Abstract
Background
Spiritual health and self-regulation are important factors influencing exercise behavior, which is crucial for physical and mental well-being, especially among infertile women. This study aimed to determine the relationship between spiritual health and self-regulation with exercise behavior (EB) among infertile women.
Methods
This cross-sectional study was conducted among 483 infertile women in Sanandaj, Iran, in 2024, selected through consecutive sampling from 35 healthcare centers. Data were collected using a four-section questionnaire that assessed demographic factors, spiritual health (existential and religious; reliability 0.82, validity 0.84), self-regulation (reliability 0.86, validity 0.89), and stages of exercise behavior change (Kappa coefficient 0.78). Binary logistic regression was performed using SPSS version 21 to analyze the relationships between exercise behavior, spiritual health, and self-regulation.
Results
The average age for infertile women was 33.88 ± 8.34. One-third of women (143/438) engaged in exercise behavior; 21.5% of them were in the pre-contemplation stage, 30.2% in the contemplation stage, 18.6% in the preparation stage, 16.8% in the action stage, and 12.8% in the maintenance stage of exercise behavior. The analysis revealed a statistically significant mean difference in self-regulation and existential health between two groups of women with high scores (≥ 160) and those with primary infertility. Binary logistic regression analysis of EB showed that the odds of EB adoption increased with self-regulation (OR = 1.02, 95% CI; 1.009-1.049, p = 0.001). Spiritual health did not have a significant effect on EB among infertile women.
Conclusion
The findings indicated that self-regulation, rather than spiritual health, was strongly associated with EB in infertile women. Spiritual health must be bolstered in infertile women due to their mental and emotional conditions, even though it did not have a substantial impact on their exercise behavior.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12905-026-04337-x.
Keywords: Spiritual health, Self-Regulation, Exercise behavior, Infertile women
Background
Infertility is the most critical concern in the field of reproductive health in developing countries [1]. Infertility is defined as the inability to achieve a successful pregnancy after one year of regular, unprotected sexual intercourse or artificial insemination without the use of any contraceptive methods [2]. According to the World Health Organization (WHO), primary infertility refers to the condition in which a woman has never conceived; in addition, secondary infertility refers to the inability to conceive in a couple who have previously had at least one successful pregnancy [3]. According to the WHO report (2023), approximately 17.5% of the adult population experiences infertility [4]. The infertility rate in Iran is estimated to range between 9% and 22%. Psychological stress resulting from infertility can directly affect physiological functions, ultimately reducing fertility. Conversely, individuals with psychological well-being and a sense of peace tend to experience lower stress levels, which may increase their likelihood of conceiving [5].
An individual’s lifestyle, particularly their level of physical activity, plays a crucial role in maintaining good health and promoting fertility in women [6]. Regular physical activity has been shown to reduce the risk of cardiovascular disease, stroke, hypertension, diabetes, cancer, osteoporosis, and depression. It plays a crucial role in maintaining energy balance, regulating body weight, increasing life expectancy, enhancing quality of life, and improving self-efficacy [7–10]. The rates of physical activity among women in various countries are as follows, despite the benefits of physical activity: 43% of Turkish women, 28% of Pakistani women, and 20% of Indian women [11]. for Iranian women is 49% [12], with 9% engaging in regular physical activity [13]. There are no exact figures on the degree of physical activity among infertile women, although one study found that infertile women have lower levels of physical activity than others [14]. Multiple factors influence women’s physical activity; among them, spiritual health [15] and self-regulation [16, 17] have been mentioned. One of the four aspects of human health, in addition to the physical, mental, and social aspects, is spiritual health. It balances the other aspects of health and can help to promote general health [18].
Spiritual health is defined as a sense of stability and inner peace, a feeling of meaningful connection with oneself, God, the community, and the environment, as well as a sense of purpose in life. It comprises two dimensions: existential and religious health. Religious health reflects an individual’s relationship with God or a higher power, whereas existential health pertains to one’s interactions with others, the environment, and one’s inner self [19]. Spiritual health determines individual integrity and wholeness [20]. It improves productivity, motivation, and capability, and promotes physical, mental, and social well-being [21].
Self-regulation also plays a crucial role in promoting health and facilitating engagement in effective exercise behaviors. Bandura, the Canadian-American psychologist, describes self-regulation as an internal mechanism that guides individuals in selecting which behaviors to perform. It serves as a consistent force that drives individuals toward their goals and motivates them to adjust their behaviors to meet specific standards [22].
Spiritual health and self-regulation are strong factors in engaging in health-related behaviors [23, 24]. Since spiritual health is associated with the promotion of psychological calmness, meaning, and purpose in life, and self-regulation plays an important role in maintaining physical activity through processes such as goal setting, self-monitoring, and behavioral control, the researchers sought to examine which of these factors plays a more prominent role in predicting exercise behavior among infertile women. Furthermore, although previous studies have illustrated the association of these factors with health-related behaviors separately, none have simultaneously compared their effects on exercise behavior specifically among infertile women. Therefore, this study addresses this gap and provides novel insights into how spiritual health and self-regulation may differentially influence exercise behavior in this population.
Research questions
First, whether there is a relationship between spiritual health and self-regulation, and second, how spiritual health and self-regulation predict EB in infertile women.
Objectives
The present study endeavors to examine the relationship between spiritual health and self-regulation with EB among infertile women in Sanandaj city, taking into account the role of spiritual health, the importance and impact of self-regulation on EB in infertile women, the effect of spiritual health on physical, mental, social well-being, and the lack of studies on the relationship between spiritual health and self-regulation with EB. It is anticipated that the findings of this investigation will be beneficial in the development of interventions that will improve the spiritual health and self-regulation of infertile women.
Methods
Study design
This cross-sectional study was conducted among infertile women in Sanandaj, Iran, from January to August 2024.
Study population
In this study, a registry-based consecutive sampling method was employed. Participants were identified through active infertility registries maintained at 35 comprehensive healthcare centers in Sanandaj, western Iran, in 2024. These registries include women who are currently receiving or have recently sought infertility-related healthcare services.
All women with primary or secondary infertility who had an active medical file and met the inclusion criteria—being married, having a marriage duration of more than one year, and willingness to participate—were consecutively recruited during the study period (n = 483). By relying on active registries and enrolling all eligible cases within the defined timeframe, the study minimized selection bias associated with arbitrary convenience sampling and enhanced the representativeness of infertile women accessing public healthcare services in the region. The sample size was determined based on a previous Iranian study on infertile women [25]. considering the estimated prevalence and statistical power. Women aged under 20 or 45 and older were excluded from the study. Women younger than 20 were excluded because infertility is uncommon in this age group, and their reproductive and psychological maturity differs from that of older women. Women aged 45 and above were excluded due to the natural decline in fertility with age, which substantially increases the likelihood of infertility.
Data collection
For gathering the data, the standardized questionnaires comprised questions on demographic characteristics, EB, spiritual health, and self-regulation. The primary investigator (AF) took informed consent and conducted face-to-face interviews in a quiet place. To minimize potential bias, all interviews were conducted under standardized conditions for all participants, ensuring that the questions, their order, and the procedure were identical. The interviewer had considerable experience in conducting interviews and a research background with publications in related areas. Questions were asked consistently, and responses were recorded anonymously to reduce participant bias.
The completion of the questionnaires took approximately 15 min, and all participants completed them in full. Data were collected using a comprehensive questionnaire consisting of four sections: demographic factors, spiritual health, self-regulation, and the stages of exercise behavior change. The first section included demographic variables such as age, weight, height, employment status, income, education level, and the duration and type of infertility.
The second component consisted of a 20-item questionnaire on spiritual health, with half of the items addressing existential health and the other half addressing religious health. The items in this section were evaluated using a six-point Likert scale, ranging from 1 (indicating complete disagreement) to 6 (indicating entire agreement), with cut off 60, minimum and maximum scores of 20 and 120. The questionnaire’s reliability (0.82) and validity (0.84) have been previously confirmed among the Iranian population [26].
The third section consisted of a 12-item questionnaire that assessed self-regulation, including the ability to control and maintain exercise behavior, pursue long-term goals, and demonstrate perseverance in behavior. Participants rated each item on a four-point Likert scale, ranging from always (score 4) to never (score 1) with cut off 30, minimum and maximum scores of 12 and 48. The questionnaire’s reliability (0.86) and validity (0.89) have been previously confirmed among the Iranian population [27].
Stages of exercise behavior change: Exercise behavior (EB)
This study defined EB as thirty minutes of physical activity over five days. The target result of this study, self-reported EB, was obtained using the stages of EB change questionnaire, which is based on the trans-theoretical model of behavior change. The questionnaire has previously been shown to be reliable among the Iranian population, with a Kappa coefficient of 0.78 [28].
The EB questionnaire, which relies on self-reporting, contains a question that assesses the different stages of EB transformation. The stages of EB transformation consist of five stages, namely.
In the pre-contemplation stage, individuals do not have any intention of taking action yet soon. In the contemplation stage, individuals to adopt a healthy behavior within the next 6 months. The preparation stage involves individuals who are ready to take action within the next 30 days. The action stage refers to individuals who have recently made a behavior change within the last 6 months. Lastly, the maintenance stage includes individuals who have successfully sustained their behavior change for a significant period, defined as more than six months [29].
The pre-contemplation, contemplation, and preparation stages signify an absence of evidence-based practices, but the action and maintenance stages reflect the adoption of evidence-based practices. Based on these five stages, we determined a subject-specific binary result for self-reported EB (absent/present) and showed whether or not women had embraced EB. This means whether they were in the initial three stages (pre-contemplation, contemplation, and preparation) or the action and maintenance stages [29].
Covariates
The covariates consisted of demographic variables such as age (< 35 Years/≥ 35 Years), weight (< 60 kg/≥ 60 kg), height (< 160/≥160 centimeters (cm), job status (housewife/employed), income (< 300 $/≥ 300 $ per month), literacy (< high school diploma/≥ high school diploma), as well as health-related information on the duration of infertility (< 6 years/≥6 years) and type of infertility (primary/secondary). It should be noted that the cut-off points used (e.g., ≥ 160 for height) were determined based on a previous study conducted in Iran by the first author of this study. Additionally, these thresholds were selected considering the distribution of scores in our sample and the need for meaningful categorization of participants for statistical analysis, allowing a logical and practical distinction between low and high levels.
Statistical analysis
All data were entered into the IBM SPSS Statistics for Windows, version 21.0 statistical software programme (IBM Corp. 2012. Armonk, NY: IBM Corp). The frequency and percentage of categorical variables, as well as the mean and standard deviation of quantitative variables, were used to characterize the baseline characteristics of the participants. Chi-square and independent t-tests were implemented to evaluate group distinctions.
Pearson correlations were utilized to examine the relationships between spiritual health and self-regulation. Binary Logistic regression models were used to investigate the link between EB and spiritual health and self-regulation. The estimates were adjusted for age, work position, income, literacy, weight, height, duration, and type of infertility. The computed logits were presented with the odds ratios (OR) with 95% confidence intervals. Before performing logistic regression, all assumptions, including the absence of multicollinearity and the linearity of continuous variables in the logit, were assessed and confirmed. Statistical significance was determined at p < 0.05.
Results
A total of 483 infertile women with a mean age 0 of 33.88 ± 8.34 were recruited in this study. One-third of women (143/438) did an EB, 20.3% of them were in the pre-contemplation stage, 26.1% in the contemplation stage, 17% in the preparation stage, 21.5% in the action stage, and 15.1% in the maintenance stage of EB. No significant difference was observed between demographic variables and EB(p > 0.05). The relationship between demographic characteristics of the participants and EB is summarized in Table 1. Based on the results, the mean difference in self-regulation between women with high (≥ 160) and low (< 160) was statistically significant (p = 0.001). Additionally, among women with primary infertility, the association between existential health and self-regulation was also statistically significant (p = 0.04). The means and standard deviations of the self-regulation, existential health, religious health, and spiritual health are summarized in Table 2.
Table 1.
The relationship between demographic characteristics of the participants and exercise behavior
| Demographic Variables | Exercise Behavior | Not doing exercise behaviorn (%) | Doing exercise behavior n(%) | p- value* |
|---|---|---|---|---|
| Age. y | < 35 | 188(74.3) | 65(25.7) | 0.09 |
| ≥ 35 | 155(67.4) | 75(32.6) | ||
| Weight, kg | < 60 | 112(73.7) | 40(26.3) | 0.38 |
| ≥ 60 | 231(69.8) | 100(30.2) | ||
| Height, cm | < 160 | 170(73.3) | 62(26.7) | 0.29 |
| ≥ 160 | 173(68.9) | 78(31.1) | ||
| Literacy | < High School Diploma | 180(74.4) | 62(25.6) | 0.10 |
| ≥ High School Diploma | 163(67.6) | 78(32.4) | ||
| Job status | Housekeeper | 220(72.4) | 84(27.6) | 0.39 |
| Employed | 123(68.7) | 56(31.3) | ||
| Income | Lower Than 300 Dollars | 160(69.9) | 69(30.1) | 0.59 |
| More Than 300 Dollars | 183(72) | 71(28) | ||
| Type Of infertility | Primary | 157(74.1) | 55(25.9) | 0.19 |
| Secondary | 186(68.6) | 85(31.4) | ||
| Duration Of infertility, y | < 6 | 225(72.1) | 87(27.9) | 0.59 |
| ≥ 6 | 113(69.8) | 49(30.2) |
Abbreviations: Y Year, kg Kilogram, cm Centimeter
* χ2 test
Table 2.
Mean ± SD of existential health, religious health, spiritual health, and self-regulation according to participants’ demographic characteristics
| Demographic Variables | Meansof determinants | Existential Health | Religious Health | Spiritual Health | self-regulation |
|---|---|---|---|---|---|
| Age | 35≤ | 37.39±4.81 | 35.83±5.28 | 73.22±8.89 | 30.66±10.54 |
| 35> | 37.31±4.31 | 35.68±5.04 | 72.99±7.9 | 31.36±10.51 | |
| P-Value* | 0.84 | 0.74 | 0.76 | 0.46 | |
| weight | 60≤ | 37.62±4.78 | 35.74±5.23 | 73.63±8.58 | 30.2±9.5 |
| 60> | 37.23±4.49 | 35.77±5.15 | 73±8.36 | 31.32±10.93 | |
| P-Value* | 0.38 | 0.95 | 0.65 | 0.31 | |
| height | 160≤ | 37.46±4.63 | 35.84±5.28 | 73.31±8.64 | 29.12±9.7 |
| 160> | 37.25±4.54 | 35.68±5.07 | 72.93±8.23 | 32.71±10.95 | |
| P-Value* | 0.6 | 0.73 | 0.62 | 0.001 | |
| Job status | Housewife | 37.27±4.67 | 35.77±5.02 | 73.05±8.35 | 31.37±10.54 |
| employed | 37.49±4.44 | 35.73±5.42 | 73.22±8.58 | 30.34±10.47 | |
| P-Value* | 0.6 | 0.92 | 0.82 | 0.29 | |
| Income | 300$≤ | 37.45±4.27 | 36.13±5.11 | 73.59±8.17 | 31.36±11.03 |
| 300$> | 37.26±4.85 | 35.42±5.21 | 72.68±8.64 | 30.66±10.05 | |
| P-Value* | 0.65 | 0.12 | 0.23 | 0.46 | |
| literacy | <High school diploma | 37.47±4.78 | 36.02±5.28 | 73.5±8.88 | 30.75±10.28 |
| ≥High school diploma | 37.23±4.38 | 35.49±5.05 | 72.73±7.94 | 31.23±10.76 | |
| P-Value* | 0.55 | 0.26 | 0.31 | 0.61 | |
| Type of infertility | Primary | 37.83±4.57 | 36.02±5.12 | 73.86±8.7 | 30.75±10.51 |
| Secondary | 36.98±4.56 | 35.55±5.20 | 72.53±8.17 | 31.17±10.54 | |
| P-Value* | 0.04 | 0.31 | 0.08 | 0.66 | |
| Duration of infertility, y | <6 | 37.40±4.54 | 35.75±5.11 | 73.16±8.18 | 30.47±10.20 |
| ≥6 | 37.12±4.71 | 35.74±5.32 | 72.87±8.96 | 32±11.05 | |
| P-Value* | 0.53 | 0.98 | 0.73 | 0.13 |
*Independent-Samples T Test
The mean and standard deviation of spiritual health and self-regulation, as well as their relationship with exercise behavior, are presented in Table 3. The analysis revealed a statistically significant mean difference in self-regulation between the two groups of women who engaged in exercise behavior and the others who did not(p = 0.001). Multiple logistic regression analysis of EB, adjusted for age, job status, income, literacy, weight, height, and duration and type of infertility showed that the odds of EB adoption increased with self-regulation (OR = 1.02, 95% CI; 1.009–1.049, p = 0.001). The remaining covariates were not statistically significant. Spiritual health did not have a significant effect on EB among infertile women. The result of logistic regression analysis of EB is summarized in Table 4.
Table 3.
The relationship of spiritual health and self-regulation with exercise behavior
| Variables | Exercise Behavior | Not Doing Exercise Behaviour | Doing Exercise Behaviour | P-Value |
|---|---|---|---|---|
| Spiritual Health | 73.7±8.67 | 73.23±7.81 | 0.83 | |
| Self-Regulation | 29.93±10.01 | 33.57±11.30 | 0.001 | |
*Independent-Samples T Test
Table 4.
Logistic regression of each variable on exercise behavior
| Predictors | b | S.E. | Odds Ratio | 95%CI | Wald | P-value |
|---|---|---|---|---|---|---|
| Model | ||||||
| Age | ||||||
|
35≤ 35> |
0.297 | 0.210 | 1.34 | 0.892–2.030.892.030 | 2.003 | 0.15 |
| Weight | ||||||
|
60≤ 60> |
0.150 | 0.228 | 1.16 | 0.744–1.816.744.816 | 0.437 | 0.5 |
| Height | ||||||
|
160≤ 160> |
0.174 | 0.214 | 1.19 | 0.783–1.810.783.810 | 0.665 | 0.41 |
| Job status | ||||||
|
Housewife employed |
0.195 | 0.219 | 1.21 | 0.791–1.866.791.866 | 0.791 | 0.37 |
| Income | ||||||
|
300$≤ 300$> |
0.145 | 0.211 | 0.86 | 0.572–1.308.572.308 | 0.475 | 0.49 |
| Literacy | ||||||
|
<High school diploma ≥High school diploma |
0.360 | 0.210 | 1.43 | 0.950–2.164.950.164 | 2.936 | 0.08 |
| Type of fertility | ||||||
|
Primary Secondary |
0.207 | 0.214 | 1.23 | 0.808–1.872.808.872 | 0.935 | 0.33 |
| Duration of infertility | ||||||
|
<6 ≥6 |
0.095 | 0.220 | 1.10 | 0.715–1.693.715.693 | 0.188 | 0.66 |
| Existential Health | 0.027 | 0.027 | 1.02 | 0.975–1.082.975.082 | 0.990 | 0.32 |
| Religious Health | 0.01 | 0.023 | 0.98 | 0.938–1.028.938.028 | 0.597 | 0.44 |
| Spiritual Health | 0.002 | 0.012 | 1.00 | 0.979–1.026.979.026 | 0.03 | 0.84 |
| Self-regulation | 0.02 | 0.010 | 1.02 | 1.009–1.049.009.049 | 8.48 | 0.004 |
Variable Dependent: exercise behaviour
Model (likelihood ratio) chi-square = 20.77, df = 11, p < 0.01
Negelkerke R2 = 6.1%
Percent correctly classified = 71.3%
Discussion
This study examined the relationship between spiritual health, self-regulation, and EB among Iranian infertile women. The findings showed that 63.4% of participants did not engage in regular exercise. Consistent with previous studies, Saremi et al. reported 54.3% of infertile women had low physical activity, while Khosrorad et al. found 73.1% had moderate activity levels [30, 31]. Mirzaei et al. reported that over 90% of infertile women exhibited low or moderate levels of physical activity, highlighting the high prevalence of insufficient physical activity in this population [32]. Cao et al. also reported a negative association between sedentary behavior and exercise [33]. Low physical activity in infertile women may result from both psychosocial factors—such as stress, anxiety, depression, and social isolation—and physiological factors, including fatigue or hormonal imbalances. Chronic inactivity can further lead to social disengagement and increased anxiety [33]. Future interventions should aim to enhance exercise behavior, reduce psychological burden, and decrease sedentary behavior.
In the present study, a significant association between self-regulation and higher scores (≥ 160) has observed. To our knowledge, no previous studies have examined the relationship between height and self-regulation in infertile women, so direct comparisons are not possible. Our findings suggest that infertile women with taller stature may be more likely to engage in exercise and fitness activities, plan their routines, and set goals, indicating higher self-regulation of EB compared to shorter women. These results should be interpreted cautiously, and further research is needed to confirm this potential relationship The study’s findings revealed that self-regulation, rather than spiritual health, was strongly associated with EB in infertile women. Silfee et al. reported that there was no statistically significant association between physical activity and spirituality [34]. In contrast, the study by Kruk et al. provided robust evidence that higher levels of spirituality and religiosity are positively associated with increased physical activity and reduced sedentary behavior. Moreover, the findings suggest that spirituality-based interventions may serve as effective strategies for promoting active lifestyles and enhancing health-related behaviors [35].
Sas-Nowosielski and his colleague demonstrated that individuals with excellent self-regulation capabilities may not only engage in and sustain exercise but also purposefully direct their health behaviors [36].
Ylitalo et al. reported that self-regulatory skills, including goal-setting and self-monitoring, are positively associated with increased physical activity, and that interventions targeting these skills can support the maintenance of long-term health-promoting behaviors [37]. Ylitalo et al. explained that incorporating self-regulatory skill development activities into exercise prescription programs in clinical settings may provide a tailored and multifaceted approach to promoting physical activity. Moreover, training healthcare providers in self-regulation strategies has substantial potential to support long-term health behaviors, such as regular exercise, for managing chronic diseases, disabilities, or disorders [37]. Similarly, the study by Sundgot‑Borgen et al. demonstrated that individuals with better self-regulatory skills maintain higher levels of physical activity over time [38].
Our findings may indicate that, among infertile women, practical skills such as goal setting, planning, and self-monitoring play a greater role in translating intention into actual exercise behavior than spiritual motivation alone. Therefore, health promotion programs for this group should primarily focus on teaching self-regulation techniques (e.g., skill-building sessions, daily tracking tools, and problem-solving strategies for practical barriers), while also incorporating spiritual support components to enhance motivation and persistence. Future studies should evaluate this combined approach through longitudinal or randomized controlled trial (RCT) designs to better clarify causal pathways and influencing conditions. Based on our comprehensive literature review, no studies were identified that contradict the findings of the present study. It should also be noted that the cultural and social context of Iran may have influenced both exercise behavior and spiritual health among infertile women. In Iranian society, religious and spiritual values are deeply integrated into daily life and may influence women’s attitudes toward health, body image, and coping with infertility. Spirituality is often expressed through religious practices and social support, which may affect emotional regulation and motivation. Moreover, social norms and gender expectations may limit women’s access to sports facilities and opportunities for physical activity. Therefore, the observed relationships between spiritual health, self-regulation, and exercise behavior should be interpreted within this cultural context, and the findings may not be fully generalizable to societies with different cultural backgrounds.
Limitations of the study
The cross-sectional design limits the ability to draw causal inferences between the study variables. In addition, the relatively low explanatory power of the regression model suggests that other unmeasured factors may also influence exercise behavior among infertile women. Finally, since the study included only urban participants and excluded infertile women living in rural areas, the generalizability of the findings to other populations may be limited.
Conclusion
The results showed that self-regulation was associated with exercise behavior in infertile women, whereas spiritual health had no significant effect. Therefore, enhancing self-regulation through supportive and counseling programs may effectively improve physical activity in this population. Given that spiritual health did not show a direct significant impact on exercise behavior, recommendations in this regard should be made cautiously, and it can be proposed as a hypothesis for future research. Future longitudinal and intervention studies could help examine causal relationships and the effect of self-regulation training on exercise behavior in infertile women.
Supplementary Information
Acknowledgements
We express our heartfelt gratitude to all infertile women who participated in the study for generously giving their time and energy in order to complete this study.
Authors’ contributions
1. Study concept and design: AF, AH SHS, Sh AM.2- Acquisition of data: S N, Sh S3- Analysis and interpretation of data: AF, S N, AH SHS, Sh AM, A R, L A, Ch HM. 4- Drafting of the manuscript: AF, AH SHS, Sh AM, Ch HM. Ch HM.5- Critical revision of the manuscript for important intellectual content: AH SHS, A R, L A6- Data analysis: AF, S N, Sh AM, Ch HM.7- Administrative, technical, and material support: S N, AH SHS, A R, L A, Sh S8- Study supervision: AF.
Funding
The authors received financial support for the research (70$).
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This work was supported by the Vice Chancellor for Research and Technology, Kurdistan University of Medical Sciences, Sanandaj, Iran, under the ethical code MUK.REC.1403.226. The authors would like to thank the Vice Chancellor for Research and Technology, Kurdistan University of Medical Sciences for providing financial support. The study was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.
After obtaining approval from the ethics committee of Kurdistan University of Medical Sciences and attending comprehensive health service centers, the research objectives were clearly explained to the participants. Informed consent to participate was obtained from all participants and they were assured of their voluntary participation in the study. Participants had the freedom to withdraw from the study at any point, and the confidentiality of the data was guaranteed throughout all stages of the research.
Consent for publication
Not Applicable.
Competing interests
The authors declare no competing interests.
Clinical trial number
not applicable.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Ombelet W, Lopes F. Fertility care in low and middle income countries: fertility care in low- and middle-income countries. Reprod Fertil. 2024;5(3):e240042. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Carson S, Kallen A. Diagnosis and management of infertility: a review. JAMA. 2021;326(1):65–76. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Benksim A, Elkhoudri N, Ait Addi R, Baali A, Cherkaoui M. Difference between primary and secondary infertility in Morocco: frequencies and associated factors. Int J Fertil Steril. 2018;12(2):142–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Who. www.who.1 in 6 people globally affected by infertility: WHO. 2023. [PMC free article] [PubMed]
- 5.Mansouri M, Heydar Z, Lotfi R, Rahimzadeh Kiwi M, Tahamtan T. The relationship between sexual and marital satisfaction level and the causes of infertility in infertile couples who referred to Nahal Infertility center in Alborz Province. aumj. 2021;11(1):24–34. [Google Scholar]
- 6.Mussawar M, Balsom A, Totosy de Zepetnek J, Gordon J. The effect of physical activity on fertility: a mini-review. F S Rep. 2023;4(2):150–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Burton N, Pakenham KI, Brown WJ. Evaluating the effectiveness of psychosocial resilience training for heart health, and the added value of promoting physical activity: a cluster randomized trial of the READY program. BMC Public Health. 2009;9(1):1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Assis MA, Mello MF, Scorza FA, Cadrobbi MP, Schooedl AF, Silva SG, et al. Evaluation of physical activity habits in patients with posttraumatic stress disorder. Clinics. 2008;63(4):473–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Martinsen EW. Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry. 2008;62(sup47):25–9. [DOI] [PubMed] [Google Scholar]
- 10.Giacobbi PR, Stancil M, Hardin B, Bryant L. Physical activity and quality of life experienced by highly active individuals with physical disabilities. Adapt Phys Activ Q. 2008;25(3):189–207. [DOI] [PubMed] [Google Scholar]
- 11.Dumith S, Hallal P, Reis R, Kohl H. Worldwide prevalence of physical inactivity and its association with human development index in 76 countries. Prev Med. 2011;53(1–2):24–8. [DOI] [PubMed] [Google Scholar]
- 12.Kahan D. Adult physical inactivity prevalence in the Muslim world: analysis of 38 countries. Prev Med Rep. 2015;2:71–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Maddah M, Akbarian Z, Shoyooie S, Rostamnejad M, Soleimani M. Prevalence of regular exercise among Iranian adults: a study in Northern Iran. J Phys Act Health. 2014;11(4):10–3. [DOI] [PubMed] [Google Scholar]
- 14.Rich-Edwards J, Spiegelman D, Garland M, Hertzmark E, Hunter D, Colditz G, et al. Physical activity, body mass index, and ovulatory disorder infertility. Epidemiology. 2002;13(2):184–90. [DOI] [PubMed] [Google Scholar]
- 15.Rabiepoor S, Sadeghi E, Sayyadi H. Spiritual health and physical activity among Iranian pregnant women. J Relig Health. 2019;58(2):506–15. [DOI] [PubMed] [Google Scholar]
- 16.Bai P, Johnson S, Trost S, Lester L, Nathan A, Christian H. The relationship between physical activity, self-regulation and cognitive school readiness in preschool children. Int J Environ Res Public Health. 2021;18(22):11797. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Vasilopoulos F, Ellefson M. Investigation of the associations between physical activity, self-regulation and educational outcomes in childhood. PLoS One. 2021;16(5):e0250984. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Norouzi R, Elahi N. Effect of group spiritual therapy on quality of life and spiritual health on patients with multiple sclerosis in Ahvaz City, Iran. Jundishapur J Chronic Dis Care. 2018;7(4):e79853. [Google Scholar]
- 19.AsarRoodi A, Golafshani A, Akaberi A. The relationship spiritual health and quality of life in nursing. J North Khorasan Univ Med Sci. 2011;3(4):79–88. [Google Scholar]
- 20.Ghaderi A, Tabatabaei S, Nedjat S, Javadi M, Larijani B. Explanatory definition of the concept of spiritual health: a qualitative study in Iran. J Med Ethics Hist Med. 2018;11:3. [PMC free article] [PubMed] [Google Scholar]
- 21.Nandika S, Nagalakshmi K. Spirituality as intrinsic motivational factor and health related quality of life among hospitalized male patients practicing Hinduism in India. Indian J Psychiatry. 2022;31(1):120–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Bandura A. The primacy of self-regulation in health promotion. Appl Psychol Int Rev. 2005;54(2):245–54. [Google Scholar]
- 23.D’Cruz A, D’Souza N, Downing K, Smith C, Sciberras E, Hesketh K. Association between physical activity and self-regulation in early childhood: a systematic review. Obes Rev. 2024;25(2):e13657. [DOI] [PubMed] [Google Scholar]
- 24.Bożek A, Nowak P, Blukacz M. The relationship between spirituality, health-related behavior, and psychological well-being. Front Psychol. 2020;11:1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Fallahi A, Rahmani A, Amin Yousif P, Ghanei Gheshlagh R, Allahqoli L, Nemat B, et al. Effects of social support and self-regulation on changes in exercise behavior among infertile women: a cross-sectional study for comparison of external and internal factors. J Educ Community Health. 2023;10(3):145–51. [Google Scholar]
- 26.Moghimian M, Salmani F, Azarbarzin M. The relationship test anxiety and spiritual health in nursing students. J Ghom Univ Med Sci. 2011;15(3):31–3. [Google Scholar]
- 27.Soleymanian A, Niknami S, Hajizadeh E, Shojaeizadeh D, Montazeri A. Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE). BMC Musculoskelet Disord. 2014;15(61):1–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.jalilian F, Emdadi S, Mirzaie M, Barati M. The survey physical activity status of employed women in Hamadan university of medical sciences: the relationship between the benefits, barriers, self-efficacy and stages of change. Tolooe Behdasht. 2010;4(9):89–98. [Google Scholar]
- 29.Liu K, Kueh Y, Arifin W, Kim Y, Kuan G. Application of transtheoretical model on behavioral changes, and amount of physical activity among university’s students. Front Psychol. 2018;9:2402. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Saremi A, Moradzadeh R. The relationship between physical activity and primary infertility in Iranian women. Women Health Bull. 2024;11(1):20–8. [Google Scholar]
- 31.Khosrorad T, Dolatian M, Riazi H, Mahmoodi Z, Shahsavari S, Yadegari M. Comparison of physical activity in fertile and infertile couples in Kermanshah, Iran during 2013. Adv Nurs Midwifery. 2016;25(89):1–9. [Google Scholar]
- 32.Mirzaei M, Namiranian N, Bagheri-Fahraji B, Gholami S. Infertility and physical activity: a cross-sectional study of women living in Yazd aged 20–49 year, 2014–2015. Int J Reprod Biomed. 2020;18(9):795–803. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Cao Y, Li G, Ren Y. Association between self-reported sedentary behavior and health-related quality of life among infertile women with polycystic ovary syndrome. BMC Womens Health. 2023;23(1):67. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Silfee V, Haughton C, Lemon S, Lora V, Rosal M. Spirituality and physical activity and sedentary behavior among Latino men and women in Massachusetts. Ethn Dis. 2017;27(1):3–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Kruk J, Aboul-Enein B. Religion- and Spirituality-Based effects on Health-Related components with special reference to physical activity: A systematic review. Religions. 2024;15(7):835.
- 36.Sas-Nowosielski K, Szopa S. Self-regulation strategies used by men and women attending to fitness clubs. Balt J Health Phys Act. 2015;7(3):23–8. [Google Scholar]
- 37.Ylitalo K, Smith J, Cox W, Lucas R, Niceler B, Umstattd Meyer M. The role of self-regulation strategies in physical activity behavior change: results from an exercise prescription program at a federally qualified health center. Psychol Health Med. 2023;28(10):2798–812. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Sundgot-Borgen C, Baardstu S, Bond D, Sniehotta F, Bergh I, Mala T, et al. Longitudinal associations between self-regulation and physical activity behavior following metabolic bariatric surgery; an exploratory study. Int J Behav Nutr Phys Act. 2025;22(1):40. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.