Exploring the nexus: physical activity, body image, and anxiety among university students

Abstract

Background

This study aimed to investigate the relationship between physical activity, body image, and anxiety among undergraduate university students.

Methods

A total of 450 university students (67 male, 383 female) voluntarily participated in this research. Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ), anxiety levels with the Beck Anxiety Scale (BAI), and body image perception using the Body Image Scale (BIS). The study was conducted in Türkiye between November 15, 2021 and February 2022.

Results

Only 18.44% of the participants met the recommended level of physical activity, with 51.11% having moderate activity levels and 30.44% being entirely low activity levels. Anxiety was prevalent, as 85.1% of students reported moderate anxiety, and 14.9% reported high anxiety. Additionally, a negative relationship between physical activity and body image was observed, implying that increased physical activity correlated with more positive body image (r=-0.177, p = 0.00). As the physical activity score increased, the body image score decreased. Due to this negative relationship, an increase in the IPAQ score had a positive influence on the individual’s perception of their body image. Conversely, a significant, moderately positive relationship existed between anxiety and body image. Regression analysis demonstrated that perceived body image significantly influenced anxiety levels (p < 0.000), explaining 20.3% of the variance (p < 0.000).

Conclusion

In this study, we found the alarmingly low physical activity levels among university students and highlight the role of physical activity in enhancing body image and potentially reducing depressive symptoms. Practical implications include the necessity for effective interventions within universities to promote physical activity, support students in maintaining adequate activity levels, and consequently, improve mental well-being. These findings stress the importance of addressing physical activity and mental health within university settings and suggest actionable strategies for enhancing the overall health of students.

Introduction

Body image, encompassing one’s perception and attitudes towards their external appearance, holds a paramount position in the assessment of individuals [1]. It is intrinsically linked with cognitive perceptions and emotions, and a positive body image fosters higher satisfaction with one’s physical self. Notably, the emotional state of individuals, particularly negative emotions, has been observed to influence their perception of body image, with weight gain being a prominent contributor to body dissatisfaction, especially among women [2]. Additionally, research has consistently shown that depressive affect is a significant risk factor for diminishing individuals’ satisfaction with their bodies [3, 4].

In the context of university life, where young adults often navigate new challenges and responsibilities, maintaining a positive body image and mental well-being is essential. Studies have underscored the positive association between a positive body image and lower depressive symptoms among university students [5]. However, achieving and sustaining a healthy body image necessitates physical activity a cornerstone of overall well-being.

Physical activity is not merely a means of enhancing one’s physical fitness, it profoundly impacts mental health and emotional stability. Regular physical activity is associated with numerous health benefits, including improved cardiovascular health, central nervous system function, bone density, immune system strength, stress reduction, and enhanced mental health [6, 7]. Conversely, physical inactivity has been found to exert detrimental effects on various facets of health, leading to a 20–30% higher risk of mortality among inactive individuals [7].

Regrettably, contemporary research reveals a pervasive lack of interest in physical exercise, which is essential for maintaining a healthy lifestyle. Factors such as limited time, space, financial constraints, and technological distractions contribute to the decline in physical activity levels among young people [8, 9]. This decline is particularly concerning among university students, where physical activity not only influences their mental well-being but can also affect their academic performance and cognitive functioning [10].

Given the critical role of higher education in shaping future prospects, understanding the physical activity levels of university students is essential. Research assessing physical activity levels among students in health-related departments has shown alarmingly low activity levels, indicating the need for interventions to promote healthier behaviors [11, 12].

Against this backdrop, it is essential to emphasize the recommended guidelines for physical activity, which advocate for at least 30 min of moderate-intensity aerobic exercise on five days per week or 75 min of vigorous exercise on three days per week, in conjunction with strength training exercises at least twice a week [11, 13]. Moreover, the COVID-19 pandemic, with its disruption of traditional educational settings and a shift towards online learning, necessitates a reevaluation of students’ well-being, including their physical activity levels and mental health [11].

Universities, as pivotal hubs of learning and personal development, play a significant role in promoting healthy behaviors among students [14, 15]. Understanding the factors that influence the psychological well-being of university students, such as physical activity and body image, is crucial. This understanding can serve as a foundation for the development of psychosocial support programs and interventions tailored to students’ needs, particularly during challenging times like the pandemic, thereby enhancing their mental health and overall well-being [16].

In light of these considerations, our study seeks to investigate the intricate relationship between anxiety, body image, and physical activity among university students. This research not only addresses a critical knowledge gap but also provides valuable insights into the development of psychosocial support programs designed to enhance the mental health and well-being of college students.

Methods

Study participants

The study focused on undergraduate students currently pursuing their education at [İstanbul Aydın University]. A total of 450 participants, ranging in age from 18 to 30 years, were recruited from the Department of Physiotherapy and Rehabilitation at İstanbul Aydın University.

The study was conducted in Türkiye between November 15, 2021 and February 2022.Written informed consent was obtained from all individuals who voluntarily participated in the study, ensuring that they had a full understanding and were willing to participate.The study adhered to the principles outlined in the Declaration of Helsinki. Their participation had entirely voluntary, and their willingness was provided with an informed consent. Additionally, they were expected to demonstrate proficiency in using computers and/or mobile phones for data collection, and possess effective communication skills.

Ethics approval

The study received ethical approval from the Istanbul Aydın University, Non-Interventional Clinical Research Ethics Committee on November 1, 2021, with approval number 2021/600.

Sample size calculation

To determine the appropriate sample size for the study, a power analysis was conducted using the G*Power (version 3.1.9.4) package program. The sample size of 450 was calculated with a 95% confidence level and a margin of error of 0.05, considering a Cohen f2 effect size index of 0.21. This calculation, based on multivariate linear regression analysis, ensured a study power of 80%.

Measurements

Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ).Short Form, anxiety levels with the Beck Anxiety Scale (BAI), and body image perception using the Body Image Scale (BIS).

International Physical Activity Questionnaire (IPAQ): International Physical Activity Questionnaire – Short Form (IPAQ) originally developed for individuals between the ages of 15 and 69, assesses the physical activity levels of participants. The short-form version consists of seven questions, covering walking, moderate-intensity activities, vigorous activities, and sitting time. The total score is calculated by summing the duration (in minutes) and frequency (in days) of these activities, with energy expenditure expressed in MET-minute scores. The results classify individuals into three activity levels: inactive, minimally active, and very active [17]. The scale used in the study was not developed for this study. These are scales previously published elsewhere [18]. Lower IPAQ scores indicate lower levels of physical activity.

The Beck Anxiety Scale (BAI), initially created by Beck et al. in 1988 and adapted into Turkish by Ulusoy et al. in 1993, assesses the frequency of anxiety symptoms experienced by individuals over the past week. Comprising 21 items scored between 0 and 3, the scale provides an indication of the severity of anxiety symptoms, with higher scores indicating greater anxiety levels [19]. The scales used in the study were not developed for this study. These are scales previously published elsewhere [20].

Body Image Scale (BIS), originally known as the Body-Cathexis Scale (BCS) and developed by Secard and Jurard in 1953, the BIS evaluates an individual’s satisfaction with 40 different body parts or functions. The Turkish adaptation of the scale, validated by Hovardaoğlu in 1989, employs a five-point Likert-type measurement for its 40 items. Scoring ranges from 1 (I like it a lot) to 5 (I don’t like it at all), with lower scores indicating higher satisfaction with one’s body [21]. The scales used in the study were not developed for this study. These are scales previously published elsewhere [22].

Statistical analysis

IBM SPSS Statistics software 21.0 (SPSS Inc., Chicago, IL) version was used to conduct statistical analysis on the study data. For continuous data, descriptive statistics such as mean ± standard deviation (SD) were employed, whereas for categorical data, they were frequency and percentage. The Kolmogorov-Smirnov test was used to examine the normal distribution of the continuous data. We concluded that the data did not follow a normal distribution. The Kruskal-Wallis test was used to assess the distribution of scale scores in groups of three or more for those that did not fit the normal distribution. The accepted significance value was p < 0.05.

The estimation model was obtained using multiple linear regression analysis with the enter and backward elimination variable selection approach. The Durbin-Watson test was used to assess the correlation between mistakes (Autocorelation), and the Variance Inflation Factor (VIF) was used to assess multicollinearity. In order to assess the model’s suitability, effective and distant observations were examined using observation statistics (case statistics, i.e., Cook’s distance and Mahalanobis distance.

Results

Considering the gender variable, it was found that 85.11% of the 450 students were girls and 14.89% were boys. 57.77% of the participants were in their 1st year, and 42.23% were in their 2nd year. (Table 1).

Table 1.

Distribution of students by demographic characteristics, physical activity, and anxiety levels

		N	%
Gender	Female	383	85.11
	Male	67	14.89
Educational status	Occupational therapy	216	48.00
	Physiotherapy	116	25.77
	Other health related departments	116	25.77
	Non-health-related departments	2	0.46
Student’s Grades	1	260	57.77
	2	190	42.23
Physical Activity Level
High	83		18.44
Moderate	230		51.11
Low	137		30.44
Anxiety Level
Medium-level		383	85.11
Severe		67	14.89

Looking at the IPAQ-SF scores, the mean total physical activity score is 1760.16 ± 89.85, median 1116. It was determined that 83 (18.44%) of the study participants had sufficient physical activity levels, 230 (51.11%) had low physical activity levels, and 137 (30.44%) were not physically active (Table 1). It was determined that the academic success of 58.19% of the students decreased.

The mean score of BAI was found 14.33 ± 12.66. According to the Beck Anxiety Inventory, 383 (85.11%) of the students participating in the study were in the moderate range, and 67 (14.89%) were in the high-level score range (Tables 1 and 2). A statistically significant difference was found between the anxiety scores of the students with low physical activity levels and those with moderate and high activity levels. The mean score of BIS was 89.58 ± 28.09 (Table 2). The body image scores of the students with high physical activity levels were statistically significantly higher than those of the students with moderate physical activity levels.The level of body image of the students whose physical activity level was high was found to be at a good level compared to the others (Table 3).

Table 2.

Mean scores of body image, anxiety, and physical activity variables

Mean scores	X ± SD	Median	min-max
BIS	89.58 ± 28.09	89.50	40-200.79
BAI	14.33 ± 12.66	11.00	0–63
IPAQ	1760.16 ± 89.85	1116	0-10879
High	2397.22 ± 1952	1710.00	636-10848
Moderate	469.358 ± 87.71	459.00	318–594
Low	201.22 ± 70.61	198.00	99–297

BIS: Body Image Scale, BAI: Beck Anxiety Scale ,IPAQ: International Physical Activity Questionnaire – Short Form, HPA: High physical activity level, MPA:Moderate physical activity level, LPA: low physical activity level, X: average, SD: standard deviation, Min-max: Minimum- Maximum

Table 3.

Comparison of anxiety and body image scores by physical activity status

		IPAQ - MET-min/week
	HPA		MPA		LPA
	Median (SD)	Min-max	Median (SD)	Min-max	Median (SD)	Min-max	KW-test p
BAI	11.50±15.48	0–61	12.00 ± 11.91	0–63	9.00 ± 11.94	0–44	2.345 0.030*
BIS	79.00 ± 28.24	40–151	90.50 ± 27.72	40–200	93.79 ± 27.86	40–170	10.50 0.005*

IPAQ: International Physical Activity Questionnaire - Short Form, HPA: High physical activity level, MPA: Moderate physical activity level, LPA: low physical activity level, BIS: Body Image Scale, BAI: Beck Anxiety Scale, KW:Kruskal-Wallis test, Significant diffeerence between categories; p value *p < 0.05

A statistically significant difference was found between the anxiety scores of the students who were low physically, had moderate activity and high activity level (p < 0.030) (Table 3). There is a statistically significant negative (p < 0.05) relationship between physical activity scores and body image scores.

The predictive of the " anxiety " scale, was evaluated by Multiple linear regression analysis using the Stepwise variable selection method. Among the assumptions of Multiple linear Regression; Multicollinearity Variance Inflation Ratio (VIF), Autocorrelation between errors (Autocorrelation) Durbin-Watson (D-W) test, nonlinear relationship between effective observations Cook distance and variables, normal distribution of errors, homogeneity of variance and outlier observations were examined through residual plots. According to the results of the Regression analysis conducted to determine the effect of physical activity and body image on anxiety; It was determined that perceived body image had a significant effect on on anxiety (β = 0.457, t (447) = 10.57, p < 0.000) and it was 20.3% explanatory (F(2,443) (56.36, p < 0.000). And analysis results showed that university students’ anxiety depends on physical activity and perceived level of body image at a rate of 20.5% (Table 4). The established model explains 20.5% of the variation in the frequency variable. A 1-unit increase in Body Perception score leads to a 0.457-unit increase in anxiety variable. A 1-unit increase in physical activity score leads to a 0.130 unit reduction in anxiety variable.

Table 4.

Multivariate regression analysis of the effects of body image and physical activity on anxiety

Variable	b	SE(b)	BETA	t	p	VIF
IPAQ	0.001	0.000	0.130	2.998	0.003	1.038
BIS	0.205	0.019	0.457	10.571	0.000	1.038
R2 (Adjusted)	20.3
F(2.443)	56.36, p < 0.000

Independent Variable: IPAQ: Physical Activity Scores, BIS: Body Image Scale, Dependent Variable: BAI: Beck Anxiety Scale

Discussion

This study reveals a significant association between the level of physical activity and students’ subjective well-being. Specifically, students with moderate and high levels of physical activity displayed higher scores of subjective well-being compared to those with low physical activity. These findings align with prior research [13, 23] and indicate that a substantial proportion of the participating students had low physical activity levels. It’s important to note that the IPAQ results indicated that 18.44% of students had high physical activity levels, 51.11% had moderate physical activity levels, and 30.44% had low physical activity level [24], suggesting that young students exhibited lower physical activity levels. This discrepancy might be attributed to an overabundance of high and moderate physical activity among students, which could have contributed to the higher total physical activity.

Modern lifestyles, characterized by reduced exercise time, increased screen time, and sedentary behaviors, underscore the pressing need to raise awareness among young people about the importance of physical activity, offer guidance in this regard, and encourage them to increase their physical activity levels [25].

There is promising evidence that physical activity can help prevent anxiety [26–28], drawing considerable research attention to this topic in young people [29, 30]. This study finds a positive and significant relationship between students’ body image and their levels of happiness. This finding resonates with prior research that established a positive link between women’s happiness and body satisfaction [2, 31]. It suggests that students’ psychological well-being may be influenced by their body image. Quyang Y et al. reported that as participants’ body image improved, their psychological resilience increased [32]. In this study, the mean score obtained from the Body Image Scale was 89.58 ± 28.09, indicating that, on average, students were not dissatisfied with their bodies. However, it’s noteworthy that 35% of students scored above 100 on the body image scale, suggesting a higher level of body image dissatisfaction compared to some existing studies [33]. This discrepancy could be attributed to differences in the sample size compared to previous literature.

In our study, we found a negative relationship between physical activity levels and body image components, with physically active individuals generally reporting greater satisfaction with their weight and body image [29, 33]. A study conducted by Zhang et al. in 2024 confirms that physical activity has a positive effect on adolescents’ body image [34]. Additionally, overweight individuals tend to experience more body image dissatisfaction, low self-esteem, and depression [35]. The relationship between physical activity and anxiety is complex, with conflicting findings in the literature. Some studies suggest a negative relationship between high physical activity levels and anxiety symptoms [36, 37] while others emphasize a positive relationship between low and moderate physical activity levels and anxiety [38]. Likewise, low-intensity physical activity has been inversely related to depressive symptoms in students [39]. It shows a significant positive correlation between the amount of physical activity and body image, indicating that increased physical activity improves body image. The data reveal that the majority of adolescents are not sufficiently active, reflecting an overall concerning trend in physical activity during adolescence. In our current study, we also found a significant effect of physical activity levels on anxiety; lower anxiety symptoms were observed in students with higher physical activity levels.

Young women, who tend to be more sensitive to their body shape, are likely to experience more stress. Higher anxiety levels in students may also be attributed to body image dissatisfaction, as suggested in previous research [29]. A positive body image is associated with lower psychological problems such as depression and social avoidance [39], making body image an important antecedent variable for negative emotions [40] and subjective well-being [41, 42].

Our regression analysis results revealed that perceived physical activity and body image and had a significant effect on anxiety levels, explaining 20.3% of the variance. A one-unit increase in physical activity level causes a 0.130-unit decrease in anxiety levels. A one-unit increase in body image level corresponded to a 0.457-unit increase in anxiety levels. These findings suggest that addressing students’ physical activity and perceived body image may help reduce their anxiety levels. It has been determined that anxiety is one of the most common mental health problems among university students. The results of our study showed that physical activity and body image are effective in reducing anxiety in university students. This finding suggests that encouraging the young population to engage in high levels of physical activity will have a positive impact on their mental well-being. However, in order for students to overcome their negative attitudes toward exercise and adopt exercise as a lifestyle, it is predicted that developing motivating, encouraging, and enjoyable exercise programs from the earliest stages of education that foster lifelong motivation for exercising will be a more effective intervention in reducing negative body image and anxiety. We believe that such interventions will also increase students’ participation in physical activity and exercise.

Limitations

This study has some limitations. Being a cross-sectional study, it focused on a single university, and due to the nature of the selected university, it had a higher representation of female students. Therefore, the potential impact of gender on the study variables was not thoroughly examined. Future research should consider gender-specific factors to provide tailored recommendations for college students of different genders.

Conclusion

At the end of this study, it was determined that there is a relationship between physical activity level, body image, and anxiety in university students. It underscores the need to promote moderate and vigorous physical activity among young students as an effective approach to improving body image and reducing anxiety. Comprehensive and controlled studies in this area may provide further insights into the relationship between physical activity levels, body image, and anxiety. Universities can play a pivotal role in encouraging physical activity through attractive sports programs, active transport initiatives, physical activity campaigns, and educational activities. These efforts can positively impact students’ mental health, contributing to their academic success.

Abbreviations

BIS

Body Image Scale

BAI

Beck Anxiety Scale

IPAQ

International Physical Activity Questionnaire – Short Form

HPA

High physical activity level

MPA

Moderate physical activity level

LPA

low physical activity level

X

average

SD

standard deviation

Min-max

Minimum- Maximum

KW

Kruskal-Wallis test

Author contributions

All authors have made substantial contributions to the concept and design of the study. DB, AG, GÖ, DTD had an important role. DB, AG, GÖ, DTD were involved in the analysis and interpretation of the data. DB, AG, were major contributors in writing the manuscript. DB, AG, GÖ, DTD substantively revised the manuscript. All authors read and approved the fnal manuscript.

Funding

The author(s) received no specific funding for this work.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

The study received ethical approval from the Istanbul Aydın University, Non-Interventional Clinical Research Ethics Committee on November 1, 2021, with approval number 2021/600.

Consent to participate

Participants were informed that participation was voluntary. Informed consent was obtained for participation from all participants participating in the study.

Consent to publish

This is not applicable.

Competing interests

The authors declare no competing interests.