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The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children with Simple Obesity: A Cross-Sectional Observational Study

Year 2022, , 106 - 112, 20.12.2022
https://doi.org/10.33438/ijdshs.1143176

Abstract

Background:Obesity is considered to impact physical fitness in children. There is scarce data on indices of physical fitness in Indian children with simple obesity We aimed to determine the effects of weight status on indices of physical fitness in North Indian children with simple obesity. Methods: Vital parameters such as blood pressure, pulse rate, respiratory rate, and rate of perceived exertionwere measured before and after the six-minute walk test (6MWT) in obese children (BMI ≥95th percentile) (Group 2, n=70) aged 5-15 years and were compared to non-obese children (BMI 25th to 75th percentile) (Group 1, n=70). President's Challenge Fitness test was used to measure the physical fitness of each subject. Results: The mean age, weight and BMI of children in Group 1 and Group 2 were 9.07±2.88 and 8.93±3.13, 27.42±12.08 and 48.87±17.89 and 16.54±4.26 and 27.30±5.2, respectively. The mean blood pressure recorded before 6MWT was similar in the two groups but pulse rate, respiratory rate, and BORG scale values were higher in Group 2. Children in Group 2 also showed significant elevation of vital parameters compared to Group 1 after the 6MWT. Additionally, children in Group 2 performed poorly in all the physical fitness parameters compared to those in Group 1 following the President’s Challenge Fitness test. Conclusions: Children with obesity showed several alterations in vital parameters and indices of physical fitness. Further studies are required to access the effect of interventions aimed at improving the physical fitness in children with obesity.

References

  • Bi, C., Yang, J., Sun, J., Song, Y., Wu, X., & Zhang, F. (2019). Benefits of normal body mass index on physical fitness: A cross-sectional study among children and adolescents in Xinjiang Uyghur Autonomous Region, China. PLOS ONE, 14(8), e0220863.
  • Blüher, M. (2019). Obesity: global epidemiology and pathogenesis. Nature Reviews. Endocrinology, 15(5), 288–298.
  • Ceschia, A., Giacomini, S., Santarossa, S., Rugo, M., Salvadego, D., Da Ponte, A., Lazzer, S. (2016). Deleterious effects of obesity on physical fitness in pre-pubertal children. European Journal of Sport Science, 16(2), 271–278.
  • Charan, J., & Biswas, T. (2013). How to Calculate Sample Size for Different Study Designs in Medical Research? Indian Journal of Psychological Medicine, 35(2), 121.
  • Chen, X., Cui, J., Zhang, Y., & Peng, W. (2020). The association between BMI and health-related physical fitness among Chinese college students: A cross-sectional study. BMC Public Health, 20(1), 1–7.
  • Contreras-Osorio, F., Guzmán-Guzmán, I. P., Cerda-Vega, E., Chirosa-Ríos, L., Ramírez-Campillo, R., & Campos-Jara, C. (2022). Anthropometric Parameters, Physical Activity, Physical Fitness, and Executive Functions among Primary School Children. International Journal of Environmental Research and Public Health, 19(5).
  • Del Corral, T., Tapia-Castañeda, J., Ríos-Pérez, G., Triviño-López, P., Sastre-Moreno, N., Fernández, P. G., & López-de-Uralde-Villanueva, I. (2022). Assessment of the determinants of changes and test-retest reliability in the 6-min walk test performance over a 4-month period in healthy 6-12-year-old children. European Journal of Applied Physiology, 122(4), 935–944.
  • Dayal, D., Gupta, S., Raithatha, D., & Jayashree, M. (2020). Missing during COVID-19 lockdown: Children with onset of type 1 diabetes. Acta Paediatrica (Oslo, Norway : 1992), 109(10), 2144–2146.
  • Dayal, D., Jain, H., Attri, S. V., Bharti, B., & Bhalla, A. K. (2014). Relationship of High Sensitivity C-Reactive Protein Levels to Anthropometric and other Metabolic Parameters in Indian Children with Simple Overweight and Obesity. Journal of Clinical and Diagnostic Research : JCDR, 8(8).
  • Dayal, D., & Kumar, T. (2019). High prevalence of thyroid dysfunction in children with simple obesity. Indian J Pediatr, 56(4), 331.
  • Dixon, A. E., & Peters, U. (2018). The effect of obesity on lung function. Expert Review of Respiratory Medicine, 12(9), 755.
  • Dumith, S. C., Ramires, V. V., Souza, M. A., Moraes, D. S., Petry, F. G., Oliveira, E. S., Hallal, P. C. (2010). Overweight/obesity and physical fitness among children and adolescents. Journal of Physical Activity & Health, 7(5), 641–648.
  • Farah, B. Q., Andrade-Lima, A., Germano-Soares, A. H., Christofaro, D. G. D., de Barros, M. V. G., do Prado, W. L., & Ritti-Dias, R. M. (2018). Physical Activity and Heart Rate Variability in Adolescents with Abdominal Obesity. Pediatric Cardiology, 39(3), 466–472.
  • Farah, B. Q., Prado, W. L. do, Tenório, T. R. dos S., & Ritti-Dias, R. M. (2013). Heart rate variability and its relationship with central and general obesity in obese normotensive adolescents. Einstein (Sao Paulo, Brazil), 11(3), 285–290.
  • Fell, B. L., Hanekom, S., & Heine, M. (2021). Six-minute walk test protocol variations in low-resource settings – A scoping review. The South African Journal of Physiotherapy, 77(1).
  • Freitas, I. M. G., Miranda, J. A., Mira, P. A. C., Lanna, C. M. M., Lima, J. R. P., & Laterza, M. C. (2014). Cardiac autonomic dysfunction in obese normotensive children and adolescents. Revista Paulista de Pediatria : Orgao Oficial Da Sociedade de Pediatria de Sao Paulo, 32(2), 244–249.
  • Goda, A., & Masuyama, T. (2016). Obesity and Overweight in Asian People. Circulation Journal, 80(12), CJ-16-1087.
  • Hale, Brendon S.;Franks, B. D. (2001). Get Fit! How To Get in Shape To Meet the President’s Challenge. A Handbook for Youth Ages 6-17. (Revised 8/).
  • Huang, Y. C., & Malina, R. M. (2007). BMI and health-related physical fitness in Taiwanese youth 9-18 years. Medicine and Science in Sports and Exercise, 39(4), 701–708.
  • Jehan, S., Myers, A. K., Zizi, F., Pandi-Perumal, S. R., Jean-Louis, G., & McFarlane, S. I. (2018). Obesity, obstructive sleep apnea and type 2 diabetes mellitus: Epidemiology and pathophysiologic insights. Sleep medicine and disorders: international journal, 2(3), 52.
  • Johnston, B. C., Merdad, R., Sherifali, D., Kebbe, M., Birken, C. S., Buchholz, A., … Ball, G. D. C. (2022). Updating the Canadian clinical practice guideline for managing pediatric obesity: a protocol. CMAJ Open, 10(1), E155–E164.
  • Khadilkar, V. V., Khadilkar, A. V., Borade, A. B., & Chiplonkar, S. A. (2012). Body mass index cut-offs for screening for childhood overweight and obesity in Indian children. Indian Pediatrics, 49(1), 29–34.
  • Krishna, P., PrasannaKumar, K. M., Desai, N., & Thennarasu, K. (2006). Blood pressure reference tables for children and adolescents of Karnataka. Indian pediatrics, 43(6), 491.
  • Köchli, S., Endes, K., Steiner, R., Engler, L., Infanger, D., Schmidt-Trucksäss, A., … Hanssen, H. (2019). Obesity, High Blood Pressure, and Physical Activity Determine Vascular Phenotype in Young Children. Hypertension (Dallas, Tex. : 1979), 73(1), 153–161.
  • Koliaki, C., Liatis, S., & Kokkinos, A. (2019). Obesity and cardiovascular disease: revisiting an old relationship. Metabolism: Clinical and Experimental, 92, 98–107.
  • Mak, K. K., Ho, S. Y., Lo, W. S., Thomas, G. N., McManus, A. M., Day, J. R., & Lam, T. H. (2010). Health-related physical fitness and weight status in Hong Kong adolescents. BMC Public Health, 10(1), 1–5.
  • Malina, R. (2007). Physical fitness of children and adolescents in the United States: status and secular change. Medicine and Sport Science, 50, 67–90. Nageswari, K. S., Sharma, R., & Kohli, D. R. (2007). Assessment of respiratory and sympathetic cardiovascular parameters in obese school children. Indian journal of physiology and pharmacology, 51(3), 235.
  • Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806–814.
  • Pacca, D. M., De-Campos, G. C., Zorzi, A. R., Chaim, E. A., & De-Miranda, J. B. (2018). Prevalence of joint pain and osteoarthritis in obese brazilian population. Arquivos Brasileiros de Cirurgia Digestiva : ABCD = Brazilian Archives of Digestive Surgery, 31(1).
  • Palmeira, A. C., Farah, B. Q., Soares, A. H. G., Cavalcante, B. R., Christofaro, D. G. D., De Barros, M. V. G., & Ritti-Dias, R. M. (2017). Association between leisure time and commuting physical activities with heart rate variability in male adolescents. Revista Paulista de Pediatria, 35(3), 302.
  • Pathare, N., Haskvitz, E. M., & Selleck, M. (2012). 6-minute walk test performance in young children who are normal weight and overweight. Cardiopulmonary physical therapy journal, 23(4), 12.
  • Pogorelic, Z., Aralica, M., Jukic, M., Zitko, V., Despot, R., & Juric, I. (2019). Gallbladder disease in children: a 20-year single-center experience. Indian Pediatrics, 56(5), 384-386.
  • Raj, M., Sundaram, K. R., Paul, M., Deepa, A. S., & Kumar, R. K. (2007). Obesity in Indian children: time trends and relationship with hypertension. National Medical Journal of India, 20(6), 288. Reinehr, T. (2018). Long-term effects of adolescent obesity: time to act. Nature Reviews. Endocrinology, 14(3), 183–188.
  • Rodríguez-Colón, S. M., Bixler, E. O., Li, X., Vgontzas, A. N., & Liao, D. (2011). Obesity is associated with impaired cardiac autonomic modulation in children. International Journal of Pediatric Obesity : IJPO : An Official Journal of the International Association for the Study of Obesity, 6(2), 128–134.
  • Rúa-Alonso, M., Rial-Vázquez, J., Nine, I., Lete-Lasa, J. R., Clavel, I., Giráldez-García, M. A., … Iglesias-Soler, E. (2022). Comparison of Physical Fitness Profiles Obtained before and during COVID-19 Pandemic in Two Independent Large Samples of Children and Adolescents: DAFIS Project. International Journal of Environmental Research and Public Health, 19(7).
  • Singh, S. P., Sikri, G., & Garg, M. K. (2008). Body Mass Index and Obesity : Tailoring ‘cut-off’ for an Asian Indian Male Population. Medical Journal, Armed Forces India, 64(4), 350–353.
  • Xu, Y., Mei, M., Wang, H., Yan, Q., & He, G. (2020). Association between Weight Status and Physical Fitness in Chinese Mainland Children and Adolescents: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 17(7).
  • Yadav, J., Jain, N., & Dayal, D. (2018). Alterations of thyroid function in overweight and obese children: An update. Indian Journal of Child Health, 5(3), 145–150.
Year 2022, , 106 - 112, 20.12.2022
https://doi.org/10.33438/ijdshs.1143176

Abstract

References

  • Bi, C., Yang, J., Sun, J., Song, Y., Wu, X., & Zhang, F. (2019). Benefits of normal body mass index on physical fitness: A cross-sectional study among children and adolescents in Xinjiang Uyghur Autonomous Region, China. PLOS ONE, 14(8), e0220863.
  • Blüher, M. (2019). Obesity: global epidemiology and pathogenesis. Nature Reviews. Endocrinology, 15(5), 288–298.
  • Ceschia, A., Giacomini, S., Santarossa, S., Rugo, M., Salvadego, D., Da Ponte, A., Lazzer, S. (2016). Deleterious effects of obesity on physical fitness in pre-pubertal children. European Journal of Sport Science, 16(2), 271–278.
  • Charan, J., & Biswas, T. (2013). How to Calculate Sample Size for Different Study Designs in Medical Research? Indian Journal of Psychological Medicine, 35(2), 121.
  • Chen, X., Cui, J., Zhang, Y., & Peng, W. (2020). The association between BMI and health-related physical fitness among Chinese college students: A cross-sectional study. BMC Public Health, 20(1), 1–7.
  • Contreras-Osorio, F., Guzmán-Guzmán, I. P., Cerda-Vega, E., Chirosa-Ríos, L., Ramírez-Campillo, R., & Campos-Jara, C. (2022). Anthropometric Parameters, Physical Activity, Physical Fitness, and Executive Functions among Primary School Children. International Journal of Environmental Research and Public Health, 19(5).
  • Del Corral, T., Tapia-Castañeda, J., Ríos-Pérez, G., Triviño-López, P., Sastre-Moreno, N., Fernández, P. G., & López-de-Uralde-Villanueva, I. (2022). Assessment of the determinants of changes and test-retest reliability in the 6-min walk test performance over a 4-month period in healthy 6-12-year-old children. European Journal of Applied Physiology, 122(4), 935–944.
  • Dayal, D., Gupta, S., Raithatha, D., & Jayashree, M. (2020). Missing during COVID-19 lockdown: Children with onset of type 1 diabetes. Acta Paediatrica (Oslo, Norway : 1992), 109(10), 2144–2146.
  • Dayal, D., Jain, H., Attri, S. V., Bharti, B., & Bhalla, A. K. (2014). Relationship of High Sensitivity C-Reactive Protein Levels to Anthropometric and other Metabolic Parameters in Indian Children with Simple Overweight and Obesity. Journal of Clinical and Diagnostic Research : JCDR, 8(8).
  • Dayal, D., & Kumar, T. (2019). High prevalence of thyroid dysfunction in children with simple obesity. Indian J Pediatr, 56(4), 331.
  • Dixon, A. E., & Peters, U. (2018). The effect of obesity on lung function. Expert Review of Respiratory Medicine, 12(9), 755.
  • Dumith, S. C., Ramires, V. V., Souza, M. A., Moraes, D. S., Petry, F. G., Oliveira, E. S., Hallal, P. C. (2010). Overweight/obesity and physical fitness among children and adolescents. Journal of Physical Activity & Health, 7(5), 641–648.
  • Farah, B. Q., Andrade-Lima, A., Germano-Soares, A. H., Christofaro, D. G. D., de Barros, M. V. G., do Prado, W. L., & Ritti-Dias, R. M. (2018). Physical Activity and Heart Rate Variability in Adolescents with Abdominal Obesity. Pediatric Cardiology, 39(3), 466–472.
  • Farah, B. Q., Prado, W. L. do, Tenório, T. R. dos S., & Ritti-Dias, R. M. (2013). Heart rate variability and its relationship with central and general obesity in obese normotensive adolescents. Einstein (Sao Paulo, Brazil), 11(3), 285–290.
  • Fell, B. L., Hanekom, S., & Heine, M. (2021). Six-minute walk test protocol variations in low-resource settings – A scoping review. The South African Journal of Physiotherapy, 77(1).
  • Freitas, I. M. G., Miranda, J. A., Mira, P. A. C., Lanna, C. M. M., Lima, J. R. P., & Laterza, M. C. (2014). Cardiac autonomic dysfunction in obese normotensive children and adolescents. Revista Paulista de Pediatria : Orgao Oficial Da Sociedade de Pediatria de Sao Paulo, 32(2), 244–249.
  • Goda, A., & Masuyama, T. (2016). Obesity and Overweight in Asian People. Circulation Journal, 80(12), CJ-16-1087.
  • Hale, Brendon S.;Franks, B. D. (2001). Get Fit! How To Get in Shape To Meet the President’s Challenge. A Handbook for Youth Ages 6-17. (Revised 8/).
  • Huang, Y. C., & Malina, R. M. (2007). BMI and health-related physical fitness in Taiwanese youth 9-18 years. Medicine and Science in Sports and Exercise, 39(4), 701–708.
  • Jehan, S., Myers, A. K., Zizi, F., Pandi-Perumal, S. R., Jean-Louis, G., & McFarlane, S. I. (2018). Obesity, obstructive sleep apnea and type 2 diabetes mellitus: Epidemiology and pathophysiologic insights. Sleep medicine and disorders: international journal, 2(3), 52.
  • Johnston, B. C., Merdad, R., Sherifali, D., Kebbe, M., Birken, C. S., Buchholz, A., … Ball, G. D. C. (2022). Updating the Canadian clinical practice guideline for managing pediatric obesity: a protocol. CMAJ Open, 10(1), E155–E164.
  • Khadilkar, V. V., Khadilkar, A. V., Borade, A. B., & Chiplonkar, S. A. (2012). Body mass index cut-offs for screening for childhood overweight and obesity in Indian children. Indian Pediatrics, 49(1), 29–34.
  • Krishna, P., PrasannaKumar, K. M., Desai, N., & Thennarasu, K. (2006). Blood pressure reference tables for children and adolescents of Karnataka. Indian pediatrics, 43(6), 491.
  • Köchli, S., Endes, K., Steiner, R., Engler, L., Infanger, D., Schmidt-Trucksäss, A., … Hanssen, H. (2019). Obesity, High Blood Pressure, and Physical Activity Determine Vascular Phenotype in Young Children. Hypertension (Dallas, Tex. : 1979), 73(1), 153–161.
  • Koliaki, C., Liatis, S., & Kokkinos, A. (2019). Obesity and cardiovascular disease: revisiting an old relationship. Metabolism: Clinical and Experimental, 92, 98–107.
  • Mak, K. K., Ho, S. Y., Lo, W. S., Thomas, G. N., McManus, A. M., Day, J. R., & Lam, T. H. (2010). Health-related physical fitness and weight status in Hong Kong adolescents. BMC Public Health, 10(1), 1–5.
  • Malina, R. (2007). Physical fitness of children and adolescents in the United States: status and secular change. Medicine and Sport Science, 50, 67–90. Nageswari, K. S., Sharma, R., & Kohli, D. R. (2007). Assessment of respiratory and sympathetic cardiovascular parameters in obese school children. Indian journal of physiology and pharmacology, 51(3), 235.
  • Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806–814.
  • Pacca, D. M., De-Campos, G. C., Zorzi, A. R., Chaim, E. A., & De-Miranda, J. B. (2018). Prevalence of joint pain and osteoarthritis in obese brazilian population. Arquivos Brasileiros de Cirurgia Digestiva : ABCD = Brazilian Archives of Digestive Surgery, 31(1).
  • Palmeira, A. C., Farah, B. Q., Soares, A. H. G., Cavalcante, B. R., Christofaro, D. G. D., De Barros, M. V. G., & Ritti-Dias, R. M. (2017). Association between leisure time and commuting physical activities with heart rate variability in male adolescents. Revista Paulista de Pediatria, 35(3), 302.
  • Pathare, N., Haskvitz, E. M., & Selleck, M. (2012). 6-minute walk test performance in young children who are normal weight and overweight. Cardiopulmonary physical therapy journal, 23(4), 12.
  • Pogorelic, Z., Aralica, M., Jukic, M., Zitko, V., Despot, R., & Juric, I. (2019). Gallbladder disease in children: a 20-year single-center experience. Indian Pediatrics, 56(5), 384-386.
  • Raj, M., Sundaram, K. R., Paul, M., Deepa, A. S., & Kumar, R. K. (2007). Obesity in Indian children: time trends and relationship with hypertension. National Medical Journal of India, 20(6), 288. Reinehr, T. (2018). Long-term effects of adolescent obesity: time to act. Nature Reviews. Endocrinology, 14(3), 183–188.
  • Rodríguez-Colón, S. M., Bixler, E. O., Li, X., Vgontzas, A. N., & Liao, D. (2011). Obesity is associated with impaired cardiac autonomic modulation in children. International Journal of Pediatric Obesity : IJPO : An Official Journal of the International Association for the Study of Obesity, 6(2), 128–134.
  • Rúa-Alonso, M., Rial-Vázquez, J., Nine, I., Lete-Lasa, J. R., Clavel, I., Giráldez-García, M. A., … Iglesias-Soler, E. (2022). Comparison of Physical Fitness Profiles Obtained before and during COVID-19 Pandemic in Two Independent Large Samples of Children and Adolescents: DAFIS Project. International Journal of Environmental Research and Public Health, 19(7).
  • Singh, S. P., Sikri, G., & Garg, M. K. (2008). Body Mass Index and Obesity : Tailoring ‘cut-off’ for an Asian Indian Male Population. Medical Journal, Armed Forces India, 64(4), 350–353.
  • Xu, Y., Mei, M., Wang, H., Yan, Q., & He, G. (2020). Association between Weight Status and Physical Fitness in Chinese Mainland Children and Adolescents: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 17(7).
  • Yadav, J., Jain, N., & Dayal, D. (2018). Alterations of thyroid function in overweight and obese children: An update. Indian Journal of Child Health, 5(3), 145–150.
There are 38 citations in total.

Details

Primary Language English
Subjects Sports Medicine, Physical Training, Sports and Physical Activity For Disabled
Journal Section Articles
Authors

Seveka Bali 0000-0002-4447-4844

Devi Dayal 0000-0002-3279-6002

Amrit Pal Singh Sood 0000-0002-5081-522X

Sougata Panda 0000-0002-5979-3565

Priyanka Gupta 0000-0003-3261-5053

Publication Date December 20, 2022
Published in Issue Year 2022

Cite

APA Bali, S., Dayal, D., Sood, A. P. S., Panda, S., et al. (2022). The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children with Simple Obesity: A Cross-Sectional Observational Study. International Journal of Disabilities Sports and Health Sciences, 5(2), 106-112. https://doi.org/10.33438/ijdshs.1143176
AMA Bali S, Dayal D, Sood APS, Panda S, Gupta P. The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children with Simple Obesity: A Cross-Sectional Observational Study. International Journal of Disabilities Sports and Health Sciences. December 2022;5(2):106-112. doi:10.33438/ijdshs.1143176
Chicago Bali, Seveka, Devi Dayal, Amrit Pal Singh Sood, Sougata Panda, and Priyanka Gupta. “The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children With Simple Obesity: A Cross-Sectional Observational Study”. International Journal of Disabilities Sports and Health Sciences 5, no. 2 (December 2022): 106-12. https://doi.org/10.33438/ijdshs.1143176.
EndNote Bali S, Dayal D, Sood APS, Panda S, Gupta P (December 1, 2022) The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children with Simple Obesity: A Cross-Sectional Observational Study. International Journal of Disabilities Sports and Health Sciences 5 2 106–112.
IEEE S. Bali, D. Dayal, A. P. S. Sood, S. Panda, and P. Gupta, “The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children with Simple Obesity: A Cross-Sectional Observational Study”, International Journal of Disabilities Sports and Health Sciences, vol. 5, no. 2, pp. 106–112, 2022, doi: 10.33438/ijdshs.1143176.
ISNAD Bali, Seveka et al. “The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children With Simple Obesity: A Cross-Sectional Observational Study”. International Journal of Disabilities Sports and Health Sciences 5/2 (December 2022), 106-112. https://doi.org/10.33438/ijdshs.1143176.
JAMA Bali S, Dayal D, Sood APS, Panda S, Gupta P. The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children with Simple Obesity: A Cross-Sectional Observational Study. International Journal of Disabilities Sports and Health Sciences. 2022;5:106–112.
MLA Bali, Seveka et al. “The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children With Simple Obesity: A Cross-Sectional Observational Study”. International Journal of Disabilities Sports and Health Sciences, vol. 5, no. 2, 2022, pp. 106-12, doi:10.33438/ijdshs.1143176.
Vancouver Bali S, Dayal D, Sood APS, Panda S, Gupta P. The Relationship Between Weight Status, Vital Signs and Physical Fitness in Children with Simple Obesity: A Cross-Sectional Observational Study. International Journal of Disabilities Sports and Health Sciences. 2022;5(2):106-12.


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