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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 2  |  Page : 97-103

Association between demographic, academic, and behavioral characteristics with physical activity levels among international students in China during COVID-19 pandemic


1 Department of Rehabilitation, The Third Affiliated Hospital of Jinzhou Medical University; Department of Rehabilitation, Jinzhou Medical University, Jinzhou, China
2 Department of Health Sciences, Uganda Christian University, Kampala, Uganda
3 Physical Medicine and Rehabilitation Department, Hubert Koutoukou MAGA National University Hospital Center, Abomey-Calavi University, Cotonou, Benin
4 Department of Clinical Sciences, Physiotherapy and Rehabilitation School, National Institute of Public Health, Bujumbura, Burundi

Date of Submission10-Jun-2022
Date of Decision19-Jul-2022
Date of Acceptance05-Aug-2022
Date of Web Publication22-Aug-2022

Correspondence Address:
Zhou Daan
Department of Rehabilitation,The Third Affiliated Hospital of Jinzhou Medical University, Liaoning PR
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_58_22

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  Abstract 


Background: International students face multiple challenges due to cultural distance, cultural shock, social support, stress and anxiety, language barriers, and classroom transition. Moreover, the outbreak of COVID-19 complicated the living situation for international students. Physical activity (PA) can be a coping strategy in overcoming health challenges as it is known to have health benefits, improve socialization and integration skills. Aim: The study aimed to determine PA levels of international students in China during COVID-19 and analyze the associated characteristics. Setting and Design: A cross-sectional study was conducted among international students in China. Subjects and Methods: An online questionnaire that included demographic, academic, and behavioral characteristics together with International Physical Activity Questionnaire Short Form tool was used to collect the data. Statistical Analysis: Descriptive statistics, Chi-square test, and Mann–Whitney U test were employed to analyze the data. Results: One thousand and hundred and twenty international students were recruited into the study. 71.3% of the participants were engaged in low, 15% in moderate and 13.8% in high PA. PA of international students was associated with gender, body mass index, marital status, continent of origin, student residence, study language, time spent in China and alcohol consumption P < 0.01; academic level P < 0.05. However, there was no significant association of PA with age and smoking status P < 0.05. Conclusion: This study indicates a lower level of PA among international students in China. International education management may consider the promotion of PA as a good intervention to the health of international students during COVID-19.

Keywords: China, COVID-19, international students, physical activity level


How to cite this article:
Nivyimana W, Mbasani R, Yollande DS, Daan Z, Bayumvire C, Wang M. Association between demographic, academic, and behavioral characteristics with physical activity levels among international students in China during COVID-19 pandemic. Saudi J Health Sci 2022;11:97-103

How to cite this URL:
Nivyimana W, Mbasani R, Yollande DS, Daan Z, Bayumvire C, Wang M. Association between demographic, academic, and behavioral characteristics with physical activity levels among international students in China during COVID-19 pandemic. Saudi J Health Sci [serial online] 2022 [cited 2022 Nov 27];11:97-103. Available from: https://www.saudijhealthsci.org/text.asp?2022/11/2/97/354166




  Introduction Top


Physical activity (PA) impart numerous health benefits such as cognitive outcomes, mental health, improved physical fitness, metabolic health among others.[1] Therefore, World Health Organization (WHO) suggests all people of different ages to practice routine PA.[1] However, previous studies described the transition from high school to university as a critical stage to the decline in PA;[2],[3],[4] 45.4% of students reduce PA when they leave high school to university.[4] The main barriers to PA in university life include: psychological, emotional, cognitive, environmental, socioeconomic, screen time, and demographic.[5]

Recent outbreak of COVID-19 is of great health concern in the world over, since the first case was confirmed in China in 2019.[6] In order to limit the spread of COVID-19, China adopted many strategies such as restrictions of access to sports and recreation facilities, public places, reduced intercity movements, canceled organization sports activities, closed schools and resorted to online learning.[7] Those measures were found to have a negative impact on PA in university students.[8],[9] A study conducted before the pandemic on 926 college students in Northeast of China reported 13% of participants had low physical activity (LPA), 39.8% were moderately active while 47.2% found to be highly active and a positive association between PA health related quality of life was revealed.[10] On the other hand, according to the study conducted in China on university students in the period of COVID-19, reported a high level of insufficient PA.[11] Moreover, there was an increment in LPA and a decline in high PA during COVID-19 lockdown.[12]

Many studies investigated the levels of PA among college students during COVID-19 pandemic but according to our knowledge, there is no research on level of PA among international students during COVID-19 pandemic. Beside transition high school to university and COVID-19 restriction barriers, international students face multiple challenges due to cultural distance, cultural shock, social support, and language barriers.[13],[14] Moreover, international students were found to be more affected by the above challenges than their local counterparts.[15] Despite the impact of these challenges to the level of PA, PA itself can be a coping strategy in overcoming health challenges as it is known to have health benefits, improve socialization and integration skills.[16] The aim of our study is to evaluate the level of PA among international students in China during the COVID-19 pandemic and determine the associated characteristics. It was hypothesized that the number of international students engaged in low PA would be high.


  Subjects and methods Top


Sample and design

A cross-sectional survey was conducted among all international university students in China via Wenjuanxing platform (https://www.wjx.cn) from March 20 to April 10, 2022. The study included all levels (undergraduate and graduate) of international students in China. Foreign students who were not in China during the survey were excluded from the study. Participants were informed about the objectives of the study and their informed consent was thought at the beginning of the questionnaire. A total of 1135 respondents were recruited. Fifteen students were excluded because of; 10 were out of China during the study and 5 reported daily time spent in different PA was more than 16 h.[17] A total of 1120 students constituted the study sample size. Ethical clearance was provided by the institution's medical ethics review committee (KX2022026).

Data collection tool

The questionnaire constituted of two parts:

Demographic, academic, and behavioral characteristics

International students reported their demographic, academic, and behavioral characteristics: age, gender, height, weight, marital status, continent of origin, academic level, student residence, study language, time spent in China, alcohol consumption, and smoking status. Body mass index (BMI) was calculated using the following formula: BMI = weight (kg)/height2 (m).

We further categorized the variables as follows: age (30 years and below or above 30 years), gender (male or female), normal weight students were of BMI 18.5–24.9 and abnormal weight had BMI out of that range,[18] marital status (unmarried or married), origin (African or non-African), academic level (undergraduate or graduate), student residence (on campus or off campus), study language (English or Chinese), time spent in China (3 years and below or above 3 years), alcohol consumption (nondrinker or drinker), and smoking status (nonsmoker or smoker).

Physical activity

The PA was measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF). It is a valid and reliable tool, a cost-effective method to classify individuals who achieve or not the current WHO's PA guidelines.[19] Participants were asked to report during last 7 days the frequency and duration of participating in PA according different intensities (low, moderate and high intensity). Energy expenditure was measured in Metabolic equivalents of tasks (METs) following the scoring rule of IPAQ-FS:

  1. Walking MET-min/week = 3.3 × walking minutes × walking days
  2. Moderate MET-min/week = 4.0 × moderate-intensity activity minutes × moderate days
  3. Vigorous MET-min/week = 8.0 × vigorous-intensity activity minutes × vigorous-intensity days.


The summation of all the three different PA intensities computed the total physical activity. Level of PA was categorized into three: respondents getting <600 MET-min/week are considered to be insufficiently active (LPA); those between 600 and 3000 MET-min/week are considered to be moderately active and the participants with more than 3000 MET-min/week are classified as highly active.

Statistical analysis

SPSS (version 25.0; IBM Corp., Armonk, NY, USA) was applied to analyze the data. Normality of distribution was assessed using Kolmogorov–Smirnov test. Since data were nonparametric, MET-min/week were presented as median values, first and third inter-quartile range. Descriptive statistics were carried out; Chi-square test was run to find the association between nominal variables (demographic, academic, and behavioral characteristics) and categorical variable (PA levels). Mann–Whitney U test was used to find the significant difference of MET-min/week between categories for each variable. Statistical significance was set as P < 0.05.


  Results Top


Participant characteristics

More than half (69%) of our participants were male, 59% were 30 years and below. Sixty-one percent had normal weight; Africans represented 62% and 73% were unmarried [Table 1]. Majority of international students were graduates (58%). Fifty-nine percent had at most 3 years in China, 66% lived on campus, only 24% studied in local language (Chinese), 61% were nondrinkers and 92% were nonsmokers [Table 2]. The highest percentages (71%) of international students were found to be engaged in low PA [Figure 1].
Figure 1: Physical activity levels of international students

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Table 1: Association between demographic characteristics and physical activity levels

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Association between characteristics and physical activity

There was statistically significant association between all demographic characteristics and PA levels of international students; gender, continent of origin, BMI, and marital status P < 0.01 except Age P < 0.05 [Table 1].

Statistically significant associations were revealed between all academic characteristics and PA levels of international students: Study language, student residence, and years in China P < 0.01; academic level P < 0.05 [Table 2].
Table 2: Association between academic characteristics, behavioral characteristics, and physical activity levels

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We further analyzed the association between behavioral characteristics and PA levels and a statistically significant association between alcohol consumption and PA levels of international students was found P < 0.01. However, no significant association between smoking status and PA levels was revealed P < 0.05 [Table 2].

Analysis of energy expenditure during physical activity

METs-min per week among different categories of variables in the respective types of PA was compared [Table 3]. In walking, only a statistically significant difference in MET-min/week was recorded between categories of gender, marital status, continent of origin and academic level P < 0.01. Moderate intensity exercise, categories of gender, BMI, marital status, student residence, and time spent in China recorded a statistically significant difference P > 0.01. In addition, there was a difference in academic levels and smoking status P < 0.05. For vigorous intensity, there was a statistically significant difference in MET-min/week for all categories of variables P < 0.01, except among academic levels and alcohol consumption P > 0.05. Lastly, for total PA, a significant difference was found among categories of gender, BMI, marital status, student residence, and time in China P < 0.01 and continent of origin and academic level P < 0.05.
Table 3: Metabolic equivalents of task-min per week comparison among categories of variables

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  Discussion Top


The transition from high school to university, COVID-19 restrictions and the change of home place are associated with reduced PA.[2],[5],[9],[20],[21] The aim of the current study was to evaluate the level of PA among international students in China during COVID-19 and determine the associated characteristics.

Our study found that most of the international students in China (71%) were engaged in low PA, which is in agreement with the study hypothesis. Psychological disorders (home sick, depression, and anxiety), lack of time and motivation, lack of accessible sport places and school support, discrimination, and COVID-19 restrictions could be some of the reasons for reduced PA. We did not find a study specifically conducted on PA among international students but studies conducted on national students during COVID-19 also found an increasing number of students engaged in low PA;[12],[20],[21],[22] however, the number of international students engaged in LPA remains higher compared to national counterparts. Therefore, further researches are needed to investigate the barriers to PA of international students, find specific strategies to improve their PA levels and analyze the impact of PA among international students as many studies in national students revealed a positive correlation between PA and mental health during the COVID-19 pandemic.[23]

In the current study, gender, BMI, marital status, continent of origin, academic level, student residence, study language, time spent in China, and alcohol consumption were the associated characteristics to PA. Surprisingly, age was not associated with PA. Contrary, a study conducted before COVID-19 reported that between ages 20 and 30, total and light intensity PA increases by age and become stable from 31 to 59 years.[24] The difference of results may be related to the time of study because COVID-19 restrictions affected PA of all ages but research of effect of age on PA among international students can be important.

Further, male international students' energy expenditure following walking, moderate intensity exercise, vigorous intensity exercise, and total PA was higher than female peers. Males seem to be more motivated to do PA than females; males majorly exercise for enjoyment, competition and to have friends while majority of females do exercise for physical appearance (weight loss and toning) among others.[25] Inline to our findings, a study reported that women compared to men have lower level of PA.[26] Strategies to reveal female's conscience about the benefits of PA are needed as females are known to be at high risk of weight gain associated with cardiovascular, metabolic, reproductive, and psychological health impact than males.[25]

Students of normal weight have more MET-min per week than their abnormal weight peers. With the COVID-19 outbreak, the weight of students increase between 2 and 3 kg and at the same time students reported a declines in PA.[27] Similar to many preceding studies, the BMI was associated to PA with normal BMI students being more engaged in PA than abnormal BMI.[28],[29] Promoting PA can be a good strategy to maintain international students healthy.

The current study, moreover, revealed married international students to be more involved in walking, moderate, and vigorous intensity exercise than unmarried students. During COVID-19, the screen time has increased and it is associated with alcohol and smoking intake[30],[31] and a decline in PA among college students.[11] Marriage is associated with reducing use of substances (tobacco, alcohol, and cannabis…) and lower odds of watching TV[32] which can explain the high level PA among married students. Similarly, married women were reported to be more actively engaged in PA than the unmarried in the USA.[33] On the other hand, married men and women at younger age were less active than single ones.[32]

Our result also revealed Africans were more engaged in walking and practicing vigorous exercise than students from other continents. No similar study has been carried out to analyze a difference in the level of PA between Africans and the rest of the world. Hence, more studies are necessary before drawing the conclusion.

The current study reports graduate international students to be more involved in walking and moderate intensity exercise than undergraduate students. Undergraduate students reduced walking and increased sedentary time during COVID-19 but not graduate students.[34] Before COVID-19 pandemic, a study reported that undergraduates were exercising more than graduates students.[35] However, another study conducted during the pandemic revealed that students who were less sedentary before pandemic decreased in moderate and vigorous exercise during pandemic.[34] This can be the explanation to high level of PA among graduate students compared to undergraduate counterparts.

Students living on campus had higher MET-min per week than off campus students. Campus provide a supportive physical environment for active movements and leisure while off-campus may produce limits to active movements and then a decline in PA.[36] Our findings are in agreement with a study which deducted living off campus as a factor of physical declining in college students.[37] The easy accessibility of sport equipment in Chinese Universities can be the reason as restrictions imposed by COVID-19 can limit off-campus students from accessing these sport facilities, consequently resulting into a decrease in PA.

Students studying in English were more active than colleagues studying in the local language (Chinese). Studying in a local language would bring a facility for international students to make friends, increase mental well-being[38] and then lead them to be more physically active. However, the gradual decrease in Chinese college students' PA levels[39] can be of negative impact to PA for international students who study in the Chinese language. Strategies to improve PA levels among local students would in turn increase at least the PA of international students studying in the local language.

Students who had 3 years and below were more engaged in moderate and vigorous intensity exercise than those spent above 3 years in China. Our findings are opposed to the study conducted in Canada that found the time since immigration was positively associated to PA level.[40] There are few studies associating the period of time and PA among people living in foreign countries.

The current study also found an association between alcohol consumption and PA. However, there is no significant difference in MET-min per week between nondrinkers and drinkers. Many previous studies also evoked similar findings between alcohol consumption and PA but suggested for more cross-cultural investigations because some findings revealed people who don't drink are more active[41],[42] while another study found people who drink more are more active.[43]

Finally, smoking was not associated with PA, but nonsmokers were more engaged in moderate and vigorous intensity exercise than smokers. Similarly, a study conducted in Iranian university found that moderate intensity activity was inversely associated with odds of smoking.[44] The carbon monoxide from cigarettes binds to red blood cells and harms the delivery of oxygen to muscles and other body tissues. This increases lactic acid accumulation, which in turn reduces physical endurance by causing muscles to feel burning and fatigue; leading smokers to have heavy breathing and increased soreness after exercise, which may bring reduction to moderate and vigorous exercises.

The current study has several limitations. First, it was a cross-sectional study design; hence, we cannot infer a causal direction. Second, self-reported PA may lead to over or underestimations of real PA.

On the other hand, this study has several strengths. According to our knowledge, this is the first study assessing PA among international students. The sample size was large enough and the study included several variables to conclude the level of PA among international students.


  Conclusion Top


The findings from this study indicate a lower level of PA among international students in China. International education counselors and administrators may consider the promotion of PA as a good intervention to the mental and physical well-being of international students, especially during the COVID-19 pandemic. This study opens new research avenues in this field of PA among international students and during periods of disaster.

Acknowledgments

The authors gratefully appreciate the dedicated efforts of all international student volunteers and the great assistance of the staff members of the department of rehabilitation at Third Affiliated Hospital of Jinzhou Medical University involved in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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