PATTERN OF PHYSICAL ACTIVITY AND

ASSOCIATED FACTORS OF PHYSICAL ACTIVITY

AMONG ELDERLY ATTENDING OUTPATIENT

CLINICS HOSPITAL UNIVERSITI SAINS MALAYSIA

Blinded Number

T3003

March 2014
ACKNOWLEDGEMENT

i
TABLE OF CONTENTS

Acknowledgement i

Table of contents ii

List of tables v

List of figures vi

List of appendices vii

List of abbreviations viii

Abstrak ( Malay version) ix

Abstract (English version) xi

Chapter 1: Introduction 1

1.1 Study Introduction 1

Chapter 2: Literature Review 3

2.1 Elderly 3

2.1.1 Definition of elderly 3

2.1.2 Demographic of the elderly 4

2.1.2.1World 4

2.1.2.2 Malaysia 4

2.2 Physical activity 5

2.2.1 Definition of physical activity 5

2.2.2 Pattern and the type of physical activities 5

2.2.3 Tools to measure physical activities 6

2.2.4 Global recommendations on physical activities for health 9

2.3 Physical activities among elderly 10

2.3.1 Prevalence 10

ii
 2.3.2 Associated factors 11

2.3.3 Importance of physical activity to the elderly 11

2.4 Conceptual framework 13

Chapter 3 : Objectives And Hypotheses 14

3.1 General Objectives 14

3.2 Specific Objectives 14

3.3 Research hypothesis 14

Chapter 4: Methodology 14

4.1 Study Area 14

4.2 Study design 15

4.3 Study period 15

4.4 Referance population 15

4.5 Source population 15

4.6 Study sample 15

4.7 Inclusion and exclusion criteria 15

4.8 Sampling method 16

4.9 Sampling size calculation 16

4.10 Operational definition 18

4.11 Research tools 18

4.11.1 Elderly Cognitive Assessment Questionnaire (ECAQ 19

4.11.2 Sociodemograhic questionnaire 19

4.11.3 Modified Baecke Questionnaire 20

4.12 Data collection 23

4.13 Data entry and statistical analysis 23

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4.14 Ethical approval 26

Chapter 5 : Result 28

5.1 Socio-demographic characteristics of subjects 28

5.2 BMI and perception of body weight among subjects 30

5.3 Pattern of physical activity among elderly 31

5.3.1 Type of physical activity among respondents 31

5.3.2 Physical activity score among subjects 32

5.3.3 Difference of physical activity score between gender 33

5.3.4Comparison of physical activity level among different

sociodemographic group 36

5.3.5 comparison of physical activity level and perceptions of bodyweight 38

5.4 Associated factors of physical activity 38

5.5 Final model of General Linear Regression 40

Chapter 6 : Discussion 41

6.1 Pattern of physical activity among elderly 42

6.1.1 Physical activity score 42

6.1.2 Type and pattern of physical activities 43

6.2 Associated factors of physical activity 45

Chapter 7 : Conclusion 49

Chapter 8 : Limitation of study 50

Chapter 9 : Recommendations 52

References 53

Appendix 57

iv
 LIST OF TABLES

Table Title Page

Table 4.1 Sample size calculation for objective 2 17

Table 5.1 Socio demographic and medical characteristics of 30

subjects

Table 5.2 Respondents BMI and perception on body weight 31

Table 5.3 Pattern of physical activity among elder participants 32

Table 5.4 Physical activity scores among elderly 33

Table 5.5 Tertile of physical activity score 33

Table 5.6: Associated factors for physical activity among elderly 40

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 LIST OF FIGURES

Figure Title Page

Figure Conceptual framework

Figure 4.1 Flow chart of the study 19

Figure 4.2 Forward and backward translation processes of the 24

Modified Baecke Questionnaire from English to Malay

version.

Figure 5.1 Comparison of BMI perception of body weight among 32

subjects

Figure 5.2 Total physical activity (median score) in male and 34

female subjects

Figure 5.3 Physical activity (median score) according to the type 35

of physical activity among male and female subjects

Figure 5.4 Physical activity level among male subjects 36

Figure 5.5 Physical activity level among female subjects 36

Figure 5.6 physical activity level according to level of education 37

Figure 5.7 Figure 5.7: physical activity level according to 38

occupational status

Figure 5.8 Comparison of BMI perception of body weight among 39

subjects

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 LIST OF APPENDICES

Appendix Title Page

Appendix A Elderly Cognitive Assessment Questionaire (ECAQ) 57

Malay version
Appendix B Sociodemographic questionnaire 58

Appendix C Modified Baecke Questionnaire for Older Adults 60

Appendix D Terjemahan ' Modified Baecke Questionnaire' 63

Appendix E: Borang Soalselidik 67

Appendix F Maklumat kajian 73

Appendix G Ethical approval letter 85

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LIST OF ABBREVIATIONS

WHO World Health Organization

ECAQ Elderly Cognitive Assessment Questionaire

HUSM Hospital Universiti Sains Malaysia

NHMS III Third National Health and Morbidity Survey

VO2max Maximum oxygen intake

PASE Physical Activity Scale for Elderly

CHAMPS Community Health Activity Model Program for Senoirs

YPAS Yale Physical Activity Survey

viii
ABSTRAK

Tajuk: Corak aktiviti fizikal dan factor berkaitan dengan aktiviti fizikal di kalangan warga

tua yang menghadiri klinik- klinik pesakit luar di Hospital Universiti Sains Malaysia

Pengenalan: Pertubuhan Kesihatan Sedunia (WHO) menyarankan aktiviti fizikal untuk

meningkatkan tahap kesihatan, di mana warga tua juga turut disarankan untuk sentiasa cergas

secara fizxikal. Di dalam situasi yang bersesuaian, warga tua disarankan untuk melakukan

aktiviti fizikal yang berintensiti sederhana selama 30 minit setiap hari dan 5 hari seminggu.

Objektif: mengenalpasti corak aktiviti fizikal dan faktor berkaitan dengan aktiviti fizikal di

kalangan warga tua.

Metodologi: satu kajian keratan rentas telah dijalankan di HUSM mulai ogos 2011 sehingga

disember 2011 yang melibatkan pesakit warga tua berumur 60 tahun dan ke atas. Soal selidik

ECAQ telah digunakan untuk menyaring keluar mereka yang mempunyai masalah

dayaingatan. Soalan selidik merangkumi soalan brkaitan latarbelakang social dan soal

kajiselidik Baecke yang telah dialih bahasa ke Bahasa Malaysia telah digunakan. Data

dikumpul melalui temubual perseorangan dengan peserta kajian.

Keputusan: 374 peserta dikenalpasti dan 90.9% telah bekerjasama, di mana 142 (41.9%)

adalah lelaki dan 197 (58.1%) adalah perempuan dengan purata umur 67.7 (sisihan piawai

6.0) tahun. Markah purata aktiviti fizikal peserta berdasarkan soalselidik Baecke adalah 6.1.

kajian mendapati factor yang berkait rapat dengan aktiviti fizikal adalah factor umur, jantina,

mereka yang tidak menganggap berat badan mereka sebagai masalah kesihatan dan tidak

bekerja.

Kesimpulan: Terdapat kaitan yang rapat antara tahap aktiviti fizikal warga tua dengan

anggap mereka terhadap imej badan dan status pekerjaan. Didapati juga peningkatan umur

dan jantina perempuan berkaitrapat dengan penurunan tahap aktiviti fizikal

ix
ABSTRACT

Title: Pattern of physical activity and associated factors of physical activity among elderly

attending outpatient clinics Hospital Universiti Sains Malaysia

Introduction: The WHO is currently developing global recommendations on physical

activity for health, in which the elderly are recommended to be physically active. Where

appropriate, older adults should engage in at least 30 minutes of moderate intensity physical

activity 5 days per week.

Objective: To determine the pattern of physical activity and associated factors of physical

activity among elderly attending the outpatient clinics Hospital Universiti Sains Malaysia.

Methodology: A cross-sectional study was conducted involving elderly patients age > 60

years attended outpatient clinics at Hospital University Sains Malaysia from August 2011 to

December 2011. ECAQ questionnaire is used to exclude patient with dementia. Structured

questionnaires consist of sociodemographic questionnaire and Malay version of modified

Baecke questionnaire are used to collect the data in face to face interviews.

Results: 372 subjects were recruited with respond rate 90.9%. Of these, 142 (41.9%) were

male and 197 (58.1%) were female with mean age of 67.7 (6.0). Median score for physical

activity according to Modified Baecke Questionnaire was 6.1 (SD 5.5). Base on this

questionnaire, there were statistical significant association between physical activity with age,

gender, patient perceive their weight not as health problem and patient not.

Conclusion: There were strong association between level of physical activity among elderly

with perceive body image and occupational status. Meanwhile increasing age and female

gender had inverse association with physical activity.

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 CHAPTER 1 : INTRODUCTION

Ageing population is taking place globally especially in the developed countries.

Initially this global phenomenon started in the developed wealthy countries such as Europe

and America and currently it is growing more rapidly among developing countries such as

Cuba, the Islamic Republic of Iran and Mongolia (1). Malaysia as one of the developing

countries is experiencing the same trend of higher growth in number and proportion of the

elderly. It is expected our country will become an ageing population by the year 2021 (2).

Healthcare system in Malaysia should prepare to address the task of caring for the

elderly in view of the increasing numbers of elderly in our country. The main burden of health

care for the elder will lie within primary care where the elderly require long term care. The

concept of healthy ageing will be a challenge for primary care service in Malaysia. This

concept of healthy ageing depends on health promotion and disease prevention in order to

minimize the incidence of illnesses and disabilities in the later years and enhance their

independence in their daily living activities. Increased public awareness on being physically

active is one of the evidence-based intervention and is highly cost effective (1).

As generally known, there are association between physical inactivity with many

health problems such as coronary heart disease, diabetes, depression, obesity, osteoporosis

and cancer(3). In Malaysia, according to the Third National Health and Morbidity Survey

(NHMS III), chronic illnesses were reported to be most prevalent with about 48.8% amongst

the age 60 and above (4). Worldwide, non-communicable disease has become the main

burden of disease in high, middle and low income countries (1). Since physical inactivity is a

modifiable risk factor, there is a significant potential to increase the health and quality of life

of older adults, as well as to improve the economic health of the nation through physical

activity intervention strategies.

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 Although the benefits of regular physical activity are well known, a large proportion

of the elderly population remain inactive. There is paucity of information regarding pattern

of physical activity among the elderly in Malaysia. Understanding the factors that influence

physical activity behaviour in our local older adults is needed to develop effective

intervention strategies that will address the problem of physical inactivity in our population.

Most studies were done in western countries which have different socioeconomic

background, culture and ethnicity compare to our local population (5-9). This study aims to

contribute to the literature by describing the pattern of physical activity among the elderly in

our population. It also aims to analyse the possible associated factors that contribute to the

level of physical activity among this age group at our local set up. The findings could be used

for our intervention to motivate older persons to increase their level of physical activity, and

thus decrease the extent of sedentary livingassociated disability and illness.

2
 CHAPTER 2: LITERITURE REVIEW

2.1 Elderly:

2.1.1 Definition of elderly

Ageing process is of course a biological realities which has its own dynamic beyond

human control (10). Definition of elderly varies between countries where most of the time it

is a reflection of the current political and economic situation of that country. Generally,

definition of elderly could be by chronological age, by change in social role or change in

capabilities of the person (10).

Most of the developed countries such as the United States of America used

chronological age to refer their elderly population. Using this definition, elderly is commonly

defined as those person at the age of 60 or 65 year old which is roughly equivalent to

retirement ages (10). In developing countries, definition of elderly is based on change in

social role compared to chronological age. In these developing countries, elderly is beginning

at the point when active contribution is no longer possible and there is the loss of roles

accompanying physical decline (10).

According to the United Nations World Assembly on Ageing held in Vienna, 1982,

60 years and over is considered the cut-off point used for ageing (1). Different definition

for the elderly used in Africa, where the elderly persons correlate with chronological ages of

50 to 65 years, depending on the setting, region and country (10). In Malaysia, our

government has adopted cut-off point which has been used by WHO in formulating and

implementing plans for our senior citizens (11).

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2.1.2 Demographic of the elderly

2.1.2.1 World

World Health Organization (WHO) statistic in 2010 showed that an estimated of 524

million people were 65 years or older, which comprises of 8% of the world population (12).

According to this report from U.S. Department of Health and Human Services and WHO, it is

expected that by 2050, this number will be nearly triple to about 1.5 billion, representing 16%

of the world population (12).

A statistic by WHO in 2012 shows about 14 million of the elderly aged 80 years or

older living in the whole world in the middle of 20th century (1). It was predicted that the

number will increase to 400 million people in this age group worldwide in the year 2050(1).

It is contributed by current more rapid speed of population aging. The shift to older

populations started in wealthy regions such as Europe and North America (1). However

currently low and middle-income countries are experiencing the greatest change (1). By

2050, it is expected that 80% of older people will live in these countries (1). Previously,

European countries such as French and Sweden took more than 100 years for their population

aged 65 and older to increase from 7 to 14% (12). Currently, these similar demographic are

experienced more rapidly by countries such as Brazil, China and Thailand (12). Based on

United Nations data, those aged 60 or over are expected to outnumber the population below

15 before 2050 in Asia(13).

2.1.2.2.Malaysia:

In Malaysia, the numbers of the elderly have increased by 35% over 10 years period

of time (11). Based on this population projection, the number of the elderly is likely to be 3.4

million in 2020 and 4.9 million by 2030 (11).

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 It is estimated that Malaysia will be an ageing population by the year 2021 when the

population aged 65 years and above reaches 7.1% (2). It is also expected that old age

dependency ratio will double from 7.4 in year 2010 to 16.6 in the year 2040 (2). This means

that the working age population would have to bear the increasing number of old age

population.

In the year 2000, Chinese had the highest population of senior citizens among

Malaysia multi-ethic population at 8.8% (11). It was then followed by Bumiputera and Indian

which constituted to 5.7% and 5.6% of their respective groups (11). These contributed by low

fertility levels experienced among the Chinese population.

2.2 Physical activity:

2.2.1. Definition of physical activity.

Physical activity has been defined as any bodily movement produced by skeletal

muscles that results in energy expenditure(14). According to Heidelberg Guidelines for

Promoting Physical Activity Among Older Persons which was issued by WHO in 1996,

physical activity is operationally defined as all movement in everyday life including work,

recreation, exercise, and sporting activities (15). Meanwhile, inactivity is defined as doing

no or very little physical activities at work, at home, for transport or during discretionary

time .

2.2.2 Pattern and the type of physical activities.

Physical activities in daily life can be classified into a variety of ways including

occupational, sports, conditioning, household or other leisure time activities (14). Leisure

time activity is an activity that has been done out of freedom from time consuming duties,

responsibilities, or activities. It could be done indoor or outdoor or involving community

5
activities. Example of transportation activities are walking or cycling. Household activity is

any activity maintaining the house such as sweeping floor.

Meanwhile sport is all forms of competitive physical activities which is through

casual or organized participation, aim to use, maintain or improve physical fitness and

provide entertainment to participants. It is usually governed by a set of rules or customs,

which serves to ensure fair competition, and allows consistent adjudication of the winner.

There is a different concept of sport between America and Europe(16). In North America,

sport is activity that involve competition meanwhile in Europe it may include recreational

activities such as walking or hiking (16).

Exercise is another subset of physical activity. It is defined as planned, structured,

and repetitive bodily movement done to improve or maintain one or more components of

physical fitness (14).

2.2.3 Tools to measure physical activities.

There were various methods have been used to assess physical activities which

generally can be grouped into several categories including calorimetry, physiological

markers, behavioural observation and mechanical or electronic monitors (17).

Calorimetry method of physical activity assessment had been used in earlier energy

balances studies. It could be sub classified into 2 which are direct and indirect calorimetry

(17). Direct calorimetry measured energy expenditure through production of heat in which it

requires that individuals to be sequestered in special chambers. This procedure is expensive,

limited to specific task only and it is deemed impractical (17). Meanwhile, indirect

calorimetry measures the consumption of oxygen that closely correlates with heat

production in which participants need to wear facemask or a mouthpiece with a nose clip,

6
 and a container for the collection of expired air (17). Both techniques although accurate, but

impractical in epidemiologic studies involving large population.

Physiological markers of physical activity includes maximum oxygen intake (VO2

max) and doubly labeled water technique (17). These methods had been used for validation

studies (18, 19) . VO2 max was used in validation and reliability study of Baecke

questionnaire for evaluation of habitual physical activities in Brazilian adult men where the

result showed this questionnaire is valid and reliable (20). Sabels et al in 2004 had done a

study on the effects of physical training on insulin sensitivity and how this relates to VO2

max (21). The result of this study showed VO2 max increased as a result of physical training

and the change in insulin sensitivity correlated positively with the change in VO2 max (21).

Doubly labeled water technique needs participant to ingest water containing

isotopically labeled hydrogen and oxygen atoms of negligible health risk. The excretion of

these isotopes in urine is measured to calculate the energy expenditure. It is costly for large

population study and cannot identify specific types or pattern of physical activities.

Measurements of energy expenditure using doubly labeled water are commonly accepted as

the optimum and gold standard in construct validation of questionnaire on physical activities

(16, 22).

Tools using specific objective monitoring such as heart rate, movement sensors and

doubly label water procedure are less practical as it is expensive and difficult to apply.

Questionnaires method is a popular and practical approach in large scale studies as their ease

of implementation, but it has a disadvantage as little is known about their reliability and

validity. There is no validation standard for questionnaires in measuring physical activities.

Most of questionnaire were validated using accelerometer, maximal oxygen uptake and

activity diaries (23) There was also the issue of limitation in the capacity of a person to

remember details of past physical activities. A systematic review by Mireille et al in 2010,

7
 to compare self-administered questionnaire assessing physical activities among adult

concluded that no questionnaire for assessing physical activities was superior and therefore

could not be strongly recommended above others (23).

There are questionnaires to measure the level of physical activities among the elderly

such as Physical Activity Scale for Elderly (PASE), Community Health Activity Model

Program for Senoirs (CHAMPS), Yale Physical Activity Survey (YPAS) and Modified

Baecke Questionnaire.

CHAMPS Questionnaire contains 41 questions on specific activities for the past 4

weeks (24). It assesses the types and intensity levels of physical activity that are appropriate

to the elderly people including lighter activities such as leisure walking, light housework,

light gardening, community or voluntary activities and light exercise, and also vigorous

activities such as heavy housework or gardening, swimming and sports. However it is not a

suitable questionnaire for Malaysian elder population because some of the questions

pertaining activities which are not popular in this country such as playing golf, dancing,

billiards, skate, tennis and basketball.

YPAS is a questionnaire which consists of two sections (19). First section is

regarding how much time spent for housework, exercise, and recreational activities for past

one week (19). The second section is questions with categorical responses. It assesses several

different types of activities for past one months (19). There are also questions comparing

amount of physical activity level in each season of the year(19). This particular question

related to four seasons of the year; make this questionnaire not applicable to be used in

tropical climate countries.

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2.2.4 Global recommendations on physical activities for health.

F.I.T.T. is an acronym commonly used as general guidelines for what should be

included in a fitness plan (25, 26). F is for frequency, I for intensity, T for time and T for type

(25). It helps people determine how often, how hard, how long, and what kinds of activities

they should perform to build health and fitness. Frequency of activity is how many times per

week the person does physical activity (25). The intensity of physical activity is how hard

you exercise (25). Exercise intensity often quantified using heart rate (25). Other ways to

prescribe exercise intensity are by calculated VO2max or category-ratio scales for rating of

perceived exertion . The greater the intensity, the shorter the duration of exercise is necessary

to achieve improvement in cardiorespiratory fitness. Exercise programs of low intensity but

long duration can yield results similar to those of higher intensity and shorter duration. Time

of physical activity is how long you perform the activity. Duration of exercise in excess of 45

minutes is associated with increased incidence of orthopedic injury (25). To avoid acute

injury, gradually increase frequency, duration, and intensity of activity over a period of

several weeks to months. Type of physical activity is what kind of activity is performed.

The global recommendation by WHO on physical activity for elderly is to be

physically active as described for adults. However, particular attention must be put on the

intensity and type of physical activities appropriate for older people to avoid exercise related

injury or complication. WHO recommended that, if appropriate, older adults should engage

in at least 150 minutes of moderate-intensity physical activities throughout the week or at

least 75 minutes of vigorous-intensity physical activity throughout the week.

American College of Sport Medicine/ American Heart Association recommended

that every older adult should participate in moderate-intensity aerobic activity for at least 30

minutes on five days of the week, or vigorous-intensity aerobic activity for at least 20

minutes on three days a week(27, 28). A moderate physical activity is referred to an activity

9
performed at an intensity of 3 to 6 METs (work metabolic rate/ resting metabolic rate) which

is equal to brisk walking at 3 to 4 mile per hour. If in adult age group, the intensity of

physical activity is measured using METs (work metabolic rate/ resting metabolite rate) but

the intensity of activity is individualized in elderly group based on the increase in heart rate

and breathing. On the scale of 0 to 10, where sitting is 0 and all out effort is 10 to produce

noticeable increase in heart rate and breathing, the score 5 or 6 are considered moderate

activity and the score 7 or 8 is vigorous activity (29). For example, slow walk is considered

moderate activity in some elderly. The meanwhile in adult age group, it need brisk walk to

classify as moderate activity.

The update on this recommendation published by American Heart Association also

emphasizes on the benefits of moderate intensity physical activity that can be accumulated in

relatively short bouts (30). Accumulation of the daily dose of moderate-intensity physical

activities in relatively short, at least 8-10 min bouts, was offered as an alternative to one

continuous bout of the same total duration and intensity (30). Daily activities such as brisk

walking to work, gardening with shovel, carpentry which was performed in minimum bouts

of 10 min or more can be included as part of the physical activities recommended.

2.3 Physical activities among elderly.

2.4.1 Prevalence.

Most of the elderly in the United States did not meet the minimum amount of

recommended physical activity. Based on the data from Agency for Healthcare Research and

Quality, Centers for Disease Control and Prevention, 28 to 34% of adults age 65 to 74 years

in United States are inactive (28).

The third National Health and Morbidity Survey 2006 (NHMS III) was published by

the Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia in

10
2008. It is a cross sectional population based household survey in Malaysia involving 33 933

subjects aged 18 years and above (31). According to this national survey, overall prevalence

of physical inactivity among Malaysian adults was 43.7% (31). It was more prevalent in

women, older adults, widow or widower and those who did not have formal education (31).

2.4.2 Associated factors

WHOs Global Strategy on Diet, Physical Activity, and Health encourages countries

to develop comprehensive approaches to individual, environment, and policy change.

Understanding the predictors factors of physical activity is important in developing our own

policy.

Previous studies have investigated factors that are associated with leisure time

physical activities among elderly. Among the factors that have correlated with physical

activities in this age group are sociological factors such as age (5-7, 32, 33), gender (5, 6,

32), marital status (6, 8), education status(6, 7, 9), smoking (6, 8, 9, 33) and economic status

(8, 33, 34) chronic illness(6, 32, 33) and body mass index (5, 6, 9, 32). Other factors are

psychosocial factors such as social support, self-efficacy and perceived barriers, and physical

environment factors such as access to sport or recreational facilities and neighborhood safety.

There is limited study focusing on the physical activity and the associated factors among

elderly population yet in Malaysia

2.4.3 Importance of physical activity to the elderly:

Physical activity is associated with a lower incidence of morbidity and mortality from

a number of major chronic illness and mortality. Previous studies had shown that physical

inactivity is associated with coronary heart disease, diabetes, depression, obesity,

osteoporosis and cancer(3). There is evidence that regular activities lower the risk of

11
developing non-insulin dependent Diabetes Mellitus. Study by Bianchi et al shows physical

activity is inversely associated with insulin resistance and metabolic syndrome even in the

elderly age group (35). Physical inactivity was also predictive of mortality (36). Based on

WHO data in 2002, overall physical inactivity is estimated to cause 1.9 million deaths

globally.

Physical activity could help the elderly live in better quality of life. Study by Ferucci

et al in 1992 showed that physical activities in the elderly population prolonged active life,

decreases the percentage of remaining life that is spent in the state of disability chances and

period of disability in remaining life, and compared with people who die at the same age in

the general population, is associated with a shorter period of disability(37). This study also

showed that the negative effect of inactivity on survival and length of disabled life is

comparable and perhaps higher than the effect of smoking.

Physical activity also had effect on the cognitive function in the elderly. A prospective

study by Weuve et al suggests long term regular activity is associated with significant better

cognitive function and less cognitive decline in older women (38). Similar findings found in

another study that shows physical activities as a protective factor for dementia in elderly

person (39).

Other than reduced morbidity and mortality, and improved quality of life in the

elderly, physical activities also indirectly reduce the financial burden of the country as the

medical cost for inactive adults are higher than for active adults and increase with age. It may

be possible to significantly help to reduce health care cost by improving the level of physical

activities in elderly as compared with any other age group (28).

12
Conceptual framework
Figure 2.1 below shows the conceptual framework for this study.

Sociodemographic Medical Factor:

factors: - *Chronic
- *Sex medical
- *Age illness
- *Smoking - *Body
- *Marital status mass index
- *Education - Functional
- *Social support limitation

PHYSICAL
ACTIVITY

HEALTH BELIEF Environmental

MODEL: factors:
Perceive Barrier: - Seasonal
- perceive body variations
image
- Lack of time
- Need for rest

Figure 2.1: Conceptual framework of the study.

13
 CHAPTER 3: OBJECTIVES

3.1 General objective:

To study the pattern of physical activity and its associated factors among elderly

patients attending outpatient clinics in Hospital Universiti Sains Malaysia

3.2 Specific objective:

1) To describe the pattern of physical activity among elderly patients attending

outpatient clinics in HUSM.

2) To determine the associated factors of physical activity among elderly patients

attending Outpatient Clinics, HUSM

3.3 Research hypothesis:

1) age, sex, marital status, economic status and educational level are associated

with physical activity among elderly in HUSM outpatient clinics.

CHAPTER 4: METHODOLOGY

4.1 Study area:

Hospital Universiti Sains Malaysia is located in the district of Kubang Kerian, Kota

Bharu , Kelantan, located on the east coast of Peninsular Malaysia. It is a hospital

university which acts as one of tertiary center in the state of Kelantan.

There are 9 outpatient clinics available in HUSM, consist of Klinik Rawatan

Keluarga, Obsteric and Gynecology clinic, Internal Medicine clinic, Pediatric clinic,

Otorhinolaryngology clinic, Ophthalmology Clinic, Orthopaedic Clinic, Surgery and

14
 Psychiatric clinic. These clinics receive referral from surrounding health centers,

district hospitals, private hospitals, general practitioner as well as patients who come

on their own choice for check up.

This study was conducted at these outpatient clinics.

4.2 Study design:

A cross sectional study

4.3 Study period:

This study was conducted from August 2011 to December 2011

4.4 Referance population:

Elderly in Kota Bharu

4.5 Source population:

Elderly patients in outpatients clinics HUSM

4.6 Study sample:

Elderly patients at outpatients clinics HUSM that fulfill the inclusion and exclusion

criteria

4.7 Inclusion and exclusion criteria:

Inclusion criteria:

Age 60 and above

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 Exclusion criteria:

1) unable to walk independently

2) Being advice by medical personal to restrict physical activity

3) Dementia (based on ECAQ score)

4.8 Sampling method

Systematic Sampling (1:2) was applied based on attendance to outpatient clinics

HUSM.

4.9 Sampling size calculation:

The sample size calculation was done for each objective. However, only the one that

yielded the biggest sample size was taken as the study sample.

Objective 1: To describe pattern of physical activity among elderly attending

outpatient clinics in HUSM

Single proportion formula.

Prevalence of physically active elderly in Ankara, Turki (Aslan et al, 2004) was
35.1%
n= (Z)2 (1- )
()2
= 0.05
Z= 1.96
So, calculated sample size for objective 1 = 338

Objective 2: To determine factors associated with physical activity among elderly.

Using PS software Sample size per group (2 means)

16
 Reference for sample size calculation in this study was from pilot study on the

physical activity among elderly visitors in HUSM by Rahayu et al for her research

project as partial fulfillment of the requirement for the degree of master of Public

Health(40).

= 0.05

power = 0.8

= within group standard deviation

= detectable difference in population mean

m = 1

Table 4.1: Sample size calculation for objective 2

Variables Sample Total

size/ group sample size

+ 20%

Sex 2.61 1 107 257

Race 2.87 1 129 311

Smoking status 3.07 1 149 358

Marital status 2.54 1 101 243

Economic status 3.13 1 155 372

Education 2.61 1 108 260

Perceive Body Mass Index as 2.05 1 67 161

health problem

Perceive BMI as disturb 2.20 1 77 185

activity

chronic disease 2.19 1 76 183

17
From the above calculation, the biggest sample size was taken as sample size for this study.

So, sample size for this study is 372.

4.10 Operational definitions:

1. Elderly: age 60 and above

2. Ex smoker: those who stop smoking for six months and above

3. Perception of body weight: subjects perception regarding their body weight

that was correctly match with their calculated BMI

4. Perceive weight as health problem: subjects perceive their body weight give

negative effect to their health

5. Perceive weight as disturb activity: subjects perceive their body weight give

problem in doing their daily physical activity.

6. Household activity: any activity in maintaining the house

7. Sport activity: competitive physical activity with a set of rules.

8. Leisure time activity: activity done at freedom from time consuming duties,

responsibilities activities.

4.11 Research tools

A. Questionnaires:

a. Modified Baecke Questionnaire (Malay vesion)

b. Sociodemographic data

c. Elderly Cognitive Assessment Questionnaire (ECAQ

18
 B. Weight and height measurement:

Weight and height was measured using calibrated digital SECA scale machine.

Weight measured to the nearest1 decimal point in kilogram and height was measured

to 2 decimal point in meter. Body mass index was calculated as body weight divided

by height squared.

4.11.1 Questionnaires

Questionnaires were administered by face to face interview by trained interviewer.

4.11.1.1 Elderly Cognitive Assessment Questionnaire (ECAQ)(appendix A):

The Malay version of the Elderly Cognitive Assessment Questionnaire (ECAQ) was

to screen for those who has memory problem. ECAQ questionnaire was initially

developed in Singapore and includes 10 items taken from the MMSE and the

Geriatric Mental State Schedule (41). The ECAQ assesses cognitive function by 3

categories which are memory, orientation and memory recall. It uses a 4 digit

number to test memory recall and the assessment of orientation is heavily reliant on

information such as age, birthday, and year of birth. It has a maximum score of 10

points. There is less bias on educational status and the questionnaire can be

completed in less than 10 min. The ECAQ reports a sensitivity of 85.3% and

specificity of 91.5% (42). Those who had score 5 or less was excluded from this

study.

4.11.1.1. Sociodemograhic questionnaire (appendix B):

On interview, participants were asked regarding general questions. The contents were

regarding age, sex, marital status, educational status, smoking status, income and co

19
 morbid illness. They were also asked regarding how they perceive their body image

and how it influence their physical activity.

4.11.1.2 Modified Baecke Questionnaire (Appendix C):

Baecke Questionnaire was initially created by Burema, and Frijters in 1982 (43). It is a

questionnaire to measure physical activity in healthy adult persons by referring to activities

over the past year. It measures physical activity at work, sport during leisure time and

physical activity during leisure time exclude sport. Study by Ono et al in 2007 showed that

this questionnaire is a useful monitoring tools for assessing multiple domains of physical

activity with acceptable reliability and validity (44). Baecke Questionnaire was later modified

by Voorrips and co workers to capture habitual physical activity specific in the elderly by

deleting the employment items and replacing it with household activity item. Validation of

modified Baecke Questionnaire was done by comparison with energy expenditure according

to doubly labelled water method (18). The validation study showed spearman correlation

between the questionnaire score and physical activity level was 0.54(95% CI 0.22 0.66)

where subjects were not wrongly classifed (18).

The modified Baecke Questionnaire was chosen for this study as it more suitable for

elderly group as most of elderly either pensioner or unemployed. It consists of 3 domains

which are household activity, sport and leisure activity:

1. For the household activity, there are 10 questions with 4 to 5 possible response. The

specific activities in this domain include questions about light and heavy housework,

shopping, transportation and the number of rooms and stairs in the participants

house.

20
 2. The sport activity section asks about participants most frequent sport activity for past

one year. For each activities reported, they are asked regarding frequency, duration of

time spent and the month of the year which the activity performed. Each activity is

scored by a formula multiplying the activity intensity code, time spent and months

during which the activity performed.

3. The leisure time activity was also measured with similar formula with the sport

activity.

The total score is obtained by summing the score for all three domains in a continuous unit

less activity score; with the higher scores indicate higher level of physical activity. Tertiles

were computed to classify people as low, moderate and high physically active. The

questionnaire was administered as a face to face interview by a trained research assistant.

Translation process of Modified Baecke Questionnaire:

The translation process was done by a group of experts consist of epidemiologist and

family physicians. Figure 4.2 outline the flow of translation process in order to preservations

of contents and meanings.

The modified Baecke Questionnaire was translated into Malay by a bilingual master

student. Another forward translation was done by the research group. Following the

translation, another bilingual student who had never seen the questionnaire reviewed the

Malay items for backward translation into English. The Malay and back translated English

version was reviewed by research group and the translators. Final Malay version was

reproduced for pretesting. Pre-test was done to 10 subjects who were native speakers of

Malays. The review of the respondent testing and production of final consensus. (Appendix

D).

21
Figure 4.2: Forward and backward translation processes of the Modified Baecke

Questionnaire from English to Malay version.

Original English Bilingual person Translate into

version Malay language

by
research
group

Bilingual Translate into

Malay version person English version

Review by research group and translators

Final Malay
version

Pretesting

22
Validation

a) Face validation

Face validation was determine by interview 10 elderly persons and asked them to classify

the questionnaire appropriateness according to three scales. Scale 1 is not appropriate,

scale 2 appropiate and scale 3most appropriate. All the respondents rated the question as

most appropriate.

b) Content validation

Content validity was determined by two experts in the field of research. In this study,

content validity was done by a Family Medicine Specialist and a Community Medicine

Specialist. After review the questionnaires, both of them agreed that the questionnaire

content was appropriate to assess the physical activity among elderly with some

modification to suite local population

4.12 Data collection:

Every 1 in 2 elderly patients attending outpatient clinics HUSM were asked for

informed consent. Those who consented for study will be screen for the inclusion and

exclusion criteria. Written consent was obtained from the subject. Face to face interviews

were done by trained investigator. Then, the weight and height measurement were done by

interviewer

4.13 Data entry and statistical analysis

Data was entered and analyzed using Statistical Program for Social Sciences (SPSS)

version 18.0 (SPSS Inc., 2003) and Stata Intercooled version 8.0 (Stata Corp., 2003). Data

checking and cleaning were performed before analysis.

23
 Objective 1 was to describe pattern of physical activity among elderly. The proportion

of elderly involved in that particular activity was calculated. The proportions of involvement

were expressed by the frequencies and percentage.

Objective 2 was to identify the associated factors of physical activity among elderly

attending Outpatient Clinic, HUSM. The dependent variable was physical activity score. The

independent variables were age, sex, race, marital status, living arrangement, income,

educational level, smoking status, occupational, present of chronic illness, body mass index

and how their perceive their body image.

The analyses for this objective comprised of:

1. Simple Linear Regression which was used to determine the potential associated

factors of physical activity, and

2. General Linear Regression which was used to determine the associated factors of

physical activity while controlling for other confounders in the model.

General Linear Regression is a statistical analysis to examine the relationship between

one numerical dependent variable and more than one independent variables. The goal is

to develop a best fitting, simple (parsimonious), biologically sound and easy model to

estimate the beta. General Linear Regression is a special name given when the

independent variables for Multiple Linear Regression consists of mixed numerical and

categorical variables.

The procedure of General Linear Regression analysis

The distribution and frequencies were examined. All continuous variables were expressed as

mean (SD) or median (IQR) depending on the data distribution. Categorical data were

presented as frequency and percentage. Categories with small sample size were noted and

meaningful combination of categories was done when indicated.

24
Simple Linear Regression (SLR) was done on all independent variables at univariable level.

The analysis was continued with General Linear Regression (GLR). Variable selection was

done to get the preliminary main effect model by automatic backward and forward stepwise

procedure. A model with the significant variables chosen from those two procedures was

reconfirmed. Preliminary main effect model was obtained from the confirmed model.

Interaction and multicollinearity were checked in fine modeling. All possible 2-way-

interaction terms of the independent variables in the preliminary main effect model were

done. Multicollinearity was checked for the variables in the preliminary main effect model

and also for all the other variables excluded to ensure that they were not excluded due to

multicollinearity problem with other variables. Serious multicollinearity problem is present if

the variance inflation factor (VIF) is equal to or more than ten. Now the Preliminary final

model was obtained.

Model assessment was done by checking the linearity assumptions (overall model linearity

and linearity of each independent numerical variable), equal variance assumption, normality

assumption and outliers by using standardized residual plots. Residual plots include scatter

plots and histogram of residuals. In scatter plot (residuals versus predicted), if the

standardized residuals were randomly scattered along the zero line (predicted value), the

model is considered fit and overall linearity assumption met. If the standardized residuals

were dispersed equally at any point of predicted value, equal variance assumption was

considered satisfied. In histogram, if the distribution of standardized residuals was normally

distributed, the normality assumption was met. In scatter plot (residuals versus independent

numerical variable), if the standardized residuals were randomly scattered along the zero line,

the variable functional form was appropriate.

25
However, for objective 2, the model assumptions were not met and biostatistician was

consulted for remedial measures. Various transformation methods of the outcome variable

were attempted and it was found that log transformation of the outcome variable gave normal

distribution of the standardized residuals. Model assumptions were rechecked using the log

transformation of the outcome variable. Overall model fitness, equal variance assumption,

normality assumption and variable functional forms were satisfied after transformation.

4.14 Etical Approval

The study proposal was presented to the academic lecturers in the Department of Family

Medicine USM, with the presence of lecturers from Community Medicine Department USM,

before being reviewed and approved by Ethics Committee of USM on 1st August 2011

26
Figure 4.1:Flow chart of the study.
Source of Population:
Patients attending outpatient clinics Hospital University Sains Malaysia.

Inclusion Criteria:
Age: 60 years old and above.
Systematic Sampling (1:2) Physically independent.

Exclusion Criteria:
Unable to walk independently.
Being advise by medical personel to
restrict physical activity.
Dementia (base on ECAQ score)

372 patients will be selected

Research Tool:
Anonymous Questionnaires:
ECAQ (Malay version)
Socio demographic data.
Modified Baecke Questionnaire (Malay
version)

Data entry, analysis and interpretation by using SPSS Software (version 18)

Report and paper preparation for presentation

27
 CHAPTER 5:

RESULTS

A total of 372 elderly were recruited in this study. The recruitment of the subjects was

performed at the outpatients clinic HUSM. Thirty three elderly refused for interview or not

completed the interview. So, the drop out for this study was 9.1%. The response rate was

considered 90.9% in this study.

5.1 SOCIO-DEMOGRAPHIC CHARACTERISTIC OF SUBJECTS.

Table 1 showed the sociodemographic characteristics of study subjects. There were 142

(41.9%) male and 197 (58.1%) female. The mean age of the subjects is 67.7 (6.0). Majority

of the subjects were Malays (93.2%), stay with family members (92%) and not working

(72.8%). As expected, majority of subjects (71%) had chronic illness.

28
Table 5.1: Socio demographic and medical characteristics of subjects:

Variable mean (SD) n (%)

Age (years) 67.7 (6.0)

Income (RM) 684 (639.84)

Gender
Male 142 (41.9)
Female 197 (58.1)

Race
Malay 316 (93.2)
Non Malay 23 (6.8)

Marital status
Married 229 (67.6)
Widow/unmarried 110 (32.5)

Living
Alone 27 (8.0)
With spouse 87 (25.7)
With family member 91 (26.9)
With both 134 (39.5)

Education level
No education 98 (28.9)
Primary 145 (42.8)
Secondary/tertiary 96 (28.3)

Smoking status
Smoker 48 (14.2)
Ex smoker 73 (21.5)
Non smoker 218 (64.3)

Chronic illness
Yes 244 (72.0)
No 95 (28.0)

Occupation:
Yes 92 (27.1)
No 247 (72.9)

29
5.2 BMI and perception of body weight among subjects:

Table 2 shows BMI and how the subjects perceived their body image. The Mean BMI for

these subjects was 25 4.28. Only 32.7% of subjects had normal body weight. Most of the

subjects (64%) are overweight and did not perceive their weight as a problem (87%) or

disturb their activity (90%).

Table 5.2: Respondents BMI and perception on body weight:

Variable mean (SD) N (%)

BMI 25.0 (4.28)
Normal 111 (32.7)
Underweight 11 (3.2)
Overweight 217 (64.0)

Perceive weight as problem:

Yes 43 (12.7)
No 296 (87.3)

Perceive weight as disturb

activity:
Yes 31 (9.1)
No 308 (90.9)

Perception of body weight:

Correct 104 (30.7)
Incorrect 235 (69.3)

Figure 5.1 shows comparison of subjects BMI and how the subjects perceive their body

weight. Only 31.5% of subjects perceive their body weight correctly. Majority of overweight

subjects (83.9%) did not realise that their weight are a health problem.

30
 perceive weight as problem perceive weight not a problem
93.7% 90.9%
83.9%

16.1%
6.3% 9.1%

Normal BMI underweight overweight

Figure 5.1: Comparison of BMI and perception of body weight among subjects

5.3 Pattern of physical activity among elderly

5.3.1 Type of physical activity among respondents

Table 5.3 shows pattern of physical activity among the subjects. Most of the subjects were

involved in unstructured physical activity such as gardening. One third of subjects involved

in walking for leisure time activity. Only minority of them (1.7%) involve in structured

physical activity such as sport.

Table 5.3: Pattern of physical activity among elder participants

Type of physical activities N %

Gardening 178 52
Walking 46 33
Cycling 17 5
Taking care of grandchildren 13 3
Sport 6 1.7
Fishing 5 1.5
Exercise 5 1.5
Jogging 4 1.2

31
5.3.2 Physical activity score among subjects

The physical activity score is presented in Table 5.4. The maximum total score of physical

activity was 31.9 and the minimum total score was 0.9. The total physical activity score and

subscores were calculated for all subjects. The distribution of the total score and subscores

were skewed, and therefore, median values were reported.

Table 5.4: Physical activity scores among elderly (n = 339)

Physical activity Scores Median (SD)

Min Max

Household activity 0.1 3.5 1.8(0.7)

Leisure activity 0.0 29.7 4.3(5.3)

Sport activity 0.0 13.0 0.0(1.2)

Total Scores 0.9 31.9 6.1(5.5)

The total score of physical activity are divided into tertile range (18). Those who score lowest

tertile, which is below 33th centile, is categorized to have low level of physical activity.

Between the 33th centile and 66th centile is categorized as moderate level of physical activity

and above 66th centile as high level of physical activity. The result is presented in Table 5.5.

Table 5.5: Tertile of physical activity score

Classification Scores Number of subjects

Lowest <4.21 113

Middle 4.21- 8.49 113

Highest >8.49 113

32
5.3.3 Difference of physical activity score between gender

Figure 5.2 illustrates the physical activity score for each gender. Median total physical

activity score for male was higher compared to female with median score of 8.8(6.5).

Figure 5.3 showed the physical activity score according to type of physical activity in

female and male subjects. Male subjects were more involved in leisure time activity

compared to female. Meanwhile female were more involved in household activity.

6.75 (6.54)
7 5.51(4.33)
6

4 total score
3

0
male female

Figure 5.2: Total physical activity (median score) in male and female subjects.

33
 6
5.44

4
3.48

3 male

2 female
2
1.3
1

0 0
0
household activity leisure activity sport activity

Figure 5.3: Physical activity (median score) according to the type of physical activity

among male and female subjects.

Figure5. 4 and Figure 5.5 respectively show physical activity level among male and female

subjects. Percentage of male subjects who have high level of physical activity level was

higher (42%) compare to female subjects (27%).

34
 low physical
activity
28.2%

high physical
activity
42.2%

moderate physical
activity
29.6%

Figure 5.4: Physical activity level among male subjects.

high
27%
low
37%

moderate
36%
.

Figure 5.5: Physical activity level among female subjects

35
5.3.4 Comparison of physical activity level among different sociodemographic group:

Figure 5.6 shows median physical activity score according to the educational level of the

subjects. Group of subjects with higher educational level has higher median physical activity

score compared to those with no education.

8
7.27
7 6.58

6
5.02
5

3
Median physical
activity score
2

0
No education Primary education Secondary and
tertiary education

Figure 5.6: physical activity level according to level of education

36
Figure 5.7 below shows level of median physical activity score according to subjects

occupational status. Not working subjects have high level of physical activity compare to

those who are working.

6.4 6.31

6.2

5.8

Median physical activity score

5.6 5.53

5.4

5.2

5
Working Not working

Figure 5.7: physical activity level according to occupational status

37
5.3.5 comparison of physical activity level and perceptions of bodyweight

Physical activity level among those who perceive and not perceive their weight as a health

problem is shown in figure 5.8. Surprisingly, those who do not perceived their body weight as

a health problem are more active compare to those who perceived their weight as a health

problem

7
6.40

5 4.59

3 median physical activity score

0
perceive their weight as a not perceive their weight as a
health problem health problem

Figure 5.8: Comparison of BMI perception of body weight among subjects

5.4 Associated factors of physical activity:

Simple Linear Regression showed that age, sex, educational status, occupational status and

those who did not perceive their weight as a problem and disturd activities were significant

associated factors of physical activity and General Linear Regression showed that only age,

sex, occupational status and those who did not perceive their weight as a problem were

significant associated factors of physical activity (Table 5.6).

38
Table 5.6: Associated factors for physical activity among elderly
Variables Simple linear regression Multiple linear regression
a b
b (95% CI) t stat P value b (95% CI) t stat P value
Age (year) -0.071(-0.16,0.02) -1.44 0.150 -0.10(-0.20,-0.01) -2.13 0.034

Income 0.001(0.001,0.001) 1.78 0.076

BMI -0.11(0.25,0.02) -1.61 0.109

Gender:
Male
Female -2.12(-3.28,-0.96) -3.59 <0.001 -2.37(-3.52,-1.21) -4.03 <0.001

Race:
Malay
Non Malay 1.13(-1.17,3.45) 0.96 0.337

Marital status:
Married
Widow/unmarried -076(-2.00,0.48) -1.20 0.230
Living arrangement
Alone
With spouse 0.70 (-1.67,3.08) 0.58 0.560
With family members 0.23(-2.13,2.59) 0.20 0.483
With both 0.81(-1.46,3.08) 0.70 0.483

Education level
No education
Primary 1.49(0.11,2.89) 2.12 0.035
Secondary/tertiary 2.25(0.73,3.78) 2.90 0.004

Smoking status
Smoker
Ex-smoker 0.93(-1.05,2.90) 0.92 0.358
Non-smoker -0.98(-2.68,0.72) -1.13 0.258

Chronic illness:
Yes
No 0.66(-0.64,1.95) 0.99 0.322

Perceive weight
as problem:
Yes
No 2.28(0.54,4.02) 2.58 0.010 2.50(0.78,4.21) 2.65 0.004
Perceive weight as
disturb activity:
Yes
No 2.02(0.01,4.04) 1.98 0.049

Occupational status:
Working
Not working 0.96(-0.35,2.26) 1.44 0.151 1.76(0.46,3.06) 2.65 0.008

39
5.5 Final model of General Linear Regression

Table 5.6 showed the final model i.e. best fit, parsimonious and biologically plausible model

for the associated factors of physical activity. The significant associated factors for physical

activity were age, sex, occupational status and those who did not perceive their weight as a

problem. The following interpretations could be made:

1. For every 1 unit increased in age, there was a decreased of 0.1 unit in physical activity

score (95% CI: -0.20, -0.01), after adjusted for other variables.

2. Female have got 2.37 units of physical activity score (95% CI: -3.52,-1.21), lower

than male after adjusted for other variables.

3. Those who did not perceive weight as a problem, there was an increased of 2.50 unit

in physical activity score (95% CI: 0.78, 4.21), when other variables are the same.

4. Those who were not working, there was an increased of 1.76 unit in physical activity

score (95% CI: 0.46, 3.06), after adjusted for other variables.

5. Regression equation:

Physical activity score = 6.45 0.1(age) 2.37 (sex) + 2.50 (perceive weight as a

problem) + 1.76 (not working)

R2= 0.08, meaning that only 8.4% of the variance in physical activity score in the sample

was explained by the four significant variables observed.

40
 CHAPTER 6

DISCUSSION:

Physical activity is known to be associated with a lower incidence of mortality

and morbidity from a number major chronic illness such as coronary heart disease, diabetes,

depression, obesity, osteoporosis and cancer (3). Despite well-known benefit of physical

activity, prevalence of those who are physically active are still low. Based on Malaysia

National Health and Morbidity survey III in 2006, about 40% of our adult Malaysian

population were inactive. We should assessed the factors that influence physical activity

especially among elderly in Malaysia in order to promote this healthy lifestyle and also to

prepare our health care system in managing the increasing burden of elderly people. There

were many literatures and study that showed socioeconomic factors such as age, gender,

marital status, education status, smoking, economic status, co morbid illness and body mass

index influenced level of physical activity (5-9, 32-34). These studies were conducted in

other countries with difference background of population as compare to our Malaysian

population. Nevertheless, in Malaysia, there is limited data on this issue.

Many studies used questionnaires as measuring tools of physical activity. It is

considered the most practical physical activity measure for large scale population studies

(17). However there was no standard questionnaires for physical activities. The Modified

Baecke questionnaire was used in this study as it measure physical activities involving

household activities, leisure time activities and sport activities. These activities are more

relevant to elderly as most of those in this age group are either pensioner or not working. In

our study 72% of subjects are not working. Besides, our country located in Khatulistiwa with

tropical climate. There are some questionnaires that specific to four seasons country. These

questionnaires are not applicable for population in tropical country such as Malaysia.

41
6.1Pattern of physical activity among elderly:

6.1.1 Physical activity score

In this study, tertiles were computed from total physical active score that classified

participants as low, moderate or high physically active, which is similar method used in

validation study of the Modified Baecke Questionnaire done by Hertogh et al (18). Even

though in Hertogh study, the mean age of participants was 70.6 years which was higher than

mean age in this study (67.7 years), but their physical activity scores were higher (median for

total score was 11.9) comparing to this study (median score 6.10). In the study done by

Hertogh et al, the lowest tertile range from 2.3 to 7.94, the middle tertile range from 9.13 to

14.91 and the highest tertile range from 15.7 to 35.6 (18). These differences could be due to

the subjects in Hertogh et al study was recruited among participants in training programme on

several cardiovascular risk factors with strict exclusion criteria. Their exclusion criteria were

those with heart disease, diabetes, history of stroke in preceding 2 years and those taking beta

blocker or diuretics. Meanwhile in this study, participants were recruited from clinic setting

with less stringing exclusion criteria. Majority of participants of this study had co morbid

illness (71%) and the exclusion criteria were those cannot walk independently or advice by

medical personnel not to physically active.

Eventhough there is big different in total score between these two studies but if we

compare the contribution from each domain of physical activity, both studies show that

leisure activity score gave the most contribution for physical activity score. In current study,

we can see that elderly more prone to involve in leisure time activity (median score of 4.28)

compare to household activity (median score of 1.8) and worse in sport activity (median

score of 0). Median leisure score in study by Hertogh et al was 5.7 meanwhile household

median score and sport median were 1.6 and 2.2 respectively. It suggest that regardless the

42
socio demographic background, elderly people more involve in leisure activities compare to

other type of activities.

In current study, if we compare between both gender, men had higher physical activity

score with median score 6.54 compare to female elder (median score 4.33). This finding also

corresponds with finding in study by Hertogh et al (18). Current study result also shows

nearly half of male subjects (42%) were classified in high physical activity. Contrast to

female elderly where percentage in all tertiles are similar, where percentage in each group of

physical activity about 30%.

Between gender, the finding similar with study by Hertogh et al (18), where female

gender show higher score on household activities compare to man. This could be due to most

culture, especially in Malay community in Malaysia, male spouse are the dominant character

in their house. They spent most of their time with outdoors activities. Meanwhile, it was

considered being female partner duty to do household chores and to take care of their

children. This could contribute higher leisure time activity among male participants compare

to female. If we compare between household activity score and leisure time activities score

among female participants, the median score for household activity are much lower. This

could be caused by the type of household activities such as sweeping floors, cooking and

washing require less intensity of energy compare to outdoors activities such as gardening and

walking.

6.1.2 Type and pattern of physical activities

Based on the results of this study, it shows that the elderly were more prone to

involved in unstructured physical activity such as household activity and leisure time activity.

Most of elderly were not active in sport. Only 6 out of 339 elderly (1.7%) participate in sport

43
activity and less than half of elderly involved in other type of exercise such as walking

(33%), aerobic exercise (1.5%), cycling(5%) and jogging(1.2%).

Gardening is the most common forms of physical activity among the subjects. Other

common physical activity are walking and cycling. Only minority of the participants involve

in sport and exercise. Almost similar finding seen in study done in western country among

white elderly women by Walsh et al (9) . In that study, walking was the commonest form of

physical activity and followed by gardening, swimming and bicycling.

In Zutphen Elderly Study, similar pattern was seen where the most common activities

among elderly tend to be lower intensity but sustained activities such as walking, yard walk

or gardening, golf and cycling (19). This suggests that most elder tend to be involved in

more unstructured activities with lower intensity activities rather than sports. This could be

due to in activities such as gardening; they can suit it with their capability and energy. This

unstructured activities such as gardening also more flexible where they can chose the type

and the intensity of the gardening activity which is appropriate to them and they can

accumulate the duration of activities according to their free time or capability which as

recommended by American Heart Association (30). Meanwhile in sport, there is element of

competitive where they need to meet the standard of their opponents and need to comply to

certain rules of the sport. This type of activity could possible exposed the elderly to sport

injury if they push themselves too hard beyond their capacity to win the games. The type of

physical activities could also influence by the economical and geology of Kelantan state

where agriculture is one of the sources for economic income. Another possible factor could

be avalaibility of facilities for recreation. Subjects of this study came from all over Kelantan

and some of might came from rural area where there is not much facilities for sport available.

This could influence their type of leisure time activities.

44
6.2 Associated factors of physical activity:

One of the purposes of this study is to determine the factors influence the physical

activity level among elderly. The results of this study show that age, female, working and

those who did not perceive their weight as a problem were significant associated factors of

physical activity (Table 6).

Finding from previous study provide association between age and level of physical

activities (5-7, 9, 32, 33). In this study, increasing age influence the level of physical activity

among elderly (OR = -0.10, 95% CI = -0.20,-0.01; p = 0.034). Regardless of type of

measurement tools for physical activity used, many study showed reduce physical activity

level by increasing age (6, 32, 33, 45). A community based cross sectional study among

12611 elderly age 65 years old and above in Canada by Kaplan et al showed similar

association between physical activity and age (6). In that study, physically active was defined

as those who reported taking part in a physical activity lasting > 15 minutes at a rate of > 12

times per month (6). Another study with similar finding but with different method of

measuring physical activity level is a study done by Aslan et al in Ankara, Turki. It was a

community based study among 360 subjects age 65 years and above (median age 71.5 SD

5.4) (32). Aslan et al defined physical activity differently in their study in which subjects

were classified by asking whether they doing regular physical activity or not doing regular

physical activity (32).

In a national survey among 33 933 adult Malaysian population age 18 years and

above, WHO-stepwise questionnaire was used as measurement tools for physical activity.

Physical inactivity was defined as fewer than 150 minutes per week spent in moderate

physical activities, fewer than 60 minutes of vigorous physical activities and total MET

minutes per week lesser than 600 minutes (31). It finding showed prevalence of physical

45
inactivity among adult population in Malaysia decreased with age until the age group of 45

49, then it showed an increasing trend with age till age group of 80 years and above (31).

The finding of this national survey suggests that level of physical activity reduced earlier at

the age of 50 years, which is before elderly age group and correlate well with increasing age

until age 80 years.

Studies among female subjects also had correlated increasing age with lower level of

physical activity (7, 9, 33). One of the study with such finding was a community based study

done in south Carolina in United State by Wilcox et al (46). The subjects in this study were

102 women age 50 years and older. The researchers used Physical Activity Scale for Elderly

(PASE) as the measurement tools.

Another cross sectional study among 9704 ambulatory women aged 65 years and

above (mean age of 70 years) was done at clinic setting in United States using Modified

Paffenbarger scale questionnaire also showed similar result (9). Age related decreases in

physical activity was seen in all 4 most common types of activity among subjects of this

study, which are walking, gardening, swimming and bicycling (9). This study also showed

significant reduced participating in medium- or high intensity exercise with increasing age

(9).

From current study and previous literatures findings, we can conclude that increasing

age is significantly associated with reduce level of physical activity regardless of

measurement tools, gender and geographic factors. The finding also not influence by the fact

that either the study was done at the clinic setting or community base.

In current study, female gender (OR = -2.37, 95% CI = -3.52, -1.21; p = <0.001) is

associated with lower level of physical activity. This finding is consistent the result of our

46
National survey, NHMS III that showed gender factors contribute to low level of physical

activity among Malaysian adults (31). Based on NHMS III, prevalence of physical inactivity

higher among female in adult Malaysian population (77.5% (CI: 76.5- 78.4) than males

(66.8% CI 65.8-67.8) (31). These results were similar to those obtained by earlier researchers

(5, 6, 32). In the study by Aslan et al in Turki, the researchers postulate this finding with the

fact that their woman were historically less educated (32). In the past, older generation of

Islamic women in their country were usually did not go out from house unaccompanied and

did not gain employement (32). The same thing could also see among our elderly population

which majorities of them were Muslim. There could be others factors such as biological

factors which contribute to the lower physical activity among women other than religious

aspect, as study in the west countries such as Canada by Kaplan et al also showed similar

result (6).

Those who are not working were more physically active compared to those who are

still working. The most likely explanation is those who are working do not have enough time

to be involved in physical activity. There is possibility that they perceive that their activities

during working are enough for them to meet the recommendation of physical activity to

maintain healthy life. However due to cross sectional design of this study, we cannot

ascertain which one affect the other, either how they perceive weight not a problem and those

who are working affect the level of physical activity or otherwise. Further description on job

classification of participants may help in clarify the association between occupation status

and physical activity level of participants. Previous study on effect of leisure time physical

activity and strenuousness of work as predictors of physical functioning, found that high

physical strenuousness of work increased the risk of later poor functioning (47). Physical

activities at work and during leisure time differ in many aspects. The type, timing and

intensity of leisure time activity may be chosen by individual. Activity at workplace

47
especially those in blue-collar strata usually of longer duration, more repetitive, monotonous

and less under control of the performer than exercise or housework. Jobs work demands may

exceed physical capacity of the worker that may lead they cannot perform much activity

during leisure time.

In this study, those subjects who do not perceive their weight as a health problem had

significant higher level of physical activity. As this is a cross sectional study, we cannot

determine either their perception of body weight lead to higher physical activity level or the

higher physical lead to their current perception to body weight. Generally known that

physical activity help in reduction of weight and better health outcome. There is possibility

that those who already physically active are satisfied with their body image currently as a

result of their active lifestyle and think their current body weight reflecting their health status.

Unfortunately, the result of this study shows majority of subjects who are overweight

perceive their weight not a health problem (83.9%). We should give more education for this

group of people to correct their perception of body weight and to promote active lifestyle as a

part of weight reduction programme.

48
 CHAPTER 7: CONCLUSSION

This analysis supports that there are correlation between sociodemographic factors and level

of physical activity among elderly. The significant associated factors for physical activity

found in this study were age, sex, occupational status and those who did not perceive their

weight as a problem. However, only 8.4% of the variance in physical activity score in the

sample was explained by the four significant variables observed.

49
 CHAPTER 8: LIMITATION OF STUDY

There are several limitations to this study. This study was conducted at outpatient

clinics Hospital Universiti Sains Malaysia. It was thus not a random, population based

sampling frame. It may influence the characteristics of the participants as 71% of them had

chronic illness.

There are possible response bias problem associated with self-report of physical

activity. The questionnaire used in this study need recall of 1 year physical activity and the

results based on self- report physical activity rather than an objective measure. This could

cause inaccurate data. The disadvantage of 1 year recall was minimized by using MMSE to

screen those who had memory problem. The interpretation of intensity of physical activity

was depend on the individual interviewer which could cause inconsistent interpretation

between interviewers. In this study, there was only one interviewer that interprets the

intensity of the physical activity.

Besides, this questionnaire only allows us to assess level of physical activity in this

group of participants, unable to classify whether participants are meeting global

recommendations for physical activity. These also make difficulty to compare the results of

this study with other study populations that use different methods or different questionnaires

to assess physical activity level.

Although this study suggests there are significant associated factors for level of

physical activity among elderly, we cannot differentiate the associations because of the study

design. This is a cross sectional study, so we cannot be sure whether this significant

associated factors affected the level of physical activity or whether the level of physical

activity affect the associated factors.

The results of this study showed that the associated factors that we analyze only

contribute 8.4% for the variance in physical activity score among elderly. This mean, there

50
are more factors need to be consider such as perceive barrier and environmental factors,

social-cultural factors and seasonal factors.

51
 CHAPTER 9: RECOMMENDATION

This study was done at outpatient clinics setting. Another community base study

recommended as it could better represent elderly in general population. Although this study

show several significant associated factors for physical activity in elder, but these only

contribute 8.4%for the physical activity in elderly. Further study on other possible such as

perceive barrier and environmental factors should be done to determine other possible

associated factors for physical activity in this group.

Modified Baecke questionnaire which was used in this study need a one recall on physical

activity. We recommend a more suitable and validated questionnaire to be used to avoid

inaccurate data.

52
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28. Elsawy B, Higgins KE. Physical activity guidelines for older adults. American Family
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influences physical activity among elders? A Turkish experience from Ankara,
Turkey. Archives of Gerontology and Geriatrics. 2008;46(1):79-88.

33. Lawlor D, Taylor M, Bedford C, Ebrahim S. Is housework good for health? Levels of
physical activity and factors associated with activity in elderly women. Results from
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34. Rautio N, Heikkinen E, Ebrahim S. Socio-economic position and its relationship to

physical capacity among elderly people living in Jyvaskyla, Finland: five-and ten-year
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35. Bianchi G, Rossi V, Muscari A, Magalotti D, Zoli M, Group tPS. Physical activity is
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36. Kaplan GA, Seeman TE, Cohen RD, Knudsen LP, Guralnik J. Mortality among the
elderly in the Alameda County Study: behavioral and demographic risk factors.
American Journal of Public Health. 1987;77(3):307-12.

37. Ferrucci L, Izmirlian G, Leveille S, Phillips CL, Corti M-C, Brock DB, et al.
Smoking, Physical Activity, and Active Life Expectancy. American Journal of
Epidemiology. 1999;149(7):645-53.

38. Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, Grodstein F. Physical
activity, including walking, and cognitive function in older women. JAMA.
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39. Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K. Physical activity and

risk of cognitive impairment and dementia in elderly persons. Arch Neurol.
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40. Rohayu Hami NAY, Azidah Abdul Kadir,Hasmalaili Husni. Preliminary study on
physical activity among elderly visitors in HUSM outpatient clinics. [research project
submitted in partial fulfillment of the requirement for the degree of master of public
health]. In press 2011.

41. Storey JE. The Development, Pilot and Validation of a Multicultural Cognitive
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42. Kua E, Ko S. A questionnaire to screen for cognitive impairment among elderly

people in developing countries. Acta Psychiatrica Scandinavica. 1992;85(2):119-22.

43. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of
habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36(5):936-
42.

44. Ono R, Hirata S, Yamada M, Nishiyama T, Kurosaka M, Tamura Y. Reliability and

validity of the Baecke physical activity questionnaire in adult women with hip
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45. Lian WM, Gan GL, Pin CH, Wee S, Ye HC. Correlates of leisure-time physical
activity in an elderly population in Singapore. Am J Public Health. 1999;89(10):1578-
80.

46. Wilcox S, Bopp M, Oberrecht L, Kammermann SK, McElmurray CT. Psychosocial

and perceived environmental correlates of physical activity in rural and older African
American and white women. The Journals of Gerontology Series B: Psychological
Sciences and Social Sciences. 2003;58(6):P329-P37.

47. Leino-Arjas P, Solovieva S, Riihimki H, Kirjonen J, Telama R. Leisure time

physical activity and strenuousness of work as predictors of physical functioning: a 28
year follow up of a cohort of industrial employees. Occupational and environmental
medicine. 2004;61(12):1032-8.

56
APPENDICES:
APPENDIX A:
Elderly Cognitive Assessment Questionaire (ECAQ) Malay version

Soal Selidik Penilaian Kognitif Orang Tua

MEMORI Skor 1 untuk

Jawapan yang betul
1. Saya ingin anda mengingati
nombor ini .Sila ulang selepas
saya ( contoh : 4517 ).Saya akan
menguji anda semula dalam masa
10 minit lagi. ______________

2. Berapa umur anda ? ______________

3. Bila tarikh lahir anda ? ______________

Atau
Tahun bilakah anda dilahirkan ? ______________

ORIENTASI DAN MAKLUMAT

4. Hari ini hari apa ? ______________

Berapakah tarikh hari ini ?

5. hari ______________

6. bulan _______________

7. tahun _______________

8. Apakah nama tempat ini? ( cth : klinik , hospital ) _______________

( tidak perlu memberi nama yang tepat )

9.Apakah pekerjaan beliau ? ( contoh , sambil

menunjukkan kepada jururawat atau doktor) _______________

MENGINGAT KEMBALI

10. Bolehkah anda menyebut semula

nombor yang telah diberikan tadi ? _______________

Jumlah _______________

57
APPENDIX B:
Sociodemographic questionnaire

1) Latar belakang sosio ekonomi:

1.1- Umur : .. Tahun

1.2- Jantina:

0- Lelaki
1- Perempuan
1.3- Keturunan:

0 Melayu
1 Cina
2 India
3 Lain-lain
Jika lain lain,sila
nyatakan.
1.4- Taraf perkahwinan:

0- Berkahwin
1- Duda/ janda
2- Tidak berkahwin

1.5- Tinggal:

0- Bersendirian
1- Bersama pasangan sahaja
2- Bersama ahli keluarga
3- Bersama pasangan dan ahli keluarga
1.6- Status ekonomi:

0- Mempunyai pendapatan tetap

1- Tiada pendapatan tetap
2- Pencen

1.7- Anggaran pendapatan keluarga:

RM_______ / sebulan.

1.8- Tahap pendidikan tertinggi:

0- Tidak bersekolah
1- Sekolah rendah
2- sekolah menengah
3- Institut pengajian tinggi

58
1.9- Status merokok:
0- Perokok
1- Sudah berhenti merokok (lebih daripada 6 bulan)
2- Tidak pernah merokok

1.11- Adakah anda mengidap penyakit kronik?

0- Ya
1- Tidak

1.12- Jika jawapan kepada soalan 1.12 adalah 'ya' sila nyatakan jenis penyakit anda
______________________________________________________________
______________________________________________________________
______________________________________________________________

1.13- Timbangan berat badan dan tinggi: Berat ________ kg

Tinggi ________ cm

1.14 Adakah berat badan anda berada dalam lingkungan :

0- Kurang berat badan
1- Normal
2- Lebih berat badan

1.15- Adakah berat badan anda merupakan satu masalah kesihatan bagi anda?
0- Ya
1- Tidak

1.16- Adakah berat badan anda mengganggu aktiviti harian anda?

0- Ya
1- Tidak

1.17- Jika anda bekerja, apakah pekerjaan anda? __________________________

59
APPENDIX C:
Modified Baecke Questionnaire for Older Adults

HOUSEHOLD ACTIVITIES
1) Do you do the light household work? (dusting, washing dishes, repairing clothes,
etc.)?
0- Never (< once a month) _____________
1- Sometimes (only when partner or help is not available)
2- Mostly (sometimes assisted by partner or help)
3- Always (alone or together with partner)

2) Do you do the heavy housework? (washing floors and windows, carrying trash
disposal bags, etc.)?
0- Never (< once a month) ____________
1- Sometimes (only when partner or help is not available)
2- Mostly (sometimes assisted by partner or help)
3- Always (alone or together with partner)

3) For how many persons do you keep house? (includimg yourself; fill in 0 if you
answered never in Q1 and Q2.)
______________

4) How many rooms do you keep clean, including kitchen, bedroom, garage, cellar,
bathroom, ceiling, etc? (fill in 0 if you answered never in Q1 and Q2.)
0- Never do housekeeping _____________
1- 1-6 rooms
2- 7-9 rooms
3- 10 or more rooms

5) If any room, on how many floors? (fill in 0 if you answered never in Q4.)
__________

6) Do you prepare warm meals yourself, or do you assist in preparing?

0- Never ________________
1- Sometimes (once or twicw a week)
2- Mostly (3-5 times a week)
3- Always (more than 5 times a week)

7) How many flight of stairs do you walk up per day?( one flight of stairs is 10 steps)
0- I never walk stairs
_______________
1- 1 -5
2- 6 -10
3- More than 10

8) If you go somewhere in your hometown, what kind of transport do you use?

0- I never go out _______________
1- Car
2- Public transportation
3- Bicycle

60
 4- Walking

9) How often do you go out for shopping?

0- Never or less than once a week ______________
1- Once a week
2- Twicw to four times a week
3- Everyday

10) If you go out for shopping, what kind of transport do you use?
0- I never go out _______________
1- Car
2- Public transport
3- Bicycle
4- walking

SPORT ACTIVITIES
Do you play sport?
Sport 1: name _________________
Intensity (code) _________________
Hours per week (code) _________________
Period of the the year (code) _________________

Sport 2: name _________________

Intensity (code) _________________
Hours per week (code) _________________
Period of the the year (code) _________________

LEISURE TIME ACTIVITIES:

Do you have any other physically active activities?
Activities 1: name _________________
Intensity (code) _________________
Hours per week (code) _________________
Period of the the year (code) _________________
Activity 2 to 6: as activity 1.

61
Codes for the Modified Baecke Questionnaire
Intensity code:
0- lying, unloaded Code 0.028
1- sitting, unloaded Code 0.146
2- sitting, hand or arm movement Code 0.297
3- sitting, body movements Code 0.703
4- standing, unloaded Code 0.174
5- standing, hand or arm movement Code 0.307
6- standing, body movements, walking Code 0.890
7- walking, hand or arm movement Code 1.368
8- walking, body movements, cycling, swimming Code 1.890
Hours per week:
1- less than 1 hour/week Code 0.5
2- 1 - <2 h/w Code 1.5
3- 2 - <3 h/wk Code 2.5
4- 3 - <4 h/wk Code 3.5
5- 4 - <5 h/wk Code 4.5
6- 5 - <6 h/wk Code 5.5
7- 6 - <7 h/wk Code 6.5
8- 7 - <8 h/wk Code 7.5
9- 8 or more h/wk Code 8.5

Months per year:

1- Less than 1 mo/yr Code 0.04
2- 1- 3 mo/yr Code 0.17
3- 4- 6 mo/yr Code 0.42
4- 7 -9 mo/yr Code 0.67
5- More than 9 months/yr Code 0.92

62
APPENDIX D:

TERJEMAHAN ' MODIFIED BAECKE QUESTIONNAIRE'

TEMPOH MASA: sila jawab soalan berikut berdasarkan aktiviti anda dalam 1 tahun
kebelakangan ini.

AKTIVITI KERJA RUMAH:

1 Adakah anda melakukan kerjarumah yang ringan?
( Contoh: menyapu, membasuh pinggan, menjahit dan sebagainya)
0- tidak pernah (kurang daripada sekali sebulan)
1- kadang kadang ( hanya apabila tiada pasangan atau orang
yang membantu)
2- kerap (kadang kadang dibantu oleh pasangan atau sesiapa)
3- sentiasa (melakukannya berseorangan atau
bersama-sama pasangan)

2 Adakah anda melakukan kerjarumah yang berat?

(contoh: mop lantai, basuh lantai, cuci tingkap, angkat sampah dan sebagainya)
0- tidak pernah (kurang daripada sekali sebulan)
1- kadang ( hanya apabila pasangan atau pembantu rumah tiada)
2- Kerap (kadang kadang dibantu oleh pasangan pembantu
rumah)
3- Sentiasa (melakukannya berseorangan atau bersama-sama
pasangan)

3 Anda mengemas rumah untuk berapa orang?

__________
(bilangan tersebut adalah termasuk diri anda. Sila tandakan 0 jika jawapan untuk soalan no. 1
dan 2 adalahtidak pernah )

4 Berapakah jumlah bilik di rumah anda yang anda kemaskan dalam sehari?
(termasuk dapur, bilik tidur, bilik air, ruang tamu dan sebagainya) Sila tandakan 0
jika jawapan pada soalan 1 dan 2 adalah tidak pernah
0- Tidak pernah mengemas.
1- Bilangan bilik: bilangan bilik tidur
Dapur
Ruang tamu
Lain-lain bilik

5 Jika ada bilik yang perlu dikemas, ditingkat berapakah? (Tandakan 0 jika jawapan untuk
soalan 4 adalah tidak pernah)
0- Tidak pernah
1- Tingkat bawah

63
 2- Tingkat atas
3- kedua-dua tingkat

6 Adakah anda memasak sendiri atau membantu memasak di rumah?

0- Tidak pernah
1- Kadang kadang (1- 2 kali seminggu)
2- Kerap (3 5 kali seminggu)
3- Sentiasa (lebih daripada 5 kali seminggu)

7 Berapa anak tangga anda naik/ turun setiap hari?

0- Tidak pernah
1- 10 ke 50 anak tangga
2- 51 ke 100 anak tangga
3- Lebih daripada 100 anak tangga

8 Jika anda keluar rumah menuju ke sesuatu tempat di daerah tempat tinggal anda, apakah jenis
kenderaan yang anda gunakan?
0- Tidak pernah keluar rumah
1- Kereta
2- Motosikal
3- Kenderaan awam
4- Basikal
5- Berjalan kaki

9 Berapa kerap anda keluar membeli belah?

0- Tidak pernah atau kurang daripada sekali seminggu.
1- Sekali seminggu
2- 2 4 kali seminggu
3- Setiap hari

10 Jika anda keluar membeli belah, apakah jenis kenderaan yang anda gunakan?
0- Tidak pernah keluar membeli belah
1- Kereta
2- Motosikal
3- Kenderaan awam
4- Basikal
5- Berjalan kaki

64
AKTIVITI SUKAN:
Adakah anda bersukan?
Sukan 1: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Sukan 2: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

AKTIVITI MASA LAPANG:

Contoh: senaman aerobik, berjalan kaki, main haji/dam, main karom, berkebun ( intensity kod
adalah berdasar jenis berkebun yang dilakukan), mengayuh basikal dan sebagainya.

Aktiviti 1: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 2: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 3: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 4: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 5: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 6: Jenis
Tahap (kod)

65
 Tempoh jam/ seminggu
Tempoh dalam setahun

PENGIRAAN MARKAH:

Markah untuk aktiviti kerja rumah: = ./10

= _____________

Markah untuk aktiviti sukan:

- aktiviti sukan 1 =
- aktiviti sukan 2 =
Jumlah = __________________

Markah untuk aktiviti masa lapang:

-aktiviti masa lapang 1 =
-aktiviti masa lapang 2 =
-aktiviti masa lapang 3 =
-aktiviti masa lapang 4 =
-aktiviti masa lapang 5 =
-aktiviti masa lapang 6 =
Jumlah = _____________

JUMLAH MARKAH UNTUK SOALSELIDIK:

= (Markah untuk aktiviti kerja rumah + Markah untuk aktiviti sukan + Markah untuk aktiviti masa
lapang)
= +
+

= _____________

66
APPENDIX E:
BORANG SOALSELIDIK

LAMPIRAN A

Borang soal selidik:

Tajuk: Soal selidik Tahap aktiviti Fizikal di Kalangan Warga Emas

Nama
Penyelidik: 1 Dr Hasmalaili Binti Husni
2 Dr Azidah Abdul Kadir
3 Dr Nani Draman
4 Prof Madya Dr. Nor Azwany Binti Yaacob

Nombor subjek(untuk kegunaan pejabat sahaja):

(4 digit akhir nombor kad pengenalan)

Sila isikan tempat kosong yang disediakan dan tanda pada kotak yang bersesuaian:

1) Latar belakang sosio ekonomi:

1.1- Umur : .. Tahun

1.2- Jantina:

0- Lelaki
1- Perempuan
1.3- Keturunan:

0 Melayu
1 Cina
2 India
3 Lain-lain
Jika lain lain,sila
nyatakan.
1.4- Taraf perkahwinan:

0- Berkahwin
1- Duda/ janda
2- Tidak berkahwin

1.5- Tinggal:

0- Bersendirian
1- Bersama pasangan sahaja
2- Bersama ahli keluarga
3- Bersama pasangan dan ahli keluarga

67
 1.6- Status ekonomi:

0- Mempunyai pendapatan tetap

1- Tiada pendapatan tetap
2- Pencen

1.7- Anggaran pendapatan keluarga:

RM_______ / sebulan.

1.8- Tahap pendidikan tertinggi:

0- Tidak bersekolah
1- Sekolah rendah
2- sekolah menengah
3- Institut pengajian tinggi

1.9- Status merokok:

0- Perokok
Sudah berhenti merokok (lebih daripada 6
1- bulan)
2- Tidak pernah merokok

1.11- Adakah anda mengidap penyakit kronik?

0- Ya
1- Tidak

1.12- Jika jawapan kepada soalan 1.12 adalah 'ya' sila nyatakan jenis penyakit anda
______________________________________________________________
______________________________________________________________
______________________________________________________________

1.13- Timbangan berat badan dan tinggi: Berat ________ Kg

Tinggi ________ Cm

1.14- Adakah berat badan anda berada dalam lingkungan :

0- Kurang berat badan
1- Normal
2- Lebih berat badan

1.15- Adakah berat badan anda merupakan satu masalah kesihatan bagi anda?
0- Ya
1- Tidak

68
1.16- Adakah berat badan anda mengganggu aktiviti harian anda?
0- Ya
1- Tidak

1.17- Jika anda bekerja, apakah pekerjaan anda? __________________________

69
TERJEMAHAN ' MODIFIED BAECKE QUESTIONNAIRE'
TEMPOH MASA: sila jawab soalan berikut berdasarkan aktiviti anda dalam 1 tahun
kebelakangan ini.

AKTIVITI KERJA RUMAH:

1 Adakah anda melakukan kerjarumah yang ringan?
( Contoh: menyapu, membasuh pinggan, menjahit dan sebagainya)
0- tidak pernah (kurang daripada sekali sebulan)
1- kadang kadang ( hanya apabila tiada pasangan atau orang
yang membantu)
2- kerap (kadang kadang dibantu oleh pasangan atau sesiapa)
3- sentiasa (melakukannya berseorangan atau
bersama-sama pasangan)

2 Adakah anda melakukan kerjarumah yang berat?

(contoh: mop lantai, basuh lantai, cuci tingkap, angkat sampah dan sebagainya)
0- tidak pernah (kurang daripada sekali sebulan)
1- kadang ( hanya apabila pasangan atau pembantu rumah tiada)
2- Kerap (kadang kadang dibantu oleh pasangan pembantu
rumah)
3- Sentiasa (melakukannya berseorangan atau bersama-sama
pasangan)

3 Anda mengemas rumah untuk berapa orang?

__________
(bilangan tersebut adalah termasuk diri anda. Sila tandakan 0 jika jawapan untuk soalan no. 1
dan 2 adalahtidak pernah )

4 Berapakah jumlah bilik di rumah anda yang anda kemaskan dalam sehari?
(termasuk dapur, bilik tidur, bilik air, ruang tamu dan sebagainya) Sila tandakan 0
jika jawapan pada soalan 1 dan 2 adalah tidak pernah
0- Tidak pernah mengemas.
1- Bilangan bilik: bilangan bilik tidur
Dapur
Ruang tamu
Lain-lain bilik

5 Jika ada bilik yang perlu dikemas, ditingkat berapakah? (Tandakan 0 jika jawapan untuk
soalan 4 adalah tidak pernah)
0- Tidak pernah
1- Tingkat bawah
2- Tingkat atas
3- kedua-dua tingkat

70
6 Adakah anda memasak sendiri atau membantu memasak di rumah?
0- Tidak pernah
1- Kadang kadang (1- 2 kali seminggu)
2- Kerap (3 5 kali seminggu)
3- Sentiasa (lebih daripada 5 kali seminggu)

7 Berapa anak tangga anda naik/ turun setiap hari?

0- Tidak pernah
1- 10 ke 50 anak tangga
2- 51 ke 100 anak tangga
3- Lebih daripada 100 anak tangga

8 Jika anda keluar rumah menuju ke sesuatu tempat di daerah tempat tinggal anda, apakah jenis
kenderaan yang anda gunakan?
0- Tidak pernah keluar rumah
1- Kereta
2- Motosikal
3- Kenderaan awam
4- Basikal
5- Berjalan kaki

9 Berapa kerap anda keluar membeli belah?

0- Tidak pernah atau kurang daripada sekali seminggu.
1- Sekali seminggu
2- 2 4 kali seminggu
3- Setiap hari

10 Jika anda keluar membeli belah, apakah jenis kenderaan yang anda gunakan?
0- Tidak pernah keluar membeli belah
1- Kereta
2- Motosikal
3- Kenderaan awam
4- Basikal
5- Berjalan kaki

71
AKTIVITI SUKAN:
Sukan 1: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Sukan 2: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

AKTIVITI MASA LAPANG:

Contoh: senaman aerobik, berjalan kaki, main haji/dam, main karom, berkebun ( intensity kod
adalah berdasar jenis berkebun yang dilakukan), mengayuh basikal dan sebagainya.

Aktiviti 1: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 2: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 3: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 4: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 5: Jenis
Tahap (kod)
Tempoh jam/ seminggu
Tempoh dalam setahun

Aktiviti 6: Jenis
Tahap (kod)
Tempoh jam/ seminggu

72
 Tempoh dalam setahun

PENGIRAAN MARKAH:

Markah untuk aktiviti kerja rumah: = ./10

= _____________

Markah untuk aktiviti sukan:

- aktiviti sukan 1 =
- aktiviti sukan 2 =
Jumlah = __________________

Markah untuk aktiviti masa lapang:

-aktiviti masa lapang 1 =
-aktiviti masa lapang 2 =
-aktiviti masa lapang 3 =
-aktiviti masa lapang 4 =
-aktiviti masa lapang 5 =
-aktiviti masa lapang 6 =
Jumlah = _____________

JUMLAH MARKAH UNTUK SOALSELIDIK:

= (Markah untuk aktiviti kerja rumah + Markah untuk aktiviti sukan + Markah untuk aktiviti masa
lapang)
= +
+

= _____________

73
APPENDIX F:

MAKLUMAT KAJIAN

Tajuk Kajian: Corak aktiviti fizikal dan faktor berkaitan aktiviti fizikal di kalangan warga emas yang
hadir ke klinik pesakit luar Hospital Universiti Sains Malaysia.

Nama Penyelidik: Dr. Hasmalaili Binti Husni (NO.MMC: 39801)

Dr. Azidah Binti Abdul Kadir (NO. MMC: 33310)
Dr Nani Draman (NO. MMC: AM50727)
Prof Madya Dr. Nor Azwany Binti Yaacob (NO. MMC: 31871)

Pengenalan

Anda dipelawa untuk menyertai satu kajian penyelidikan secara sukarela. Sebelum menyertai kajian ini, anda
dikehendaki membaca dan memahami borang ini. Borang ini menerangkan tujuan kajian, prosedur, risiko dan
manfaat kajian. Ia juga menerangkan bahawa anda boleh menarik diri dari kajian ini pada bila-bila masa. Jika
anda bersetuju menyertai kajian ini anda akan menerima salinan borang ini untuk simpanan anda.

Set soal-selidik Pengubahsuaian Baecke secara amnya digunakan untuk menilai beberapa aspek berkaitan
dengan aktiviti fizikal di kalangan warga emas. Set soal-selidik itu adalah bertujuan untuk mengkaji aktiviti di
rumah, aktiviti sukan dan aktiviti semasa lapang warga emas. Sehubungan itu, anda diminta agar membaca dan
memahami segala keterangan di bawah yang akan memberi penerangan lanjut mengenai kajian ini.

Tujuan Kajian

Kajian ini bertujuan untuk mengenalpasti bentuk aktiviti fizikal atau senaman yang dilakukan oleh warga emas. Ia
juga untuk menilai faktor- faktor yang mempengaruhi tahap aktiviti fizikal di kalangan warga emas.

Kelayakan Penyertaan

Untuk membolehkan anda menyertai kajian ini, anda hendaklah memenuhi syarat-syarat di bawah:

1) Warga Emas (berumur 60 tahun dan ke atas)

2) Boleh berjalan tanpa bantuan
3) Tidak dinasihatkan oleh pengamal perubatan untuk mengurangkan aktiviti fizikal disebabkan oleh
masalah kesihatan.
4) Tidak mempunyai masalah ingatan

74
Prosedur-prosedur Kajian

Sekiranya anda layak serta bersetuju untuk turut serta dalam kajian ini, anda perlulah memberi persetujuan
bertulis dengan cara menandatangani borang keizinan peserta yang dilampirkan. Anda juga diminta agar
memberi maklumat am tentang latar belakang diri anda.
Kemudian, anda akan diminta untuk menjawab soal-selidik tersebut yang akan disoal kepada anda. Tiada masa
yang ditetapkan atau dihadkan bagi anda menghabiskan soal-selidik tersebut, tetapi masa yang dianggarkan
untuk menjawab kesemua set soal-selidik adalah selama 20 minit. Anda diminta agar menjawab semua soalan
yang diajukan.
Jika anda mempunyai sebarang kemusykilan atau tidak memahami mana-mana bahagian di dalam soal-selidik
tersebut, anda bolehlah merujuk masalah tersebut kepada penyelidik yang akan sentiasa berada di situ bagi
membantu anda.

Risiko

Tiada risiko yang akan anda hadapi kerana kajian ini tidak melibatkan sebarang ubatan atau ujikaji.

Manfaat

Anda tidak mendapat apa-apa manfaat secara langsung.

Ganjaran

Setiap peserta akan diberikan hadiah saguhati.

Penyertaan Dalam Kajian

Penyertaan anda dalam kajian ini adalah secara sukarela. Anda boleh menolak penyertaan dalam kajian ini
atau anda boleh menamatkan penyertaan anda dalam kajian ini pada bila-bila masa, tanpa sebarang hukuman
atau kehilangan sebarang manfaat yang sepatutnya diperolehi oleh anda.

Penyertaan anda mungkin juga diberhentikan oleh penyelidik tanpa persetujuan anda sekiranya didapati anda
tidak layak sebagai peserta kajian.

Soalan

Sekiranya anda mempunyai sebarang soalan mengenai prosedur kajian ini atau hak-hak anda, sila hubungi;
Dr. Hasmalaili Binti Husni (NO.MMC: 39801)

Jabatan Perubatan Keluarga

75
 Pusat Pengajian Sains Kesihatan
USM Kampus Kesihatan.
Tel: 019-4707871

Sekiranya anda mempunyai sebarang soalan berkaitan kelulusan Etika kajian ini, sila hubungi;
Puan Mazlita Zainal Abidin
Setiausaha Jawatankuasa Etika Penyelidikan (Manusia) USM
Pelantar Penyelidikan Sains Klinikal, USM Kampus Kesihatan.
No. Tel: 09-7663760 / 09-7663756

Kerahsiaan

Kajian ini adalah melibatkan isu-isu yang sensitif, semestinya identiti anda sebagai peserta kajian adalah
dirahsiakan. Segala maklumat yang bakal diperolehi dalam soal-selidik ini akan sentiasa dirahsiakan dan
hanya digunakan untuk tujuan kajian semata-mata. Ia juga tidak akan didedahkan kepada umum
melainkan atas perintah undang-undang.

Rekod anda yang asal mungkin akan dilihat oleh pihak universiti (Jabatan yang berkenaan), Lembaga Etika
kajian ini dan pihak berkuasa regulatori untuk tujuan mengesahkan prosedur dan/atau data kajian klinikal.
Maklumat anda mungkin akan disimpan dalam komputer dan diproses dengannya.

Dengan menandatangani borang persetujuan ini, anda membenarkan penelitian rekod, penyimpanan maklumat
dan pemindahan data seperti yang dihuraikan di atas.

Tandatangan

Untuk dimasukkan ke dalam kajian ini, anda mesti menandatangani serta mencatatkan tarikh halaman
tandatangan (Lihat contoh Borang Keizinan Peserta di LAMPIRAN 1 atau LAMPIRAN 2).

76
 LAMPIRAN 1

Borang Keizinan Peserta

(Halaman Tandatangan)

Tajuk Kajian: Corak aktiviti fizikal dan faktor berkaitan aktiviti fizikal di kalangan warga emas yang
hadir ke klinik pesakit luar Hospital Universiti Sains Malaysia.

Nama Penyelidik: Dr. Hasmalaili Binti Husni (NO.MMC: 39801)

Dr. Azidah Binti Abdul Kadir (NO. MMC: 33310)
Dr Nani Draman (NO. MMC: AM50727)
Prof Madya Dr. Nor Azwany Binti Yaacob (NO. MMC: 31871)

Untuk menyertai kajian ini, anda mesti menandatangani mukasurat ini.

Dengan menandatangani mukasurat ini, saya mengesahkan yang berikut:
Saya telah membaca semua maklumat dalam Borang Maklumat dan Keizinan Peserta ini
termasuk apa-apa maklumat berkaitan risiko yang ada dalam kajian dan saya telah pun diberi
masa yang mencukupi untuk mempertimbangkan maklumat tersebut.
Semua soalan-soalan saya telah dijawab dengan memuaskan.
Saya, secara sukarela, bersetuju menyertai kajian penyelidikan ini, mematuhi segala prosedur
kajian dan memberi maklumat yang diperlukan kepada penyelidik dan kakitangan yang berkaitan
apabila diminta.
Saya boleh menamatkan penyertaan saya dalam kajian ini pada bila-bila masa.
Saya telah pun menerima satu salinan Borang Maklumat dan Keizinan Peserta untuk simpanan
peribadi saya.

Nama Peserta (Dicetak atau Ditaip) No rujukan (disi oleh penyelidik)

No. Kad Pengenalan Peserta (Baru) No. K/P (Lama)

Tandatangan Peserta Tarikh (dd/MM/yy)

Nama & Tandatangan Individu yang Mengendalikan Tarikh (dd/MM/yy)

Perbincangan Keizinan (Dicetak atau Ditaip)

Nama Saksi dan Tandatangan Tarikh (dd/MM/yy)

LAMPIRAN 2

77
 Borang Keizinan bagi Penerbitan Bahan yang berkaitan dengan Peserta
(Halaman Tandatangan)

Tajuk Kajian: Corak aktiviti fizikal dan faktor berkaitan aktiviti fizikal di kalangan warga emas yang
hadir ke klinik pesakit luar Hospital Universiti Sains Malaysia.

Nama Penyelidik: Dr. Hasmalaili Binti Husni (NO.MMC: 39801)

Dr. Azidah Binti Abdul Kadir (NO. MMC: 33310)
Dr Nani Draman (NO. MMC: AM50727)
Prof Madya Dr. Nor Azwany Binti Yaacob (NO. MMC: 31871)

Untuk menyertai kajian ini, anda atau wakil sah anda mesti menandatangani mukasurat ini.
Dengan menandatangani mukasurat ini, saya memahami yang berikut:

Bahan yang akan diterbitkan tanpa dilampirkan dengan nama saya. Saya memahami,
walaubagaimanapun, ketanpanamaan yang sempurna tidak dapat dijamin.
Bahan yang akan diterbitkan dalam penerbitan mingguan/bulanan/dwibulanan/suku tahunan/dwi
tahunan merupakan satu penyebaran yang luas dan tersebar ke seluruh dunia. Kebanyakan
penerbitan ini akan tersebar kepada doktor-doktor dan juga bukan doktor termasuk ahli sains dan
ahli jurnal.
Bahan tersebut juga akan dilampirkan pada laman web jurnal di seluruh dunia. Sesetengah laman
web ini bebas dikunjungi oleh semua orang.
Bahan tersebut juga akan digunakan sebagai penerbitan tempatan dan disampaikan oleh ramai
doktor dan ahli sains di seluruh dunia.
Bahan tersebut juga akan digunakan sebagai penerbitan buku oleh penerbit jurnal.
Bahan tersebut tidak akan digunakan untuk pengiklanan ataupun bahan untuk membungkus.

Saya juga memberi keizinan bahawa bahan tersebut boleh digunakan sebagai penerbitan lain yang diminta
oleh penerbit dengan kriteria berikut:

Bahan tersebut tidak akan digunakan untuk pengiklanan atau bahan untuk membungkus.
Bahan tersebut tidak akan digunakan di luar konteks contohnya: Gambar tidak akan digunakan
untuk menggambarkan sesuatu artikel yang tidak berkaitan dengan subjek dalam foto tersebut.

Nama Peserta (Dicetak atau Ditaip) No rujukan (disi oleh penyelidik)

No. Kad Pengenalan Peserta T/tangan Peserta Tarikh (dd/MM/yy)

78
 RESEARCH INFORMATION

Research Title: Pattern of physical activity and associated factors of physical activity among elderly
attending outpatient clinics Hospital University Sains Malaysia

Researchers Name: Dr. Hasmalaili Binti Husni (NO.MMC: 39801)

Dr. Azidah Binti Abdul Kadir (NO. MMC: 33310)
Dr Nani Draman (NO. MMC: AM50727)
Prof Madya Dr. Nor Azwany Binti Yaacob (NO. MMC: 31871)

Introduction
You are invited to take part voluntarily in a study on pattern of physical activity and associated factor of physical
activity among older adult. Before agreeing to participate in this research study, it is important that you read and
understand this form. It describes the purpose, procedures, risk and benefits of the study. It also describes
your right to withdraw from the study at anytime. If you participate, you will receive a copy of this form to keep
for your records.

The Modified Baecke Questionnaire was developed to measure habitual physical activity in the elderly. The
questionnaire includes items about household activities, sport, and leisure time activities. Thus you are adviced
to read the information given below for further understanding.
.

Purpose of the Study

To describe pattern of physical activity among elderly and to determine factors associated with physical activity
among elderly.

Qualification to Participate

To qualify for this study you have to fulfill these criteria:

1) Age 60 and above

2) Able to walk independently
3) Not being advice by medical practitioner to limit physical activity due to health problem.
4) No dementia

Study Procedures

If you fulfilled the criteria and agreed to participate in the study, you need to give your written consent on the
form attached. You are also required to give your background information.

79
Then you will be interviewed by a researcher. No time limit to answer all the questions but the estimated time to
finished all the questions are 20 minutes. You are required to answer all the questions asked. If you have any
doubt or do not understand any part of the questions, you can refer to the researcher who will always be there to
help you.

Risks

There is no risks if you participate in this study as it does not involve any medication or experiment.

Benefit

You may not gain anything directly.

Gift

Each participants will be given a souvenir.

Participation in the Study

Your taking part in this study is entirely voluntary. You may refuse to take part in the study or you may stop
participation in the study at anytime, without a penalty or loss of benefits to which you are otherwise entitled.
Your participation also may be stopped by the researcher without your consent if you does not fulfill the criteria.

Questions

If you have any question about this study or your rights, please contact;

Dr Hasmalaili binti Husni

Department of Family Medicine
USM Health Campus.
Tel: 019-4707871 (HP)

If you have any questions regarding the Ethical Approval, please contact;

Puan Mazlita Zainal Abidin

Secretary of Research Ethics Committee (Human) USM
Clinical Science Research Platform
USM Health Campus
No. Tel: 09-7663760 / 09-7663756 (P)

80
Confidentiality

Your information will be kept confidential by the researcher and the research assistants and will not be made
publicly available unless disclosure is required by law.

Your original records may be reviewed by the supervisor in the department (involved in the research), the
Ethical Review Board for this study, and regulatory authorities for the purpose of verifying clinical trial
procedures and/or data. Your information may be held and processed on a computer.

By signing this consent form, you authorize the record review, information storage and data transfer described
above.

Signatures

To be entered into the study, you must sign and data the signature page (ATTACHMENT 1 or ATTACHMENT
2).

81
 ATTACHMENT 1

Participant Information and Consent Form

(Signature Page)

Research Title: Pattern of physical activity and associated factors of physical activity among elderly
attending outpatient clinics Hospital University Sains Malaysia

Researchers Name: Dr. Hasmalaili Binti Husni (NO.MMC: 39801)

Dr. Azidah Binti Abdul Kadir (NO. MMC: 33310)
Dr Nani Draman (NO. MMC: AM50727)
Prof Madya Dr. Nor Azwany Binti Yaacob (NO. MMC: 31871)

To become a part this study, you must sign this page.

By signing this page, I am confirming the following:

I have read all of the information in this Participant Information and Consent Form including any
information regarding the risk in this study and I have had time to think about it.
All of my questions have been answered to my satisfaction.
I voluntarily agree to be part of this research study, to follow the study procedures, and to provide
necessary information to the doctor, nurses, or other staff members, as requested.
I may freely choose to stop being a part of this study at anytime.
I have received a copy of this Participant Information and Consent Form to keep for myself.

Participant Name (Print or type) Participant No(by researcher)

Participant I.C No. (New) Participant I.C No. (Old)

Signature of Participant Date (dd/MM/yy)

(Add time if applicable)

82
Name of Individual
Conducting Consent Discussion (Print or Type)

Signature of Individual Date (dd/MM/yy)

Conducting Consent Discussion

Name & Signature of Witness Date (dd/MM/yy)

83
 ATTACHMENT 2

Participants Material Publication Consent Form

Signature Page

Research Title: Pattern of physical activity and associated factors of physical activity among elderly
attending outpatient clinics Hospital University Sains Malaysia

Researchers Name: Dr. Hasmalaili Binti Husni (NO.MMC: 39801)

Dr. Azidah Binti Abdul Kadir (NO. MMC: 33310)
Dr Nani Draman (NO. MMC: AM50727)
Prof Madya Dr. Nor Azwany Binti Yaacob (NO. MMC: 31871)

To become a part this study, you must sign this page.

By signing this page, I am confirming the following:

I understood that my name will not appear on the materials published and there have been efforts
to make sure that the privacy of my name is kept confidential although the confidentiality is not
completely guaranteed due to unexpected circumstances.

I have read the materials or general description of what the material contains and reviewed all
photographs and figures in which I am included that could be published.

I have been offered the opportunity to read the manuscript and to see all materials in which I am
included, but have waived my right to do so.

All the published materials will be shared among the medical practitioners, scientists and journalist
world wide.

The materials will also be used in local publications, book publications and accessed by many
local and international doctors world wide.

I hereby agree and allow the materials to be used in other publications required by other
publishers with these conditions:

The materials will not be used as advertisement purposes nor as packaging materials.

The materials will not be used out of contex i.e.: Sample pictures will not be used in an article
which is unrelated subject to the picture.

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Participant Name (Print or type) Participant No (by researcher)

Participant I.C No. Participants Signature Date (dd/MM/yy)

Name and Signature of Individual Date (dd/MM/yy)

Conducting Consent Discussion

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APPENDIX F

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