May 2019

Sex Differences on Foot Health Related to the Quality of Life in Sedentary People

Abbreviations: BMI, body mass index; METS, metabolic energy equivalent; IR, interquartile range; SD, standard deviation. In all the analyses, P < .01 (with a 99% confidence interval) was considered statistically significant. * Kruskal Wallis test for independent samples was performed.

By Daniel López-López, Jose María Cancela-Carral, Romeu Araujo, and colleagues

The sedentary lifestyle is known for its lack of activity and exceptional amount of sitting, all leading to depressed energy expenditure. The medical consequences—from hypertension and obesity to musculoskeletal pain and osteoporosis—are many and represent leading risk factors for early mortality. Although the general health risks of the sedentary lifestyle have been studied, we sought to analyze the impact of the quality of life related to foot health among both men and women who identified as sedentary.

The cross-sectional observational study, which was carried out in Porto, Portugal, from October 2016 through October 2017. We recruited 312 volunteers (mean age, 39.81 ± 15.40 years); those with a previous injury or a host of chronic medical conditions were excluded.

After an initial interview, the volunteers filled out the European Prospective Investigation into Cancer and Nutrition (EPIC) Physical Activity Questionnaire, which sought to determine the duration and average intensity of physical activity (across day, week, and month) in 3 different tasks (professional, domestic, and free time) and for 5 types of activities (rest, transport, professional work activity, household activities, and exercise).

Subsequently, participants completed the Portuguese version of the Foot Health and Quality of Life (PFHQL) tool that contains 2 sections. The first section looks at foot pain, foot function, footwear, and general health; the second section presented items related to overall health (general health, physical activity, social capacity, and vigor). The Foot Health Status Questionnaire (FHSQ) software (Version 1.03) showed points from 0 (poor health status) to 100 (better health status).

Results #1137937150

A total sample of 312 subjects, between 18 and 87 years old with a mean (± SD) of 39.81 (± 15.40) years, concluded the investigation pathway. Most participants were of average weight (BMI, 24.75 ± 3.942) and their metabolic equivalent of tasks showed a sedentary activity (301.09 ± 72.22 min/wk).

Descriptive sociodemographic characteristics of the people, stratified by sex, are presented in Table 1. The findings of the comparison between quality of life (QoL) related to the foot values of sex groups are shown in Table 2. The first specific section for the feet analyzed 4 domains: pain, function, overall foot health, and footwear. The values were higher for foot pain and foot function and lower for general foot health and footwear. The second general section assessed 4 health domains: overall health, physical function, social capacity, and vitality. The values were higher for general health and vigor and lower for physical activity and social capacity. The differences between the groups of the study were statistically significant for footwear (P = .008), physical activity (P = .002), social capacity (P = .001), and vigor (P = 0.001) showing a worse QoL related to foot health in male subjects. The rest of the domains did not show any statistically significant difference (P ≥ .01).


This study aimed to analyze the QoL impact on the overall and foot health among male and female sedentary people. Foot health may be very important for the overall health, independence, and QoL in the sedentary population.

Regarding a prior case–control study, a sample of 140 active and sedentary participants in Iran who had a mean age of 40 years were randomly selected and showed that active people presented better QoL than sedentary people. Nevertheless, the QoL associated with foot health was not analyzed in this context in any investigation.

This is the first study to reveal that sedentary individuals present poor QoL values on the dimensions related to the foot. The outcomes of this research highlighted the need for medical and podiatric care in sedentary people. Sedentary people should be advised about the changes that a sedentary lifestyle will bring to their feet. Therefore, podiatric care would help to improve the lifestyle and overall health in this population. These findings are consistent with a randomized controlled clinical intervention conducted by Campbell et al., which indicated that leg, ankle, and foot are habitually sites of the most pathologies in sedentary individuals.

Abbreviations: FHSQ, Foot Health Status Questionnaire; IR, interquartile range; SD, standard deviation. In all the analyses, P < .01 (with a 99% confidence interval) was considered statistically significant. *Kruskal Wallis test for independent samples was performed.

Furthermore, this investigation revealed a significant increase in FHSQ scores for foot pain, foot function, general health, and vigor, and lower scores for general foot health, footwear physical activity, and social capacity in the levels of QoL related with foot health in sedentary people. This is consistent with research that has demonstrated that lifestyle affects the risk of illnesses, symptoms, poorer response to treatment, and a significant increase in the use of medical services.

However, this study presented several limitations that should be acknowledged. Firstly, a new classification related to different lifestyles may help identify if there are other mechanisms involved. Secondly, subcategories of metabolic energy equivalent would be beneficial to improve the strength of the study. Finally, expanding data collection to other countries would be beneficial to strengthen this study. This highlights the need for further studies that should focus on foot health, lifestyle, and QoL of the population.


The sedentary population evidenced a negative impact on the QoL related to foot health. This problem may be associated with this lifestyle, especially in the males.

This article has been excerpted from “Association Between Sex Differences on Foot Health Related to the Quality of Life in a Sample of Sedentary People,” by the same authors, which appeared in Revista da Associacao Medica Brasileira, 2019; 65(2):149-155. Text has been summarized and truncated and references have been removed for brevity. Use is per the Creative Commons Distribution 4.0 International License. To read the full article, go to

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