# Comparison of Fitness and Physical Activity Levels of Obese People with Hypertension
## 4 Discussion
Of course, it cannot be conclusively shown that low PF is a causative factor of DM, but we have demonstrated the relations between these two variables. Moreover, we noted that the level of fitness of our patients was relatively low. For example, patients studied by us performed on average 12 repetitions in the chair stand test, whereas 64 older adults (\(\geq\)60 years) studied by [PERSON] et al. [47] performed approximately 16 repetitions before undertaking exercise, and even 20 repetitions after 18 weeks of training. [PERSON] and [PERSON] [48] indicated that a low number of repetitions in this test may significantly increase the risk of falls, because people who reported falls were able to perform only approximately nine repetitions. People in the age group studied by us should perform more than 13 repetitions on average [49]. The low fitness of our patients was also demonstrated in the co-ordination tests. In the one leg stand test, their time was only approximately 12 s, which shows a weak functioning of the body's balance system. [PERSON] et al. [50] noted that subjects aged over 60 years, living independently, with no falls in the past, can stand for 25 s (ranging from 6 to 74 s). The subjects also had very significant difficulties with the correct execution of the 2-min step-in-place test. Based on the previous studies [51, 52], we expected that handgrip strength would correlate to PA or other health-related components. [PERSON] and [PERSON] [53] observed that handgrip strength correlated to nutritional status. In our study, the level of handgrip strength was independent of the other tested variables. The low level of handgrip strength in our patients can explain this rare and dangerous situation. Poor grip strength has been found to be a common factor in the elderly who have suffered a fall [54]. Maximal hand grip strength is associated with self-efficacy as related to the fear of falling [55]. Interestingly, [PERSON] et al. [56] observed that grip strength correlates strongly to overall body strength and the ability to perform functional tasks. For this reason, the low level of hand grip strength in our patients could be worrying. On the other hand, the lack of statistically significant relationships with other components of functional efficiency is difficult to explain. In addition, [PERSON] et al. [57] observed that people with diabetes mellitus likewise demonstrated poor handgrip strength and that selected upper limb anthropometric characteristics significantly correlate to handgrip strength. Our subjects presented a low level of handgrip strength, which correlated only to gender. This is worth further investigation with a more in-depth study. The functional fitness factors studied by us are listed as some of those that contribute to successful ageing [58]. Among the limitations of the study, we can list a possible recall bias for the PA in the past and a small sample size; however, considering the specificity of the analysed factors (DM, HT, and obesity), the sample size was still reasonable. Adding PF with group-specific tailoring of the tests, which is rare in this kind of research, should be considered a strength. The analysis shows that a deeper understanding of the causes of the lower PF of obese people with HT and additionally DM is needed in order to recognise the motivation, or the lack of motivation, to participate in the therapeutic process. Without the patient's cooperation, a doctor involved in the patient's care may be ineffective. Obese patients, particularly those with concomitant HT and DM, should be provided with interdisciplinary care by not only physicians and dieticians, but also by physical activity specialists: physiotherapists, occupational therapists, or personal coaches. The presence of several concomitant diseases depletes patients' health resources and generates a greater anxiety against and an unwillingness to make changes in terms of PA with its underestimated protective role.