Health related physical fitness can be defines a set of measurement of physiological characteristic and physical level that associate with premature of non-communicable disease that is associates with sedentary life behavior (Vanhees et al. 2005). There are two component of physical fitness which is, health related fitness and skill related fitness. Health related fitness is composed by aerobic fitness, muscle strength and endurance, flexibility and body composition (Huang, 2002), while skill related fitness associate with agility, balance, power, static strength and coordination (Miller et al. 2008).Even thought skill related fitness is not importance as health related fitness but skill related fitness is importance to athlete and military. Physical fitness are influence by many factor such as, age, gender, body mass index or body type and as well as level of physical activity, therefore each individual need to maintained physical fitness level in order to cope with daily activity and stay healthy.

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According to Chung (2008), physical fitness level of school children are being influence by physical education and physical activity. Each individual need to retain at least basic physical fitness prior to sense the benefit of adequate fitness. Recently research has showed that more children are getting fat and less fit and more prone to expose to chronic diseases. It is importance to keep in mind that maintaining physical fit in early age can contribute to decreases risk mortality and morbidity from chronic diseases (Malton, 2006).
Non communicable diseases (NCDs) such as, overweight, obese, high blood pressure, high blood cholesterol, hypertension, cardiovascular diseases, diabetes, cancer and related condition are the major health burden to this country (Zainal Ariffn, 2012). Alarmingly, a non-communicable disease in Malaysia, prevalent among children has increase rapidly past few decades (NMM, 2012) and it will continue to be rising (Tee, 2012). One of the major causes lead to this rising is, sedentary life behavior that lead to low physical fitness (Mokdad et al. 2004). The studies on health related fitness on non-communicable diseases has been reported widely in all age (Jonker et al. 2006). Numerous healthy benefit can be achieve through engagement of regular and vigorous level exercise that lead to increase physical fitness (Ruiz et al. 2006).
There are a lot of studies that has been done, mainly focusing in growing concern on physical fitness component among children in determining harmful effect of unfitness that can lead to adulthood (Dumith et al. 2008). Most of physical fitness that has been diagnosed showed that poor physical fitness level lead to potential strategy in early detecting metabolic disorder (Anderson et al. 2009). Despite of growing concern and its importance to physical health in life, in Malaysia physical fitness study on children is still no well established. According to (Shabeshan, 2006) the prevalence of level physical fitness among school children is not very satisfactory.
Furthermore, there a lot of variable associates with physical fitness level, such as cardiovascular, muscular strength/resistance and flexibility. Other association variable, that may contribute in identify factor predicted for fitness level are such anthropometric measurements, body mass index (BMI), and waist circumference (WC) that associate with muscular strength or resistance (Brunet et al. 2007), and cardiorespiratory fitness (Eisenmann, et al. 2005).
1.2 Problem Statement
Low physical fitness among school-going children may decline physiological capability. According to Rowland (1999) deterioration of physiological capability is due to low physical fitness that will lead to decreases in physical function and muscle strength. Furthermore, there was a lack data have been reported on physical fitness level among school-going children, taken into consideration that physical fitness testing, anthropometric and body composition measurement assessment are foundation steps for changing intervention life style or sedentary behavior, this present study is carried out to investigate the association between health related physical fitness with anthropometric indicator and body composition in primary school children in Beruas, Perak.
1.3 Significance of Study
It is a well know that there are association between health related fitness with cardiovascular disease, overweight and obese among primary school children. This study will determined to what extend current growth of school growing children respected to their physical fitness. The data being obtained in this study will work as a platform for intervention on healthy life style and increase awareness among parent and teacher. This study is expected to provide a baseline data on physical fitness and other health parameters among school children. Furthermore, teacher, health department, and relevant agencies could develop program and help them making decision for obesity prevention among school children.
Objective
To determine the anthropometry of the primary school children.
To determine body composition of the primary school children.
To determine physical fitness level of the primary school children.
To determine relationship between anthropometric measurement, body composition with health related physical fitness among school children.
1.5 Hypotheses
Ho: there are no significant relationships between anthropometric measurements, body composition to health related physical fitness.
Assumption
Fitness test instruction were presented in this study to primary school children, therefore each participant understood the instruction.
Each participant five full commitment to the fitness measurement.
Each participant was involved are free from any injury
Each participant’s guardian understood the research study and give permission to their children in taking part in this research by fill up the inform consent.
Limitations
The limitations of the study are stated below:
Study population
Participants were involved in this study came from rural area located in Beruas, Perak. This study not take participant from other area, thus limited geographical presented of the population.
Limited time
Participant has limited time because they need to participant in education class, thus the test has to be done in one day only.
Instrument
The skinfold measurement (harpenden) may not accurate as Dual Energy X-ray Absortiometry (DEXA), thus limited study finding.
Operational Definition
The study’s operational definitions are as below:
1.8.4 Flexibility
According to William et al. (2003) flexibility is ability of joint to move in full range of motion and allows freedom of movement around the joint.
1.8.5 Muscle strength
Muscle strength refer as external forced (work express in newtons, kilograms or pounds) that can be generated by specific muscle or muscle size also been called resistance lift (William et al. 2003).
1.8.6 Body composition
Body composition is a distribution of body fat to lean body mass (Pangrazi, 1991).
1.8.7 Obesity
Obesity is known as a condition of excess body fat and it is associated with a large number of debilitating and life-threatening disorders, such as major increase in associated cardiovascular, metabolic and other no communicable diseases (Must et al., 1999).
1.8.8 Waist circumferences
A waist circumference is measured using nan- elastic tape by placing on the trunk between iliac crest and lower costal margin (NCCFN, 2005).
CHAPTER 2
Literature Review
2.1 Introduction
“Health” can be described in variety approach the term itself can be used to describe how a person’s feeling, shape or appearance and people’s fitness. However according WHO, (2003), the term health, is not simply the lack of disease or medical condition but it is a state of complete mental, physical, and social well-being or medical condition.
Health related fitness is a sub scale of healthy well being the health related fitness major focusing in maintaining human body’s system to endure or to sustain human daily life activity, does not affect surplus fatigue, stress or illness by maintaining basic functioning of body’s system (Brunetto et al. 2009). Furthermore, as human’s body can maintaining basic function of body’s system that focusing in health related fitness it can cause or reduce chronic disease such as non-communicable disease and help faster in recovery on what they should occur. According to Jonatan et al. (2006), in order to persuade the healthy development of body’s system, human need to create regular workload demand on their body such as regular exercise, so that human’s body can adjusts to the demand workload to perform, and living an active lifestyle.
However, if human live as sedentary behavior lifestyles their physical workload may reduce and doing beyond sitting or walking about may become a struggle, moreover body also not functioning effectively as a result may contribute to health conditions.
2.2 Definition of Physical fitness
Physical fitness can be defines in many ways, according to Kamil et al. (2012), physical fitness being defines as competence to adjust and recovery from extraneous exercise. Furthermore, physical fitness being defined as a condition that granted human to carry their daily activity without fatigue and have enough energy to enjoy leisure activity (Malina et al. 2004). According to Miller (2006) physical fitness can ne defined in various point view such as, cardiorespiratory fitness, muscular strength or muscular endurance.
Other definition for physical fitness is when body function at optimum efficiency thought capacity of the heart, blood vessels, lungs and the muscle (Pate, 1993). All definition above has cover performance related fitness, but according to McGlynn, (1993) health relate fitness is focusing on protection against cardio disease, illness that associate with overweight, a diversity of joint and muscle problem and physiological complication that lead to further stress. Example of components of health related fitness is cardio respiratory endurance, flexibility, muscular strength and endurance and body composition.
2.3 Health related fitness
2.3.1 Cardiovascular fitness
Cardiovascular fitness is closely related to ability exercise in prolonged period with involve large and dynamic muscle size and intensity of exercise from moderate to high capacity (ACSM, 2010). Performance of exercise is depending to efficiency of skeletal muscle system, cardiovascular and respiratory state. In order to improve cardiovascular fitness, body must receive sufficient oxygen supply to the working muscle and these will increase necessary enzymes activity for production energy in the working muscle. The general method in increasing or develop cardiorespiratory fitness is by increase intensity, duration and frequency of exercise (William et al. 2003). Example of general exercise for young children to achieve the fitness level is at least 130-150 beats per minutes maintain it for 20 to 30 minutes for optimal benefit.
According to ACSM (2010), cardiovascular fitness is health related fitness because decreased in cardiovascular it has been connected with premature death associated to cardio disease. Second reduction of death from various causes has been associated with increased cardio fitness and lastly high physical activity level associated with high cardiovascular fitness in turn has many associations with health benefit. The cardiovascular fitness test is an importance assessment in preventive program
2.3.2 Flexibility
According to William et al. (2003) flexibility is ability of joint to move in full range of motion and allows freedom of movement around the joint. In order to have a good health lifestyle, individual need some definite amount of flexibility to cope with their daily life routine.
Muscle viscosity, adequate warming up and distensible joint capsule are importance or specific variable that affect flexibility of individual (ACSM, 2010). Furthermore, ligament and tendon also associated with flexibility. Stretching or 10 to 30 second and stretch beyond normal length have been recommended to increase the flexibility. Example of stretch being recommended is static trenching where it allows rapidly increased in strength reflex to a point of discomfort zone.
2.3.3 Muscle strength and muscle endurance
Muscle strength refer as external forced (work express in newtons, kilograms or pounds) that can be generated by specific muscle or muscle size also been called resistance lift (William et al. 2003). According to ASCM (2010) strength can be test out using two ways the first method is using static, refer to no movement and muscular and limb movement. Second method is using dynamic refer as muscle change in length caused by external forced.
Muscle endurance is ability of muscle group to repeatedly contract over period of time and enough to caused muscular fatigue or ability to maintain specific percentages of muscular contraction (ACSM, 2010). To develop both muscular strength and endurance the basic principle need to be master is overload, progression, specificity and intensity of load (William et al. 2003). Method can be used to develop muscular strength is, exercise at maximum or near maximum resistance and this will lead to physiological adaptation where muscle increased in strength. For muscular endurance development, method can be used is low intensity but with high repetition.
2.3.4 Body composition
Body composition is a distribution of body fat to lean body mass (Pangrazi, 1991). The balance proportions of body fat in human body is one factor contribute to individual’s fitness level. Essential fat and storage fat are two classification of fat in human’s body (Macardle, 1986), where essential fat being stored in the liver , the lungs, kidney, spleen, lipid rich tissues in the central nervous system and intestine muscles. Second the storage fat is being stored in adipose tissue for nutritional and also for internal protection function.
According to NIH (1996) stated that excess body fat especially that located surrounding abdominal, will associated with metabolic syndrome, hypertension, stroke, type 2 diabetes, hyperlipidemia and coronary artery diseases. Other related illness may contribute caused of excess body fat is problem on muscle and joint where extra weight being stress on these two part, heart disease and high cholesterol. Understanding this problem is essential in order to counter back the problem being faced by many children right now.
2.4 Benefit Health Related Fitness
To increased health among school children or youth, component health related fitness play a vital role in improving individual fitness level. If student or youth involved in regular physical activity that involved proper or specific frequency, intensity, time, and duration of exercise they may develop good healthy fitness level. A strength or improve in health fitness will avoid such many chronic diseases or in other word non-communicable diseases.
Second by improving health related fitness especially muscular strength and endurance it will help in resistance to fatigue. Thus it also will help increasing in the quality of life and help enjoy leisure activity.
Student should be told or expose to the benefit of all packages of health related fitness, most of health problem occur in early part of life. In Malaysia it has being diagnosed, children under 12 years old, being overweight is 12.6% while 13.5% is obese caused of low physical activity that lead to low physical fitness level (Yeevon, 2011). The increasing health problems among children now are very alarming where most of cased will associated with failure metabolic rate and heart disease. The knowledge of health related fitness is very importance for the student to master it for early development health lifestyle, by understanding the importance, student will created attitude to value the fitness and the will knowledge that the fitness need some effort of regular exercise with a correct intensity and this will be the best preventive medicine for their life.
2.5 Current Health related fitness in school children
According to Tee, (2012) he stated that, the rate of mortality for local and abroad is very alarming where most of problem associated with cardiovascular death. One conclusion from the local data showed or stated that health related physical fitness among student and adult are not at satisfactory target or level. According to Frederick et al. (2010) electronic devices and automation that came from modern technology has made people less active as a result low physical fitness level among children and adults.
Second, current status of Malaysia growing’s children right now is very alarming where now Malaysia facing double burden problem such as increase in number of overweight and obese children and also increased in number of thinness or in other word undernourished children. The problem should be given full attention because the growing numbers are increase tremendously and Malaysian country is the leading country in Asian pacific in obesity rate (Tummy, 2011).
On the other hand, other health problem being faced by the Malaysia country is low bone mass and anemia this due to low body weight. Body images perception being faced by young adult and teenagers lead to eating disorder such as bulimia and anorexia (MASO, 2005). In nut shell it is importance for Malaysia people maintain their health status.
Furthermore, available data showed that, the prevalence of obesity among children in Malaysia has equal match on developed country (NCCFN, 2005). Two cross-sectional surveys has being carry out in year 2007 and 2008 (Ismail et al., 2009) on children age 6 until 12 years old in Peninsular Malaysia. The data showed that, increase overweight and obese children from 11.0% to 12.8% and 9.7% to 13.7% respectively (figure 2.1).
Figure 2.1: Prevalence overweight and obese in children age 6 to 12 years old in Peninsular Malaysia
Waist circumference has strongly associated with abdominal fat (NCCFN, 2005). According to Zhou, (2002) he pointed out, in large epidemiology studies, there are strong significant and independently correlated with dyslipideamia, blood pressure, 2 hours plasma glucose or diabetes. Based on the finding, waist circumference is one major importance test in determining individual at risk of chronic diseases.
Being inactive or low physical activity has not only associated with heart illness but many other related illnesses. Diabetes, obesity, failure of metabolic rate is some sort of low physical fitness level. In order to overcome the problem is by increase the awareness among children the benefit having physical fitness level.
CHAPTER 3
Methodology
3.1 Research Design
The study was a cross sectional study. All subjects male and female were enrolled in physical fitness test. This study tends to investigate the relationship between physical fitness, anthropometric and body composition among obese children. All subjects were recruited voluntarily and with consent from parents/guardian. The subjects were briefed verbally during the meeting. The protocol and potential advantages were explained to the subjects before they were given the consent form filled by their parents or guardian. Approval was obtained from the State Education Department as well as school authority prior to data collection.
3.2 Subject selection
Two hundred and eleven subjects were randomly sampled in eight primary schools in Beruas area. Subjects include male and female age 10-11 years old. Multistage sampling technique was used to to select all 211 subjects. The Multistage sampling technique was ensure equal reresentation of the subject.
3.3 Data collection
The data collection was carried out in primary schools. Data on anthropometry and body composition was collected before the subjects undergo the fitness tests. Standard fitness measurements were used to assess the fitness tests which were Queens College step test, hand grip test, partial curl-up, and sit-and-reach test.
Obtained ethical clearance and approval from Research Management Institute (RMI) and Ministry of education Malaysia
Exclusion criteria
Has medical condition
No approval from parent or guardian
Inclusion criteria
Male and female
Age of 10 and 11 years old
Screening and recruitment of
the subjects
SK Gelung Gajah
SK Jenis Kebangsaan Cina Pei Ching
SK Kampung Kota
SK Gangga
Subjects were recruited randomly
N=246
Informed written consent was obtained from each subject and parent /guardian
Data collection:
Anthropometry, body composition, physical activity and fitness tests
Statistic was analysis
Figure 3.1. Research Approach
3.4 Sampling Calculation
A total two hundred and four six subject were enrolled in this study. Sample size is determined using table prevalence population. (Krejce and Margan, 1970). The internal confident is 90 percent (confident level) and population percentages not more than .05.
Table 3.1
Determining sample size from given population
N
S*
480
214
500
217
550
226
Note: N = is population size; S = sample size; *sample size for 90% confident that the difference in the population and p There are 8 primary school located at Beruas perak. The population of all school children in Beruas is about 550 students and based on the determining sample size table, the sample size been required is about 217 subject. In order to avoid drop out the required sample size is being multiple by 10% . The calculation as followed:
N = sample size
= 226 x 10% (drop out) = 22 subject
= 22 + 227
= 248 subject.
3.5 Data Collection
3.5 1 Antropometry measurement
Anthropometry which includes body weight and height measurements were used in determining the subject’s Body Mass Index (BMI) by dividing the weight (kg) by height (m²). The height was measured using a body meter, SECA, 208 (Germany) to the nearest 0.5 cm and the weight was measured using a digital weighing scale, Tanita (Japan). Procedures are as below:
For measuring height:
The equipment was mounted on the wall and the subject was bare footed.
Both feet were closed together with the heels in contact with the wall, same as the shoulder, back and the buttocks.
With the head facing forward the height of the subjects were then measured.
For measuring weight:
The body weight was being measured in kilograms to the nearest 0.5 kg using the digital weighing scale with the subjects’ shoes off and light clothing.
Then, they were asked to step onto the equipment and stand straight with both hands placed on their side.
The measurement appeared on the screen of equipment and was recorded.
Waist circumference
With participant standing and arm at the sides. Feet together and abdominal relax, a horizontal measurement is taken at narrowest part of the torso (above the umbilicus and below the xiphoid process)
Hip circumference
With the subject standing, leg slishtly apart (10 cm), a horizontal measurement is taken at the maximal circumference of the hip/proximal thigh, just below the gluteal fold.
http://healthfreedoms.org/files/2012/07/Waist-to-Hip-Ratio-%E2%80%93-How-can-measure-Waist-and-Hip-Ratio.jpg
Figure 3.2 Figure of waist and hip circumference measurement
3.6 Waist-to-Hip Ratio
Waist-to-hip ratio compares circumferences of the waist to the circumference of the hip. WHR was expressed as a ratio, using the formula:
WHR = Hip Circumference ÷ Waist Circumference
Where:
WHR = waist-to-hip ratio
WC = waist circumference
HC = hip circumference
3.6 Body Mass Index Measurement (BMI)
The BMI (kg/m2) value of body mass index was calculated using WHO, (2007). It was used to analyze and differentiate subjects according to the underweight, normal, overweight and obese category.
Table 3.2
Classification of Body Mass Index (kg/m²) for male by age
Age
Underweight
Normal weight
Overweight
Obese
10
17.1 – 18.5
18.6 – 21.5
> 21.5
11
17.1 – 19
19.1 – 22.5
> 22.5
Note. From “World health organization,” (2007). Retrieved September 20, 2012, from: http://www.who.int/growthref/who2007_bmi_for_age/en/index.html
Table 3.3
Classification of Body Mass Index (kg/m²) for female
Age
Underweight
Normal weight
Overweight
Obese
10
16.6 – 19
19.1 – 22.5
> 22.5
11
17.4 – 19.9
20 – 23.7
> 23.7
Note. From “World health organization,” (2007). Retrieved September 20, 2012, from: http://www.who.int/growthref/who2007_bmi_for_age/en/index.html
3.7 Skinfold Measurement
Skinfold measurement was made on the right side of the body with subject standing upright. The clipper was placed directly on the skin surface, 1 cm away from the thumb and finger, perpendicular to the skinfold, and halfway between the crest and the base of the fold. A pinch was maintained while reading the clipper. Wait 1 to 2 second (not longer) before reading caliper. Take duplicate measurement at each site, and retest if duplication measurement are not within 1 to 2 mm. Rotate through measurement sites to regain normal texture and thickness calculation based on ACSM (2010), 4 site formula (triceps, biceps, subscapular and suprailiac).
Instrument:
Skinfol clipper: SFCH80 Harpenden UK range 80mm
Procedures are as below:
Triceps: vertical fold: on the posterior midline of the upper arms, halfway between the acromion and olecranon processes, with the arms held freely to the side of the body.
Biceps: vertical fold: on the anterior aspects of the arms over the belly of the biceps muscle, 1 cm above the level used to mark the triceps site.
Subscapula: diagonal fold (at a 45-degree angle); 1 to 2 cm below the inferior angle axillary line immediately superior to the iliac crest.
Suprailiac: diagonal fold; in line with the natural angle of the iliac crest taken in the anterior axillary line immediately superior to the iliac crest.
Calculation: Equation developed by Durnin and Rahama (1967) to predict percentage total body fat (%TBF) as follows:
Formula density: Equation for boy = 1.1533 – 0.0643 (x)
Equation for girl = 1.1549 – 0.0678 (x)
(x) = log of sum of skinfold at 4 sites (triceps, biceps, subscapular and suprailiac)
Formula total body fat (TBF%) = (4.95 / Dencity – 4.5) x 100
3.8 Body fat percentage
The body fat percentage was taken using Bio-impedance Analyzer, Karada (810), (Omron, Japan). It measures the body fat percentage in relation to lean body mass. A normal balance of body fat to lean body mass is associated with good health and longevity. Procedures are explained as below;
In straight standing position, subjects were to hold the equipment, grab the handle, and with the hand extend 90° from their body.
Measurement was appeared on the screen of equipment and was recorded.
Physical Fitness Test
Queen college step test (cardiovascular)
The Queen College Step test had been used to measure the cardio respiratory or aerobic fitness. According to Bolboli et al. (2008), it was quoted to predict maximum oxygen consumption and the reliability of the 3-minute step test was investigated with a specific rhythm. The procedures suggested are explained as below:
Subject was ask to step up and down on the step box height 30.5 cm at 24 cycles (up-up-down-down) a minute (metronome setting of 96) for 3 minutes.
Immediately after 3 minutes of stepping, the subjects were required to sit down.
A 60 second heart rate will be taken starting 5 seconds after the completion of stepping.
If the subject does not complete the test, they have to restart again.
The subject score is total 60 second pulse rate following 3 minutes of stepping.
Table 3.4
Queen Step test norms
Score Age
5
4
3
2
1
Male
10
71 – 92
93 – 113
118 – 142
>143
11
76 – 99
100 – 124
125 – 148
>150
12
24 -34
12 – 23
1 – 11
>0
Female
10
74 – 95
96 – 123
125 – 148
>150
11
83 – 99
100 -129
130 – 153
>154
12
78 – 107
108 – 137
138 – 167
>168
Note. From “Measurement by the physical educator: Why and how (5th ed),” by David K. Miller, 2006, Boston: McGraw-Hill Humanities Social. Copyright 2006 by David K. Miller. Adapted with permission.
3.9.2 Hand Grip Test (upper body Strength)
A muscular strength refer to the external force that can be generate by a specific muscle group and it can be express either statically or dynamically and isometric strength can be measured using hand grip dynamometer (ACSM, 2010). The hand grip test was measured using Digital Hand Grip Dynamometer (Takei A5401). Procedures are explained as below;
A maximum voluntary grip is performed on a pair of short parallel bars held between the flexed fingers and the palm, with counter-pressure being applied by the thumb.
The subject is verbally encouraged to produce a maximum effort by squeezing the bars as hard as possible and maintaining the maximal effort for 2-3 seconds.
Reset the dynamometer to zero before use. Adjust the handgrip dynamometer to fit the size of the subject’s hand.
The distance between the base and the handle of the dynamometer should approximate the distance between the base of the thumb and the base of the first digit.
The subject stands with the heels, buttocks and back resting against a wall. Set the pointer reading to zero.
Have the subject grip the dynamometer closely to their side of the body. When ready the subject grips as hard as possible to the count of three.
Record the score in the data entry screen and repeat for the other hand (Clerke, 2005).
Table 3.5.
Norms for hand grip test
Male
Female
Age
Wea