Firdous Jahan^1*, Muhammad Siddiqui², Joseph Francis³, Hawriaa Al Fatlawi³, Kimia Majid Askari³

¹Department of Family Medicine College of Medicine and Health Sciences (COMHS) National University Science and Technology

²Population Health, Saskatchewan Health Authority, Regina, Canada

³Medical Student, College of Medicine and Health Sciences (COMHS) National University Science and Technology

*Corresponding Author: Firdous Jahan, Department of Family Medicine College of Medicine and Health Sciences (COMHS) National University Science and Technology.

Abstract
Background
The lifestyle of medical students is reasonable. One of the hardest things to do while in medical school is to be physically active; similarly, to others with busy schedules, medical students can need extra time to engage in regular exercise. The primary purpose of this study was to assess the healthy lifestyle, knowledge, and practice of a balanced diet and physical activity among medical students.

Methods
A questionnaire-based cross-sectional study was conducted in the College of Medicine and College of Pharmacy. The pre-tested, structured questionnaire was used. All medical students were invited to participate by completing an online questionnaire. The study questionnaire consists of three parts. The first part includes demographics. The second part relates to exercising, personal dietary habits, and other factors influencing a healthy lifestyle. An electronic survey link was sent out via email. Statistical analysis was performed in SPSS 25 software.

Results
A total of 98 students participated, of which 93 % were aged between 20 to 25 years. More than half (55 %) of the study participants perform physical activity. The common reason for physical activity was to stay physically active (35 %), for proper health (28 %), and for fun (25 %). Most study participants (72 %) do not have a balanced diet. Lack of time (43 %) and unavailability of a balanced diet (34 %) were the familiar study participants' responses regarding lack of balanced diet intake. 90 % of student consumes tea or coffee, and 48 % diet or skip meal due to lack of accessibility. Lack of time (70 %) is one of the significant barriers to performing physical activity, whereas poor time management (36 %) and work-related stress (49 %) is the other contributing factor. 

Conclusion
Medical students in their final year are aware of healthy lifestyles. However, there are some barriers to practice. The study findings help raise awareness of healthy living behaviors that can be encouraged among students who will serve as fit role models for society in the future. The College of Medicine's decision to build a fitness center and incorporate nutrition-related lectures and clinical experiences throughout the curriculum is noteworthy.

Keywords: Undergraduate, medical students, healthy lifestyle, physical activity, balanced diet

Introduction
Medical students better understand healthy diets and lifestyles; however, their practices may need to be revised to maintain good health. The world is facing an epidemic of non-communicable diseases, and lack of physical activity is found to be one of the significant risk factors for these diseases [1-2]. Cardiovascular disease, obesity, and diabetes are now among the most prevalent and preventable health problems. These diseases have been strongly associated with unhealthy lifestyle habits, including inappropriate nutrition, lack of exercise, smoking, alcohol consumption, overuse of caffeine, and improper sleeping [3-4]. A balanced diet and regular physical activity are the most important practices a person can do to stay healthy; they can also help control body weight and reduce risks for cardiovascular disease, type 2 diabetes, metabolic syndrome, and some cancers [5-6]. Regular exercise strengthens bones and muscles, prevents falls among older adults, and improves mental health [7-8].

Medical students come under the vulnerable group because of a long college study schedule, clinical postings, and other curriculum activities. Their living in the hostel or as day scholars away from parents and families reflected upon their diet habits and significantly reflected the prevalence of non-communicable diseases [9-10]. Encouraging healthy lifestyle practices among medical students who will be future doctors would facilitate the cadre of healthy physicians who are more likely to provide proper health counseling [11-12]. 

Medical students have an appropriate lifestyle. Staying physically active during medical school is one of the hardest things; as with busy schedules, medical students may need more time to exercise regularly. The primary purpose of this study was to assess the healthy lifestyle, knowledge, and practice of a balanced diet and physical activity among medical students. 

Methodology 
The College of Medicine and Health Sciences conducted a questionnaire-based cross-sectional study. Study participants were selected based on a convenient nonprobability sampling technique. All students in clinical year were invited to participate. An online questionnaire was used to minimize face-to-face interactions and facilitate participation. The administrative time for the filling was about 30 minutes. The study questionnaire consists of three parts. The first part includes demographics; the second is related to exercising and dietary habits; the third is related to other factors influencing a healthy lifestyle. The questionnaire was pilot tested with 20 students to ensure fluency and ease of understanding of inquiry points.

A favorable ethical opinion was obtained from the National University Science and Technology Research Ethics Board before the commencement of the study. Written informed consent was obtained from the study participants. Before conducting the survey, the study's purpose was explained at the beginning of the electronic survey. The respondents were allowed to ask questions via a dedicated email address for the survey. All information about you, the students, collected during the study was kept confidential, secure, and accessible only to the research team members. All data was anonymized as much as possible, and students were not identifiable from any data collected. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive analyses were expressed in terms of percentages.

Results
A total of 98 students participated, of which 93 % were aged between 20 to 25 years and 7 % were between 25 to 30 years. Two-thirds (71 %) of the participants were Omani, and 29 % were non-Omani students. Nearly half of the students had normal BMI (18.5-22.9 kg/m2), and 8 % were underweight (<18.5 kg/m2) (Table 1). Most of the students were nonsmokers (98 %).

Table 1: Selected study participant’s characteristics

Study participants were asked multiple questions about their physical activity. More than half (55 %) of the study participants perform physical activity. The common reason for physical activity was to stay physically active (35 %), for proper health (28 %), and for fun (25 %). The most prevalent motivation for exercise was to keep themselves healthy (45 %) and smart (25 %) (Table 2).

Table 2: Physical Activity of study participants

Students’ dietary habits and food intake are shown in Table 3. Most study participants (72 %) do not have a balanced diet. Lack of time (43 %) and unavailability of a balanced diet (34 %) were the familiar study participants’ responses regarding lack of balanced diet intake. More than half (59 %) of students eat cafeteria foods, whereas 35 % have homemade food. Most students take two (40 %) or three (48 %) meals daily ay. Sixty percent of students consumed junk food, 33 % drank carbonated cold drinks, and 47 % consumed sweets (halwa/sweets/pastries) thrice in the past week.

Table 3: Study participants’ dietary habits and food intake

Students were asked about barriers to a healthy lifestyle (Table 4). Most study participants (62 %) sleep for 4-6 hours at night, and 51 % take naps during the daytime. 90 % of students consume tea or coffee, and 48 % diet or skip meals due to lack of accessibility. Lack of time (70 %) is one of the major barriers to performing physical activity, whereas poor time management (36 %) and work-related stress (49 %) is the other contributing factor.

Table 4: Barriers to a Healthy Lifestyle

Discussion
Generally, medical students tend to adopt undesirable lifestyle habits. For the mental and physical fitness of the students, they have to follow a balanced diet and healthy eating habits. Scientific data proves that unhealthy eating habits lead to many disorders in all age groups. Many students confront changes in living conditions and health-promoting/damaging adjustments to lifestyle and environment [13]. A recent study noted that the average weight gain of freshmen during the first term of university was 1.3-3.1 kg [14]. It is a well-established fact that healthy lifestyles not only prevent disease but also promote a sense of well-being [15].

Obesity is a known risk factor for cardiovascular disease and heart failure (HF) [16], including in Asia [17] indicating high BMI. The majority of the study participants in our study have shown pre-obesity and obesity categories of BMI [Table 1]. This study shows that 34.7 % of students are physically active for physical fitness, and 27.6 % are physically active for proper health [Table 2].

A healthy lifestyle of a person depends upon personal behavioural choices. A health-promoting lifestyle has a multidimensional pattern of self-initiation and perceptions. Health-promoting behaviours include health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management [18]. Al Qahtani Regardless of their academic standing, most medical students have low physical activity and harmful eating habits. Medical scholars require [19].

Most of our study participants (72 %) do not have a balanced diet. Lack of time (43 %) and unavailability of a balanced diet (34 %) were the familiar study participants' responses regarding lack of balanced diet intake. Literature has reported that improving students' self-awareness, self-efficacy, and motivation to serve as role models for healthy behaviour for their patients may be to implement such curriculum initiatives that target fundamental lifestyle habits [20-21].

More than half (59 %) of students eat cafeteria food, whereas 35 % have homemade food. Most students take two (40 %) or three (48 %) meals daily. Sixty percent of students consumed junk food, 33 % drank carbonated cold drinks, and 47 % consumed sweets (halwa/sweets/pastries) thrice in the past week [Table 3]. Vibhuti et al. reported that consuming high-quality meals is as important as getting the right portions and amounts. There is growing evidence from studies and publications across the globe that a regular diet of fruits and vegetables is beneficial. As future doctors, good eating habits are even more crucial for medical students, and those who don't prioritize them personally will be less inclined to support patient health promotion initiatives [22-23].

The majority of students in this study consume tea or coffee, and half of them skip meals due to lack of accessibility. Lack of time (70 %) is one of the significant barriers to performing physical activity, whereas poor time management (36 %) and work-related stress (49 %) are the other contributing factors [Table 4]. Mckerrow et al. reported that although students may show improved wellness, concerns remained about emotional difficulties, such as anxiety and irritability, and feeling a lack of control [24].

Study limitations: This study relied on the self-reported questionnaire and only clinical year students, which might result in missing information. Sample size of the study is relatively small, which may restrict generalizability.

Conclusion
Study results will be helpful in awareness regarding healthy lifestyle practices that can be promoted among students who would become fit future role models for society. It is significant that the College of Medicine has added a fitness center and has integrated lectures and clinical experiences relating to nutrition throughout the curriculum. Additionally, incorporating behavioral counseling into the didactic and experiential components of the program may improve students' abilities to practice preventive counseling. Such educational initiatives may result in healthier lifestyles and better health outcomes for aspiring doctors and their patients.

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