Journal of Exercise Physiologyonline

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1 24 Journal of Exercise Physiologyonline December 2017 Volume 20 Number 6 Official Editor-in-Chief Research Journal of Tommy the American Boone, Society PhD, MBA of Review Exercise Board Physiologists Todd Astorino, PhD Julien ISSN Baker, PhD Steve Brock, PhD Lance Dalleck, PhD Eric Goulet, PhD Robert Gotshall, PhD Alexander Hutchison, PhD M. Knight-Maloney, PhD Len Kravitz, PhD James Laskin, PhD YitAun Lim, PhD Lonnie Lowery, PhD Derek Marks, PhD CristineMermier, PhD Robert Robergs, PhD Chantal Vella, PhD Dale Wagner, PhD Frank Wyatt, PhD Ben Zhou, PhD Official Research Journal of the American Society of Exercise Physiologists ISSN JEPonline Physical and Physiological Literacy Feedback Improves the Exercise Behavior in TOFI Governors and Chief Executive Officers Khadijeh Irandoust 1, Morteza Taheri 2, Gabriel Rodrigues Neto 3, Lotfail Lotfi 4 1 Associate Professor, Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran, 2 Assistant Professor, Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran, 3 Coordination of Physical Education, Nursing and Medical Schools, Nova Esperança (FAMENE/ FACENE), 4 Master of Science, School of Physical Education and Sports Sciences, Payame Noor University, Tehran, Iran ABSTRACT Irandoust K, Taheri M, Neto GR, Lotfi L. Physical and Physiological Literacy Beedback Improves the Exercise Behavior in TOFI Governors and Chief Executive Officers. JEPonline 2017;20(6): This study determined the effect of physical and physiological literacy feedback on the exercise behavior of Governors and Chief Administrative Officers. Sixtyeight TOFI (Thin Outside, Fat Inside) male Governors and Chief Executive Officers were randomly assigned to three groups: (a) personalized feedback group (PFG) (n=24); (b) family feedback group (FFG) (n=23); and (c) control group (CG) (n=21). At the end of the 2-month physical and physiological literacy feedback, both experimental and control groups were asked to monitor their steps daily for 1 wk. Subjects in the PFG and FFG had significant improvement in steps per day after receiving health literacy instructions (P=0.001). Both physical and physiological factors in the experimental groups were significantly improved after receiving health feedback compared to the control group (P 0.05). The findings indicate that TOFI managers should follow the health intervention programs to live a healthier lifestyle and maximize organizational performance. Keywords: Exercise Behavior, Health Feedback, TOFI

2 25 INTRODUCTION Physical and physiological problems associated with excessive work is found largely among Governors and Chief Executive Officers. The TOFI (Thin Outside, Fat Inside) phenomenon is a key risk factor that threatens the Governors health. It is also associated with chronic diseases that threaten their quality of life, especially after retirement. Unhealthy individuals have normal weight with extra fat and muscle atrophy simultaneously. Job stress due to increased secretion of stress hormones such as cortisol and inactive lifestyle are among the main primary causes that lead to TOFI. Also, the work environment of the Governors and Chief Executive Officers has an important influence on the quality of their health. There is the increased likelihood of adopting a sedentary lifestyle that sets the stage for the increase in body fat and visceral fat, which has a negative effect on the pulmonary function of obese individuals (4). Additional reasons why Governors fail to adapt to a more physically active lifestyle are lack of time, energy, and motivation. There is also the fear of being injured as well as the inconvenience of exercising along with low self-efficacy, the lack of encouragement and support from the family (6). As a result, there is an increase in complaints of fatigue at work that limit the Governors maximal mental capacity to make crucial decisions for society. Enjezab et al. (3) and Perez et al. indicate that the effect of overtime and/or long hours of work result in numerous musculoskeletal disorders and mental health problems. Thus, it is important to create strategies to individuals of all ages to be more physically active in their daily life. One possible way to do so is to increase the motivation for doing exercise (7) by increasing personal knowledge about the body fat percent, lean muscle mass, and visceral fat. Also, raising the awareness of an individual s lack of daily physical activity compared with his or her perceived level of activity is another strategy that may be helpful in living a healthier lifestyle. In this context, electronic pedometers provide an accurate, objective, and low-cost method of measuring walking and other ambulatory activities (2). Pedometers are more effective than physical activity questionnaires, since they do not merely rely on self-recall of exercise or subjective assessment of exercise intensity. To the best of our knowledge, there is no research that has determined whether family versus personalized feedback on health literacy (i.e., body knowledge and exercise behavior) in Governors causes a greater increase of the individual s physical activity level compared with their own health knowledge. Given the importance of keeping the Governors healthy for making crucial decision on behalf of society, effective strategies of successful physical activity promotion interventions should be seriously considered. Therefore, the purpose of this study was to investigate the effect of physical and physiological literacy feedback (health feedback) on the physical activity behavior in Governors and Chief Administrative Officers. METHODS Subjects Sixty-eight male Governors and Chief Executive Officers (mean age, 45 to 57 yrs old; body weight, 78.7 ± 9.2 kg; BMI, 27.1 ± 2.4 kg m -2 ) voluntarily agreed to participate in this study. The inclusive criteria consisted of the lack of regular physical activity within the past 6 months, no symptoms of illness that restricted their exercise activities, having muscle

3 atrophy, and high body fat percent. Baseline screening tests of physical activity were done using Beck Physical Activity Questionnaire and pedometer in all groups for 1 wk. Percent body fat (PBF) and total muscle mass (TMM) were measured using a body composition analyzer (In Body 320). Nutritional status of the subjects was monitored for a 24-hr caloric intake. Then, the subjects were randomly assigned into 3 groups: Personalized Feedback Group, PFG (n=24); Family Feedback Group, FFG (n=23); and Control Group (n=21) (Figure 1). The subjects in the PFG consulted with a sports doctor once a week for 2 months. They were informed of their visceral fat, percent body fat, muscle atrophy, pulmonary functions, and the possible consequences of the physical and physiological problems. For the FFG, all the procedures were performed by the subjects families. After giving the feedback, the sports doctor emphasized the key effect of regular exercise on improving their own tested physical and physiological status, especially in the case of poor test results. The subjects were encouraged to improve their physical activity. The subjects in the Control Group received neither their test results nor feedback on these results. 26 Figure 1. Recruitment and Allocation of the Study Participants. PFG = Personalized Feedback Group; FFG = Family Feedback Group; CG = Control Group The purpose of this study was to provide a synergist force among family in order to follow the exercise behavior more powerful. The intervention phase for the two experimental groups included giving the body feedback focusing on body composition parameters, educating the subjects with the training protocol to optimize their body status, consulting with each subject individually during the 8 sessions within the 2-month period. At the end of the 2 months of instruction, both experimental groups and the control groups were asked to monitor their steps daily for 1 wk, then, the post-test physical and physiological factors were performed.

4 Ethics committee approval was obtained from the Ethics Committee of Imam Khomeini International University (ID: 17628). An informed consent was signed by the subjects prior to the beginning of study. Statistical Analysis The data were analyzed statistically using the ANOVA for comparisons (SPSS software 21) among the groups before and after the intervention. Then, the post hoc Tukey test was used to determine the differences among the groups. All variables were expressed as mean ± SD. Values less than an alpha level of 0.05 were considered statistically significant. RESULTS No significant differences were found in the pre-test variables, which included the subjects physical (weight, TMM, PBF, and BMI), physiological (FVC and FEV1) and exercise behavior (number of daily steps) in the groups. The measures in pre-test and post-test are shown in Table 1. Table 1. Physical and Physiological Characteristics of the Intervention Group and the Control Group in Pre-Test and Post-Test. 27 Variables PFG FFG Control F Sig Pre-Weight (kg) ± ± ± 4.65 Post-Weight (kg) ± ± ± * Pre-TMM 25.9 ± ± ± 0.9 Post-TMM 27.9 ± ± ± * Pre-PBF (%) ± ± ± 4.02 Post-PBF (%) ± ± ± * Pre-WHR (cm) 0.93 ± ± ± ± ± 1.6 Post-WHR (cm) 0.91 ± ± ± 1.4 Pre-BMI (kg m -2 ) ± ± ± 2.03 Post-BMI kg m -2 ) ± ± ± * Pre-Steps ± ± ± Post-Steps ± ± ± * PFG = Personalized Feedback Group; FFG = Family Feedback Group; TMM = Total Muscle Mass; PBF = Percent Body Fat; BMI = Body Mass Index The post hoc Tuckey test showed a significant decrease in the body weight in the PFG and the FFG versus the control group after the intervention (P=0.001), while no significant difference was found in weight between the experimental groups (P=0.055). The PBF was significantly decreased in the PFG and the FFG (P=0.001), but it wasn t different between the two groups (P=0.77). The subjects TMM was also significantly increased in the two intervention groups (P=0.04). The results suggested that both PFG and FFG had higher muscle mass after intervention compared to the control group (P=0.001). There was also a significant difference (i.e., increase) in the daily steps in the PFG and the FFG versus the control group (P=0.001), but there were no significant difference of daily steps between the two experimental groups (P=0.93). The ANOVA test indicated a significant

5 difference in the pre-test and post-test FVC responses in the intervention groups (P=0.001). The FEV1 of the PFG and the FFG were improved significantly after intervention (P=0.001) (Figure 2). The post hoc Tukey test results are shown in Figure 1. After being given health literacy instructions, the Governors and Chief Executive Officers in the PFG and the FFG had taken an average of 7245 and 7559 steps d -1, respectively. 28 Figure 1. The Effect of Physical Activity and Health Literacy Feedback on FVC. PFG = Personalized Feedback Group; FFG = Family Feedback Group; CG = Control Group; FVC = Forced Expiratory Volume Figure 2. The Effect of Physical Activity and Health Literacy Feedback on FEV1. PFG = Personalized Feedback Group; FFG = Family Feedback Group; CG = Control Group; FEV1 = Forced Expiratory Volume in One Second DISCUSSION Malik et al. (7) indicate that excessive work among the Governors and Chief Executive Officers is associated with physical and physiological problems that influence their health and exercise behavior as well as their organizational performance. Also, given that the TOFI

6 phenomenon is highly epidemic among these individuals, it is important to acknowledge the right intervention and strategies to motivate them to pursue a healthier lifestyle. Considering the role of the Governors and the Chief Executive Officers as valuable human resources in making important decisions and delivering services to the population, this intervention research was designed to investigate the effectiveness of physical and physiological feedback as health literacy feedback (i.e., body composition, exercise behavior, and some physiological feedback) to enhance daily physical activity in TOFI Governors and Chief Executive Officers. Interestingly, the presents study indicates that the verbal feedback had favorable effects on the subjects body weight, percent body fat (PBF), total muscle mass (TMM), and daily steps. Furthermore, the Governors and the Chief Executive Officers response to the interventions resulted in an improvement in their forced vital capacity (FVC) and forced expired ventilation in 1 sec. Although this finding is consistent with the work of Baheiraei and Mirghafourvand (1) who suggested that health promotion behaviors can be found more frequently in individuals who have strong and positive social support networks, the findings disagree with Proper et al. (9) who reported no significant effect of feedback on the level of physical activity among inactive persons. In addition to PBF, TMM, FVC, and FEV1, the status of other health factors (due to limitations in time and place) among Governors and Chief Executive Officers is without question not favorable for sustaining a healthy lifestyle. Hence, it is vitally important to plan for the implementation of health interventions that focus on the effective motivational approaches based on more physical and physiological feedback (5,10). It highly recommended that not only is it important to provide the proper facilities in work hours at the workplace to encourage involvement in health related exercises, but also educational seminars and programs for increasing the motivation for exercise. CONCLUSION It can be concluded that TOFI Governors and Chief Executive Officers must follow the healthy intervention programs in order to have a healthier lifestyle that allows for maximizing the organizational performance. 29 Acknowledgments We are very grateful to all Governors and Chief Executive Officers who so generously gave their valuable time and effort toward this work. The study has been granted by Qazvin sport and youth administration. Address for correspondence: Morteza Taheri, Department of Sport Sciences, Imam Khomeini international university, Qazvin, Iran. Tel: +98 (281) , Fax: +98 (281) , Postal Code: m.taheri@soc.ikiu.ac.ir

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