By Author
  By Title
  By Keywords

June 2018, Volume 68, Issue 6

Research Article

Wellness integrative profile 10 (WIP10) - an integrative educational tool of nutrition, fitness and health

Adela Badau  ( University of Medicine and Pharmacy Tirgu Mures )
Dana Badau  ( University of Medicine and Pharmacy Tirgu Mures )
Costela Serban  ( University of Medicine and Pharmacy Timisoara, Romania )
Monica Tarcea  ( University of Medicine and Pharmacy Tirgu Mures )
Victoria Rus  ( University of Medicine and Pharmacy Tirgu Mures )

Abstract

Objective: To assess the educational impact and satisfaction of using Wellness Integrative Profile 10 both by specialists and clients in nutrition, health and fitness centres.
Methods: This cross-sectional study was conducted at 42 wellness centres in Romania during March-November 2016, where Wellness Integrative Profile 10 was implemented with no less than 3 months before the beginning of the study. Data was gathered through a 15-item questionnaire related to the educational impact of integrating 10 parameters regarding the level of health, nutrition and fitness of the subjects.
Results: The questionnaire had a reliability Cronbach score of 0.777 for specialists and 0.705 for clients. The number of subjects who rated the satisfaction questionnaire WIP10 with maximum grade (5) were: 181.93(61.88%) specialists and 1,309.40(65.88%) clients.
Conclusions: The implementation of Wellness Integrative Profile 10 will allow in the future to design customised and specialised programmes for health.
Keywords: Physical wellness, Fitness, Health, Nutrition. (JPMA 68: 882; 2018)

Introduction

The latest scientific results and specific products for nutrition and physical education show that the identification of variables like beliefs and behaviours, also the sensitivity to cultural values and habits of the population, can be used to design an efficient community education intervention.1 In order to optimise the activity and services at the wellness centres it is required to implement modern technologies for data collection concerning the level of health, nutrition, fitness and lifestyle characteristics in order to develop customised profiles and programmes. In this regard we have created Wellness Integrative Profile 10 (WIP10) which we consider to be a practical and educational tool focussing on the physical part of wellness. The physical wellness stands for the interconnection between health, nutrition and physical activity, and it also targets the ways in which vital signs of the body are corroborated with exercise practice and completed by a tailored programme of nutrition. An efficient wellness programme is the result of interdisciplinary approaches based on collaboration, experience and knowledge of specialists in nutrition, physical education, kinesiotherapy and medicine fields. Wellness requires implementation of adequate lifestyle habits for improving health and quality of life, and achieving total wellbeing. Wellness incorporates factors such as adequate fitness, proper nutrition, stress management, disease prevention, spirituality beliefs, no smoking or alcohol abuse, personal safety, regular physical examination, health education and environmental support.2-4 Modifiable lifestyle behaviours targeted in health promotion programmes should be prioritised in an evidence-based manner. Health is static and is measured at a specific point in time. On the contrary, wellness is dynamic and consists of an individual\\\'s health in relationship with his habits and practices over time.5 A number of recent studies have demonstrated the influence of fitness on wellness, health, quality of life and longevity,6-14 both on healthy or ill people, along with nutrition habits.15-18 Despite the increasing use of apps for monitoring lifestyle changes, recent studies  suggest their efficacy remains unclear, particularly because of different lifestyle behaviours for both children and adults.18-21 The evaluation of wellness centres\\\' websites reveals an increased frequency in the use of wellness profiles especially in America; in Europe their number was much lower and in Romania there wasn\\\'t any. The purpose of developing WIP10 was to gather the integrated information about the dynamics of physical health, nutritional status and fitness levels followed by the provision of useful corroborated tasks that will educate the clients and specialists in order to achieve an accurate analysis of the specific wellness issues. The current study was planned to assess the educational impact and satisfaction of using WIP10, both by specialists and clients from Romania wellness centres.

Subjects and Methods

This cross-sectional study was conducted at 42 wellness centres across Romania from March to November 2016, where WIP10 was implemented with no less than 3 months before the beginning of the study. The centres were located in 39 of the 42 counties of Romania. All specialists employed in these centres were invited to participate. The clients were recruited by the specialists. The use of WP10 was implemented in April-October 2016, and the questionnaire was completed in September-November 2016. All the participants in this study were volunteers, and prior to their inclusion they expressed their consent for participation. Our target population was active adults aged 18-65 years who practised physical activity in wellness centres located in urban areas of Romania. According to the National Institute of Statistics, the total number of inhabitants in urban areas within 18-65 years were about 8.5 million inhabitants,22 of which about 72.1% are adequately physically active.23 The representative sample with a 95% confidence interval (CI) and a 2.5% margin of error was 1,537 subjects. For the selection of the wellness centre the main inclusion criteria was the existence of at least 3 different specialisations among the employees: medicine, nutrition, physiotherapy, or sport. Wellness centres were included only after receiving manager\\\'s approval for the implementation of WP10 instrument among specialists and clients. The criteria for clients\\\' inclusion were the existence of a subscription for a period of at least 3 months in one of the wellness centres concerned; filling in WIP10 and the implementation of personalised recommendations. People aged less than 18 or over 65 years, individuals who did not have regular physical activities and those who had subscriptions for less than 3 months, clients who did not implement or offer feedback on WIP 10, and clients who worked independently without specialist counselling were excluded. The hypothesis of the study was that WIP10 is an educational, practical and effective tool for assessing the physical wellness as an integrative part of the following components of our body: health, nutrition and fitness, from the perspective of specialists and clients involved in wellness activities. Providing this information in real time and also prospectively, it is expected to allow an objective personal profile evaluation and can optimise proactive healthy behaviours (Table-1).



This assessment included a questionnaire-based survey on the degree of satisfaction and the educational, practical and innovative impact of WIP10 implementation in order to optimise the specific activities in wellness centres. The questionnaire included 15 items with Likert\\\' type of responses (1 minimum to 5 maximum). Questionnaires were created with \\\'Google Form\\\' directly targeting the clients and specialists of wellness centres (Table-2).



SPPS 21 was used to analyse the data. To assess the reliability or the internal consistency of the questionnaire the statistic index Cronbach\\\'s alpha was calculated. For comparisons between specialist and client cohorts, Mann-Whitney test was used, using the following formula: r=z/sqrt(n), where z was provided by the statistical software, and n was the sample size. The effect size (r) was calculated only for those differences which were statistically significant. For each item, data was tabulated as mean rank and median. The percentages of individuals that offered maximum grade (5) were tabulated. Separately, on the cohorts of specialists and clients, the patterns of opinions regarding the use and applicability of WIP 10 were investigated. The Cronbach\\\'s alpha coefficient for 15 items was 0.777 for specialists, and 0.705 for clients, suggesting that the items had high internal consistency.

Results

Of the 2281 subjects, 1,987(87%) were clients and 294(13%) were specialists. Among the specialists, 177(60.54%) were men, while among the clients, 820(41.82%) were men. Specialists with personal trainings background were 126(42.8%), nutrition 42(14.2%), physiotherapy 94(31.9%), and medical doctors 32(10.8%). Clients provided significantly better scores than specialists (p<0.05), but for general data, daily water needs, heart rate zones and customised training plan, specialists provided significantly better scores than clients (p<0.05) (Table-2). For specialists, Principal Component Analysis (PCA) was conducted on 15 items with orthogonal rotation (varimax). The Keiser-Meyer-Olkin (KMO) measure verified the sampling adequacy for analysis (KMO=0.73), which are above Keiser\\\'s criteria (>0.5). Bartlett\\\'s test of sphericity (p<0.001) indicated that correlation between items were sufficiently large for PCA. An initial analysis was used to obtain eigenvalues for each component in the data. Six components had eigenvalues over Keiser\\\'s criterion of 1 and in combination explained 70.7% of the variance. After inspecting the screen plot we decided to keep four components which in combination would explain 53.6% of the variance. For the clients, the KMO measure verified the sampling adequacy for analysis (KMO=0.74), which was above Keiser\\\'s criteria (>0.5). Bartlett\\\'s test of sphericity (p<0.001) indicated that correlation between items was sufficiently large for PCA. An initial analysis was run to obtain eigenvalues for each component in the data. Four components had eigenvalues over Keiser\\\'s criterion of 1 and in combination explained 50.2% of the variance. It was decided to keep all the four components. The mean number of subjects who rated the satisfaction questionnaire WIP10 with maximum grade (5) was 181.93(61.88%) specialists and 1,309.40(65.88%) clients. For specialists, the analysis revealed four patterns. The first pattern which accounted for 14% of variance included the questions related to the importance of: caloric needs on different levels of activity, nutritional recommendation for different somatic types, hydric and caloric necessities. The second component included evaluation on information provided regarding level of fitness, heart target zone, hydric necessary and the novelty and recommendation of WIP 10. The third component included the high relevance of personal information, personalized training plan, hydric recommendations and heart target zone. The fourth component included appreciations on information upon metabolism, body composition and fitness level. It accounted for 12.7% of the variance of the whole group. For the clients, the analysis revealed four patterns as well. The first pattern which accounted for 15.5% reassembles the pattern obtained in the specialist cohort. It included the relevance of caloric needs on different levels of activity, nutritional  recommendation for different somatic types, hydric and caloric necessities and additional information related to personal information. The second pattern included high ratings on novelty, utility, recommendation and additional information utility. The third pattern gathered appreciation for, personalised training plan and heart target zone. The forth component included appreciations on metabolism, body composition and caloric needs. It accounted for 10.2% of the variance of the whole group. In the case of specialists, as well as for the clients, patterns did not include significant negative eigenvalues (Table-3).



Discussion

WIP10 was designed as a practical and educational tool for clients of wellness centres in Romania that integrates three components of physical wellness — nutrition, fitness and health. For characteristics like utility, complexity parameters, recommendation, adjacent information metabolic information, body composition, and caloric needs according to exercise level, clients had a significantly higher percentage than specialists. While for general data, daily hydric needs, heart rate zones, and customised training plan, specialists had significantly higher values than clients, meaning a better level of physical training and education.3,18 Our study highlighted the importance and necessity of using specialised software for data processing of clients in wellness centres based on which specialised wellness profiles can be designed in order to optimise the nutritional, physical and health levels of the clients. 2,12,15 In 1986, MicroFit and the Stanford University School of Medicine devised a software called The Wellness Profile which focuses on the areas of exercise, nutrition, alcohol drinking, safety, tobacco use, and stress.24,25 Most of the software and wellness profiles are focused mainly on the health component. WIP10 distinguishes itself from these profiles through an integrated approach of the 10 components of nutrition, fitness and health and by providing additional information in order to form the proactive wellness behaviours. The current study outlined the need to implement specialised software in wellness units. This programme will increase the level of clients\\\' training at wellness centres and it can be standardised and implemented in the Romanian universities as practice for students of specialisations like Nutrition and Dietetics, Physical education, Kinesiology, and even Medicine.

Conclusions

The repeated use of WIP10 over time will provide data for future improvement of client health status, will highlight the validity and reliability of the overall design, and it will be a basic and accessible tool for the good practice in sport and healthcare areas.

Disclaimer: None.
Conflict of Interest: None.
Sources of Funding: None.

References

1.  Chapman-Nishiwaki M, Nakashima N, Ikegami Y, Kawakami R, Kurobe K, Matsumoto N. A pilot lifestyle intervention study: effects of an intervention using an activity monitor and Twitter on physical activity and body composition. J Sports Med Phys Fitness 2017; 57 Suppl 4: 402-10.
2.  Chwa?czy?ska A, J?drzejewski G, Socha M, Jonak W, Sobiech KA. Physical fitness of secondary school adolescents in relation to the body weight and the body composition: classification according to World Health Organization. Part I. J Sports Med Phys Fitness 2017; 57 Suppl 3: 244-51.
3.  Corbin CB, Pangrazi RP. Toward a Uniform Definition of Wellness: A Commentary. President\\\'s Council on Physical Fitness and Sports Research. Digest 2010; 1: 3.
4.  Byrne DW, Rolando LA, Aliyu MH, McGown PW, Connor LR. Awalt BM, et al. Modifiable Healthy Lifestyle Behaviors: 10-Year Health Outcomes From a Health Promotion Program, Am J Prev Med 2016; 51: 1027-37.

5.  Fair SE. Wellness and Physical Therapy. USA: Jones and Bartlett Publisher, 2010; pp 176-9.
6.  George GL, Schneider C, Kaiser L. Healthy Lifestyle Fitness Camp: A Summer Approach to Prevent Obesity in Low-Income Youth. J Nutr Educ Behav 2016; 48: 208-12.
7.  Berlin K, Kruger T, Klenosky DB, Berlin K, Kruger T. A mixed-methods investigation of successful aging among older women engaged in sports-based versus exercise-based leisure time physical activities. J Women Aging 2016; 29: 1-11.
8.  Sallis R, Franklin B, Joy L, Ross R, Sabgir D. Strategies for Promoting Physical Activity in Clinical Practice. Prog Cardiovasc Dis 2015; 57: 375-86.|
9. Yerrakalva D, Mullis R, Mant J. Medicine and Sciences in Sport and exercises. The associations of "fatness," "fitness," and physical activity with all-cause mortality in older adults: A systematic review. Obesity 2015; 23: 1944-56.
10.  Marques A, Santos R, Ekelund U, Sardinha LB. Association between physical activity, sedentary time, and healthy fitness in youth. Med Sci Sports Exerc 2015; 47: 575-80.
11.  Muntaner-Mas A, Vidal-Conti J, Borràs Pa, Ortega Fb, Palou P. Effects of a Whatsapp-delivered physical activity intervention to enhance health-related physical fitness components and cardiovascular disease risk factors in older adults. J Sports Med Phys Fitness 2017; 57 Suppl 2: 90-102.
12.  Cahalin LP, Myers J, Kaminsky L, Briggs P, Forman DE, Patel MJ, et al. Current Trends in Reducing Cardiovascular Risk Factors in the United States: Focus on Worksite Health and Wellness. Prog Cardiovasc Dis 2014; 56: 476-83.
13.  Lindsay AR, Hongu N, Spears K, Idris R, Dyrek A, Manore MM. Field Assessments for Obesity Prevention in Children and Adults: Physical Activity, Fitness, and Body Composition. J Nutr Educ Behav 2014; 46: 43-53.
14.  Green AN, McGrath R, Martinez V, Taylor K, Paul DR, Vella CA. Associations of objectively measured sedentary behavior, light activity, and markers of cardiometabolic health in young women. Eur J Appl Physiol 2014; 114: 907-19.
15.  Roussou IG, Savakis C, Tavernarakis N, Metaxakis A. Stage ependent nutritional regulation of transgenerational longevity. Nutr Healthy Aging 2016; 4: 47-54.
16.  Meiselman HL. Quality of life, well-being and wellness: Measuring subjective health for foods and other products. Food Qual Prefer 2016; 54: 101-9.
17.  Bianco A, Mammina C, Jemni M, Filippi Ar, Patti A, Thomas E, et al. A Fitness Index model for Italian adolescents living in Southern Italy: the ASSO project. J Sports Med Phys Fitness 2016; 56 Suppl 11: 1279-88.
18.  Pacanowski CR, Loth KA, Hannan PJ, Linde JA, Neumark-Sztainer DR. Self-Weighing Throughout Adolescence and Young Adulthood: Implications for Well-Being. J Nutr Educ Behav 2015; 47: 506-15.
19.  Vandelanotte C, Müller AM, Short CE, Hingle M, Nathan N, Williams SL, et al. Past, Present, and Future of eHealth and mHealth Research to Improve Physical Activity and Dietary Behaviors, J Nutr Educ Behav 2016; 48: 219-28.
20.  Buchan DS, Young JD, Boddy LM, Malina RM, Baker JS. Fitness and adiposity are independently associated with cardiometabolic risk in youth. Biomed Res Int 2013; 2: 66-8.
21.  Schoeppe S, Alley S, Lippevelde WV, Braym NA, Williams SL, Duncan MJ, et al. Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review. Int J Behav Nutr Phys Act 2016; 13: 127.
22.  Romanian National Institute of Statistics [online] 2017 [cited 2017 June 16] Available from: URL: http://www.insse.ro/cms/ro/ content/statistici-teritoriale.html.
23.  Gerovasili V, Agaku IT, Vardavas CI, Filippidis FT. Levels of physical activity among adults 18-64 years old in 28 European countries. Prev Med 2015; 81: 87-91.
24.  Cohen J. A power primer. Psychological Bulletin 1992; 112 Suppl 1: 155-9.
25.  Microfit Wellness profile. [Online] 2016 [Cited 2017 May 10]. Available from URL: http://www.microfit.com/products/fitness_assessment_software
/wellness_profile.html. 

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: