The influence of WHO recommendations on the level of physical activity of office workers in China

Т. Чжун1, , 0000-0003-1021-5577

Л.Н. Рогалева2, , 1 Хэнаньский педагогический университет, Синьсян, Хэнань, Китай 2 Уральский федеральный университет, Екатеринбург, Россия

Introduction. The problem of increasing physical activity among office workers is related to the fact that they spend a significant part of their working time sitting. Despite the fact that data vary from country to country, it can be said that on average office workers may spend up to 7 hours sitting during a workday [1, 20]. Therefore, they are more likely to be at high risk of many chronic diseases, which will lead to a decrease in their quality of life. In review studies, it is stated that a sedentary lifestyle among office workers leads to diseases such as musculoskeletal disorders, dry eye syndrome, cardiovascular and metabolic diseases, coronary heart disease, metabolic syndrome, and some types of cancer [5, 8, 13]. In addition, a number of studies have stated that physical inactivity and a sedentary lifestyle are important determinants of mental health, and therefore office workers may have such negative symptoms as pain, fatigue, stress, depression, and decreased psychological well-being [3, 9, 15].

Therefore, promoting physical activity among office-based employees is of importance from a public health perspective [6]. In light of the importance of physical activity engagement, the World Health Organization has advocated an international guideline for health-enhancing physical activity for adults aged 18–64 years [19]. While the guideline has been proposed, several questions remain unanswered. First, little is known concerning whether and how socio-demographic variables would influence public awareness of the behavioral guideline. Second, it is unknown whether the guideline knowledge would significantly affect concomitant behavior. Hence, the present study strived to address the research gaps by investigating the socio-demographic correlates of health-enhancing physical activity and the impact of guideline knowledge on consequent behavior among office-based employees.

In this regard, this study aimed to determine the relationship between knowledge of WHO recommendations and physical activity levels among Chinese office workers, accounting for their socio-demographic characteristics.

Materials and methods. Participants. The study participants were 493 office employees from China. Detailed information about the sample is given in Table 1.

Procedure. An electronic survey, covered with an introduction, was created on a platform powered by a professional survey organization Wen Juan Xing. Sample service provided by this organization was used to recruit target participants. In the introduction of the online survey, participants were informed of the research purpose and voluntary, anonymous, confidential nature of the study. They were also informed that they had the right to withdraw their survey participation at any time without penalty. The present investigation was conducted in accordance with the principles of the Declaration of Helsinki, and informed consent was obtained from the participants.

Measurements. Socio-demographic variables. Items concerning participants’ age, gender, height, weight, education attainment, monthly income, marriage, and health status were asked in the survey battery. Height and weight were used to calculate the body mass index (BMI) for analysis, which is a person's weight in kilograms divided by the square of height in meters. The criteria to classify participants based on their BMI values were: a BMI range 18.5–24.0 is considered normal, while values below 18.5 and above 24.0 are considered indicative of being underweight and overweight, respectively [16]. Education attainment was categorized based on the highest education received, namely secondary education, undergraduate education, and postgraduate education.

Table 1

Socio-demographic characteristics and self-rated health of office workers (N = 493)

Variable	N (%)
Age (years)
20–29	232 (47.1)
30–39	233 (47.3)
40–49	20 (4.1)
50–60	7 (1.4)
Missing	1 (0.2)
Gender
Male	194 (39.4)
Female	299 (60.6)
Education level
Secondary	14 (2.8)
Undergraduate	442 (89.7)
Postgraduate	37 (7.5)
Marital status
Single	124 (25.2)
Married	369 (74.8)
Monthly income (Chinese yuan)
< 5000	94 (19.1)
5000–10000	322 (65.3)
10001–15000	59 (12.0)
15001–20000	11 (2.2)
> 20000	7 (1.4)
BMI (kg/m2)
Under/overweight	150 (30.4)
Normal	334 (67.7)
Missing	9 (1.8)
Self-rated health
Very bad	0 (0)
Bad	10 (2.0)
Satisfactory	115 (23.3)
Good	279 (56.6)
Very good	89 (18.1)

Physical activity. Participants’ physical activity behavior was assessed by the Global Physical Activity Questionnaire (GPAQ). It is part of the World Health Organization’s STEPwise Approach to noncommunicable disease risk factor surveillance (STEPS). It has been widely adopted, and its reliability and validity have been well established [2]. The 19-item questionnaire measures moderate and vigorous physical activity taking place in subdomains including work, travel, and recreation, lasting at least 10 minutes per bout. A score of moderate and vigorous physical activity was calculated by summating weekly time spent in moderate physical activity (with a weight of one) and vigorous physical activity (with a weight of two) across subdomains in units of minutes [10].

Data analysis. The associations between socio-demographic variables (age, gender, BMI, education attainment, income, and marital status) and knowledge of guidelines for physical activity were assessed. Due to some categories having a small number, they were combined for analyses. Specifically, education attainment below undergraduate education was categorized as low education, while undergraduate education or above was categorized as high education. Health status was classified into two categories, namely “good/very good” and “fair/poor”. For categorical variables in the present study, chi-squared analysis was used, while for continuous variables, an independent samples t-test was adopted. Once socio-demographic variables significantly differentiated people in terms of knowledge of the health-enhancing physical activity guideline, they would be entered into multiple logistic regression analyses for further examination. SPSS version 26.0 was employed for data analysis. The significance level was set at 95 %.

Results and discussion. The results on the relationship between the level of knowledge of WHO recommendations among office workers, depending on their socio-demographic variables, are presented in Table 2.

As can be seen from Table 2, 190 people (70 men and 120 women), or 38.5% of the total sample, reported that they knew physical activity recommendations.

The chi-square analysis results revealed significant differences in guideline knowledge among people with differing marital and health statuses. Specifically, married and healthier people tended to be more informed about the physical activity guidelines. Besides, those who were aware of the guidelines had higher monthly earnings and more positive physical activity behavioral outcomes. When it comes to the effect of education, the test was close to significance, where more educated people may be more likely to know the behavioral guidelines.

Thus, the study revealed differences in awareness of WHO physical activity guidelines among Chinese office workers. Further analysis identified statistically significant variables, which were

Table 2

Differences in knowledge of physical activity guidelines across socio-demographic variables and behavioral outcomes

	Guideline knowledge		p
	Yes (N, %)	No (N, %)
Gender			.35
Male	70 (36.1 %)	124 (63.9 %)
Female	120 (40.3 %)	178 (59.7 %)
Education			.06
Low	2 (14.3 %)	12 (85.7 %)
High	188 (39.3 %)	290 (60.7 %)
Marital status			.00
Single	31 (25.2 %)	92 (74.8 %)
Married	159 (43.1 %)	210 (56.9 %)
BMI (kg/m2)			.17
Under/overweight	48 (32.2 %)	101 (67.8 %)
Normal weight	138 (41.3 %)	196 (58.7 %)
Health status			.00
Good/very good	168 (45.7 %)	200 (54.3 %)
Satisfactory/poor	22 (17.7 %)	102 (82.3 %)
Age (years)	30.55 (4.85)	30.94 (5.78)	.42
Income (Chinese yuan)	8299.84 (4421.90)	7446.10 (4388.38)	.04
Behavioral outcome*	212.70 (156.83)	136.39 (130.62)	.00

Table 3

Multiple logistic regression analysis results

	B	SE	Wald	p	OR	95 % CI OR
Behavioral guideline
Marital status a	.73	.25	8.32	.00	2.07	[1.26, 3.38]
Health status b	1.32	.27	23.71	.00	3.76	[2.21, 6.41]
Income (Chinese yuan) c			.31	.99
5000–10000	–.08	.27	.09	.77	.92	[.54, 1.57]
10001–15000	.05	.37	.02	.89	1.05	[.51, 2.2]
15001–20000	–.20	.78	.06	.80	.82	[.18, 3.80]
> 20000	.12	.88	.02	.89	1.12	[.20, 6.28]
Physical activity	.00	.00	24.71	.00	1.004	[1.002, 1.005]

Note: Reference categories are indicated as follows: a – single; b – satisfactory/poor; – income < 5000. Abbreviations: OR – odds ratio; CI – confidence interval.

used as independent variables in a multiple logistic regression model to predict knowledge of the recommendations. The results are presented in Table 3.

According to Table 3, it was found that people who were married and healthier were more likely to know the recommendations for physical activity. Single people were at a heightened risk of lacking guideline knowledge, which would be inversely associated with physical activity engagement. One possible explanation is that married people have more obligations from family, and the sense of responsibility to maintain one's health for the sake of the relationship and family may motivate individuals to prioritize physical activity and more proactively search out information regarding physical activity and health [18]. Also, people in a marriage could provide social support to each other and share information on health-enhancing physical activity [12].

The data also demonstrated that healthier people were more likely to be aware of the behavioral guideline. This may be because being in a healthier condition provides individuals with the energy necessary for engaging in various health-related activities, including obtaining knowledge on behavioral guidelines. It was also possible that people who were better informed of behavioral guidelines would be more physically active and, in turn, receive more health benefits and be healthier [14]. Besides, in the chi-square analysis, the p-value was close to a significant level, suggesting that individuals who obtained more education were relatively more likely to know health-enhancing physical activity guidelines. More educated people may have a better understanding of the importance of a healthy lifestyle and have more access to information about physical activity. And a previous study has also shown that education helps promote and sustain a healthy lifestyle [11]. However, due to the small number of less educated people in the sample (i.e., people who have not received higher education), the difference awaits to be confirmed in the future.

The present research demonstrated that healthenhancing physical activity guideline knowledge was associated positively with concomitant behavioral outcomes. Such a finding is congruent with the premise of behavioral change theories, which underlines that sufficient knowledge is key to successful health behavior performance [4, 7]. Therefore, an improved knowledge of the behavioral guideline can serve as an important approach to physical activity promotion. As such, disseminating the behavioral guideline effectively is of importance. However, based on the present research, it seems that using general messages such as “regular physical activity is beneficial for your health” may not be sufficient to promote public health behavior. Instead, by providing a clear guideline for health behavior change [17], people may be more motivated, as they can have specific goals to strive for and know how much physical activity is needed to boost their health.

Findings from the present research could have the potential to inform strategies aiming to effectively promote guideline knowledge and, in turn, boost health-enhancing physical activity.