritional changes were improved. According to the 1985-2014 student physique and health survey data, Chinese college students have increased their height and weight, their physical fitness has continued to decline, and the obesity detection rate has continued to increase [19]. The present study also implicated that correctly guiding the learning and training through specific situations had a significant effect on weight loss. Thus, PHDT allowed students to master the skills of self-learning and develop the ability of self-learning. The magnitude of PA determines a person’s nutrition and fatigue status, and to some extent is a comprehensive reflection of changes in body composition indicators [7]. In the present study, we further analysed PA and found that subjects with more physical activity had higher PA and better nutritional status in both males and females (Tables 2A and 2B). After PHDT intervention, PA of males in the experimental group was increased by 0.25 degrees, females increased by 0.24 degrees (both P<0.001), while males in the control group increased 0.19 degrees, and females increased 0.23 degrees (both P<0.001). The malnutrition rates of baseline indicators in the control and experimental groups were 38.7%/34.0% for males and 22.7%/0.7% for females. The experimental and control composition ratios (both P<0.001) had been improved significantly. Malnutrition is a serious problem for the health of college students, while young people should have moderate fat because it is essential for energy storage and nerve pads to support internal organs. Abdominal organs in students are prone to sagging, poor muscle nourishment, indigestion and fasces, fatigue, and endurance [20]. We thus guided students to strengthen their muscle strength and exercise with a reasonable dietary intake. Consequently, students found malnutrition and took corrective measures in a timely manner, so that they could truly understand that health and beauty are the foundation of physical beauty. We evaluated PHDT and found that in the experimental group, the average score of two-year in male subjects was 3.12, which was 0.17 points higher than that of the control group, and that of the females 3.45 was 0.20 points higher than that of the control group. In parallel, the physical performance of males and females in experimental group was increased. PHDT model requires students to pay attention to their physical health. Physical health is a prerequisite to ensure good learning for college students. This model is mainly to cultivate students ‘self-learning ability, so students’ physical learning ability has improved, and cultural learning performance has also improved.

Conclusion

We also evaluated PHDT by comparison with traditional physical education. Traditional physical education has neglected the light body reorganization crowd. For light body reorganization students, we must recognize that reasonable nutrition and physical exercise are both means to improve human health. Nutrition is the basis of human health. Physical exercise plays a solid role in training students. The two together escort human health. Physical healthdriven teaching model requires students to combine reasonable nutrition with physical exercise in order to finally achieve the goal of human health. We have proven in the process of physical education that through specific design of classroom situation training, students can master the skills of autonomous learning and develop the ability of autonomous learning. Therefore, PHDT has realized the concept of lifelong physical education in school physical education, achieving a good effect. In conclusion, data from the present study indicate that two years of physical education intervention based on body composition and PA, the PHDT model can simultaneously improve physical education and cultural performance by improving college students’ BMI, while the magnitude of change is affected by gender and baseline BMI and PA influences.

Competing Interests

None declared.

Research Funding

This study was supported by the research grant from Nanjing University of Aeronautics and Astronautics (NUAA-160830), Jiangsu Provincial Fourth “333 Project”, the Priority Academic Program for the Development of Jiangsu Higher Education Institutions (Public Health and Preventive Medicine) and the start grant of China Pharmaceutical University (CPU-180517).

Ethics Approval

The ethics approval of the present study was obtained from Research Ethics Committee in Nanjing Medical University, China (No. 2016-290).

References

1. Sayma M, Williams HR. A new method for teaching physical examination to junior medical students. Adv Med Educ Pract.2016;7:91.
2. Bailey R. Physical education and sport in schools: A review of benefits and outcomes. J Sch Health. 2006;76(8):397-401.
3. Birch DA, Auld ME. Public health and school health education: aligning forces for change. Health Promot Pract. 2019;20(6):818-823.
4. Bera TK. Bioelectrical impedance methods for noninvasive health monitoring: A review. J Med Eng. 2014;28:381251.
5. Lyons-Reid J, Ward LC, Kenealy T, Cutfield W. Bioelectrical impedance analysis-an easy tool for quantifying body composition in infancy?. Nutrients. 2020;12(4):920.
6. Gonzalez MC, Barbosa-Silva TG, Bielemann RM, Gallagher D, Heymsfield SB. Phase angle and its determinants in healthy subjects: Influence of body composition. Am J Clin Nutr. 2016;103(3):712-716.
7. Lukaski HC, Kyle UG, Kondrup J. Assessment of adult malnutrition and prognosis with bioelectrical impedance analysis: Phase angle and impedance ratio. Curr Opin Clin Nutr Metab Care. 2017;20(5):330-339.
8. Nescolarde L, Yanguas J, Lukaski H, Alomar X, Rosell-Ferrer J, Rodas G. Localized bioimpedance to assess muscle injury. Physiol Meas. 2013;34(2):237.
9. Bartels EM, Sørensen ER, Harrison AP. Multi�frequency bioimpedance in human muscle assessment. Physiol Rep . 2015;3(4):e12354.
10. Marini E, Campa F, Buffa R, Stagi S, Matias CN, Toselli S, et al. Phase angle and bioelectrical impedance vector analysis in the evaluation of body composition in athletes. Clin Nutr. 2020;39(2):447-454.
11. Bosy�Westphal A, Danielzik S, Dörhöfer RP, Later W, Wiese S, Müller MJ. Phase angle from bioelectrical impedance analysis: population reference values by age, sex, and body mass index. J Parenter Enteral Nutr. 2006;30(4):309-316.
12. VanderJagt DJ, Harmatz P, Scott-Emuakpor AB, Vichinsky E, Glew RH. Bioelectrical impedance analysis of the body composition of children and adolescents with sickle cell disease. Sci Eng  Ethics. 2002;140(6):681-687.
13. Martins PC, De Lima LR, Berria J, Petroski EL, Da Silva AM, Silva DA. Association between phase angle and isolated and grouped physical fitness indicators in adolescents. Physiol Behav. 2020;217:112825.
14. Gao H, Liu W, Nie J. Who, What and Where (WWW) problems in scientific communities. Sci Eng Ethics. 2018;24(1):327-330.
15. Zhang X. Contributions and challenges faced by Chinese students physical health research. Chinese School Health, 2016;37(8):1121-1123.
16. Su J, Wang H, Tian Y, Hu H, Gu W, Zhang T, et al. Impact of physical exercise intervention and PPARγ genetic polymorphisms in a Chinese youth population. BMJ Open Sport Exerc. 2020;6:e000681.
17. Chen C. Introduction to the recommendations of Chinese adult body mass index classification. 2001;35(5):349-350.
18. Zhou BF. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci. 2002;15(1):83-96.
19. Chen X, Cui J, Zhang Y, Peng W. The association between BMI and health-related physical fitness among Chinese college students: A cross-sectional study. BMC Public Health. 2020;20(1):1-7.
20. Jurjus RA, Lee J, Ahle S, Brown KM, Butera G, Goldman EF, et al. Anatomical knowledge retention in third�year medical students prior to obstetrics and gynecology and surgery rotations. Anat Sci Educ. 2014;7(6):461-468.