Physical Activity, Stress, and Physically Active Stress Management Behaviors Among University Students With Overweight/Obesity

Abstract

Student physical activity is associated with lower stress. Research gaps remain regarding the types of stress management behaviors students use and how these behaviors are associated with students’ activity levels. This study examined associations between physical activity and stress management behaviors among students (18-35 years). Students with overweight/obesity (n = 405) attending universities in 2 urban locations enrolled in a randomized controlled trial to promote healthy weight and completed the following baseline measurements: perceived stress, stress management behaviors, accelerometer-measured physical activity, and demographic characteristics. Perceived stress did not differ by physical activity status or race. A greater proportion of students meeting moderate-to-vigorous physical activity guidelines used physically active stress management behaviors compared to those not meeting guidelines (74% vs 56%; P = .006), and students using physically active stress management had lower stress scores (13.1 vs 15.5; P = .003). Among Black and White students only (n = 306), a greater proportion of White students used physically active stress management behaviors compared to Black students (77% vs 62%, P = .013). Results indicate differences in stress management behaviors by student activity level and race. During times of high stress, colleges/universities might support students by promoting stress management and physical activity in tandem, and tailoring messages to student activity levels and demographic characteristics.

Evidence suggests that engaging in physically active stress management (eg, walking, jogging, lifting weights) can lead to alterations in cognitive function and neurotrophic pathways that enhance stress resilience . . .

Stress among college/university students poses a significant concern in the United States. The Stress in America Survey, conducted in 2017 by the American Psychological Association, found that young adults ages 18 to 38 years reported the highest levels of stress compared to older age groups. ¹ Commonly reported young adult stressors include financial hardships, pressures of majors or careers, challenges with roommates or relationships, and family demands. ² Furthermore, Black youth report greater exposure to stressful life events that can affect future academic, behavioral, and health outcomes.^3-5 Black youth are also more likely to experience social and physical environments that exacerbate, rather than protect against, these stressors.^6,7

Physical activity (PA) is important for physical and mental health. ⁸ Studies show self-reported reductions in stress following acute bouts of PA.^9,10 Lazarus and Folkman coined the Transactional Theory of Stress and Coping in which there is an appraisal of the stressor and a coping response. ¹¹ This coping response to managing stress can take many forms including both cognitive and behavioral strategies. Evidence suggests that engaging in physically active stress management (eg, walking, jogging, lifting weights) can lead to alterations in cognitive function and neurotrophic pathways that enhance stress resilience,^9,12,13 and that physical activity can be influenced by stress if individuals are engaging in physically activity stress management as a form of behavioral activation. ¹⁴ Yet disparities exist in the prevalence of PA by gender and race with only 45% of Black females aged 18 to 29 years reporting any moderate or vigorous PA compared to more than 67% of White peers, ¹⁵ pointing to the potential for differential stress outcomes by race.

There is little consensus regarding the theoretical mechanisms linking physical activity to stress reduction. ¹⁶ Some potential hypothesized mechanisms include distraction, sense of mastery, or through biological mechanisms. Furthermore, limited research exists describing the extent to which diverse student populations use physically active strategies to manage stress. Previous studies have been conducted in non–university populations and/or focus on depression/anxiety rather than perceived stress. Since there is ample evidence that (1) students are experiencing unprecedented levels of stress^17,18 and (2) stress is inversely related to PA,^9,12,13 it is important to understand whether students use PA as a way to manage stress.

This study had 2 primary aims. Primary Aim 1 was to examine whether university students who met moderate-to-vigorous PA (MVPA) guidelines (≥150 MVPA min/week) reported lower stress scores than those who did not meet guidelines. Sub-aims included examination of (1a) whether meeting MVPA guidelines was associated with use of physically active stress management behaviors, and (1b) whether use of physically active stress management behaviors was associated with lower stress scores. It was hypothesized that students meeting MVPA guidelines would report lower perceived stress than those not meeting guidelines, that students meeting MVPA guidelines would use more physically active behaviors to manage stress than those not meeting the guidelines, and that students who used physically active stress management behaviors would report lower stress scores. Primary Aim 2 was to examine differences in key outcomes between Black and White students, given the existence of racial disparities in PA prevalence and stress exposure. It was hypothesized that White students would report lower stress scores than Black students and that Black students would be less likely to use physically active stress management behaviors compared to White peers.

Methods

Sample

Participants were enrolled in the Healthy Body Healthy U (HBHU) randomized controlled trial using digital interventions to aid university students in weight loss and maintenance. ¹⁹ Main eligibility criteria included individuals aged 18 to 35 years with a body mass index (BMI) of 25 to 45 kg/m², enrolled in a university in the greater Washington, DC or Boston areas, regular Facebook user, fluent in English, and had access to regular text messaging. Participants were excluded if participating in other weight loss or PA studies or if trying to lose weight. For full inclusion and exclusion criteria, see Napolitano et al. ¹⁹ Participants with complete baseline data for accelerometer-measured PA and survey questionnaires for perceived stress and stress management behaviors were included in these secondary analyses, which resulted in a final sample size of 405 participants. Baseline data were collected from May 2015 to January 2018. For analyses examining disparities in stress and stress management behaviors by race, only Black and White students were included (n = 306).

Measures

Stress

Perceived stress was measured using an abbreviated version of Cohen’s Perceived Stress Scale (PSS). ²⁰ This 10-item scale used Likert-type responses to various scenarios occurring within the last week with answers that range from 0 (never) to 4 (very often). Scores were summed, with a total possible score ranging from 0 to 40. Higher scores indicated higher stress levels.

Stress Management

This questionnaire was adapted from the 2014 Stress in America report of stress habits. ²¹ Stress management was assessed using the following question: “Do you do any of the following to relieve or manage stress?” Response options included “lay awake at night,” “sleep or take a nap,” and “exercise, walk, or play sports.” An additional open-response item asked participants to describe other methods used to managing stress. Qualitative responses with MET values >2.0 were coded as physically active stress management behaviors^9,22: cooking/baking, yoga, sexual intercourse, playing with baby or pet, cleaning, traveling, gardening, hiking, going to church, judo, and stretching (see Table 1). Stress management behaviors were recoded into a dichotomous variable indicating use of physically active stress management behaviors if participants indicated any of the above-mentioned behaviors or selected exercise, walk, or play sports, regardless of whether they were in combination with sedentary stress management behaviors (Table 1).

Table 1.

Physically Active Versus Sedentary Stress Management Behaviors ^a .

Physically active stress management behaviors
Close-ended survey responses
Exercise, walk, or play sports (n = 279)
Open-ended survey responses
Cooking/baking (n = 10)
Yoga (n = 6)
Sexual intercourse (n = 5)
Playing with baby or pet (n = 4)
Cleaning (n = 3)
Traveling (n = 1)
Gardening (n = 1)
Hiking (n = 1)
Going to church (n = 1)
Judo (n = 1)
Stretching (n = 1)

^aParticipants were considered to engage in physically active stress management if they indicated any of the above physically active stress management behaviors, regardless of whether they were reported in combination with sedentary stress management behaviors; open-ended responses with MET value ≤2.0 (eg, listen to music, read, play video games, talk to someone) were considered sedentary stress management behaviors

Physical Activity

Participants wore an ActiGraph (wGT3X-BT) for at least 4 days of 10 hours. See Napolitano et al ¹⁹ for methodological details. To account for variability in days of accelerometry data, weekly MVPA was calculated by multiplying the daily average by 7, which were summed for a weekly total. The continuous MVPA variable was recoded into a dichotomous MVPA guideline variable representing those meeting/exceeding current guidelines (≥150 MVPA minutes/week) and those not meeting guidelines (<150 MVPA minutes/week). ⁸

Demographics

Baseline demographics collected included age, sex, race/ethnicity (ie, Black, non-Hispanic White, Asian/Pacific Islander, Hispanic, multiracial/refuse/unknown), academic year, and clinic-measured height and weight.

Statistical Analysis

Participant characteristics were summarized by means (± standard deviations) and frequencies. Independent sample t tests were conducted to examine (1) the relationship between PA and perceived stress, (2) the relationship between physically active stress management behaviors and perceived stress, and (3) the relationship between race and perceived stress. Chi-square tests were used to determine (1) whether those who met MVPA guidelines managed stress using physically active behaviors more often than those who did not meet guidelines and (2) whether differences existed in use of physically active stress management behaviors by race. IBM SPSS Statistics Version 26 and RStudio Version 1.3.1056 were used for analyses.

Results

Participants (n = 405) were mostly female (78.5%), 18 to 25 years (71.1%), and undergraduate (57.5%). The sample was predominantly White (55.3%), followed by Black (20.2%), and was evenly split between participants with overweight (49.6%) and obesity (50.4%). Most used physically active stress management behaviors (71.6%). The sample of Black and White students included 306 participants with similar characteristics (Table 2).

Table 2.

Demographic Characteristics of the Participants.

Characteristic	Full sample (N = 405)	Black students (N = 82)	White students (N = 224)
Reported physically active stress management behaviors (n, %)	290 (71.6)	51 (62.2)	173 (77.2)
Weekly MVPA (minutes)	311.1	271.2	328.7
Students meeting MVPA guidelines (n, %)	343 (84.7)	79.3 (65)	199 (88.8)
Perceived stress score (range 0-40)	13.8	14.3	13.5
Age (years)	23.3	23.4	23.3
Female (n, %)	318 (78.5)	75 (91.5)	167 (74.6)
Race (n, %)
White	224 (55.3)	—	224 (100)
Black	82 (20.2)	82 (100)	—
Other	99 (24.4)	—	—
Undergraduate (n, %)	233 (57.5)	50 (61.0)	121 (54.0)
BMI (kg/m2)	31.1	32.7	30.5

Abbreviations: MVPA, moderate-to-vigorous physical activity, BMI, body mass index; Meeting MVPA guidelines = weekly MVPA ≥150 minutes.

Physical Activity and Perceived Stress

An independent sample t test revealed that mean perceived stress scores were not significantly different between students meeting MVPA guidelines compared to those who were not (13.6 ± 6.8 vs 14.8 ± 5.7, P = .136).

Physical Activity and Stress Management Behaviors

A χ² analysis revealed significantly higher rates of physically active stress management behaviors for participants meeting or exceeding MVPA guidelines compared to those who were not (74% vs 56%; χ²[1, N = 405] = 7.411, P = .006).

Stress Management Behaviors and Perceived Stress

An independent sample t test revealed that mean perceived stress scores were significantly lower among students using physically active stress management behaviors compared to those who were not (13.1 ± 6.2 vs 15.5 ± 7.4, P = .003).

Race and Perceived Stress

Among Black and White students only, an independent sample t test revealed that Black students did not report significantly higher mean stress scores (14.3 ± 6.6 vs 13.5 ± 6.9, P = .373).

Race and Stress Management Behaviors

Among Black and White students only, χ² analysis revealed significantly higher rates of physically active stress management behaviors for White compared to Black students (77% vs 62%; χ²[1, N = 306] = 6.174, P = .013).

Discussion

This study revealed that a majority of university students use physically active strategies to manage stress, and that use of physically active stress management is associated with lower perceived stress scores. Although students in this sample who met MVPA guidelines did report lower levels of stress than students who did not meet guidelines (13.6 ± 6.8 vs 14.8 ± 5.7), the difference was not statistically significant. The stress scores reported in this sample were lower than those reported by young adults in 2009 but similar to scores reported by young adults in 1983. ²³ It is possible that the significance of the current finding was attenuated by the nature of the sample, which included only students with overweight and obesity and who may experience stress differently from the general student population. ²⁴

Our results indicate that Black students used physically active stress management behaviors at lower rates than White students. Lower rates of physically active stress management among Black students represent a clinically significant finding. Lower physical activity mediates the relationship between chronic stress and BMI among African American women, ²⁵ and physical activity is also protective against depressive symptoms in Black adults. ²⁶ However, there exist systemic barriers to exercise for Black Americans, including unique challenges with being physically active in public spaces. ²⁷ Systemic-level factors impacting physically active stress management behaviors among Black students should be further explored.

In this sample, students who met MVPA guidelines did report using physically active stress management behaviors at significantly higher rates than students not meeting the guidelines. This is consistent with other research indicating that those who are regularly physically active tend to use physically active stress management behaviors to cope with stress. ¹⁴ Although there is a logical association between physically active stress management and overall physical activity, these variables do measure distinct behaviors. Our findings indicate a potential mechanism for improving student physical activity: introducing physical activity as a stress management tool and delivering combined interventions to address both insufficient activity and stress management in tandem.

These findings have clinical significance. Stress is a known risk factor for cardiovascular disease.^28,29 Several studies have posited that PA reduces stress via biological mechanisms.^12,30 It is also possible that using PA for stress management reduces exposure to maladaptive coping strategies (eg, rumination, worry), which have negative consequences on long-term stress resilience. ³¹ Thus, engaging in PA may promote a positive feedback loop that enhances stress resilience over time and further incentivizes the individual to continue physically active routines.^14,32 In addition to biological explanations for this phenomenon (alteration of monoamines, endorphin activation), psychological mechanisms of action have also been proposed, including the distraction hypothesis, the mastery hypothesis, and the self-expansion theory. ¹⁶ Finally, physical activity provides a protective effect on cardiovascular disease risk independent of stress, ³³ making physical activity an important adjunct to daily life regardless of stress levels.

Our findings are particularly important in the context of recent and emerging pandemics, where students may be faced with environments and messages that do not promote PA (eg, reduced access to gyms and public spaces, fear-based media messages). Communication from colleges/universities to students may include simple suggestions for physically active stress management, such as going for a walk or jog in safe, open spaces; performing strength exercises at home; and joining virtual activity groups for accountability and connectivity.

Several limitations should be noted. First, the study measured perceived stress rather than physiological stress. Future studies may benefit from objective assessments of stress, such as serum cortisol levels.^34-36 Second, the sample majority was White and female with overweight/obesity and may not be representative of university student populations more generally. Future research on stress, stress management, and PA among college/university students should prioritize samples that represent racial/ethnic and gender diversity. Additionally, this sample included only students who were active on Facebook, which may limit generalizability of the findings. Third, students in this sample may have been using a combination of physically active and sedentary behaviors, which could attenuate beneficial associations between physically active stress management behaviors and perceived stress. It is also possible that participants’ physical activity behavior may have been influenced as part of the assessment battery for baseline data collection for the randomized controlled trial. Finally, this was a cross-sectional study of baseline data, which were collected prior to the COVID-19 pandemic and recent social justice events, and my not reflect current student stress responses.

Conclusions

This study investigated the relationship between PA and stress management behaviors in a sample of university students with overweight/obesity. Students meeting MVPA guidelines were more likely to manage stress using physically active behaviors compared to students not meeting the guidelines, and stress scores were lower among students using physically active stress management behaviors. In comparison to Black students, White students were more likely to manage stress using physically active behaviors. During the dual pandemics of COVID-19 and social justice, colleges/universities might support students by promoting stress management and PA in tandem, and tailoring messages to student activity levels and demographic characteristics.