Abstract
Objective:
This study tested the hypothesized stress-buffering effects of social support on physical activity, sitting time, and blood lipid profiles.
Participants:
537 college students.
Methods:
College students volunteered to self-report stress, social support for exercise, physical activity and sitting time, and provided blood samples to assess lipid profiles in this cross-sectional study.
Results:
Lower stress was associated with higher vigorous physical activity (β=−0.1, t=−2.9, p=.004). Higher social support was associated with higher moderate (β= 0.2, t=2.0, p=.042), vigorous (β= 0.5, t=5.4, p<.001), and total (β= 0.1, t=3.2, p=.001) physical activity, and lower sitting time on weekdays (β=−0.1, t=−3.3, p=.001) and weekends (β=−0.2, t=−3.6, p<.001). Social support moderated the association between stress and sitting time on weekdays.
Conclusions:
Stress reduction and fostering social support may be important strategies for promoting physical activity and reducing sedentary behaviors in college students. Additional strategies are needed to buffer the deleterious effects of stress.
Keywords: Early adulthood, health outcomes, health behaviors
Introduction
Obesity negatively impacts most bodily systems and is linked to a myriad of chronic conditions including diabetes, hypertension, coronary artery disease, many cancers and cognitive dysfunction.1 With an estimated prevalence of 39.8% among adults, the obesity epidemic continues to pose a significant threat to public health in the United States 2. Obesity prevention primarily consists of promoting the maintenance of a healthy body weight and can include both dietary and physical activity interventions.1 While preventing obesity is a priority across the lifespan, national trend data suggest that early adulthood is a risky period for the development of obesity and is a particularly promising age for intervening.3 Health behaviors that are established during this time can continue into later adulthood.4 Furthermore, individuals who do not engage in behaviors such as physical activity during early adulthood have a higher likelihood of continuing to remain inactive in later adulthood, which increases the potential for health risks such as obesity later in the life span.5,6 Thus, it is critical to establish healthy lifestyle behaviors and to implement strategies against detrimental behaviors during this learning period.
Stress is another common risk factor for obesity.7,8 Stress and other adverse mental health outcomes among college students are a growing concern.9,10 The transition period from adolescence into early adulthood can be a challenge for college students. During this transition, students are faced with increased academic and social stressors, which are linked to chronic stress and can have a detrimental impact on mental health outcomes.11,12 Stress also negatively impacts multiple physical health outcomes, such as increasing blood lipid profiles and cardiometabolic risk.13 Previous research has demonstrated the prevalence of dyslipidemia among those with jobs associated with high psychological stress.14,15 Other studies have shown that experiencing psychological stress is a significant risk factor for blood lipid disorders, and that engaging in regular physical activity may have an protective effect against this.16
There is substantial evidence that physical activity helps manage and reduce stress.17 However, research has consistently shown that physical activity declines with age, with some studies showing a disproportionate decline during young adults’ transition into early adulthood.18 Furthermore, physical activity behaviors also decline as students’ progress through college.19 In addition to decreasing physical activity levels, another concerning behavioral trend demonstrated by college students is increased sedentary behaviors, which increases the risk of obesity and all-cause and cardiovascular disease-specific mortality.3,20,21
The stress-buffering hypothesis posits that social support may play a protective role against the deleterious effects of stress on illness and illness behaviors.22 According to this hypothesis, social support may intervene before or after an event is appraised as stressful by either attenuating or preventing a stress appraisal response, or by resulting in reappraising the stressful event, inhibiting maladaptive responses to the stressful event, or facilitating adaptive counter responses to the stressful event.22 In college students, findings relating to the stress-buffering hypothesis have been mixed.23,24 While a classical study by Steptoe and colleagues23 found that social support did not moderate the effect of academic examination stress on physical exercise, more recent research has supported the stress-buffering hypothesis on mental health outcomes, such as depression.24 Overall, there are limited studies assessing the stress-buffering effects of social support on both illness symptoms, such as adverse blood lipid profiles, and illness behaviors, such as low physical activity and high sitting time, in college-aged adults. Furthermore, some studies have suggested that task-specific social support may be more important for maintaining or changing health behaviors when compared to general support.25,26 The association between social support for exercise and physical activity has also been established;27 yet, there is limited research that specifically includes social support for exercise when testing the stress-buffering hypothesis. A greater understanding of the stress-buffering effects of social support for exercise in college students may provide insight for the development of campus-based health interventions aiming to improve health outcomes and behaviors in college-aged adults.
Thus, the purpose of this study was to test the stress-buffering hypothesis on illness symptoms and illness behaviors among college students by 1) exploring the associations among stress, social support for exercise, physical activity, sitting time, and blood lipid profiles, and 2) assessing the moderating effects of social support for exercise on the relationship between stress and physical activity, sitting time, and blood lipid profiles. The conceptual framework for the current study is based on Cohen and Wills’ stress-buffering hypothesis (Figure 1a–b).28 We hypothesized that: 1) lower perceived stress was associated with higher levels of physical activity, lower levels of sitting time and healthier blood lipid profiles, 2) higher social support for exercise was associated with higher levels of physical activity, lower sitting time and healthier blood lipid profiles, and 3) social support for exercise moderated the associations between stress and physical activity, sitting time, and blood lipid profiles.
Figure 1a-b.
Stress buffering hypothesis (Cohen & Wills, 1985) and current study conceptual framework.
Materials and methods
Design
The current study utilized a cross-sectional study design.
Sample
Participants were a voluntary sample of college students enrolled in a variety of physical activity and exercise science courses recruited though the Center for Fitness and Wellness (CFW) at The Pennsylvania State University. The physical activity and exercise science included lifestyle activity courses such as tennis, fitness courses such as weight lifting, and physical activity theory courses. The Institutional Review Board at the Pennsylvania State University approved this study, and all participants provided written informed consent prior to completing study activities.
Measures
Demographics.
Participants self-reported their age, gender, race/ethnicity, and parent education level as an indicator of socioeconomic status. Height and weight were objectively measured to calculate body mass index (BMI=kg/m2).
Perceived stress.
Perceived stress was assessed via the shortened Perceived Stress Scale (PSS-4), a 4-item scale assessing the degree to which participants perceive situations in their life as stressful.29 Participants indicated how often they felt or thought a certain way during the last month from “never” to “very often”. Scores ranged from 0 to 16, and higher scores indicated greater perceived stress. The PSS is a valid and reliable self-report measure for assessing stress among college students.30 The internal reliability coefficient for this study was α=.74.
Social support for exercise.
Social support for exercise was assessed via a modified version of the Social Support and Exercise Survey, a scale assessing the extent to which participants perceive positive and negative social support for exercise behaviors.26 The Social Support and Exercise Survey includes 13 items assessing social support specifically from family, and the same 13 items assessing social support from friends (total 26 items). The modified version in the current study used the 13 items to assess social support received from any individual, and did not ask specifically about family or friends. Participants indicated the frequency by which people had done or said what was described in the item during the past three months on a 5-point scale, ranging from “none” to “very often”. Total score ranged from 10–50, and higher scores indicated higher social support for exercise. The internal reliability coefficient for this study was α=.90.
Physical activity and sitting time.
Self-reported physical activity and sitting time was assessed via the Global Physical Activity Questionnaire (GPAQ).31 Participants indicated time spent doing moderate and vigorous physical activity in a typical week in days per week and minutes and/or hours per day. Participants also indicated time spent doing sedentary behaviors on weekdays and weekends, separately, in hours per day. The GPAQ scoring protocol was used to assess minutes per week of moderate, vigorous and total physical activity and hours per week of sitting time of weekdays and weekends.32 The GPAQ is a valid and reliable self-report measure for assessing physical activity,33,34 and has previously been used to assess physical activity among college students.35,36
Blood lipid profiles.
Total cholesterol level, low-density lipoproteins (LDL), and high-density lipoproteins (HDL) were measured via the Cholestech LDX analyzer (to Cholestech LDX, Abbott Labs, Abbott Park, Illinois, USA). Forty microliters of blood were collected from each participant via finger stick and injected into a Cholestech LDX lipid plus glucose cassette. The Cholestech LDX measures total cholesterol level, HDL and triglycerides and estimates LDL using the Friedewald equation (LDL = Total cholesterol – HDL – Triglyceride/5).37
Analysis
Descriptive statistics and frequencies were computed to describe characteristics of the study sample. Histograms were examined to determine skewness and kurtosis and outliers were removed. With the exception of self-reported GPAQ physical activity, all variables were normally distributed. All GPAQ data were natural log transformed to meet assumptions of normality, and log transformed GPAQ data were used in analyses. Pearson correlations were used to determine bivariate associations between stress, social support, physical activity, sitting time, and lipids. Unadjusted and adjusted linear regression models were used to examine the associations between 1) stress and physical activity, sitting time, and blood lipid profiles (total cholesterol, HDL, LDL), and 2) social support for exercise and physical activity, sitting time, and blood lipid profiles, controlling for gender, age, BMI and parent education status. To assess the moderating effect of social support for exercise on the relationship between stress and physical activity, sitting time, and blood lipid profiles, stress*social support for exercise was included as an interaction term in separate regression models. All statistical analyses were performed using SPSS 25.0 (IBM SPSS Statistics, Armonk, NY), and statistical significance was inferred at p<.05.
Results
Participant characteristics
Overall, participants (N=537) were mostly male (55.3%), non-Hispanic white (73.4%), in their 20s (M age=21.3, SD=1.7), and normal weight (M BMI=24.5 kg/m2, SD=4.1). Participants reported low perceived stress (range: 0–16, M=4.8, SD=2.7), a mean overall social support for exercise score of 26.5 (range: 10–50, SD=8.9), and reported doing between 0 and 306 minutes of total physical activity per day (M=86.5 min/day, SD=52.9). Participant characteristics are shown in Table 1.
Table 1.
Participant characteristics (N=537)
| Male N (%) | Female N (%) | Total N (%) | p | |
|---|---|---|---|---|
| Age (years) [M ± SD] | 21.5 ± 2.0 | 21.1 ± 1.0 | 21.3 ± 1.7 | .001 |
| BMI (kg/m2) [M ± SD] | 24.9 ± 3.6 | 23.9 ± 4.6 | 24.5 ± 4.1 | .396 |
| Ethnicity | .046 | |||
| Non-Hispanic White | 215 (72.4) | 177 (78.0) | 394 (73.4) | |
| Non-Hispanic Black | 7 (2.4) | 7 (3.1) | 14 (2.6) | |
| Hispanic | 18 (6.1) | 14 (6.2) | 32 (6.0) | |
| Native American | 1 (0.3) | 0 (0.0) | 1 (0.2) | |
| Asian/Pacific Islander | 47 (15.8) | 26 (11.5) | 73 (13.6) | |
| Other | 5 (1.7) | 2 (0.9) | 8 (1.5) | |
| Multiracial | 3 (1.0) | 0 (0.0) | 3 (0.6) | |
| Parent Education | .064 | |||
| Some High School | 4 (1.3) | 2 (0.9) | 6 (1.1) | |
| High School Diploma | 28 (9.4) | 17 (7.5) | 46 (8.6) | |
| Some College/Associate Degree | 52 (17.5) | 34 15.0) | 86 (16.0) | |
| Baccalaureate Degree | 113 (38.0) | 98 (43.2) | 212 (39.5) | |
| A More Advanced Degree | 94 (31.6) | 75 (33.0) | 170 (31.7) | |
| Not Sure/Don’t Know | 3. (1.0) | 1 (0.4) | 4 (0.7) | |
| Social support (scale: 10–50) [M ± SD] | 25.9 ± 9.1 | 27.3 ± 8.6 | 26.5 ± 8.9 | .216 |
| Perceived stress (scale: 0–16) [M ± SD] | 4.7 ± 2.6 | 4.9 ± 2.8 | 4.8 ± 2.7 | .343 |
| Physical activity (min/week) [M ± SD] | ||||
| Moderate-intensity | 155.0 ± 143.2 | 158.8 ± 129.7 | 154.9 ± 137.9 | .504 |
| Vigorous-intensity | 192.2 ± 161.7 | 142.3 ± 135.1 | 170.2 ± 154.5 | .877 |
| Total | 633.6 ± 363.8 | 579.6 ± 357.7 | 605.7 ± 370.6 | .582 |
| Sitting Time (hours/week) [M ± SD] | ||||
| Weekday (Mon-Fri) | 6.3 ± 2.0 | 6.1 ± 1.8 | 6.2 ± 1.9 | .235 |
| Weekend (Sat-Sun) | 6.3 ± 2.4 | 6.2 ± 2.3 | 6.3 ± 2.4 | .496 |
Note: p-values were derived using independent samples t-tests and chi-squared or Fisher’s exact tests where appropriate.
Associations among stress, social support, physical activity, sitting time and blood lipid profiles
Correlations between stress, social support for exercise, physical activity, sitting time and blood lipid profiles are shown in Table 2. Stress was negatively associated with social support for exercise (r=−.198, p<.001), moderate (r=−.080, p=.034) and vigorous physical activity (r=−.132, p=.001), and total cholesterol (r=−.087, p=.050), and stress was positively associated with sitting time on weekends (r=.083, p=.032). Social support for exercise was significantly positively correlated with all physical activity measures and significantly negatively correlated with sitting time, but not blood lipid profiles.
Table 2.
Bivariate associations between stress, social support for exercise, physical activity, sitting time, and blood lipid profiles (total cholesterol, HDL, LDL)
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | ||
|---|---|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||||
| 1 | Perceived stress | 1 | |||||||||
| 2 | Social support for exercise | −.198** | 1 | ||||||||
| 3 | Moderate PAa | −.080* | .103** | 1 | |||||||
| 4 | Vigorous PAa | −.132** | .312** | .211** | 1 | ||||||
| 5 | Total PAa | −.044 | .137** | .689** | .549** | 1 | |||||
| 6 | Sitting time weekdayb | .039 | −.173** | −.023 | −.063 | −.030 | 1 | ||||
| 7 | Sitting time weekendb | .083* | −.173** | .005 | −.074 | .002 | .530** | 1 | |||
| 8 | Total cholesterol | −.087* | −.026 | −.013 | .051 | −.044 | −.029 | .023 | 1 | ||
| 9 | HDL | −.006 | −.015 | .046 | −.023 | −.003 | .053 | .017 | .405** | 1 | |
| 10 | LDL | .008 | −.007 | −.019 | .021 | −.017 | −.060 | .047 | .664** | −.063 | 1 |
p<0.01
p<0.05.
Minutes/week
Hours/week
Abbreviations: PA, physical activity; LDL, low-density lipoproteins; HDL, high-density lipoproteins
Lower perceived stress was associated with higher vigorous physical activity (β=−0.1, t=−2.7, p=.007), as shown in Table 3. Perceived stress was not significantly associated with sitting time or any markers of blood lipid profiles. Higher social support for exercise was associated with higher moderate physical activity (β=0.2, t=2.0, p=.042), vigorous physical activity (β=0.5, t=5.4, p<.001), and total physical activity (β=0.1, t=3.2, p=.001), and lower sitting time on weekdays (β=−0.1, t=−3.3, p=.001) and weekends (β=−0.2, t=−3.6, p<.001). Social support for exercise was not significantly associated with any markers of blood lipid profiles. Results are shown in Table 4.
Table 3.
Linear regression models exploring associations between perceived stress and physical activity, sitting time, and blood lipid profiles (total cholesterol, HDL, LDL)
| Adjusteda | |||
|---|---|---|---|
| β | t | p | |
| Physical activity (min/week) | |||
| Moderate-intensity | −0.1 | −1.9 | .061 |
| Vigorous-intensity | −0.1 | −2.7 | .007 |
| Total | −0.1 | −1.2 | .139 |
| Sitting Time (hours/week) | |||
| Weekday (Mon-Fri) | 0.1 | 0.6 | .538 |
| Weekend (Sat-Sun) | 0.1 | 2.0 | .051 |
| Total cholesterol | −0.1 | −1.0 | .328 |
| HDL | 0.0 | 0.1 | .943 |
| LDL | 0.0 | 0.7 | .478 |
Adjusted for race/ethnicity, gender, BMI, and parent education
Abbreviations: LDL, low-density lipoproteins; HDL, high-density lipoproteins
Table 4.
Linear regression models exploring associations between social support for exercise and physical activity, sitting time, and blood lipid profiles (total cholesterol, HDL, LDL)
| Adjusteda | |||
|---|---|---|---|
| β | t | p | |
| Physical activity (min/week) | |||
| Moderate-intensity | 0.2 | 2.0 | .042 |
| Vigorous-intensity | 0.5 | 5.4 | .000 |
| Total | 0.1 | 3.2 | .001 |
| Sitting Time (hours/week) | |||
| Weekday (Mon-Fri) | −0.1 | −3.3 | .001 |
| Weekend (Sat-Sun) | −0.2 | −3.6 | .000 |
| Total cholesterol | −0.0 | −0.8 | .398 |
| HDL | −0.0 | −0.6 | .583 |
| LDL | −0.0 | −0.5 | .642 |
Adjusted for race/ethnicity, gender, BMI, and parent education
Abbreviations: LDL, low-density lipoproteins; HDL, high-density lipoproteins
Moderating effect of social support for exercise
Social support for exercise moderated the association between stress and sitting time on weekdays after adjusting for race/ethnicity, gender, BMI, and parent education, as indicated by a significant stress*social support for exercise interaction (β=−0.1, p=.044). Simple slope analyses were used to further decompose the moderating effects, which revealed that among those with high social support (1 standard deviation above the mean), higher stress was associated with lower sitting time on weekdays (β=−0.1, p=.001). Among those with low social support (1 standard deviation below the mean), higher stress was non-significantly associated with higher sitting time on weekdays (β=0.1, p=.198).
There were no other statistically significant moderating effects of social support for exercise on the association between stress and physical activity, sitting time on weekends, or any markers of blood lipid profiles.
Discussion
We found that lower stress was associated with higher vigorous physical activity, and that higher social support for exercise was associated with higher physical activity and lower sitting time. However, our results did not confirm the hypothesized stress-buffering effects of social support for exercise on physical activity or blood lipid outcomes. Further research is needed to confirm these findings, which may imply that interventions should include stress reduction components and leverage social support for exercise as a strategy to increase physical activity and decrease sedentary behaviors among college students. Furthermore, our results underscore the need to find further strategies to mitigate the detrimental effects of stress in college students. Our findings contribute to research on the stress-buffering effects of social support for exercise on illness symptoms (e.g. adverse blood lipid profiles) and illness behaviors (e.g. low physical activity and high sitting time) among college aged adults.
As hypothesized, we found that lower perceived stress was associated with higher vigorous physical activity. Previous research on the relationship between stress and physical activity has shown that college students meeting vigorous physical activity recommendations were less likely to report poor mental health and perceived stress.38 Our findings may suggest that stress reduction may help college students meet guidelines for moderate-to-vigorous physical activity, thus, physical activity interventions aimed toward college students should incorporate components that focus on stress reduction and management. However, further research is warranted to confirm our results and test the effect of intervention strategies for stress management in college students.
We did not find significant associations between perceived stress and blood lipids. This contradicted our hypothesis, which was based on research establishing the association between stress and adverse blood lipid profiles.13 Previous studies measured longer periods of stress, such as stress over the lifespan,13 and the current study assessed perceived stress during the past month. Thus, further research is needed to determine whether long-term measures of stress, such as stress over the lifespan or life-event stress, are associated with adverse blood lipid profiles and other detrimental physical health outcomes in college students.
We found that higher social support for exercise was associated with higher moderate, vigorous, and total physical activity and lower sitting time on weekdays and weekends. This is consistent with previous research showing that social support has a positive effect on promoting physical activity and reducing sedentary behaviors,38–40 and extends prior findings, which included general support, to task-specific social support. Our findings suggest that increasing social support for exercise may facilitate health behaviors in this population. Thus, interventions aiming to promote physical activity and decrease sedentary behavior in college students may need to incorporate components that foster social support for exercise. Further studies are needed to determine the effectiveness of interventions that incorporate elements enhancing social support for increasing physical activity and reducing sedentary behaviors in college students.
We found that social support significantly moderated the relationship between stress and sitting time on weekdays, such that higher stress was associated with lower sitting time on weekdays among those with high support, and higher stress was associated with higher sitting time on weekdays among those with low support. Our results provide preliminary support for the stress-buffering hypothesis on sitting time on weekdays, however, we did not find that social support significantly moderated the relationship between stress and sitting time on weekends. Some studies have shown that there may be notable differences in health behaviors among college students, such as physical activity and sedentary behaviors, on weekends and weekdays.41 Future research in this area should explore whether there are also differences in the moderating effects of social support on the association between stress and behaviors and health outcomes on weekdays and weekends, and interventions for college students may need to account for those differences.
Furthermore, contrary to our hypothesis we found that social support for exercise did not have a moderating effect on the association between stress and physical activity or any markers of blood lipid profiles, which suggests that strategies beyond fostering social support for exercise may be needed to buffer the detrimental effects of stress in college students. The aim of the current study was limited to testing the stress-buffering hypothesis, which is based on the assumption that stress has a detrimental effect on physical activity. However, the relationship between stress and physical activity is known to be bi-directional, with physical activity also having a salubrious effect on stress.42 Thus, there may be additional pathways, such as the positive effect of physical activity on stress, which need to be accounted for when assessing the relationships between stress, social support, physical activity, sitting time, and blood lipid profiles.
Limited research has assessed the stress-buffering effects of social support for exercise on illness and illness behaviors in this population. Despite presenting a number of unique findings, the current study had some limitations. First, we were unable to draw causal inferences about the relationships found due to the cross-sectional nature of the current study. Future studies should aim to utilize a longitudinal design, identify trends over time and discern the directionality of the relationships between stress, social support, physical activity, sitting time and lipid profiles. Second, this study used survey-based assessments of stress, physical activity and sitting time, which are subject to self-reporting bias, and we recommend that future studies use device-based measures such as accelerometers. Additionally, the modified version of the Social Support and Exercise Survey used in the current study was not previously validated, and we recommend that researchers used validated measures in future studies. Lastly, our study sample predominantly consisted of non-Hispanic white students with normal weight. Due to this, our findings may not be generalizable to racial/ethnic minority or overweight and obese college students, and results from the current study may not be generalizable to students attending other universities. Furthermore, our results may have been skewed given that our sample were enrolled in physical activity and exercise science courses whom reported high levels of physical activity. For example, our sample may have had skewed blood lipid profiles based off their physical activity levels, or may perceive more positive benefits of physical activity which may have influenced the self-reported levels of stress. Therefore, findings may not be generalizable to the average college student, and future studies should aim to assess the stress-buffering effects of social support for exercise on illness and illness behaviors using more representative samples of college students. However, given that previous studies had not assessed the associations among stress, social support for exercise, physical activity, sitting time, and blood lipid profiles in college students, the current study makes a unique contribution to the literature and can provide direction for future studies in overweight and obese or racial/ethnic minority college students.
Despite these limitations, the current study tested the stress-buffering hypothesis in college students, extended previous research on stress, social support for exercise, physical activity, sitting time, and blood lipid profiles, and provided a number of implications for future research and practice. Due to the declining rates of physical activity and increases in sedentary behaviors in college students, this population can benefit greatly from behavioral health interventions. Our findings may aid the development of interventions aiming to promote physical activity, reduce sedentary behaviors and promote health outcomes in college students.
Acknowledgments
Funding: NB is supported by National Institute on Aging Grant T32 AG049676 to The Pennsylvania State University.
Footnotes
Conflict of Interest: The authors declare that they have no conflict of interest.
Data Availability:
The data that support the findings of this study are available from the corresponding author, NB, upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author, NB, upon reasonable request.