Topic : Anthropometric Indices of High School Children & Familial Risk Factors
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RAJIV GANDHI UNITERSITY OF HEALTH SCINCES BANGALORE, KARNATAKA ANNEXURE-II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
UMA.H.M D/O Mr. H.P. 1. NAME OF CANDIDATE AND ADDRESS Mariswamy, # 216 GnanaMarga, siddharthanagar, Mysore -570011 THE OXFORD COLLEGE 2. NAME OF THE INSTITUTION OF PHYSIOTHERAPY J.P.Nagar, 1st phase Bangalore-78
MASTER OF 3. COURSE OF STUDY AND SUBJECT PHYSIOTHEREPY (PHYSIOTHEREPY IN PAEDIATRICS)
4. DATE OF ADMISSION 31st May 2008
5. TITLE OF THE STUDY: “ ANTHROPOMETRIC INDICES OF HIGH SHOOL CHILDREN AND FAMILIAL RISK FACTORS” – A CORRELATIONAL STUDY. 6. BRIEF RESUME OF THE INDEED WORK
6.1 NEED OF THE STUDY
Child hood obesity is a serious medical condition that affects children & adolescents. It occurs when a child is well above the normal weight for his or her age & height. ¹
Childhood obesity is particularly troubling because the extra pounds start kids on the path to health problem that were once confined to adults, such as diabetes, high blood pressure & high cholesterol.
There are some genetic & hormonal causes of childhood obesity. Most of the excess weight is caused by children eating too much & exercising too little.
Children, unlike adults need extra nutrients & calories to fuel their growth & development. So if they consume the calories needed for daily activities, growth & metabolism, they add pounds in proportion to their weight beyond what is required to support their growing bodies.1
Genetic diseases and hormonal disorders predispose a child to obesity. These diseases, such as prader-willi syndrome & Cushing’s syndrome affect a very small proportions of children. In the general population, eating & exercise habits play a much larger role.1,2
Many factors increase the Child’s risk to become overweight. These factors are diet and nutrition, inactivity, genetics, psychological factors, family factors, socio economic factors.1 Anthropometric measurements provide a base line for measuring the physical growth in terms of body composition & body fat distribution in children and several. Studies considered anthropometry as an important parameter reflecting the pattern of growth and development and nutritional status in community.3 ,4 Anthropometry is particularly use full as a practical approach for field method measurement in children and adolescents. Using this techniques body mass index, waist circumferences, hip circumferences, conicity index, skin fold thickness are assessed and they help in identifying the individuals at risk for disease.4, 5
A BMI percentile >5th & <85th is considered normal weight for height, 85th to 95th percentile is considered at risk for over weight & > 95th percentile is defined as over weight.2,6
A recent report from the American institute of medicine has specially used the term “obesity” to characterize BMI > 95th percentile in children and adolescents.2
Skin fold measures the thickness of subcutaneous adipose tissue fat. These measurements estimate the regional fat distribution by determining the ratio of subcutaneous fat on the trunk and extremities and establish anthropometrics profile.3
When the skin fold thickness > 85th percentile of weight for height, and for age and sex , then such children are classified as obese / over weight.7
Studies have shown that the waist circumference had strong association with blood pressure & prevalence of hypertension in men & BMI had the strong association with blood pressure & hypertension in women .8
Conicity index is also anthropometric measurement having potential for predicting fat distribution & disease risk.3 CI = waist circumference (in meters) 0.109 √(weight / height) in meters .
Early onset obesity was suggested as a risk factor for morbidity and mortality later in life. The morbidity factors are diabetes, coronary heart disease, arteriosclerosis, hip fracture, osteoarthritis, gout and colorectal cancer.9
Adolescent obesity has been found to be associated with increased risk of developing Cardio vascular diseases diabetes in adulthood. 2
In western societies, machines, electronics & other technological advances have supplemented virtually every physical activity that had been required by humans for daily living. This minimizes the physical activity & energy expenditure. 10
In India, under nutrition attracted the focus of health workers as child hood obesity was rarely seen. But over the past few years, child hood obesity is increasing with the changing life style of families such as increased purchasing power, increasing hours of inactivity due to television viewing, video games & computers which have replaced the out door games & other social activities . 11
Extent of child hood obesity is increasing at an epidemic rate. 16 percent of children (more than 9 million) between the age of 6-9 years are over weight & obese-a number that has tripled since 1980. 12
Over than past 3 decades , the child hood obesity rate has more than doubled for pre school children aged 2-5year & adolescents aged 12-19 year & it has more than tripled for children aged 6-11 year.12
Over weight adolescents have a 70% chance of becoming overweight or obese adults. This increased to 80% if one or more parent is over weight or obese.13
Studies have identified family factors that place the child at risk for over weight & obesity including family history, parental knowledge & values and family life style.14
Considering the prevalence of child hood obesity and the risk factors associated with it, it becomes necessary to assess the anthropometric indices and family predispositions to obesity, check for any relationship between the same, and also to identify the children who are at risk.
6.2 REVIEW OF LITUATURE
1) PREVALENCE OF OBESITY IN CHILDREN AND ADOLESCENTS
Dr. Kannan Pugahendi (2005)15 in his online edition sates that the incidence of obesity in children and youth is very high all over the world and is increasing at an alarming pace in India.
S C Savva, Y Kourides (2000)16in their study estimated the prevalence of child hood and adolescents obesity from Cyprus. It was 10.3% in males and 9.1% in females by using national health and nutrition’s examination definition and International obesity task force definition.
T. Agarwal, R C Bhatia (2007) 17 studied the prevalence of obesity and overweight in adolescents in Punjab. They found the incidence of obesity was 3.4% and over weight was 12.7%. A significantly greater number of boys (15%) were over weight as compared to girls (10%).
Berg I M, Simonson B (1997) 18 in their study found that prevalence of our weight and obese was high in Sweden populations and it was high is 15 years old boys.
World health organization - Obesity (2004) estimated that more than one billion adults and 17.6 million children are over weight and the numbers are creasing.
2. CORELATIONS OF FAMILIAL FACTORS TO OBESITY
M.A.A. Moussa ,A.A. Shaltout (1998)19 et al in their study showed that family history of obesity , diabetes mellitus , respiratory and bone disease are associated factory for children obesity after adjusting for social and behavioral problem physical activity and parental social class were not significant.
D.R. Bharati, P.R. Deshmukh (2008)6 et al studied the magnitude of over weight / obesity of 31 middle school and high school children of warada city, India. The magnitude of over weight /obesity as been found that 4.3%. He concluded that family characteristics play important role in predisposing the children to over weight and obese. Scaglioni et al (2000) 21 in their study verified that prevalence of overweight in five year old children and found it significantly higher in those with over weight parents than in the ones whose parents did not present with over weight.
Juliana farias de Novas et al (2007) 20 in their study, compared the eutropic and obese children anthropametric relations with their parental BMI and anthropometry. They have shown that there was a difference concerning to the body fat distributions and lipid profile among eutropic children and maternal obesity was influencing the child’s obesity.
Espostio – Rel Puente A et al (1998)22 in their survey on fourth grade of primary school in Naples showed that there was a direct Correlations between parental BMI and children anthropometric measurement.
Abhijeet Dhoble M.D. MPH et al (2008)14 in their study concluded that the genetic factor, cultural differences related to the nutritional habits, level of physical inactivity and acceptance of weight among African Americans plays a major role in the development of obesity.
Strauss R S, Knight J (1999)23 in their study showed that the standardized measures of home environment and house hold income were also found to be important predictors of child hood obesity.
Polley DC et al (2005)24 in their study showed that there was significant correlations between children BMI and parent’s BMI, weekly television viewing hours and a trend for percent energy from fat.
Akhil Kanth singh et al (2006)25 in their study on 12-18 years age group student showed that there was a association between BMI, systolic and diastolic blood pressure among children and other life style factors. 3. RELIABILITY AND VALIDITY OF ANTHROPOMETRIC MEASURMENT. Vivan H Heyward and Lisa M – Stalarzysk (1996)3 states the body mass index is the ratio of body weight in kilo grams divided by height squared in meter.
M. Mamtani, H Kulkarni (2003)26 in their study concluded that waist circumference is simple non invasive and accurate predictor of the risk of type 2 diabetes that can potentially be used in screening program in developing countries.
Asif Z Khan et al4 studied the anthropometric measurements of rural school children. He considered that anthropometry is an early and convenient method of assessing nutritional and socio economic status of growing children.
A Must, GE Dallal and W H Dietz (1991)27 states that the 85th and 95th percentile of BMI and Triceps skin fold are often used operationally to define obesity and super obesity respectively.
Pamela J Schrenier et al (1996)28 in their study concluded that when the waist circumference or body mass index is used as a surrogate for intra abdominal fat area in man, a quadratic term should be included in the analysis as a predictor variable
Masaru Sakuri et al (2005)8 in their study conclude that the waist circumference had strongest association with blood pressure and prevalence of hypertension in men and BMI had the strong association with blood pressure and hypertension in women.
4. RISK FACTORS ASSOCIATED WITH OBESITY
M.J.Muller et al (1999)29 in their study showed that over weight, physical inactivity and unhealthy eating habits were seen more frequently in children from low socio-economic background.
J. Kennard Fraley et al (2004)30 in their study found that children who watch television and played videogames more frequently, who have over weight parents and come from families of lower socio economic background are at increased risk of obesity.
H. Mozaffari et al (2006) 31 in their study found the prevalence of over weight and obesity in young Iranian girls was high. Advanced age, lack of physical activity, low economic factors and maternal educational status could be risk factors for obesity in children.
6.3 OBJECTIVE OF THE STUDY 1. To find out the prevalence of obesity in high school children by anthropometric measurements. 2. To correlate the familial risk factors with anthropometric indices of high school children. 3. To identify the children at risk of developing obesity.
6.4 RESEARCH HYPOTHESIS
A. Null hypothesis Familial risk factors may not be associated with anthropometric indices of high school children.
B. Alternative hypothesis Familial risk factors may be associated with anthropometric indices of high school children.
6.5 VARIABLES A. Independent variable - Familial risk factors - Height - Weight - Blood Pressure B. Dependent variables Anthropometric indices of school children - Skin fold measurements - Age - Gender - Waist circumference - Hip circumference
MATERIALS & METHODS
7.1 STUDY DESIGN & SETTING. 7.1.1 Research design Non-experimental cross sectional correlation study will be done to examine the relationship between anthropometric indices of high school children & associated familial risk factors. 7. 7.1.2 Source of data Oxford School J.P.Nagar, Bangalore JSS Public School, Bangalore JSS Public School, Mysore Arabindo School, Bangalore
7.2 METHODOLOGY 7.2.1 Population All high school children aged between 13-16 years from various schools. 7.2.2 Selection criteria 1. Inclusion criteria - All high school children’s of age group between 13-16 years - Both genders will be included as samples. 2. Exclusion criteria - Those who are not willing to participate in the study 3. Withdrawal criteria - Those who fail to return the questionnaire duly filled. 7.2.3 Sampling A. Sampling method Convenient sampling B. Sampling size Total 300 high school children.
7.2.4 Procedure
Informed consent will be taken from parents. There explain the objectives as well as the method of the study to the school authorities.
All the high school children’s age group between 13-16 years of class 8th, 9th & 10th standard are selecting for the study.
Subjects would be instructed previously about the procedure & for their co-operation through out the study. All the children will be screened for anthropometric measurements.
Initially height (in certain meters) & weight (in kilograms) will be measured by using height board & weighing machine respectively. This height & weight will be taken to calculate the body mass index (BMI).
Skin fold thickness measurements will be taken by caliper at 2 regions of the body i.e. one is at triceps and another is at calf regions.
Using the skin fold caliper grasp a skin fold, which is held between the testers thumb and finger to provide a measurement in millimeters for a double fold of skin and subcutaneous tissue fat.
Body circumferences will be measured by standardized inch tape, circumferences will be measured at two levels one is at waist circumference and another one is at hip circumference. Waist to hip ratio and Conicity index will be calculated.
Blood pressure of the children will be measured by sphygmomanometer and values will be recorded.
Physical activity of the children including hours of time spending in television viewing and out door games will be recorded by the family reported questionnaire filled by the parents of the children.
A family reported questionnaire will be used to collect the information about family compositions family history and lifestyle. This questionnaire will be send to parents through their children.
The questionnaire will be pre-tested on five parents of the school children each from five schools to check the reliability. Necessary modifications will be done in the questionnaire before start of study.
A. Duration of the study: - single time study.
B. Materials used - Sphygmomanometer - Skin fold caliper - Stethoscope - Height board - Weighing machine - Inch tape - Calculator - Pen and paper 7.3 7.3.1 OUTCOME MEASURES. - BMI - Skin fold thickness measurement - Waist to hip ratio - Conicity index - Blood pressure - Family reported questionnaire
7.3.2 DATA MANAGEMENT Formulae a) Body mass index = weight in Kilograms (Height) ² in meters
b) Waist to hip ratio = Waist circumference in meters Hip circumference in meters
c) Conicity index
= Waist circumference in meters 0.109 √ (weight / height) in meters
d) Skin fold measurement = ΣSKF
e) Blood pressure = SBP mm Hg DBP 7.3.3 STATISTICAL ANALYSIS Pearson product moment correlation co-efficient will be used to correlate the data. 7.4 a. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? Yes, it requires an investigation i.e. Anthropametric Measurements is to be done on high school children b. Has ethical clearance been obtained from you institutions? Yes, ethical clearance has been obtained from my institution. ethical clearance form attached.
REFERENCES 1.www.myoclinic.com child hood obesity.
2. Stephen.R.Daniels et al. “Over weight in children and adolescents”. AHA circulation, 2005; 111: 1999-2012. 3. vivan H Heyward and Lisa M-Stalarzyk “ Body composition assessment”. USA. 8. Human kinetics, PP 79. 4. Asif. Z. Khan et al “Anthropometric measurements in rural school children”. www.google.com
5. colleen Keller “ child hood obesity ; measurement & risk assessment”. 1996;82-85.
6. DR. Bharathi, P.R Deshmukh and B S Garg. “Correlates of over weight and obesity among school going children of wardha city, central India”. Indian J M edres 127, June 2008; pp 539-543.
7. Freed man DS, Harsha DW et al “Relationship of changes in obesity to serum lipid & lipoprotein changes in child hood & adolescence”. JAMA 1985; 254:512-20
8. Masaru sakurai , Katsuyki MIURA et al. “Gender difference in the associations between Anthropometric Indices of obesity & blood pressure in Japanese”. HYPRES: Vol 29 (2006), pp 75-80.
9. Willam H. Dietz. “Child hood weight affects Adult morbidity & mortality”. American society for Nutritional sciences 1998.
10. Bevan C Grant, Stan Bassin “The challenge of paediatric obesity: more rhetoric than actions”. The Newzealand medical Journal 2007, vol 120.
11. Sing M, Sharma M. “Risk factor for obesity in children “. Indian paediatr 2005; 42 : 183-5. 12. Centers for disease control and prevention (2004). “Prevalence of over weight and obesity among children and adolescents”. United States. 1999-2002. 13. U.S. Department of health and human services (2007) htpp://www.surgeongeneral.gov/topics/obesity/calltoaction/fact adolescents.htm.
14) Abhijeet Dhoble M.D et al. “Familial and Behavioral determinants of obesity in black childrens and preventive strategies”. International journal of health 2008, volume 7 Number 2.
15) Dr.Kannan pugazhendi. “Emphasizing health elated fitness from school will keep be active, stress free and promote life long fitness”.
16) S. C. Savva, Y. Kourides et al. “obesity in children and divestments is Cyprus. Prevalence and predisposing factors”. International Journal of obesity (2002) 26, 1036- 1045.
17) T. Agrawal, R C Bhatia et al. “Prevalence of obesity and over weight in Affluent Adolescents from Ludhiana, Panjab”. Indian pediatrics; vol 45; 2008.
18) Berg IM , Simons son B et al “prevalence of over night and obesity is children and adolescents in a country is Sweden” http://www.ncbi.nlm.nih.gov/pubmed/11440102
19) M.A.A. Maussa et al. “Factors associated with obesity is Kuwaiti Children”. Springs link –Journal article: 1998
20) Juliana Farias de Novaes et al. “Comparison of the anthropometric and biochemical variables between children and their parents”. www.alanrevista.org/edicjones:2007.
21) Scaglioni S. Agostoni C et al. “Early macronutrient intake and over weight at five years of age”. Int J obes 2000; 24:777to81.
22) Esposito - Del Puente A et al. “Familial and environmental influences on body composition and body fat distribution in childhood in southern Italy”. Int J obes Relat Metab Disord .1.
23) Strauss R.S, Knight J. et al. “Influence of the home environment on the development of obesity in children. American Academy of Paediatrics.1999 ; 103(6):e 85.
24) Polley D C, Spicer MT et al. “Intra-familial correlates of over weight and obesity in African and American and Native American grand parents , parents and children in rural Oklahoma”. Journal of American Dietic Association. 2005; 105(2):P262-5.
25) AKhil Kanth singh et al. “Life style Associated Risk factors in Adolescents”. Indian Journal of Pediatrics, Vol 73; 2006.
26) M.Mamtani, H Kulkarni. “Predictive Performance of Anthropometric Indexes of central obesity for the risk of Type 2 Diabetes”. Archives of Medical research 2003, Vol 36, Issue 5, page 581-589.
27) A Must, G E Dallal et al. “Reference data for obesity: 85th and 95th Percentiles of body mass index (Wt/Ht²) and triceps skin fold thickness”. American Journals of clinical nutrition, 1991; Vol 53, 839-846.
28) Pamela J Schrenier et al. “The Atherosclerosis Risk in Community study”. Am J Epidomol 1996; 144:335-45.
29) M.J.Muller et al. “Physical activity and diet in 5 to 7 years old children”. Public health nutrition 1999; 2:443-444.
30) J.Kennard Fraley et al. “Risk Factors for childhood obesity in an urban public school population”. Journal of children’s Health, 2004; Vol 2, Issue 2, pages 159-169.
31) H.Mozaffari et at. “Obesity and Related Risk Factors”. Indian Journal of Pediatrics, 2007; Vol 74. 9 Signature of candidate
10. Remarks of the guide
11 NAME AND DESIGNATION OF THE GUIDE
11.1 Guide Mr.Pruthvi raj. R. MSPT Assistant Professor
11.2 Signature
11.3 Co-guide
11.4 Signature
Mr. K.G. Kirubakaran., MPT 11.5 Head of the Department
11.6 Signature
12. 12.1 Remarks of chairman and principal
Mr. K.G. Kirubakaran., MPT 12.2. Signature APPENDIX –I
THE OXFORD COLLEGE OF PHYSIOTHERAPY I PHASE, J.P.NAGAR, BNGALORE – 560078.
Review Board on Ethics for Research
We here by declare that the project titled,
Carried out by Ms. Uma H.M. of I Year M.P.T. has been brought forward for scrutiny to the board members. After analyzing the Objectives, subjects involved and the methodology of the project, the following conclusions were drawn.
The project does not have nay mental or physical harm to the subjects involved and there is no risks involved by mean as mental or physical harm to the subjects and there is no risks involved with the study. The performance of the study procedure will not cause nay injury to the subjects. The board has evaluated and confirmed that the experimenter is trained and qualified in giving the intervention and / or measuring outcome. The informed consent form prepared ensures that, the experimenter explains the procedure of the study to the subjects, their voluntary participations is confirmed and the identification of subjects is maintained confidential.
Further more the finding of the study will benefit similar subjects, the profession and the society.
Hence the review board has no objections on the conduct of the above mentioned study.
Chairman of Departmental Review Board Project Guide
Principal
APPENDIX II CONSENT FORM
TITLE: “Anthropometric indices of high School children and familial risk factors” – A Co relational study.
INVESTIGATOR: Ms. Uma H.M( M.P.T 1st Year)
PURPOSE OF THE RESEARCH
PARENTAL PERMISSION:
I ……………………. PARENT/GUARDIAN of master/miss……………… have been informed that this will reveal the relation between anthropometric indices of high school children and familial risk factors .
PROCEDURE
I have been explained that this study is conducted by physical examination in which I will be assessed by anthropometric measurements, which is easy to perform and clear instructions are given to me about the procedure.
MEDICAL CONSENT
I also assure that my ward is fit for this assessment and in not having any health problems, which can induce complication to this assessment. My ward is physically, mentally and socially sound. He /she is under no medications. RISKS/ DISCOMFORTS
I understand that this study will not produce any harm to me by anthropometric measurements and does not hurt the subject in any manner. I am aware that I have to follow the instruction that has been told to me. I understand that there wont be any discomfort throughout the study, I am aware that Ms. Uma H.M. will help me for better understanding of the procedure
BENEFITS
I understand that the record values, its interpretations and its result will help to find out the prevalence of obesity in high school children and associated familial risk factors.
ALTERNATIVES
I understand the procedure being studied is the standard way than compare to other studies which can be conducted by using other measures
CONFIDENTIALITY
I understand that the medical information produced by this study will be confidential. If the data are used for publication in the medical literature or for teaching purpose no names will be used.
PHOTOGRAPHY CONSENT DOCUMENT
I…………………………………….have been explained by Ms. Uma H.M. that photographs are required in order to illustrate various aspects of the study for the thesis and other articles, and at presentations and conferences . These images may also be converted to electronic formats for use in multimedia presentations and documents accessible to others by computer for the purpose of sharing the results of the study and for promoting this research. By giving my consent authorize her to use any of the photographs taken of my ward in printed format, in slides for presentations, and in electronic format. If the photograph is used the face will be taped to prevent identification.
REQUEST FOR MORE INFORMATION
I understand that I/ my ward are encouraged to discuss any concerns regarding this study at any time. Ms. Uma H.M is available to answer my questions to the best of her knowledge. A copy of this consent form will be given to me for my careful reading.
REFUSAL FOR WITHDRAWAL OF PARTICIPATION
I understand that my wards participation is voluntary and I may withdraw consent and discontinue participation any time without fear of prejudice. My decision whether or not to participate will not affect relationship with ( agency , health care provider, school etc. I also understand that she may terminate my participation in the study after she has explained the reason for doing so.
INJURY STATEMENT
I understand that in the unlikely event of injury resulting directly from the participation in the study, medical treatment would be available , but no further compensation will be provided. I understand my wards agreement to participate in the study and I am not waiving any of the legal rights for the same .
I have explained to …………………………parent/guardian of …………….the purpose of the research, the procedures required and possible risks and benefits associated , to the best of my ability.
PRINCIPAL PERMISSION (SUBJECTS SCHOOL)
I…………………………… PRINCIPAL of the school of master/miss ……………………………… been informed to let the subject involve in the study. According my knowledge, as told by the investigator this study is simple, safe and accurate. Assuring potential benefits to the society and with this test.
INVESTIGATOR DATE
I confirm the Ms. Uma H.M. has explained me the purpose of this research, the study procedure and the possible risks and benefits associated that I may experience . I have read and understood this consent form to let my ward participate as a subject in this research project and I am giving the consent willfully.
PARENTS/GUARDIAN DATE
PRINCIPAL OF THE SUBJECTS SCHOOL DATE
SUBJECT DATE
SIGNATURE OF WITNESS DATE
APPENDIX III
DATA PROFORMA:
Serial No. ------
Name : Date of Assessment:…………………
Age :
Sex :
Address :
Phone No: Source:
Anthropometric measurements
Family reported questionnaire:
……………………………. ……………………………………….
Signature of the subject/ guardian Signature of the investigator APPENDIX IV
FAMILY REPORTED QUESTIONNIRE
I . FAMILY COMPOSTION
Parents Name Father -
Mother -
Address and phone number
Date Age Father - Mother - Height Father - Mother - Weight Father - Mother - 1) How many members are there in your family?
2) How many children are there in your family?
3) What is the age of children? Son ______
Daughter______II. FAMILY HISTORY [ Please select all that apply]
Father Mother Siblings 1) Heart attack or Surgery prior to age 55
2) Stroke prior to age 50
3) Congenital heart disease or left ventricular hypertrophy
4) Hypertension
5) Osteoporosis
6) Arthritis
7) High Cholesterol
8) Diabetes
9) Obesity
10)Asthma / respiratory Disorders
11) Leukemia or cancer Prior to age 60
12) Other - Specify ______III FAMILY LIFE STLYE
1) Diet habits (please select all that apply)
[ ] I seldom consume red or high fat meats
[ ] I prefer a low- fat diet
[ ] My diet includes many fiber foods
[ ] I eat at least _____ servings of fruits per day
[ ] I eat at least ______servings of vegetables per day.
[ ] I almost always eat something for break fast
[ ] I really eat high sugar or high fat desserts
2) Are you alcoholic?
[ ] Yes
[ ] No
3) Are you smoker?
[ ] Yes
[ ] No
4) Do you exercise regularly? If yes, how many hours?
[ ] Yes
[ ] No
______
5) What is the nature of your work?
[ ] Sedentary
[ ] Non Sedentary
6) How many hours do you work in a day?
______
7) Do you have any high stress level?
[ ] Yes
[ ] No
8) Do you engage in any of the sports activity? [ ] Yes
[ ] No
9) How many hours do you watch television?
______10) Do you participate in any other recreational activity?
[ ] Yes
[ ] No
11) How many hours do you sleep in a day? Is that enough? ______[ ] Yes
[ ] No
12) Do your children participate in indoor or outdoor games? [ ] indoor
[ ] outdoor
13) How many hours your children will watch television?
______
14) How many hours does your children play outdoor games and indoor Games - Outdoor games - Indoor games.