Hong Kong Chinese adults’ knowledge of exercise recommendations and attitudes towards exercise

Summary

More education about the latest PA recommendations, especially lifestyle PA is needed. The weak correlation between PA knowledge and actual behaviour showed that knowledge itself might not affect behaviour. Enhancement of the public’s knowledge, motivation, and psychosocial support along with stage-of-change interventions and proper counselling skills, for example, motivational interviewing, may result in PA behaviour change to achieve health benefits.

Strengths and limitations

This study was a cross-sectional design but not a controlled trial, and was thus unable to provide causal relationship as the researchers only tested the association between variables. Generalisability was limited because the data were collected from only a single clinic with convenient sampling. The modest sample size may limit the applicability of the studies. It contained self-reported data which tended to have recall bias. The use of subjective measures of PA may be fraught with overestimation or problems with recall.⁹ Data on income, which are likely to be influential factors on doing exercise, were not measured. Not all professions were assessed in this study; for example, those who were physically active as part of their job may bias the study findings. The high frequency of results for willingness to begin or maintain PA might be explained by possible interviewer bias towards those handing in their questionnaires. Finally, the validity of the questionnaire has yet to be determined.

Despite these limitations, this study is one of the first to assess PA knowledge of the exercise recommendations in an adult Hong Kong Chinese population. It found that their PA knowledge was generally lower than previously known. In addition, their knowledge of lifestyle PA was lower than that of traditional PA.

Comparison with existing literature

The average mean knowledge scores were generally lower than that from studies by Morrow and colleagues⁶ in which 76.8% (knowledge score 16 +/– 2.2) were correctly answered. A nationwide random-digit dialing was undertaken to arrive at a representative sample of US adults. For an approximate 1-week period, it resulted in 2002 responders after three telephone attempts. The increased number of responders may be the reason accounting for the difference between the two studies.

The results revealed the responders in this study had knowledge about how to be physically active for a health benefit that varied by PA type. This is illustrated in Table 2, where percentages of correct responses are presented by subscales and across all 20 items. Table 4 presents similar results by demographic variables. However, knowledge on different subscales is generally lower than Morrow and colleagues's study,⁶ except for the minimum minutes per day and the vigorous activity necessary to achieve a health benefit. Only 56.3% of responders viewed weight lifting as an activity that can provide a health benefit. This is far below the results of Morrow and colleagues,⁶ in which 82.4% viewed it as a healthy activity. This may be related to the concept that some Chinese viewed weight lifting as a strenuous activity, which might therefore not contribute to a health benefit. In another study, excellent knowledge about recommended PA guidelines was seen¹⁰ which may be related to the closed-ended questions asked, while open-ended questions were asked about the recommended PA guidelines for an adult in this study and may have been too general for responders. Overall, the scores for the exercise guidelines suggest a need for further education about the latest PA recommendations. A lack of association between PA knowledge and various demographic or disease factors were shown in this study.

Education level was found to positively associate with PA knowledge in a local study for diabetic patients.¹¹ Dishman¹² and Sallis and colleagues¹³ also suggested increasing PA knowledge through education is an effective method of promoting PA. Although the result of this study is different, programmes for education and promotion of PA should be advocated for all ages, sex, and education, irrespective of the presence of a chronic illness. Furthermore, this study demonstrated that the sample population had more knowledge about traditional PAs than lifestyle PAs, consistent with the study by Morrow and colleagues.⁶

The current lifestyle behaviour activities and PA guidelines (for example, accumulation of 30 minutes of PA), were still not as well known by the public. It is possible that the responders had various perceptions of lifestyle activities. For example, actively playing with children is different from vigorously playing with children.⁸ Actively playing with children includes walking, running, or climbing, while vigorously playing with children includes running longer distances, or playing strenuous games with them. Actively playing with children is represented as a moderate type of PA and counts for at least 3 METs, while vigorous play accounts for at least 6 METs. To raise the awareness of PA, education programmes, such as physiotherapy, could incorporate PA guidelines and lifestyle PA knowledge into their programmes. Active transportation, such as climbing the stairs, could also be advocated as a way to increase lifestyle PA.¹⁴

Implications for research and practice

The Pearson correlation results (Table 6) demonstrate a weak correlation between knowledge of physical activity for a health benefit and actual PA undertaken. This finding is consistent with those previous studies that showed a lack of a direct association between PA knowledge and reported weekly duration of PA.^15–16

One of the previous studies suggested that the poor relationship between knowledge and behaviour might result from an insufficient assessment of knowledge.¹⁵ Thus, a definite and objective system is needed to measure PA knowledge. The researchers believe that the 20-item questionnaire is a concise and effective tool. The various factors and barriers leading to PA could be evaluated by further qualitative research.

Most of the responders reported sufficiency in performing exercises and willingness to start or maintain exercise. It has been reported that attitude to exercise and knowledge of exercise are weakly related to participation in PA. Non-availability of facilities or supportive environment may present important barriers in avoiding desired participation in PA.^17–19 Thus, the establishment of a better environment for sports is important.

Nevertheless, to enhance a positive attitude towards exercise, healthcare workers’ counselling skills on healthy lifestyle could be objectively assessed and further training provided where necessary. Motivational interviewing is one way achieving this.