Physical Activity Is Associated With Better Health and Psychological ...

JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 55, NO. 2

Physical Activity Is Associated With Better Health and Psychological Well-Being During Transition to University Life Steven R. Bray, PhD; Matthew Y. W. Kwan, BA

Abstract. The authors investigated vigorous physical activity, psychological well-being, and self-reported illness during transition to first-year university life in a sample of 175 Canadian undergraduates. At the completion of their first year of university study, participants completed retrospective measures assessing vigorous physical activity, upper respiratory infectious illness (URI), doctor visits, as well as measures of psychological well-being. Based on nationally recommended (US Department of Health and Human Services) standards, 61% of students reported engaging in adequate levels of vigorous activity during their first year at university. The authors found no differences in URIs between sufficiently and insufficiently active students. However, insufficiently active students scored lower on psychological well-being and were twice as likely to have consulted a physician regarding an illness compared with sufficiently active students.

chological health problems. For example, in a study of firstyear undergraduate students in the United Kingdom, Fisher and Hood2 discovered that students scored high on measures of both depression and loneliness. Aspinwall and Taylor3 found decreases in physical health and increases in negative mood among female undergraduates 3 months into their first year of college. A more recent Canadian study by Gall et al4 found that undergraduate students experienced their lowest levels of well-being, as represented by life satisfaction and perceived mental and physical health, upon entry to university. Although it may be assumed that adaptation to transition occurs readily (eg, during the first few months of the first year), data from another Canadian study by Arthur and Hiebert5 showed that second-year students reported having experienced their highest levels of general stress late in their first year of study. The latter findings are supported by data from Adlaf et al,6 who found that firstyear students have the highest levels of psychological distress within the Canadian higher education student population. In concert, these findings are consistent with an interpretation that transitional adjustment to college or university life is a chronic stressor throughout students’ first post-secondary year. The view of transition as a time of chronic stress links empirically to the physical- and psychological-health results reviewed previously. That is, in the broader study of stress and illness, research results show a consistent association between life stress and physical ailments, such as upper respiratory infection (URI).7,8 and psychological distress.9 Although stress and illness are linked, numerous personality, social, and behavioral factors have been identified that may mediate (eg, social support10) or moderate the relationship between the 2 variables (eg, coping3). Two behavioral variables that have been identified as moderating protective factors in studies of acute11 and

Key Words: exercise, freshmen, illness, stress

T

he transition from high school to college or university attendance represents a major life stressor for most students.1 Leaving home and moving to a dormitory or shared student residence during late adolescence is a major disruption to existing family and friendship relations. First-year students also have to deal with changing familial and societal roles involving greater independence. Furthermore, first-year students often encounter more difficult courses that demand not only attendance at lectures, tutorials, and laboratory experiences, but also a great deal of independent coursework requiring diligent and adept time management skills. Research indicates transition to college or university attendance is associated with increased physical and psy-

Both authors are with the Department of Kinesiology at McMaster University in Hamilton, Ontario, Canada. Copyright © 2006 The American College Health Association 77

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chronic life-event stress are physical activity and physical fitness. For example, consistent with findings from the larger stress-illness literature, Brown12 showed that undergraduate students who had experienced higher levels of lifeevent stress reported higher incidences of illness and made more visits to the doctor than did those who scored lower on life stress. However, when Brown factored in physical fitness, the results showed that individuals who had experienced high stress but who were physically fit scored similarly on illness measures to those who had low stress. The detrimental health effects of higher stress were only evident for participants who were unfit. In a study by Roth and Holmes,13 the investigators actually trained undergraduate students who reported high levels of life stress at a baseline measurement to become more physically fit. They found that after an 11-week cardiovascular training program, students improved their aerobic fitness and scored better than control-group participants on depression. However, trained and untrained students did not differ on measures of physical health. Although Brown’s12 and Roth and Holmes’13 studies involved undergraduate students, the participants were recruited across all years of study. Given that first-year students collectively experience the transition stressor, it would be informative to examine the health and well-being of those students during the transition year. An additional complication regarding the health and well-being of firstyear students arises when behavioral surveillance statistics are considered. According to cross-sectional studies of late adolescence and young adulthood, physical activity drops dramatically from high school to college or university attendance.14,15 In a recent longitudinal study of first-year students, Bray and Born16 also found that physical activity levels decreased significantly among first-year students compared with previous high school activity levels. Thus, when considered together, the chronic stress of transition, coupled with a general decline in physical activity that occurs at the same time, may have important negative health implications for this population. Our purpose in the present study was to examine the association of vigorous physical activity with psychological well-being and illness during first-year students’ transition to university life. We chose to focus on vigorous physical activity (rather than moderately or mildly intense activities) for 3 reasons. First, self-report or recall of vigorous activity engagement is more accurate and reliable than that of either moderate- or mild-intensity activities.17–19 Second, the percentages of students who engage in adequate amounts of moderate activities are relatively low in college or university (19.5%).15 The third reason for focusing only on vigorous activity was based on the assertion of the US Department of Health and Human Services that although light and moderate intensity activities may incur health benefits, “people who exercise both regularly and vigorously would be expected to improve cardiovascular fitness the most.”20(p181) Recall that previous researchers12 have demonstrated positive effects for cardiovascular fitness moderating the 78

stress–illness relationship. Based on accepted criteria for adequate vigorous physical activity,20 we classified students as being either sufficiently or insufficiently active during their first year at a university. We hypothesized that students who were sufficiently active would report fewer URIs and seek medical attention for illness less often than would insufficiently active students. We also expected that sufficiently active students would report more positive psychological well-being during their first year, compared with students who were insufficiently active. METHOD Participants and Procedure Participants were 175 first-year university students (male, n = 60; female, n = 115) aged between 17 and 19 years (M = 17.79, SD = .54) who had entered the university following high school graduation earlier in the same year. We collected data by questionnaire during the 11th week of the spring semester (ie, at the completion of the first year of classes). Participants had initially been recruited to a larger study examining physical activity during transition to college and university life during their first week of post-secondary classes the previous autumn. We report here from the final wave of data collection in March 2004. The university ethics review board approved the study, participation was voluntary, and we obtained informed consent. We assured participants of the confidentiality of their responses, and they completed a survey at a questionnaire-administration center that was supervised by trained research assistants. We provided each of the participants with an envelope in which they sealed their completed questionnaire, and they each received $5 for participation in the study. According to the institutional analysis unit at the university, our sample constituted 30% of the eligible first-year intake who were direct entrants from high school. The ratio of men (34%) to women (66%) was generally representative of the first-year population at the university, which was 64% female. MEASURES Vigorous Physical Activity There is currently no uniformly accepted method of measuring physical activity.21 We used a paper-and-pencil version of the vigorous-activity measure drawn from the interview schedule of the 2003 Behavior Risk Factor Surveillance System22 to assess vigorous physical activity. Participants reported the average number of sessions of vigorous physical activity in which they engaged per week, as well as the average duration of each vigorous activity session, over the previous 7 months (ie, since the beginning of their first semester at the university) in response to the following questions: (1) In a usual week, on how many days do you do vigorous activities (such as running, aerobics, hockey, squash, rollerblading) for at least 10 minutes at a time, causing large increases in breathing or heart rate? (2) On days that you do vigorous activities for at least 10 minutes at a time, how much total time per day do you spend JOURNAL OF AMERICAN COLLEGE HEALTH

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doing these activities? Although recall of average frequency and duration of weekly vigorous physical activity has been used effectively in previous research as a representation of actual activity in adults, validity and reliability of these types of measures (ie, self-report) may be susceptible to response biases and are problematic because estimates of physical activity are dependent on the survey instrument.17–19 However, self-report measures of exercise behavior have the advantages of nonreactiveness, ease of completion and administration, and low cost.17 As noted above, we based our decision to assess only vigorous activities on findings showing that behaviors requiring this intensity of activity are recalled with higher accuracy than are moderate- or mild-intensity activities.19 Psychological Well-Being We used the somatic symptoms and anxiety–insomnia subscales of the General Health Questionnaire-28 (GHQ28)23 to assess psychological well-being. Each subscale consists of 7 items scored using a simple Likert-type method and summed to yield a single score for each subscale. Participants based their responses to questions from both measures on how they had been feeling over the previous 2 months. The GHQ-28 has shown good evidence of construct validity and reliability and has been used widely in research investigating psychological distress.23 We selected the somatic symptoms and anxiety–insomnia subscales because they have shown sensitivity to change in previous research involving transitioning students.24 Thus, we determined that the range of scores obtained using these 2 subscales of the GHQ-28 would provide adequate measures of general psychological well-being, with lower scores representing greater well-being and higher scores representing greater distress. Self-Reported URI Participants indicated the number of times they had developed a cold or flu during the previous 7 months. A total of 164 students reported 510 cold and flu incidences. Self-Reported Medical Visits Participants reported the number of occasions on which they had sought medical attention from a doctor for an illness (doctor visits relating to check-ups and injuries were reported separately and not analyzed) during the previous 7 months. Sixty-four students sought medical attention from a doctor for illness on 142 occasions. RESULTS Table 1 reports descriptive statistics for the study measures. These statistics showed that, on average, students were engaging in 3.13 weekly sessions of vigorous activity lasting longer than 20 minutes in duration, reflecting generally sufficient amounts (ie, ≥ 3 sessions of ≥ 20 minutes duration20) of weekly vigorous activity for the sample. Further inspection of those data indicated that 106 (61%) students were meeting or exceeding the recommended dosage VOL 55, SEPTEMBER/OCTOBER 2006

TABLE 1. Descriptive Statistics for Study Variables Variable Weekly bouts of vigorous physical activity lasting ≥ 20 minutes Self-reported physician visits for illness Self-reported upper respiratory infectious illness Somatic symptoms Anxiety/insomnia

M

SD

3.13 0.79

1.71 1.50

2.83 5.98 7.24

2.23 3.44 4.19

Note. N = 175. Scores for somatic symptoms and anxiety/ insomnia range from 0 to 21.

of weekly vigorous physical activity during their first year at the university. The proportions of sufficiently active versus insufficiently active students were similar for men (63% active) and women (57% active). As noted earlier, incidents of self-reported URI were fairly common, with an average of 2.8 colds or flu reported over the school year. The indicators of psychological wellbeing showed relatively positive scores for both somatic symptoms (5.98) and anxiety–insomnia (7.24), as scores on each of these measures could range from 0 to 21. To investigate the potential protective effect of being physically active on the various illness and well-being outcomes, we compared the scores of students who exercised vigorously 3 or more times per week with those of students who exercised fewer than 3 times per week using a one-way multivariate analysis of variance (MANOVA). Initial multivariate diagnostic tests indicated that the 2 psychological well-being variables met the assumptions of MANOVA as prescribed by Tabachnick and Fidell.25 Self-reported URI was moderately positively skewed (1.13) and was transformed using a square-root function. The resulting squareroot URI variable adequately met the assumptions of the test (eg, skewness = –0.20). As we will discuss further, the variable representing the number of self-reported doctor visits was drastically skewed and required separate analysis. The MANOVA was not significant, Wilks’s lambda = 0.97, F(3, 167) = 1.91, p = .13. However, because multivariate statisticians26 have recommended liberal criteria for examining multivariate effects in the early stages of research, we also assessed post hoc univariate comparisons. Descriptive and univariate ANOVA results for sufficiently and insufficiently active students are reported in Table 2. As indicated in the table, there was a small, significant univariate effect, F(1, 169) = 5.34, p = .02 η2 = .03, for somatic symptoms, with active students showing more positive (lower) scores than did insufficiently active students. As we reported earlier, 64 of the 180 students in the study sought medical attention for illness over the course of their first year of university study. Because almost twothirds of the sample did not seek any medical attention over 79

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TABLE 2. Comparative Statistics of Sufficiently and Insufficiently Active FirstYear Students

Variable Self-reported URI Somatic symptoms Anxiety/insomnia

Sufficiently active (n = 106)

Insufficiently active (n = 69)

F

p

2.69 ± 2.21 5.50 ± 3.21 6.82 ± 4.41

2.82 ± 2.15 6.72 ± 3.66 7.88 ± 3.77

0.15 5.34 2.69

0.70 0.02 0.10

Note. URI = upper respiratory illness. N = 175. Students classified as “sufficiently active” participated in ≥ 3 sessions of ≥ 20 minutes duration of vigorous activity weekly. “Insufficiently active” students participated in fewer than 3 sessions of vigorous activity weekly. Scores for somatic symptoms and anxiety/insomnia range from 0 to 21.

that period of time, the distribution of scores was not appropriate for analysis treating this variable as a continuous one. We, therefore, dichotomized the variable into a binary-outcome variable, reflecting students who had either sought (ie, 1 or more doctor visits) or not sought medical attention from a doctor for illness. Of the 106 students who met or exceeded the minimum recommended dosage of vigorous physical activity, 30 (28.3%) saw a doctor at least once regarding illness. However, among the 69 students who did not accumulate sufficient weekly vigorous physical activity, 32 (46.4%) had seen a doctor for illness concerns at least once during their first year of university study. We analyzed the statistical significance of this effect using direct binary logistic regression in which we regressed the variable “sought or did not seek medical attention” on the variable “sufficiently or insufficiently active.” The logistic regression model was significant, χ2 (1, N = 175) = 5.92, p = .015. Based on the Wald criterion, these results showed a significant effect for being physically active (B = 0.784, SEB = .324, z = 5.872, p = .015). Examination of the odds ratio, Exp(B) = 2.19, 95% CI = 1.162–4.132, indicated that the insufficiently active students were more than twice as likely to have seen a doctor for illness-related concerns than were students who had been sufficiently active. DISCUSSION Our purpose in this study was to examine the association of vigorous physical activity with psychological well-being and illness during first-year students’ transition to university life. Although results were not significant in every case, there was a general indication that students who participated in sufficient levels of vigorous physical activity during their transitional first year of university study had more positive psychological well-being and fewer illnesses than did students who were not sufficiently active. Data presented by Bray and Born16 provided a preliminary indication that changes in physical activity occur during transition from high school to university or college attendance and that the effect is negative (ie, increased prevalence of inactivity). Our data showed a higher proportion of sufficiently active students (61%), compared with 80

that of Bray and Born (44%). However, their data were based on the first 2 months of transition, whereas the present data were representative of the first 7 months. As suggested by Bray and Born,16 activity levels may be more affected during the early stages of transition, and some students may resume regular activity after a period of initial adjustment. A 61% activity rate is consistent with Canadian national statistics27 for this age group. Despite the fact that the majority of the sample in the present study was sufficiently active, the implications of being insufficiently active were still apparent. There was a twofold greater incidence of doctor visits among students who were insufficiently active. Research on the transition to college or university life has consistently identified it as a chronic stressor that is associated with decreased physical and psychological well-being.2–6 Those findings are consistent with a larger body of literature that has examined broader life-stress issues in relation to illness and wellbeing.8,9,28 Although we did not assess other sources of life stress in our sample population, students were consistently exposed to the transition stressor. What did vary among our participants were their levels of weekly vigorous physical activity during the transition year. Consistent with results reported in other work on physical activity and wellbeing,12 we found physically active students navigating the transition to university life to have fewer illnesses that prompted them to seek medical consultation than did physically active students. This primary finding is interesting to interpret in light of the parallel finding that students reported similar incidences of URI, regardless of activity level. Furthermore, URIs were fairly common, averaging 2.8 illnesses per student over the course of the 7-month study period. This evidence is consistent with Cohen et al’s results of a highly controlled examination of psychological stress and URI, where they found that physical exercise did not affect the stress–URI association.8 Although it is possible that insufficiently active students experienced more severe URI symptoms than did active students, whether students sought medical attention for URIs or other maladies was not assessed. At this stage in the research, these findings can be interpreted JOURNAL OF AMERICAN COLLEGE HEALTH

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in at least 2 major ways. One explanation is that insufficiently active students may be a group at higher risk than are active students for more serious illnesses requiring a doctor’s attention. On the other hand, insufficiently active students may display individually a set of motivational characteristics showing that they are less inclined to look after themselves, by being inactive and by seeking out medical help, even when they experience relatively minor illnesses. Examination of the nature of the illnesses requiring a doctor’s consultation among transitioning students would be an interesting avenue for future inquiry. Insufficiently active students also reported lower levels of psychological well-being, as indexed by somatic symptoms. The content of the GHQ somatic symptoms subscale reflects respondents’ general feelings of illness, headaches, and feeling run down. Thus, it may not be surprising that students scoring higher on this measure also sought medical attention more frequently. These results are in alignment with those of Bray and Born,16 who found higher negative mood and lower positive mood scores among transitioning students who were insufficiently active. Although the present study showed results similar to those of previous research on physical activity, illness, and life stress, several limitations should be acknowledged. One consideration is that, although transition to university has been documented as a chronic stressor in previous research,1,3,5 it may have represented a greater source of stress for some students than it did for others. Future researchers should attempt to assess students’ perceived transitional stress. However, regardless of students’ impressions of the degree of perceived stressfulness experienced during transition, their experiences required some form of adjustment and adaptation to new academic, social, and living environments. Another limitation was our reliance on self-report measures for illness and doctors’ visits. Although this may raise concerns that there may be biases in reporting illnesses, other researchers have found high levels of agreement between self-reported and doctor-verified colds,8 which gives us confidence in the accuracy of those data. Being insufficiently active during transition to university life thus appears to have negative short-term implications for health and well-being. However, research shows that additional health issues arise for the transition population. Major life transitions, such as starting university study, are times when individuals encounter change in a variety of aspects of their lives, and such changes can further contribute to significant alterations in behavior. Baranowski and his colleagues29 recently reviewed research that was conducted on the young adult population transitioning out of high school (although pathways to work, higher education, etc, were not differentiated), examining a variety of health-related behaviors. In general, their findings revealed transition from high school is associated with “changes in lifestyle behaviors that exacerbate cancer risk.”29(p694) Their review specifically showed changes in diet (increased fat and meat consumption), alcohol use (higher consumption VOL 55, SEPTEMBER/OCTOBER 2006

and unhealthy drinking habits30), sun exposure (highest unprotected exposure among college students), tobacco use (increases in smoking and use of smokeless tobacco), and sexual behavior (decline in use of condoms, peak in number of partners, and highest incidence of HIV infection during transition). Consistent with more recent findings by Bray and Born,16 they noted that physical activity also decreases. With these general findings and those of the present study in mind, researchers and illness-prevention and health-promotion practitioners should consider transitioning students an important at-risk group. Given that other research shows that first-year students are also at high risk for life-threatening infectious diseases (eg, meningococcal disease),31 researchers are encouraged to investigate changes in health risk behaviors, including, but not limited to, physical inactivity during transition to university and college life. Practitioners, particularly those based at postsecondary institutions, need to develop and engage programs to educate incoming students about the changes and challenges they will face during transition and how these may affect determinants of health. Researchers and practitioners should ultimately work together to examine the efficacy and effectiveness of determinants-based interventions to promote and maintain healthier, active lifestyles among postsecondary students. NOTE A Health Research Fund grant awarded to Steven R. Bray by the Alberta Heritage Foundation for Medical Research supported this study. For comments and further information, please address correspondence to Steven R. Bray, PhD, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada L8S 4K1 (email: [email protected]).

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