EXERCISE BEHAVIOR OF MIDDLE-AGED PATIENTS WITH HYPERTENSION IN TAIWAN

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1 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved EXERCISE BEHAVIOR OF MIDDLE-AGED PATIENTS WITH HYPERTENSION IN TAIWAN RUEY-MEEI LEE, MHA, MSN, PHD(C), RN, CHIEH-YU LIU, PHD, CHIH-WEI LEE, MD, YU-CHU CHUNG, PHD, RN, KEH-LING YU, BSN, RN, AND HUNG-RU LIN, PHD, RN School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan Graduate Institute of Nurse-Midwifery, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan Department of Community Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan Department of Nursing Home, Cheng Hsin General Hospital, Taipei, Taiwan Correspondence to: Hung-Ru Lin; hungru@ntunhs.edu.tw ABSTRACT Purpose: To understand the exercise behavior of middle-aged patients with hypertension and its affected factors. Design: A cross-sectional correlational design. Sample: A total of middle-aged patients aged - who were diagnosed with hypertension. Measurements: Demographic data, exercise of change, and exercise self-efficacy questionnaires, international physical activity questionnaire. Results: The results showed that.% of the participants did not have exercise habits..% took exercise at least three times per week, and.% took exercise at least five times per week. In terms of physical activity,.% of them engaged in high physical activity,.% had sufficient physical activity, and.% of engaged in insufficient physical activity. The important predictors affecting the physical activity concerning entertainment, exercise, and leisure were in the following order: self-efficacy, age, marital status, and high diastolic blood pressure. The total variance explained was.% (F=., p<.). Physical activity was positively correlated with self-efficacy, age and marital status, and it was negatively correlated with diastolic hypertension. Conclusions: Increasing physical activity is important to enhance the self-efficacy of middle-aged patients with hypertension. The results could be provided as reference for health professionals to encourage patients to participate in activities. Keywords: Hypertension; Physical activity; Exercise change ; Self-efficacy Background Hypertension is one of the most important causes of premature death worldwide. There are at least million people globally who have hypertension. It is estimated that by, there will be. billion people suffering from hypertension, which is an increase off % compared with that in []. Data from the statistics on causes of death from the Ministry of Health and Welfare, R.O.C. [], in, hypertension is eighth highest cause of death among the top causes of death, and fully one quarter of the total number of patients died of hypertensionrelated or other closely-related chronic diseases among the top ten causes of death in Taiwan. The treatments for hypertension can be divided into lifestyle changes and medication treatments. Lifestyle changes include salt restrictions, alcohol restrictions, weight loss, smoking cessation, dietary control, and exercise. Such lifestyle changes are more important than medication treatments. Only when an individual s lifestyle is changed can he/she prevent hypertension instead of treat it [].

2 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved Exercise is particularly important. The Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine both suggest that adults should engage in exercise at least five days per week, with moderate physical activity for minutes, to achieve better health [-]. A clinical study verified that regular exercise can significantly reduce the blood pressure of patients with hypertension []. Fagard [] reviewed studies and reports concerning exercise and hypertension, and found that participants who engage in exercise frequently can reduce an average of -% of the risk of suffering from hypertension. Differences in gender, age, or ethnic group do not have any effect []. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) also indicated that engaging in moderate exercise five days per week with moderate physical activity for minutes can reduce blood pressure by approximately - mmhg []. Lin and colleagues [] found that the prevalence of hypertension in central Taiwan is higher than the national prevalence, and that the prevalence increases with the increase of age. Approximately.% of female patients and.% of male patients didn t know that they suffer from hypertension. In addition, some researchers found that the prevalence, selfawareness rate, treatment rate, and control rate of rural areas are lower than those of urban areas [,]. Lin [] conducted a study in a rural area in eastern Taiwan, found that.% (N=) of people did not keep the habit of regular exercise. The reasons why they failed to exercise were in the order as follows: work stress, lack of time, and lack of companions. In addition, Chang et al. [] found that exercise and physical activity of middle-aged individuals are lower than those of other groups. The maintenance of good physical and psychological adjustment at middle age is significantly correlated with future elderly depression []. Middle age is a changeable when individuals transform from maturity to gradual aging. During this time, many physiological functions naturally decline, physical activity relatively decreases, body lipids increase, and cardiopulmonary function declines, which all lead to the increase of incidences of cardioand cerebrovascular diseases and various degenerative diseases. These phenomena impose serious threats to the physical health of middle-aged people []. In the psychological aspect, middle-age is the most reproductive of life. Middle-aged individuals are not only the economic foundation of the country and social economy but also provider of family resources. Middle-aged individuals have to bear more work and life pressure []. Some studies have shown that the happiness of people in their life reflects a U-shaped curve, and the bottom is at middle age []. In busy modern life, middle-aged individuals are the population carrying more burdens and having nowhere to complain []. They not only have to strive for the best in their workplace but also have to endeavor to learn to avoid being eliminated or fired. In their families, they have to bear the economic burden, teach and cultivate the next generation, and worry about the physical health or psychological status of their older parents []. Middle-aged individuals have to fully devote themselves to career and family, and they lack the motivation and time to exercise. Moreover, middleage is also the before aging, and it is the important for the health foundation of the elderly. Therefore, how to improve the health status of middle-aged individuals and increase their exercise participation rate are important []. The concept of self-efficacy, proposed by Bandura, is based on social cognitive learning theory. Selfefficacy refers to individuals subjective judgment of their level of confidence in overcoming difficulties on their own in a special situation. It is also viewed as the perception of the ability to execute a behavior. In other words, the higher the self-efficacy is, the more significant the effect on changing the behavioral is, and the longer a new behavior will last. Netz and Wu [] summarized and analyzed studies on exercise behavior and found that selfefficacy can predict exercise behavior. Some studies have also found that self-efficacy is positively correlated with exercise behavior. Individuals with higher self-efficacy will engage in regular exercise, and the higher the self-efficacy score is, the higher the exercise change will be. In addition, selfefficacy is also an important factor predicting exercise behavior [-]. These studies emphasized that an individuals possession of relevant knowledge and skills is not sufficient for the development of behavior, and that behavior will not occur or be changed until individuals have sufficient selfconfidence and believe that they have sufficient ability to execute relevant behaviors [].

3 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved Regular exercise can indeed reduce the blood pressure of patients with hypertension, and the effect of regular exercise with low and moderate intensity is particularly more significant than that of higher intensity exercise (e.g. playing soccer and running). In recent years, studies on the improvement of exercise have been paid attentions by many researchers. However, only few studies have been published in which middle-aged population. The authors intended to understand the exercise behavior of middle-aged patients with hypertension to further plan and promote the cultivation of regular exercise habits in middle-aged patients with hypertension. Therefore, the main purpose of this study was to understand the exercise behavior and its related factors of middle-aged patients with hypertension. Methods Research Design and Samples This study was based on a descriptive cross-sectional correlational design. Using convenience sampling, the authors enrolled study participants at the outpatient department of a certain regional teaching hospital in a county in middle Taiwan. Selection criteria included () age -; () with unstable blood pressure and hypertension requiring medication treatment at the discretion of a doctor; () able to communicate in Chinese, Taiwanese or Hakka; () able to independently complete daily activities, and () willing to participate in this study. The exclusion criteria were patients with kidney complications or cardiac diseases, physical and psychological disabilities, mental illness, and severe illness. Measures Demographic data Demographic data included gender, age, birthplace, marital status, educational background, career, family socioeconomic status, living status, medical history, exercise experience, time spent on TV watching, height, weight, blood pressure, waistline measurement, and hypertension medication. Exercise Change Stage Questionnaire The Chinese version of Exercise Change Stage Questionnaire was used in this study, which was translated from English to Chinese by Lin et al. []. The original questionnaire was amended by Marcus et al. [] from the questionnaire for the change of smoking cessation. The questionnaire included five items in total. Each item described every change of, which represented () the precontemplation ; () the contemplation ; () the preparation ; () the action ; and () the maintenance. The test-retest reliability of the Chinese version of this questionnaire applied to elderly people was.. []. Exercise Self-efficacy Questionnaire The Chinese version of Exercise Self-efficacy Questionnaire was used in this study, which was translated from English to Chinese following by Lin et al. []. The original questionnaire was a five-item questionnaire developed by Marcus et al. in [], which used middle-aged employees in the workplace as the participants. A five-point Likert scale was used to enable the patients to choose their level of confidence in engaging in exercise (in which scores ranged from : unconfident to : extremely confident). The Cronbach s alpha was. and the test-retest reliability was. [] in previous study, suggesting that the reliability of the questionnaire was good. Long form of the International Physical Activity Questionnaire (IPAQ-L) The Chinese version of IPAQ-L was used in this study, which was translated from English to Chinese by Liu []. The original questionnaire was developed by WHO, which include a total of items, with four dimensions measuring the work, family affairs, traffic, and leisure. The IPAQ-L can be used to understand the time spent on high intensity and moderate intensity walking, the number of working days, and time spent sitting during onworking days in the four dimensions of an individual s past seven days. The test-retest reliability of the IPAQ-L was., and the concurrent validity was.. According to IPAQ s calculation of physical activity, it can be divided into three levels: () high intensity activity; () sufficient physical activity; () insufficient physical activity. Data Collection Data were collected between March and October. Before data collection, the study was approved by the Institutional Review Board of a teaching hospital located in Taiwan (No: ()A- ). Writen information explaining the study was given to potential participants during their visits to an outpartment. If the potrntial participant expressed

4 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved interest in participation, the purpose and process of the study, including participant s rights and protection of their identity, were discussed. In addition, a signed consent form was obtained from every participant prior to the interview. Data Analysis Data were analyzed by SPSS for Windows version. (SPSS Inc., Chicage, IL, USA) using independent sample t test, chi-square test, one-way ANOVA, Scheffe s post hoc comparison, Pearson product-moment correlation, and regression analysis. Results Demographic and Disease Attributes In this study, middle-aged patients aged - (mean:.; SD:.) with hypertension were recruited. Of the participants, most were male (.%), married (.%), had graduated from high school (.%), and currently employed (.%). Due to regional restrictions, most of the participants were Hakka (.%). In this study, of the participants (.%) had suffered from hypertension for more than five years. The self-perceived health status of participants (.%) was good, while that of (.%) was normal or poor. Among the enrolled patients with hypertension, only met the BMI standard (.%), were overweight (.%), and of them were obese (.%). Under medication, of the participants (.%) were able to maintain their blood pressure at less than /mmhg. The waistline measurements of participants (.%) were within normal range. Only of them (.%) did not suffer from chronic diseases other than hypertension. Regarding the exercise change, of the participants (%) were at the precontemplation, (.%) at the contemplation, (.%) at the preparation, (%) at the action, and (.%) at the maintenance. Of the participants, (.%) described that they did not have exercise habits, while of them (.%) had exercise habits. Regarding such exercise habits, of the participants (.%) exercised at least three times per week, while only of them (.%) actually met the WHO-recommended standard for physical activity (five times per week). For physical activity, of the particpants (.%) engaged in high physical activity, (.%) in sufficient physical activity, and (.%) in insufficient physical activity. The time spent engaging in strenuous exercise per week was. ±. minutes, in moderately strenuous exercise was. ±. minutes, that spent walking was. ±. minutes, and that spent sitting during working days was. ±. minutes. The participants spent an average of. hours sitting during working days and. ±. minutes sitting during non-working days, averaging. hours during non-working days. Analysis of Demographic and Disease Characteristics on Exercise Habits and Exercise Change Stage The results showed that demographic characteristics, such as age, marital, employment and living condition had a significant effect on exercise condition. In addition, demographic characteristics such as age, marital status, employment, exercise habits and living condition had a significant effect on the exercise change (Table ). In terms of disease characteristics factors such as BMI, normal/abnormal blood pressure, and selfperceived health status had a significant effect on exercise condition. Disease characteristics such as BMI, normal/abnormal blood pressure, normal/abnormal waistline measurements, and selfperceived health status had a significant effect on the exercise change (Table ). The study results showed that the proportion of participants with normal BMI (.%) who engaged in exercise was higher than that of those who were overweight (.%) or obese (.%). Influence of Demographic and Disease Characteristics on Physical Activity The results showed that in the leisure activity dimension, gender, marital status, exercise habits, Systolic Blood Pressure(SBP),Diastolic Blood Pressure(DBP), and waistline measurements had a statistically significant effect on exercise change. The leisure physical activity of the male participants was higher than that of female ones (p<.), and the married participants was higher than that of the unmarried ones (p<.). The leisure physical activity of the particpants who had exercise habits was higher than those without such habits (p<.).

5 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved SBP had a significant effect on leisure physical activity. The Scheffe s post hoc comparison found that the leisure physical activity of patients with an SBP mmhg was lower than that of those with an SBP of ~mmhg. DBP also had a significant effect on leisure physical activity. The Scheffe s post hoc comparison found that the leisure physical activity of patients with a DBP mmhg was lower than that of those with a DBP mmhg. The leisure physical activity of patients with a normal waistline was higher than that of those with an abnormal waistline (p<.). In addition, leisure physical activity had a statistically significant effect on the exercise change. The Scheffe s post hoc comparison found that the leisure physical activity of patients at the maintenance and action was higher than that of those at the precontemplation, the contemplation, and the preparation (p<.). Analysis on Demographic Characteristics, Disease Characteristics and Self-efficacy The results showed that exercise habits had a significant effect on self-efficacy (p<.). The selfefficacy of the participants with exercise habits was higher than those without such habits. SBP had a significant effect on self-efficacy (p<.). The Scheffe s post hoc comparison found that the selfefficacy of the patients with an SBP mmhg was lower than that of those with an SBP of ~mmhg. Besides, exercise change had a significant effect on self-efficacy (p<.). The Scheffe s post hoc comparison found that the selfefficacy of patients at the action and maintenance was higher than that of those at the precontemplation, contemplation, and preparation. The self-efficacy of patients at the preparation was also higher than that of those at contemplation. Predicators of Physical Activity and Exercise Habit This study used stepwise regression analysis to analyze important predictors which were significantly correlated with entertainment, exercise, and leisurerelated physical activity. The independence among various variables showed that the variance inflation factor (VIF) was <. Therefore, there was no collinearity among variables, and stepwise regression analysis could be used. As shown in Table, the variables with the highest predictability were in the order as follows: self-efficacy, age, marital status, and normal/abnormal DBP, which could explain.% of the total variance (F=., p<.) in predicating leisure-related physical activity. The results showed that entertainment, exercise, and leisure-related physical activity were positively correlated with self-efficacy, age, and marital status, and were negatively correlated with diastolic hypertension. In other words, the participants whose self-efficacy scores were higher, those who were older, were married, and with a normal DBP, who was higher the exercise and leisure-related physical activity of. In order to understand the predictors affecting the exercise behavior of middle-aged patients with hypertension, this study also used the logistic regression model to perform further analysis. As shown in Table, the predictors affecting exercise behavior were marital status (OR=., p=.), employment status (OR=., p=.), living condition (OR=., p=.), and exercise selfefficacy (OR=., p<.). Discussion The results of this study showed that % of the patients with hypertension engaged in at least five times per week and that.% of them engaged in exercise three times per week. This proportion was slightly higher than the national average proportion of people engaging in regular exercise in Taiwan. The reason might be that the patients with hypertension were frequently exposed to the advocacy of medical and nursing professionals. Besides, the participants in this study were middleaged individuals, which.% were aged -, and.% had retired. Previously study reported that the proportion of people engaging in exercise increased with the increase of age []. As a result, the proportion of people engaging in exercise was higher than that of the general population of national survey. Self-perception of exercise habits had a significant effect on exercise change in this study. The exercise change of those with exercise habits was mainly above the preparation (.%), while that of those without exercise habits was mainly under the preparation (%). Many studies in Taiwan have shown that the exercise change of people is mainly at the preparation (.%-.%, with an average of.%), followed by the contemplation (.%-.%,

6 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved with an average of.%), suggesting that individuals in Taiwan have not cultivated the habit of regular exercise []. The study showed that.% of the female participants reported that they had exercise habits, and that.% actually exercised at least three times per week. This proportion was higher than the results reported by other studies [-]. The reason might be that the age of the participants in this study was older than in other studies. Furthermore, the illness awareness of the female patients was higher, and they attached more importance to personal health []. Thus, they were willing to spend more time exercising. However, previous studies revealed that the proportion of men engaging in exercise is higher than that of women engaging in exercise [,]. However, the proportion of male patients engaged in exercise was significantly lower than the female patients in this study. More studies are required to verify whether disease factors could lead to this difference. This study divided participants into two groups: those aged -, and those aged -. The results showed that the older the participants were, the more likely they would be to have exercise habits and the more likely their exercise would be at the maintenance. This result was consistent with that of Chang et al. []. However, it was opposite to that of Chie et al. [], as well as that of the study by the CDC [] in the U.S. Whether the difference was caused by the urban-rural gap is also worthy of subsequent investigation. In this study,.% of the participants maintained their SBP at less than mmhg, and.% maintained it at -mmhg. Additionally,.% of them maintained their DBP at less than mmhg, and.% maintained it at -mmhg. In terms of the control effect of SBP, the control rate was lower than that (%) in the U.S. (CDC, ), as well as that (.%) of the study in Taipei City []. This result was consistent with the result of previous study, which suggested that the control rate in urban areas is better than that in rural areas []. An investigation on people aged - in Taiwan by Liu et al. [] found that the physical activity of % of the people is sufficient, while that of % is insufficient. Their study also found that.% of the individuals engage in strenuous activities minutes per week, and that.% of them engage in moderately strenuous activities minutes per week. In this study,.% of the participants engaged in high physical activity,.% engaged in sufficient physical activity, and.% engaged in insufficient physical activity. Possiblely, because the average age of the participants in this study was older, a higher proportion of them engaged in sufficient physical activity. However, only.% of the participants engaged in strenuous activities minutes per week and % engaged in moderately strenuous activities minutes per week in this study, which was significantly lower than that in the study by Liu et al. []. The reason might be that the participants were older and most of them suffered from chronic disease. This study found that the self-efficacy of the patients with exercise habits was high. Exercise change had a significant effect on self-efficacy. The selfefficacy of patients at the action and maintenance was higher than that of those at the precontemplation, contemplation, and preparation. In addition, the self-efficacy of patients at the preparation was also higher than that of those at the contemplation. This result was consistent with that of previous studies, stated that self-efficacy was positively correlated with exercise behavior [-]. The order of the important predictors affecting entertainment, exercise, and leisure-related physical activity was as follows: self-efficacy, age, marital status, and normal/abnormal DBP. In addition, physical activity was positively correlated with selfefficacy, age and marital status, and negatively correlated with DBP. This result was consistent with the results of studies by numerous scholars [-]. Limitations Data collection for this study was based on convenient sampling. Participants were drawn from a single hospital in a rural area in Taiwan. Such a focused sampling may limit the ability to generalize study findings. Another limitation comes from the study being based on a cross-sectional design, which may restrict the explanation of findings. Findings will be enhanced with data collected from a wider range of settings. Future studies are also recommented to enroll patients in urban areas as the participants to compare urban-rural differences, thus the results can be extended to a greater scope. In order to assist patients with hypertension in controlling disease better and improving quality of life, developing

7 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved effective approaches to increase patients exercise behavior are also recommended. Conclusion Self-efficacy, age, marital status, and normal/abnormal DBP were the significantly predictors affecting entertainment, exercise, and leisure-related physical activity. These results could be provided as a reference for medical and nursing professionals to strengthen clinical patients perception and their exercise self-efficacy, as well as to develop strategies for increasing the physical activity of patients with hypertension. References. World Heart Federation. Hypertension and cardiovascular disease. [Internet]. Geneva, Switzerland: World Heart Federation; [cited Feb ]. Available from: Ministry of Health and Welfare. Statistics: cause of death statistics. [Internet]. Taipei: Ministry of Health and Welfare; [cited Feb ]. Available from: aspx?f_list_no=&fod_list_ no=. Chiang CE, Wang TD, Li YH, Lin TH, Chien KL, Yeh HI, et al. guidelines of the Taiwan society of cardiology for the management of hypertension. Elsevier & Formosan Medical Association. ;():-. Center for Disease Control and Prevention. Physical activity and health. [Internet]. Atlanta, GA: Center for Disease Control and Prevention; [cited Feb ]. Available from: ne/health/index.html #LiveLonger. American College of Sports Medicine. ACSM, AHA support Federal physical activity guidelines. [Internet]. Indianapolis, IN: American College of Sports Medicine; [cited Feb ]. Available from: Lin CR. Effect of a regular communitybased physical activity program on metabolic parameters in middle-aged women. Tzu Chi Nursing Journal. ;():-.. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. ;():S-S Millar PJ, McGowan CL, Cornelissen VA, Araujo CG, Swaine IL. Evidence for the role of isometric exercise training in reducing blood pressure: potential mechanisms and future directions. Sports Med. ;():-. National Heart Lung and Blood Institute. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC). [Internet]. Bethesda, MD: National Heart Lung and Blood Institute; [cited Feb ]. Available from: sion/jncfull.htm. Lin HF, Chang CM, Lai SW, Liu CS, Lin T. Descriptive analysis of hypertension in patients receiving health checkups-a hospitalbased study. Taiwan Fam Med Res. ;():-.. Chiang YT, Li YD, Shih WJ. Fitness level, living conditions and quality of life perceived by university students at different s of exercise. Journal of Sports Research. ;():-. Chang SH, Chang C, Gau YM, Hsiao YC, Wu LY. Exploring exercise behaviors and the factors influencing them among community dwellers in Taoyuan. Journal of Evidence- Based Nursing. ;():-. Taylor D. Physical activity is medicine for older adults. Postgrad Med J. ;:-. Chou CC, Wang JM. The effects of exercise social support and exercise enjoyment on well-being for middle aged exerciser. Taiwan Journal of Sports Scholarly Research. ;:-.

8 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved. Pan PH, Rong JR, Wu SI. The study of health problems and self-efficacy in health behaviors influence the mental health of middle-aged people. The Journal of Psychiatric Mental Health Nursing. ;():-.. Jiang WC. Confusion: mental crisis and turnaround of middle-aged. Counseling & Guidance. ;:-.. Ko CH. Middle-aged man's frustration trilogy - stress, insomnia, depression. Kaohsiung Medical University Medical News magazine. ;:.. Tsai YM, Wang JM. Relationship among participation motivation, self-efficacy, perceived exercise barrier and exercise behavior. Bulletin of Sport and Exercise Psychology of Taiwan. ;:-. Netz Y, Wu MJ. Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies. Psychology and Aging. ;():-. Lee SH, Xie MY, Hong GQ. The studies of behaviors and influence factors of motors for tertiary education students in Pingtung area. Journal of Sport Health and Leisure. ;:-.. Ma SM, Liu YY. An application of transtheoretical model to the research of recreational sports participation behavior with female college staff. Leisure & Society Research. ;():-.. Wang HW, Chang M. The effects of exercise intervention based on the transtheoretical model for employees in a worksite. Formosan J Med. ;:-.. Lin TH. Validation of psychometric properties in exercise of change, exercise processes of change, exercise decisional balance, and exercise self-efficacy questionnaires for older adults. Unpublished master s thesis. Taichung, Taiwan:Institute of Medicine of Chung Shan Medical University,. Marcus BH, Rossi JS, Selby VC, Niaura RS, Abrams DB. The s and processes of exercise adoption and maintenance in a worksite sample. Health Psychology. ;:-. Liu YM. Development and verification of validity reliability of the international physical activity questionnaire Taiwan version. Unpublished doctoral dissertation. Taipei: National Taiwan University College of Medicine, Institute of Nursing,. Sports Administration, Ministry of Education. The R.O.C. sport city survey in. [Internet]. Taipei: Sports Administration, Ministry of Education; [cited Feb ]. Available from: Chang WC, Lin CF. The study of physical activity and manifestation of climacteric symptoms for perimenopausal women of outpatients of gynecology & obstetrics department. NPUE Journal of Sport Science. ;:-.. Chie WC, Fu CM. A study of participation of physical activity of community residents. Taiwan J Public Health. ;():-.. Huang YN, Wu TY, Kau KL, Wang SM, Chen CC. Prevalence, awareness, treatment and control of hypertension and diabetes mellitus among adults participating in health examinations in Taipei city. Taiwan J Fam Med. ;():-.

9 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved Item Gender Female Male Age - years old -years old Native place Taiwanese Hakka Other Marital status Unmarried Married Level of education () Literate, elementary school () Junior high school and senior high school () Junior college and college and above Employment Status () Unemployed () Employed Exercise Habit No Yes Living Condition () Living alone () Living with Number of Participants (%) (.) (.) (.) (.) (.) (.) (.) (.) (.) (.) (.) (.) (.) (.) (.) (.) Exercise Condition Nil Irregular Regular X /p./../.*./../.*./../.* (.)./.* Precontemplation Contemplation Exercise Change Stage Preparation Action Maintenance X /p./../.*./../.*./../.*./.*./.*

10 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved spouse and children () Others Daily TV time () Less than hour () ~ hours () ~ hours () More than hours (.) (.) (.) (.) (.) (.)./. Table Analysis on Demographic Characteristics and Exercise Habits (N=)./. Item BMI Normal: BMI< Overweight: BMI< Obese: Table Analysis on Disease Characteristics and Exercise Habits (N=) Number of Exercise Condition Exercise Change Stage Participants Nil Irregular Regular X precontemplation Contemplation /p (%) (.) (.) (.)./.* Preparation Action Maintenance X /p./.* SBP Normal Prehypertension High DSP Normal Prehypertension High Time suffering from hypertension < year ~ years ~ years > years (.) (.) (.) (.) (.) (.) (.) (.) (.) (.)./.*./../../ P<.*./ P<.*./.

11 April.. Vol., No. ISSN - - IJRSS & K.A.J. All rights reserved Waistline measurement Normal Abnormal Number of chronic diseases Nil One Two > three Self-perceived health status Very good Good Normal Bad *P<. (.) (.) (.) (.) (.) (.) (.) (.) (.) (.)./../../.*./.*./../.* Table Stepwise Regression Analysis on Factors Affecting Leisure-related Physical Activity (N=) Item B SE Beta t p Constant <. Self-efficacy.... <. Age..... Marital status..... DBP R =., Adjusted R =., F=., p<.