Status of the Exercise Habits for Health in Turkish Population: A General Review of the Turkish National Publications

The information about the positive effects of exercise on health is increasing day by day. While minimum exercise values are found for a healthy life, therapeutic and beneficial effects of exercise on many different diseases are also being investigated. American College of Sports Medicine (ACSM) recommends that all healthy adults aged 18-65 years should do 5 days a week, 30 minutes of moderate exercise, or 3 days a week, 20 minutes of vigorous exercise [1]. It has also been shown in many kinds of research that at least 10,000 steps per day should be taken for a healthy life [2,3]. Despite known lots of benefits of exercise, 31.1% of adults in the world’s population are physically inactive [4]. It has been shown that 51.6% of the American population meet aerobic activity suggestions, 29.3% fulfill muscle-strengthening recommendations and 20.6% meet both [5]. It has also been reported in America that 300,000 people have died each year from bad diet and less exercise [6]. This review concentrated on the studies about exercise habits of the Turkish population based on Turkish publications. This study aims to reveal the general situation of health-related exercise studies in Turkey.

It has been several studies on the exercise habits of various populations within Turkey. A study on 542 students in Adıyaman University showed that 204 students were normal weight, 278 were overweight and 60 were obese. Additionally, to the average score of the university students’ healthy lifestyle behaviors, exercise was the lowest [7]. Same lowest score has been shown in Elazığ, Malatya provinces [8,9]. In a study involving 604 nursing students, it was reported that only one-third of the students were exercising, despite having exercise facilities [10]. In Afyon and Denizli, 316 health workers working at universities and state hospitals have shown that their exercise habits are very low [11]. In the province of Edirne, it was revealed that the exercise habits were at a very low level in the survey that included 410 teachers [12]. Ankara showed that only 14.7% of 849 school personnel exercise, working in primary schools in the central districts of Ankara [13]. In a study involving a total of 391 students in Kocaeli province, it was determined that weekly exercise periods of about four quarters of the group were insufficient. In addition, it has been reported that inactivity behaviors such as television watching, and computer use are very common in the group [14]. In addition, in a survey conducted in a sports center in Ankara, the frequency of exercise of 504 members was followed and found to be significantly lower than adequate levels [15]. In a survey attended by 206 health personnel, it has been revealed that 59.0% of doctors, 49.2% of dentists, and 68.9% of nurses did not do any sports [16]. Contrary to this, according to the investigation that 1000 people are included in the 18-80 age range in İzmir province, the first two actions taken by people to protect their health are nutrition and exercise [17]. In Turkish national publications, there are many pieces of research on women’s exercise habits. In a survey of 365 married women residing in the Ankara Castle region, it was shown that the lowest score among the health indicators was exercise [18]. Similarly, Altıparmak stated that exercise was at the lowest level in the analyzes that 350 women participated in Altıparmak [19]. In the province of Edirne, it has been shown that women perform the least amount of exercise in the result of the research that the teachers of 33 elementary schools have participated [12]. Numerous studies comparing men’s and women’s exercise habits have shown that men exercise more [12,15,20-22]. Research have also shown that single people exercise more than married people [23,24]. In a very current study, 75,7% of 481 university students was found physically inactive [25]. Considering all specified data, it is clear that the level of exercise extremely poor in Turkey.

Açıksöz [26] think that although people have positive aspects of exercising, they are having trouble turning it into exercise activity. Among the 156 students studying in Çanakkale [27], it was shown that the exercise levels of the 2nd-grade students were higher than the 1st-grade students. It has been stated by researchers that the practical courses taken at the 2nd term may have provided this. In addition, Demirdöken [28] emphasize the importance of age and marital status among the factors that affect women to exercise. In the study conducted in the Ankara Kalesi region, it is thought that a large majority of women cannot exercise because of being a housewife, having responsibilities such as housework, childcare, lack of exercise facilities, and inadequate socioeconomic status. Researchers emphasize that women should be aware of regular exercise and be directed to exercise programs that take into account their preferences [18]. In addition, low exercise habits of women are thought to be influential in working status, family type, pregnancy, and the number of living children. Exercise points for women who have a small family structure and who have 1-2 pregnancies are higher than those who have 3 or more pregnancies with a large family structure. However, it is also thought that women do not perceive exercise as a part of a healthy life, depending on their personal and cultural characteristics [19].
Ünalan suggest that men have a high level of exercise and that they have the freedom to move freely in this area while girls are associated with gender-related and cultural limitations of having limited mobility. The group also notes that the physical and emotional disadvantages of living in student dormitories are limited for exercise. However, they also stated that staying with family in their own home reflects the existence of a certain economic power, which can also be effective in providing exercise regulation [22]. Kasırga [25] stated that the obstacle perceptions about exercise are a barrier to exercise participation. Geçkil [9] emphasize that efforts to improve health should aim to increase the exercise levels of adolescents. The research group also proposed relaxation exercises to cope with stress and stated that the “demonstration method” could be useful in teaching and practicing these exercises [9]. Kara et al. [14] suggesting that the lack of physical activity during the last 7 days and the lack of participation in physical education classes in the school may be related to suicidal ideation over the last year. In addition, there is a need for new politics in areas such as transport, sports, entertainment, urban planning to make young people more active, and that this policy should aim to encourage people to use their bodies more in daily activities. Beyond these, Baştuğ [29] conducted an 8-week aerobic exercise study on 80 women who did not practice sports and found that the pre-exercise weight average was 65.76 ± 10.31 kg and 62,36 ± 9,18 kg after exercise. However, the body mass index of women participating in the study was found to be better at the end of the study. In addition, it has been observed that the self-esteem of women increased significantly, and that the psychological well-being increased. In another study involving 72 sedentary individuals, positive changes in body weight, resting heart rate, aerobic and anaerobic strength, and flexibility were observed by 12-week aerobic exercise [30]. Ülger [31] remarked educating adolescents about awareness of physical activity benefits has rewarding effects on physical activity participation.

In the Turkish national publications, the number of researches on the effects of exercise on diseases is increasing. Çakır [32] have been included 2M Cardle patients (a disease due to myophosphorylase deficiency, which started to show signs of exhaustion resistance, fatigue, muscle aches, cramps during exercise and often in the twenties or thirties) in a low-intensity exercise program. In two patients who regularly participated in the exercise program, no health problems were observed, and in both patients, improved grip strength, 10-meter walking time, and functional capacities were observed after the exercise program. Çakır [32] emphasized that exercise in patients with McArdle increases functional capacity even if exercise is performed for a short time and at low severity, and therefore patients should be encouraged to participate in physical activity. In 57.9% of 38 patients discharged with cerebrovascular disease diagnosis, exercise participation problems such as not being able to exercise effectively and not wanting to exercise were found and contracture, deformity, and atrophy were developed in 26.3% of patients with inadequate exercise. The reasons for not participating in exercises include lack of adequate information about the physical therapy program during discharge, limited physiotherapist needs of the patients due to limited financial resources of the patient, inability of the patient’s relatives to make the exercise program provided by the physiotherapist during the monitoring, it is indicated that they cannot receive support from another neighbor [33].
In a study of 439 patients with hypertension, researchers showed that 54.2% of patients did not exercise. According to Body Mass Index (BMI) values, the proportion of obese patients in this group of hypertension was found to be 56.4% [34]. American College of Sports Medicine treats people with low back pain as a separate group in the recently published book [1]. Diracoglu [16] have shown that a great majority of 206 health personnel with pain in the lumbar region have never exercised. Among the groups involved in the study, all groups (doctors, nurses, and patient caregivers) without the physician thought that medical treatment was at least as effective as exercise. In a study of the effects of exercise on the immune system, it was noted that moderate-intensity endurance exercise had a lasting, meaningful, and positive effect on Natural Killer activity [35]. In their earlier studies, Koz [36] have shown that swimming exercise increases lipid peroxidation in the muscles. It has been stated in the study that acute exercises may damage tissues via free radicals and lipid peroxidation, but chronic and regular exercises may be beneficial in increasing tissue defenses against lipid peroxidation. Ersöz [37] emphasized that exercise and physical conditioning should be recommended to those who have undergone liver transplantation without hesitation. Studies have shown that exercise habits increase after intensive education in patients with type 2 diabetes [38,39]. In another important finding, Kafkas [40] showed that the duration of exercise habit was a positive contribution to diabetes and blood pressure. The effects of exercise on depressive symptoms were investigated in a study involving 48 women and it was shown that aerobic exercises were effective in reducing the level of depression [41]. In another finding, Alkaya [42] have shown that low exercise may be associated with poor sleep quality [10]. As in many European countries, Akalan [42] showed that the increasing prevalence of obesity, in Turkey. For this reason, it is necessary to focus on physical activity and nutritional behavior before it is too late in children.

In this study, the results of exercise habits of people living, working or studying in various cities of Turkey have been reviewed. The results of the studies suggest that exercise habits in Turkey at a very low level. Researchers in Turkey are carried out numerous studies on the effects of exercise on health. The benefits of regular exercise on both sedentary individuals and patients have been revealed by many studies. The results of the research should be evaluated by the practitioners and the exercise habits of the population should be increased.

1. Pescatello LS, Riebe D, Thompson PD (2013) ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins, Philadelphia, Pennsylvania, USA.
2. Choi BC, Pak AW, Choi JC (2007) Daily step goal of 10,000 steps: A literature review. Clin Invest Med 30(3): 146-151.
3. Schneider PL, Bassett DR, Thompson DL, Pronk NP, Bielak KM (2006) Effects of a 10,000 steps per day goal in overweight adults. Am J Health Promot 21(2): 85-89.
4. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, et al. (2012) Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet 380(9838): 247-257.
5. Centers for Disease Control and Prevention (2013) Adult participation in aerobic and muscle-strengthening physical activities--United States, 2011. MMWR 62(17): 326-330.
6. McGinnis JM, Foege WH (1993) Actual causes of death in the United States. JAMA 270(18): 2207-2212.
7. Murathan F, Uğurlu FM, Murathan T, Koç M (2017) Comparison of physical education and sports school students and health school students' healthy lifestyle behaviors (adiyaman university example). Turkish Studies 12(3): 493-504.
8. Cihangiroğlu Z, Deveci (2011) Healthy lifestyle behaviors of Fırat University Elazig Health School students and influencing factors. Fırat Medical Journal 16(2): 78-83.
9. Geçkil E, Yıldız S (2006) The effects of nutrition and stress coping training for adolescents on health promotion. Journal of Cumhuriyet University School of Nursing 10(2): 19-28.
10. Alkaya SA, Studying CB (2017) Exercise behavior and sleep quality of nursing students. Dokuz Eylul University Faculty of Nursing Electronic Journal 10(4): 236-241.
11. Yalçınkaya M, Özer FG, Karamanoğlu AY (2007) Evaluation of healthy lifestyle behaviors in healthcare workers. TAF Preventive Medicine Bulletin 6(6): 409-420.
12. Tokuç B, Berberoğlu U (2007) Health-promoting behaviors of teachers working in Edirne central district primary schools. TAF Preventive Medicine Bulletin 6(6): 421-426.
13. Şerife A, Çelen Ü, Yelda Ö, Tabak RS, Piyal B (2006) Health behavior of primary school employees in Ankara central districts. TAF Preventive Medicine Bulletin 5(2): 83-92.
14. Kara B, Hatun Ş, Aydoğan M, Babaoğlu K, GÖkalp AS (2003) Evaluation of risky behaviors in high school students in Kocaeli province. Journal of Child Health and Diseases 46: 30-37.
15. DÖlek BE (2017) Determination of exercise behaviors of healthy adult individuals over 18 years of age Examination of exercise habits of healthy adult individuals over the age of 18. Journal of Human Sciences 14(2): 1924-1937.
16. Diraçoğlu D (2006) Musculoskeletal pain in healthcare personnel. Turkiye Klinikleri Journal of Medical Sciences 26(2): 132-139.
17. Araz A, Harlak H, Meşe G (2007) Health behaviors and use of alternative treatment. TAF Preventive Medicine Bulletin 6(2): 112-122.
18. Bilgili N, Ayaz S (2009) Women's health promotion behaviors and affecting factors. TAF Prev Med Bull 8(6): 497-502.
19. Altıparmak S, Koca Kutlu A (2009) Health promotion behaviors and affecting factors in 15-49 age group women. TAF Prev Med Bull 8(5): 421-426.
20. Kocaakman M, Aksoy G, Eker HH (2010) Healthy lifestyle behaviors of nursing school students in I SD Ü Medical Faculty Journal 17(2): 19-24.
21. Tamba GYDDH (2011) Healthy lifestyle behaviors of the students of Hatay health college and the factors affecting them. Hacettepe University Nursing Faculty Journal 18(2): 47-58.
22. Kasırga D, Şenol V, Öztürk A, Erkorkmaz Ü (2007) Investigation of the relationship between healthy lifestyle behaviors and self-care ability levels of students studying in the health and social programs of vocational schools. Turgut Özal Medical Center Journal 14(2): 101-109.
23. İlban MO, Özcan K (2003) A Study on the differentiation in leisure time preferences according to demographic characteristics (nevşehir example). Proceedings Book, Turkey, pp. 21-22.
24. Öcalan M (1996) Leisure activities of teachers working in eastern city centers and place of sports. Fırat University Unpublished Master Thesis, Elazığ.
25. Kasırga, Z, Odabaşıoğlu M, Dedeoğlu T (2021) Investigation of physical activity level and exercise benefit / disability perceptions among university students. Journal of Social Research and Management 1(1): 83-95.
26. AçıksÖz S, Uzun Ş, Arslan F (2013) Investigation of the relationship between nursing students' perception of health and their health promotion behaviors. Gulhane Medical Journal 55: 181-187.
27. Çelik GO, Malak AT, Bektaş M, Yılmaz D, Yümer AS, et al. (2009) Investigation of factors affecting health promotion behaviors of health college students. AJCI 3(1): 164-169.
28. DemirdÖken Ç, Atan T, Deryahanoğlu G, Çiçek G, DemirdÖken S (2017) Factors that motivate females to do exercise Factors that motivate women to exercise. Journal of Human Sciences 14(2): 2140-2148.
29. Baştuğ G, Akandere M, Yildiz H (2011) The effect of aerobic exercise on body composition and self-identification values in sedentary young women. Journal of Sports and Performance Research 2(2): 22-27.
30. Çolakoğlu FF, Karacan S (2006) The effect of aerobic exercise on some physiological parameters in young women and middle-aged women. Kastamonu Education Journal 14(1): 277-284.
31. Ülger Ö, Fil Balkan A, Demirel A, Keklicek H, Ceren A et al. (2018) Examination of the change in activity levels of young individuals who received awareness training on physical activity. Journal of Ergotherapy and Rehabilitation 7(1): 17-26.
32. Çakır T, Filiz MB, Otağ B, Toraman NF (2017) The effect of low intensity, short duration aerobic exercise on functional capacity and quality of life in two patients diagnosed with McArdle. Turk J Phys Med Rehab 63(1): 82-87.
33. Akdemir N, Bostanoğlu H, Yurtsever S, Kutlutürkan S, Kapucu S, et al. (2011) Home care service requirements for the health problems experienced by bedridden patients at home. Dicle Medical Journal 38(1): 57-65.
34. Meltem Ç, Özdemir O, Ocaktan ME (2006) Treatment-control status and behavioral factors in hypertensive patients over the age of 35 in the Park Health Center area. Ankara University Faculty of Medicine Magazine 59: 144-150.
35. Koz M, ErsÖZ G, BabÜL A (1997) Immune response to physical exercise: possible mechanisms of action. Turkiye Klinikleri Journal of Medical Sciences 17(2): 85-90.
36. Koz M, Erbaş D, Bilgihan A, Aricioğlu A (1992) Effects of acute swimming exercise on muscle and erythrocyte malondialdehyde, serum myoglobin, and plasma ascorbic acid concentrations. Canadian journal of physiology and pharmacology 70(10): 1392-1395.
37. Ersoz G, Ersoz S (2003) Changes in portal blood flow following acute exercise in liver transplant recipients. Transplant Proc 35(4): 1456-1457.
38. Acemoğlu H, Ertem M, Bahçeci M, Tuzcu A (2006) Health service utilization levels of patients with type 2 diabetes mellitus. EAJM 38: 89-95.
39. Hekimsoy Z, Kandoğan G, Dolu D, AguĢ A, Aslan L (2001) Yoğun diyabet eğitim Öncesi ve sonrasi hasta bilgi düzeyinin değ Türk Diyabet Yıllığı 2001-2002.
40. Kafkas ME, Çınarlı FS, Yılmaz N, Eken Ö, Kızılay F, et al. (2017) Investigation of the relationship between exercise habit duration and diabetes and blood pressure. European Conference on Science Art Culture (ECSAC) pp. 90-91.
41. Aylaz R, Güllü E, Güneş G (2011) The effect of aerobic walking exercise on depressive symptoms. DEUHYO ED 4(4): 172-177.
42. Akalan C (2013) Body composition changes among 7-14 years old male children living in Ankara province-a fifteen-year cross-sectional study. Life Science Journal 10(600): 90-312.