Vol.1, No.3, 94-100 (2011)
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
Open Journal of Preventive Medicine
Relationship between meeting the recommendations for
physical activity and health-related quality of life in adult
Chinese Internet users
Jia-Meng Ma1,2*, Ai Shibata3, Isao Muraoka3
1Graduate School of Sport Sciences, Waseda University, Tokyo, Japan; *Corresponding Author: jiameng2011@gmail.com
2School of Physical Education, Sendai University, Sendai, Japan;
3Faculty of Sport Sciences, Waseda University, Tokyo, Japan; aishibata@aoni.waseda.jp, imuraoko@aoni.waseda.jp
Received 10 September 2011; revised 17 October 2011; accepted 29 October 2011.
Background: The benefits of a recommended
level of physical activity on physiological health
indicators such as morbidity and mortality are
well-accepted, but few researches has addressed
whether or not the association between the re-
commended level of physical activity and a
health-related quality of life (HRQOL) exists in
the Chinese adults. Purpose: The present study
examined whether the recommended physical
activity (PA) would be associated with HRQOL
in the Chinese adults. Methods: Cross-sectional
data were collected through an internet-based
survey. Total of 1394 Chinese adults responded
the International Physical Activity Question-
naire-Chinese version examining whether indi-
viduals met the recommended ACSM/AHA PA
guideline. Demographic data were also obtained.
HRQOL was assessed with the Medical Out-
comes Survey Shor t Form-3 6 que sti onnair e (SF -
36). Multivariate analyses of covariance were
utilized to examine differences in multidimen-
sional scales of the SF-36. Results: In both gen-
ders, the recommended group had significantly
higher physical functioning, vitality, and mental
health scores than the inactive group. Signifi-
cant differences in role physical, general health,
social functioning scores were only found among
the recommended and insufficient male groups.
Conclusion: Individuals w ho attained the recom-
mended level of PA had better scores on some
dimensions of HRQOL than those who did not.
Keywords: Behavior Science; Health Promotion;
HRQOL; Physical Activity
In its focus on healthy living, the World Health Or-
ganization (WHO) places an emphasis not simply on
preventing chronic diseases, but on preserving or im-
proving quality of life (QOL) through the maintenance
of a good state of physical independent function and
mental health in daily life. Health-related quality of life
(HRQOL) is defined as individual and community per-
ceptions of physical and mental health, and is considered
an important indicator in evaluating health status [1]. It
is also a basic tool used to evaluate self-awareness of the
physical and mental aspects of health status in daily life
Sufficient physical activity is already known to reduce
the risk of mortality and morbidity of chronic conditions
such as coronary artery disease, diabetes mellitus, or
hypertension [4-7]. It is also well-documented that as
well as having such physical effects, physical activity
also has mental effects. Previous studies have reported
that people who are physically inactive in their daily
lives have lower HRQOL than active people [8-10], and
that the mental aspect of HRQOL in those who engage
in regular exercise is superior to that of those with a
sedentary lifestyle [11]. Based on these findings, health
care providers and health promotion workers recom-
mend engaging in regular physical activity as a means to
maintain or improve HRQOL.
In the United States (US), the American College of
Sports Medicine/American Heart Association (ACSM/
AHA) published guidelines encouraging people to par-
ticipation physical activity in order to prevent chronic
diseases and maintain or improve health [12]. These
guidelines recommend engaging in 150 minutes per
week of at least physical activity of moderate-intensity,
and the guidelines are currently in widespread use
around the world [13,14]. In a study using the Medical
Outcomes Study short form 36 (SF-36) to investigate the
J.-M. Ma et al. / Open Journal of Preventive Medicine 1 (2011) 94-100
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
relationship between meeting the recommended amount
of physical activity and HRQOL in French adults, those
who met the recommended amount scored higher than
those who did not in five of the eight SF-36 domain
scales: physical functioning, vitality, general health, so-
cial functioning, and mental health [12,15]. Thus, reports
mainly from the US and Europe indicate that meeting
the recommended amount of physical activity not only
reduces the prevalence of chronic diseases or the mortal-
ity rate from such diseases, but is also beneficial in in-
creasing the HRQOL[10].
China also has the same emphasis on HRQOL as
other countries. In the Healthy China 2020 Strategy an-
nounced by the Ministry of Health of the People’s Re-
public of China, the ultimate goal of health promotion is
to increase HRQOL [16]. While there have been occa-
sional studies in China of the relationship between
HRQOL and physical activity focusing on specific groups
such as people suffering a particular disease [17,18],
there have been no studies investigating this relationship
in Chinese adults across a wide range of age-groups
There has been tremendous socioeconomic growth in
China in recent, particularly in urban areas, and lifestyles
are becoming westernized at an ever-increasing rate.
According to a 2009 survey report of the development of
the Internet in China, the number of Internet users in
urban areas is increasing every year. Internet penetration
in China is 31.8%, and 72.6% of Internet users are urban
dwellers. Health problems among these urban Internet
users are expected to increase as a result of increasing
Westernization of their lifestyles and decreased physical
activity. In order to build the measures to address physic-
cal inactivity, it would be useful to survey physiccal
activity and HRQOL among urban dwellers in China,
who are at particularly high risk of physical inactivity.
The present study examined that the relationship be-
tween recommended amount of physical activity and
HRQOL among adult Chinese Internet users.
2.1. Participants
The survey was carried out from December 2009 to
January 2010. The participants were Chinese adults reg-
istered as monitors (approx. 1,950,000 people as of No-
vember, 2009) with a Japanese company specializing in
overseas surveys. The goal was to have responses from
1,300 people, and after stratifying the participants to
ensure equal numbers of each gender and age group (30
- 39 years, 40 - 49 years, 50 - 59 years), 39,000 adults
from across China were randomly selected. The survey
company sent an e-mail to each person requesting their
cooperation with the questionnaire survey. The final num-
ber of respondents was 1501, a response rate of 3.8%.
By way of remuneration, the participants who responded
to the questionnaire survey were awarded Internet points
by the survey company according to the number of sur-
vey items to which they responded. The present study
was approved by the institutional review board by the
Waseda University (approved number 2009-145, Dec. 7.
2.2. Measures
2.2.1. Physical Activity
The Chinese version of the International Physical Ac-
tivity Questionnaire–Short Version (IPAQ–SV) [20] was
used to estimate the amount of physical activity. The
IPAQ–SV was designed for the purpose of identifying
the frequency and duration of walking, moderate and
vigorous physical activity, and sedentary activity during
the past week The reliability and validity of the Chinese
version of the IPAQ–SV have already been investigated
in a previous study, with a test-retest reliability coeffi-
cient of r = 0.779 and validity shown by a good correla-
tion of r = 0.598 with the daily energy expenditure cal-
culated from the physical activity log [20]. This is a
similar result to verification of the reliability and validity
of the International Physical Activity Questionnaire car-
ried out in 12 countries [21].
The total amount of physical activity (hours/week)
was weekly minutes of walking, moderate-intensity and
vigorous-intensity activity were calculated by multiply-
ing the number of days/week by the frequency of physic-
cal activity. On the basis of the ACSM/AHA guidelines,
participants with a total weekly amount of physical ac-
tivity (including walking and moderate-intensity and
vigorous intensity physical activity) of 150 minutes or
more were classified into the sufficient group, and those
with a total of less than 150 min were classified into the
insufficient group.
2.2.2. HRQOL
The Chinese version of the SF-36 [22] was used to
measure HRQOL. The validity and reliability of apply-
ing this instrument to Chinese people have been con-
firmed [23]. It has also been shown that the electronic
version, used over media such as the Internet, has the
same levels of validity and reliability as the paper self-
reporting version [24]. The questionnaire has 36 items,
organized into the following eight domain scales: physic-
cal functioning (PF), role-physical (RP), bodily pain
(BP), general health (GH), vitality (VT), social func-
tioning (SF), role-emotional (RE), and mental health
(MH). Each domain scale is calculated as a score from 0
J.-M. Ma et al. / Open Journal of Preventive Medicine 1 (2011) 94-100
Copyright © 2011 SciRes. http://www.scirp.org/journal/OJPM/Openly accessible at
to 100, with higher scores indicating better levels of sub-
jective health and functioning.
2.3. Statistical Analysis
Of the 1501 respondents, 107 were excluded on the
basis of the data exclusion criteria established in the
IPAQ-SV protocol, including cases in which the total
physical activity exceeded 960 minutes (16 hours) and
cases for which data were lost. The remaining 1,394
subjects (92.9%) were analyzed. All analyses were per-
formed after stratification by gender. A t-test and a
one-way analysis of variance (ANOVA) were used to
investigate the relationships between demographic vari-
ables and differences in the SF-36 domain scales. The
differences in scale scores between the two groups clas-
sified according to whether they met the recommended
amount of physical activity (sufficient group, insuffi-
cient group) were investigated using a multivariate
analysis of covariance (MANCOVA), with the demo-
graphic variables for which a significant relationship
with the domain scales was found in the ANOVA (age,
marital status, employment status) as covariates. The
significance level was set at p < 0.05. The analysis soft-
ware was SPSS ver. 17.0.
3.1. Basic Characteristics of Respondents
The mean age of subjects was 43.0 ± 8.0 years, and
50.2% were male. The participants were 91.7% married,
97.8% employed, and 67.6% had university or higher
educational status. In addition, 62.3% had a personal
annual household income of 50,000 yuan or more and
63.7% had a body mass index within the standard range.
As for walking, total minutes were 280.2 ± 319.2 min
per week in male, while females accumulated totally
294.8 ± 373.2 min per week. Also, males spent 250.6 ±
348.5 min in moderate-intensity activity, whereas females
spent 254.8 ± 346.6 minutes. In addition, weekly time of
vigorous-intensity activity in males and females were
180.7 ± 279.0 minutes and 160.9 ± 281.6 minutes respect-
tively. Of the total attributes, 87.3% met the recom-
mended amount of physical activity (Table 1). Of these,
89.0% of males and 85.6% of females met the recom-
mended amount of physical activity. Moreover, there
were 2.6% of participants were found to be inactive.
Table 1. Basic characteristics and physical activity level for male and female Chinese respondents.
Men Women
n (%) mean(SD ) n (%) mean (SD) Total n (%)
Total 700 (50.2) 694 (49.8) 1394 (100)
30 - 39 234 (33.4) 235 (33.9) 469 (33.6)
40 - 49 234 (33.4) 232 (33.4) 466 (33.4)
50 - 59 232 (33.1) 227 (32.7) 459 (32.9)
Marital status
married 650 (92.9) 628 (90.5) 1278 (91.7)
unmarried 50 (7.1) 66 (9.5) 116 (8.3)
Employment status
employed 688 (98.3) 701 (97.5) 1364 (97.8
not employed 12 (1.7) 18 (2.5) 30 (2.2)
Educational status
high school graduate 4 (7.0) 53 (7.6) 102 (7.3)
2years college or equivalent 160(22.9) 189 (27.2) 349 (25.0)
college graduate 491(70.0) 452 (65.1) 943 (67.6)
Income level (RMB)
<30,000 90 (12.9) 78 (11.2) 168 (12.1)
30,000 - 40,000 75 (10.7) 69 (9.9) 144 (10.3)
>40,000 - 50,000 105 (15.0) 108 (15.6) 213 (15.3)
>50,000 430 (61.4) 439 (63.0) 869 (62.3)
BMI (kg/m²)
<18.5 10 (1.4) 49 (7.1) 59 (4.2)
18.5 - 23.9 398 (56.9) 490 (70.7) 888 (63.7)
24.0 - 27.9 252 (36.0) 136 (19.6) 388 (27.8)
28.0 40 (5.7) 19 (2.7) 59 (4.2)
Physical activity level
Recommendeda 623 (89.0) 594 (85.6)
Walking (min/week)b 280.2 (319.2) 294.8 (373.2)
Moderate-intensity activity (min/week)b 250.6 (348.5) 254.8 (346.6)
Vigorous-intensity activity (min/week)b 180.7 (279.0) 160.9 (281.6)
MB = China yuan. a. Met the recommended amount of physical activity. b. Mean (SD).
J.-M. Ma et al. / Open Journal of Preventive Medicine 1 (2011) 94-100
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
3.2. Effects of Physical Activity Level on
Regarding the 8-domain scales scores, a one-way
ANOVA was conducted to examine the group differ-
ences in the SF-36 measures for each demographic vari-
able. In both genders the differences of PF, BP, and GH
with meeting the required amount were lowest in the 50
- 59 years age group and highest in the 30 - 39 years age
group. For marital status, unmarried males only showed
higher RP than married males. For employment status,
PF, RP, GH, VT, and MH were higher among employed
males than unemployed males, and BP and GH were
higher among employed females than unemployed fe-
males. Also, a MANCOVA was performed with these
influential variables (age, marital status, and employ-
ment status) as covariants, the scores on the eight do-
main scales as dependent variables, and the physical
activity groups as independent variables. Multivariate
effects for PF, RP, GH, VT, SF, and MH were found
among males and for PF, VT, and MH among females
(males; Wilk’s = 0.934, p = 0.000; females: Wilk’s =
0.934, p = 0.000). Moreover, a univariate analysis
showed that PF, VT, and MH were significantly higher
in the sufficient group than the insufficient group for
both genders. In the insufficient group, RP, GH, and SF
were significantly higher in both genders (Table 2 ).
The present study investigated the relationship be-
tween meeting the recommended amount of physical
activity and HRQOL among Chinese adults that use the
Internet. Overall, 87.3% of participants met the recom-
mended amount of physical activity. A previous study of
physical activity among Chinese adults using the
IPAQ-SV found that 88.8% of adults carried out 150
minutes of physical activity per week [25], so the results
of the present study were consistent with this previous
study. Moreover, with regard to HRQOL, the overall
results of the present study were slightly lower than a
previous survey of Chinese adults using the SF-36 [26],
but the trends in scores for each scale were similar.
Meeting the recommended amount of physical activity
had a significant relationship with better scores for al-
most all domain scales (PR, RP, GH, VT, SF, and MH)
among males, even after adjustment for demographic
factors. Among females, meeting the recommended
amount was significantly related to with better scores for
PF, VT, and MH. The findings of the present study thus
imply that engaging in the recommended amount of
physical activity is associated with both physical and
mental aspects of HRQOL. The SUVIMAX epidemiol-
ogical cohort study in France also reported that partici-
Table 2. Aadjusted HRQOL measures in respondents among
physical activity groups stratified by gender.
Physical Activity Group
Male mean (SD)Recommended Insufficient F P
PF 88.44 (14.6) 80.71 (20.3) 16.45<0.001
RP 84.70 (19.6) 78.99 (23.2) 5.700.017
BP 77.90 (16.8) 76.86 (15.0) 0.180.676
GH 67.71 (19.7) 56.40 (22.8) 19.82<0.001
VT 68.64 (16.0) 58.79 (18.3) 22.29<0.001
SF 77.12 (17.6) 70.94 (18.5) 8.050.005
RE 79.95 (20.3) 75.76 (22.2) 2.720.100
MH 67.17 (15.3) 62.14 (18.4) 5.410.020
Female mean (SD )
PF 88.36 (12.4) 83.30 (17.0) 13.75<0.001
RP 85.98 (18.1) 86.32 (19.8) 0.010.934
BP 77.55 (16.7) 80.28 (18.0) 1.960.163
GH 67.46 (20.2) 64.22 (19.9) 2.690.102
VT 69.08 (15.2) 64.40 (17.9) 8.330.004
SF 78.72 (17.1) 81.50 (17.0) 1.970.161
RE 81.47 (18.5) 81.67 (21.8) 0.000.951
MH 67.59 (14.8) 63.05 (18.1) 7.110.008
Comparison in multidimensional scales of SF-36 among physical activity
levels withcovariate of age, marital status, employment status. Bonferroni-
adjusted univariate multiple comparison.
pants engaging in the recommended amount of physical
activity showed greater values for PF, RP, GH, RE, VT,
SF, and MH than the control group [15]. Furthermore,
the Behavioral Risk Factor Surveillance System (BRFSS),
a large-scale survey of physical activity conducted in the
US, reported that a significantly lower proportion of
people who subjectively evaluated themselves as un-
healthy for 14 or more days in a month met the recom-
mended amount of physical activity than other people
[27]. It therefore appears that meeting the recommended
amount of physical activity is associated with better
HRQOL among adult Internet users in China in the same
way as in developed countries.
Of the eight domain scales, no significant relationship
was found between BP or RE and physical activity in
males, or between RP, BP, GH, SF, or RE and physical
activity in females. In a previous study, vigorous-inten-
sity physical activity is associated with all domains of
the SF-36 scale, and that vigorous-intensity activity has
a greater effect on all domains in females than in males
J.-M. Ma et al. / Open Journal of Preventive Medicine 1 (2011) 94-100
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
[28]. Another previous study also found that vigor-
ous-intensity leisure-time physical activity was more
strongly associated with all of the domains than moder-
ate-intensity physical activity [15]. With the present
study, it is not possible to make direct mention to any
amount-response relationship between the intensity or
amount of physical activity and HRQOL, as the survey
examined the relationship between HRQOL and engage-
ing in 150 minutes per week of at least physical activity
of moderate-intensity. Nonetheless, in light of the pre-
vious studies, the present results suggest the possibility
that higher intensity or greater amount of physical active-
ity are required in order to have an effect on the domains
in which no relationship with meeting the recommended
amount was found, and that carrying out the recom-
mended amount of physical activity of 150 minutes per
week of physical activity of moderate-intensity or vig-
orous-intensity may not be sufficient.
Furthermore, while a significant relationship between
physical activity and the SF domain was found among
males, no relationship was found among females. In a
previous study, a longitudinal study found that five years
of continual leisure-time activity had a favorable effect
in raising SF in females [29]. The present study was
cross-sectional, and, moreover, physical activity habits
and period of duration were not surveyed, but it seems
that engaging in a constant amount and duration of
physical activity has an effect on SF in females. There is
therefore a need to investigate this point using a longitu-
dinal study.
Moreover, in the present study, female found a weaker
relationship between the physical aspects of HRQOL in
particular and meeting the recommended amount of
physical activity. A previous study that examined the
relationship between long-term physical activity and
HRQOL reported that the more intense the physical ac-
tivity, the stronger the relationship between physical
activity and the physical aspects of HRQOL [30]. This
suggests that engaging in high-intensity activity has an
effect on the physical aspects of HRQOL. There is also a
trend for males to favor high-intensity activity, while
females generally engaging in moderate-intensity physic-
cal activity [31]. Consequently, in the present study, it is
likely that, among those engaging in 150 min or more
physical activity per week, the males were engaging in
high-intensity activity, while more females were engage-
ing in moderate-intensity activity. It would probably be
desirable to recommend that female engaging in high-
intensity activity in order to achieve more effective im-
provement of the physical aspects.
In a previous study, engaging in leisure-time physical
activity of moderate or greater intensity for 150 min or
more per week showed a strong relationship to the
HRQOL domain scales (except BP) [15]. In the present
study, however, evaluation of the relationship to
HRQOL of physical activity of moderate or greater in-
tensity that includes activities of daily life observed sev-
eral domain scales for which no relationship was found.
From this, it may be conjectured that leisure-time physic-
cal activity has a greater relation to HRQOL than the
general activity of daily life. Moreover, as leisure-time
physical activity has a positive effect on overall health,
while physical activity from commuting or work has a
negative effect on subjective well-being, it has been
suggested that physical activity engaging in a passive
condition has a great effect on psychological factors [32].
In China, one-third of all people commuting to work go
by bicycle or on foot. One would therefore expect that
the participants of the present study included many peo-
ple met physical activity recommendation by such active
commuting. Therefore, the finding of the present study
that there was no relationship between physical activity
and the psychological domains RE and SF was probably
due at least in part to differences in the type of exercise
being engaging in by participants.
There are a number of limitations to the present study.
First, the cross-sectional design of the study makes it
impossible to mention a causal relationship between
engaging in the recommended amount of physical active-
ity and HRQOL. Second, there is the presence of sam-
pling bias. Subjects were selected after stratifying by
gender and age group, but it has been pointed out that
sampling error can occur when subjects are selected by
random sampling from monitors registered with a survey
company [33]. Comparing the characteristics of the sub-
jects of the present survey with the adult population of
China as whole using information released by the Na-
tional Bureau of Statistics of China in 2008, the survey
participants were better educated and had higher income.
Adult Chinese people who use the Internet are those
with higher socioeconomic status, so there is probably a
bias toward people with the same attributes in the moni-
tors of the survey company. According to a survey by
the China Internet Network Information Center (CNNIC),
at least 70% of Internet users are urban dwellers, so that
the subjects of the present study were probably a largely
urban group. These points mean that caution must be
exercised in any attempt to generalize the results of the
present survey to the adult population of China as a
whole. Furthermore, with regard to the amounts of
physical activity of moderate or greater intensity and of
walking assumed in the IPAQ, it is impossible to avoid
bias due to inaccurate assumptions or recollections on
the part of the subjects because of the self-reporting na-
ture of the study. In a previous study of physical activity
evaluation methods with Chinese subjects [34], the IPAQ
J.-M. Ma et al. / Open Journal of Preventive Medicine 1 (2011) 94-100
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
gave a higher evaluation of physical activity amount
than a heart rate monitor, an accelerometer, and a ques-
tionnaire relating to a daily physical activity log. There-
fore, the IPAQ may overestimate the amount of physical
Since a relationship was found between meeting the
amount of physical activity recommended in the ACSM/
AHA guidelines and HRQOL, it is likely that engaging
in the recommended amount of physical activity has an
important effect on health. However, as discussed above,
further studies should be done to determine more accu-
rately the association between HRQOL and the recom-
mended physical activity level using a representative
sample and a larger sample size. Participants should not
be only restricted to the internet user sample. HRQOL
may possibly be related to other characteristics of the
Chinese population. Moreover, the association between
HRQOL with specific domains of physical activity (such
as leisure-time household, occupational and transport)
should be examined further. Furthermore, effective sup-
port strategies are needed for promoting physical activity
with the goal of improving HRQOL.
This work was supported by a Global COE program “Sport Sciences
for the Promotion of Active Life” from the Japan Ministry of Educa-
tion, Culture, Sports, Science, and Technology.
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