thesis statement on physical fitness

BRIEF RESEARCH REPORT article

Physical fitness and exercise during the covid-19 pandemic: a qualitative enquiry.

• 1 Freelance Researcher and Activist, Jaipur, India
• 2 Department of Psychology, Banaras Hindu University, Varanasi, India
• 3 Amity Institute of Behavioural and Allied Sciences (AIBAS), Amity University Uttar Pradesh, Lucknow, India

The COVID-19 pandemic has brought this fast-moving world to a standstill. The impact of this pandemic is massive, and the only strategy to curb the rapid spread of the disease is to follow social distancing. The imposed lockdown, resulting in the closure of business activities, public places, fitness and activity centers, and overall social life, has hampered many aspects of the lives of people including routine fitness activities of fitness freaks, which has resulted in various psychological issues and serious fitness and health concerns. In the present paper, the authors aimed at understanding the unique experiences of fitness freaks during the period of lockdown due to COVID-19. The paper also intended to explore the ways in which alternate exercises and fitness activities at home helped them deal with psychological issues and physical health consequences. Semi-structured telephone interviews were conducted with 22 adults who were regularly working out in the gym before the COVID-19 pandemic but stayed at home during the nationwide lockdown. The analysis revealed that during the initial phase of lockdown, the participants had a negative situational perception and a lack of motivation for fitness exercise. They also showed psychological health concerns and overdependence on social media in spending their free time. However, there was a gradual increase in positive self-perception and motivation to overcome their dependence on gym and fitness equipment and to continue fitness exercises at home. Participants also tended to play music as a tool while working out. The regular fitness workout at home during the lockdown greatly helped them to overcome psychological issues and fitness concerns.

Introduction

The COVID-19 pandemic is a massive global health crisis ( Bavel et al., 2020 ) and rapidly spreading pandemic ( Bentlage et al., 2020 ) of recent times. As compared to the earlier pandemics the world has witnessed, the current COVID-19 pandemic is now on the top of the list in terms of worldwide coverage. This is the first time the whole world is affected simultaneously and struck strongly in a very short span of time. Initially, the death rate due to COVID-19 was around 2%, which has now increased to around 4–6% ( World Health Organization [WHO], 2020 ). The statistics does not look so severe, but the total number of cases and the rate at which these cases are increasing day by day make the situation alarming. Exponential growth in COVID-19 cases has led to the isolation of billions of people and worldwide lockdown. COVID-19 has affected the life of nearly each person around the world. The difference between personal or professional lives has narrowed due to work-from-home instructions, and people’s lives are revolving around these two due to the lockdown. People have also been pondering over a vital concern at home, i.e., the importance of their health and fitness.

Although imposing lockdown or quarantine for the population has been one of the widely used measures across the world to stop the rapid spread of COVID-19, it has severe consequences too. Recent multinational investigations have shown the negative effect of COVID-19 restrictions on social participation, life satisfaction ( Ammar et al., 2020b ), mental well-being, psychosocial and emotional disorders as well as on sleep quality ( Xiao et al., 2020 ), and employment status ( Ammar et al., 2020d ). Announcement of a sudden lockdown of all services and activities, except few essential services, by the authorities has resulted in a radical change in the lifestyle of affected people ( Jiménez-Pavón et al., 2020 ) and has severely impaired their mental health, which has been manifested in the form of increased anxiety, stress, and depression ( Chtourou et al., 2020 ). The sudden changes in people’s lifestyle include, but are not limited to, physical activities and exercise. Ammar et al. (2020a) have reported that COVID-19 home confinement has resulted in a decrease in all levels of physical activities and about 28% increase in daily sitting time as well as increase in unhealthy pattern of food consumption. Similar results are also reported by other researchers ( Ammar et al., 2020c ; de Oliveira Neto et al., 2020 ) as well. Although these abrupt changes have influenced every individual, many people who were regularly following their fitness activities in gyms, or in the ground, or other places before the lockdown have been affected intensely. Closure of fitness centers and public parks has forced people to stay at home, which has disturbed their daily routines and hampered their fitness activities. While compulsion to stay at home for a long period of time poses a challenge to the continuity of physical fitness, the experience of hampered physical activities, restricted social communication, uncertainty, and helplessness leads to the emergence of psychological and physical health issues ( Ammar et al., 2020a , c ). Varshney et al. (2020) have found that psychological problems are occurring in adults while adjusting to the current lifestyle in accordance to the fear of contracting the COVID-19 disease. However, effective coping strategies, psychological resources, and regular physical exercise can be helpful in dealing with such health-related problems during the COVID-19 pandemic ( Chtourou et al., 2020 ).

It is important to note that physical activities (PA) and exercise not only maintain physical and psychological health but also help our body to respond to the negative consequences of several diseases such as diabetes, hypertension, cardiovascular diseases, and respiratory diseases ( Owen et al., 2010 ; Lavie et al., 2019 ; Jiménez-Pavón et al., 2020 ). In a recent review of 31 published studies, Bentlage et al. (2020) concluded that physical inactivity due to current pandemic restrictions is a major public health issue that is a prominent risk factor for decreased life expectancy and many physical health problems ( Jurak et al., 2020 ). Exercise is shown to keep other physical functions (respiratory, circulatory, muscular, nervous, and skeletal systems) intact and supports other systems (endocrine, digestive, immune, or renal systems) that are important in fighting any known or unknown threat to our body ( Lavie et al., 2019 ; Jiménez-Pavón et al., 2020 ).

Regular physical activity, while taking other precautions, is also considered effective in dealing with the health outcomes of the COVID-19 pandemic ( Chen et al., 2020 ). Researchers from the University of Virginia Health System ( Yan and Spaulding, 2020 ) suggests that regular exercise might significantly reduce the risk of acute respiratory distress syndrome, which is one of the main causes of death in COVID-19 patients. Exercise and physical activities have important functions for individuals’ psychological well-being as well ( Stathi et al., 2002 ; Lehnert et al., 2012 ). There is sufficient literature to show that exercise can play a vital role in the promotion of positive mental health and well-being (e.g., Mazyarkin et al., 2019 ). However, when health promotion activities such as sports and regular gym exercises are not available in this pandemic situation, it is very difficult for individuals to meet the general WHO guidelines (150 min moderate to mild PA or 75 min intensive PA per week or combination of both) (cf. Bentlage et al., 2020 ). Amidst this pandemic-related restriction (home confinements and closed gyms, parks, and fitness centers), how people cope up and find ways to continue their physical fitness remains an important question.

Rationale for the Present Research

Since the onset of this disease, people have been confined to their homes, which has not only resulted in various psychological health issues but also challenged their physical fitness and health ( Ammar et al., 2020a , b , c , d ; Chtourou et al., 2020 ; Xiao et al., 2020 ). Although this pandemic situation has led to the unexpected cessation of almost all the outside routine activities of all the individuals, it has profoundly hampered the physical activities of fitness freaks (those who regularly go to the gym for their physical fitness), as gyms and other such places have been shut down due to the lockdown. However, studies addressing the issues of fitness freaks, who used to spend a significant amount of time for regular workout in order to maintain their physical fitness, health, and appearance, seem to have found no place so far in the literature in relation to the current pandemic situation. Supposedly, the unique experiences of such people, their health issues, and the ways in which they have dealt with these issues during the COVID-19 pandemic have remained underexplored.

Also, it is well-known that the COVID-19 pandemic has made it difficult for people to adequately maintain their normal physical activity patterns at home ( Ammar et al., 2020a ). There are plenty of studies that have addressed the impact of COVID-19 on physical activities of the general public ( Ammar et al., 2020a , b , c , d ; Chtourou et al., 2020 ; Xiao et al., 2020 ), demonstrated the significant decrease in physical activities and exercise patterns, and illustrated its ill effects on physical and mental health status. There is also a growing body of literature that suggests strategies to encourage people to be involved in home-based exercises and fitness activities ( Ammar et al., 2020a , b , c , d ; Chtourou et al., 2020 ; de Oliveira Neto et al., 2020 ). However, all these studies were conducted in the earlier phase of the pandemic. There is a lack of studies investigating the way in which people have dealt with the problems arising from the COVID-19 pandemic and subsequent lockdown/home confinement. In fact, it would be interesting to explore how and to what extent people were able to follow and benefited from the workout at home advices. Therefore, the present research aims at understanding people’s unique experiences during the period of lockdown due to COVID-19 and exploring the ways in which regular exercise engagements helped them deal with the psychological and physical consequences of home confinement.

In order to gain a rich and extensive understanding of experiences into people’s lives during this pandemic and their efforts to maintain a healthy lifestyle, a qualitative approach was adopted for the study. We used Interpretive Phenomenological Analysis (IPA) to delve into the participants’ perceptions and to provide a close picture of the participants’ unique experiences during the lockdown period.

Participants

A homogeneous sample of 22 participants was selected for this study. The criterion-based purposive sampling technique was used to identify and select the participants. We first contacted the gym owners/trainers and sought their consent to help us in the conduction of this study. Upon consent, we requested them to provide us with the details of their regular gym members who continuously go to the gym and do fitness exercises for at least 6 months prior to the imposed lockdown. Once the list was generated, the prospective participants were then connected by phone, were explained the purpose of the study, and were requested for their consent to participate. Those who consented for their inclusion in the study were then asked some questions based on the pre-decided inclusion and exclusion criteria for the study. On the basis of this information, those participants who met the inclusion criteria (i.e., those who were continuing fitness workout in their home or hostels and were following strict home confinement measures during the COVID-19 pandemic and subsequent lockdown) were further contacted and requested to provide an appointment for a telephone interview.

Inclusion and Exclusion Criteria for the Participants

The participants meeting the following criteria were included in the study:

• Individuals aged 18 years or older.

• Individuals with no known history of physical and/or psychological illness.

• Individuals who were doing regular gym workout for the last 6 months or more for at least 45 min daily before COVID-19.

• Individuals who were completely dependent on gym exercise for their physical fitness.

However, individuals meeting the following criteria were not included in the study:

• Individuals who were irregular or occasional gym visitors.

• Individuals who were practicing other physical exercises besides gym workout.

• Individuals with any physical and/or psychological conditions or individuals on any kind of medication.

Table 1 presents the demographic and exercise characteristics of the participants included in this study.

Table 1. Demographic characteristics of the participants.

The purpose, importance, and relevance of the study were explained to the participants, and informed consent was obtained for their participation. All the participants were assured of the confidentiality of their responses and identity. Upon consent, the participants were requested to share their convenient time for a telephone interview. Semi-structured telephone interviews were conducted to explore the exclusive experiences of the participants with regard to their physical fitness during the lockdown. An interview schedule composed of non-directive, open-ended questions was prepared. There was no fixed order of questions; they were modified and re-modified as per the flow of the conversation with each participant. Some of the main questions prepared for the semi-structured interviews included “What is your perception of this situation we are currently living in?,” “What is your lockdown experience?,” “How frequently you used to go to gym for exercise before the lockdown was imposed?,” “How do you manage exercise at home?,” “What is your exercise schedule now?,” “What changes did you perceive in yourself during this lockdown?,” “How are you coping with this lockdown?,” “Did you experience any psychological issue during this period of time?,” “How do physical exercises help in combating the crisis you are facing?,” “What background aid do you use while exercising at home?,” “What is the need to use such aids while exercising?,” “How does fatigue impact you when you exercise during the lockdown?,” “What is the importance of proper sleep in following a regular schedule of exercise during this lockdown?,” “Do you miss your gym mates?,” “Do you feel you share an identity with your fellow gym mates?,” etc. Additional probing questions were also added as the need occurred during the individual interviews. In addition questions were also asked t o understand the differences between their pre and during COVID-19 lockdown fitness exercise patterns (see Table 2 ). All the interviews were conducted in the native language of the participants in Hindi and English. With due permission from the participants, the interviews were recorded. The interview time duration range was between 20 and 30 min. All the interviews conducted in Hindi were transcribed and then translated in English by the researchers. The translated interviews were then proofread by a native English speaker for correctness and consistency.

Table 2. Pre- and during COVID fitness exercise information of the participants.

Analysis and Results

All the recorded interviews were transcribed. These transcripts were then analyzed using the Interpretative Phenomenological Analysis (IPA) framework to identify the participants’ experiences of lockdown, their alternative choice to continue their fitness routine, and its impact on their health. A stepwise progression method was used to analyze the data. At first, the researchers read the transcripts many times to get a deeper understanding of the experiences as described by the participants. In order to gain as close an understanding of the data as possible, the researchers listened to the audio recordings of the participants while reading the transcribed data.

In the following step, the attempts were made to transform the transcripts into a conceptual framework that was deeply connected to the participant’s original verbatim in order to identify emergent themes (see Table 3 ).

Table 3. Major themes and subthemes that emerged from the interviews indicating participants’ experiences during the COVID-19 pandemic.

After identifying the emerging themes, the transcripts were read again so as to cluster these emergent themes together according to their similarities at the basic level. In this process, some themes emerged as the broad themes under which subthemes were incorporated. The major themes and subthemes that emerged in the analysis are presented in Table 3 .

Table 3 presents six major themes describing the experiences of participants with regard to the COVID-19 pandemic and their efforts to maintain a healthy lifestyle. The following section discusses each of these themes and its subthemes along with the relevant excerpts from participants’ experiences.

Psychological Health Issues

Almost every participant reported facing psychological health issues linked to the COVID-19 pandemic and subsequent lockdown. Participants experienced frustration, anxiety, fear, and stress. For example, participant 11 reported,

“I am experiencing frustration daily for spending my 24 by 7 time at home, looking at same faces and am not allowed to go anywhere. Anxiety of work and its upcoming scenarios tickle my mind a lot. What if I have to do my job virtually for a lifetime? ………….Like that. And especially experiencing a fear of losing my ever charming personality, the economic status of family, no wages or less wages, fewer opportunities in future, job shift, health care of my family.”

The closure due to the pandemic has created a state of uncertainty about an individual’s own future as well as about the future of the family and community, which in turn is being reflected in terms of psychological states of frustration, anxiety, fear, and stress.

Individuals stuck at their homes without a clearly defined routine and work are not able to prioritize their work schedules, resulting in the experience of unexplained laziness and fatigue. Participant 7, for example, reports that

“Physical fatigue has reduced as there is no physical load or fixed working hours, but the mental fatigue and mental pressure has increased manifolds. Worries have increased. Spare time is more than what was required and due to this lethargy has increased. Frustration level is going up.”

The monotonous and closed life cycle of one confined to one’s own home has also resulted in extreme disturbances of one’s sleep cycle. For example, Participant 5 reports,

“Sleep a lot, a lot!! Just imagine I have been sleeping 10 to 12 hours after the lockdown. My sleep pattern was set earlier due to office, but it is disturbed now in the absence of a routine. I have virtual meetings now also, but if the meeting is to start at 10, I would get up at 9.40, wash my face and attend the meeting. After that I feel like taking a nap again. I sleep for 8 hours wake up and exercise in the morning, but I have the liberty to be flexible with my time. seriously I am craving for gyms to open, my trainer to keep a check on me, scold me, I really want complete sleep and a routine.”

It is therefore evident from these examples that the onset of the COVID-19 pandemic has resulted in the experience of psychological problems characterized by frustration, anxiety, fear, and stress. The sleep–wake cycle is interrupted, leading to a state of laziness and mental fatigue.

Lack of Motivation for Fitness

The closure of gyms and other fitness activity centers, including sports stadiums, morning walk parks, etc., and the heightened psychological health issues have resulted in the lack of fitness motivation. For example, participant 1 reports,

“See, ultimately due to the shutdown of gym during this pandemic, my rhythm has been disturbed, you are getting it? I have had a tight schedule always due to my profession but each evening I used to hit the gym daily…………. I mean, that zeal is gone, ……….now also I am getting time in the evening but then also I am unable to ask myself to work out because that gym environment is gone, the gym people as you would see other fellows at gym, that would motivate you, their body gives you an inspiration that how he or she is that fit, they motivate you, here I share an identity with them, I find those people as source of my motivation to physical exercise, those people give you so much morale and now that is lost totally, I literally crave for that.”

The motivation for fitness is not only internal but also external. People are motivated when they observe others doing fitness activities. Gym mates and their physique work as motivating factors for individuals to engage in a regular and routine gym activity. Participant 10 said in frustration that,

“Almost all gone, ………….the motivation is the most ruined thing today, ……….talking about my workout, I have been hitting the gym since I was 22………, Imagine how much that space motivated me, I miss that, my pals there……., not because we are friends or something, see gym doesn’t provide you an environment to make pals or something as people change their gyms and many a thing but, they give you a lot of competition, you become jealous of their appearance and later that workout that space becomes your habit, I miss that, say like anything, but still I am trying.”

It is evident from the above statement that a lack of motivation for fitness was due to the home confinement and lack of presence of others. The presence of others engaged in a similar activity not only creates a sense of shared identity but also is a source of healthy competition and thus motivation.

Change of Perception

As the days progressed, individuals learned to respond to the pandemic in a more constructive and positive manner. Their perception for the situation remained the same (negative), but their perception toward themselves started to change. They started believing that even though they could not change the situation, they could do the same for their own self to deal with the situation. Participant 2, for example, commented on the situation and said,

“Ah! Talking about the situation we are living in, it is so unprecedented, anything can happen anytime, though I am less stressed as compared to the date the lockdown was announced, I perceive this whole situation is so terrible, worst… what is this happening, you just tell me, wake up in fear and sleep in fear. I wonder when this is going to end.”

However, upon asking about her/his own self, s/he added

“You know this COVID has done only one thing right, that is, you know giving me immense time to work on myself, which otherwise I always overlooked. Though I went to gym for my physique only but never gave time to my thoughts, skills, etc. So when talking about changes in myself or perception of self, I would say changes come under three categories in me- first physical, that is appearance, personal, like I will quote enjoying every bit of time. Who knows I am next. I now celebrate life, and finally social changes in myself, as I have got time to work on my communication skills, talking on virtual platforms and sense of oneness or say unity, as I am locked down in hostel and we guys do every deed and task on our own without family, standing together.”

Similarly participant 22 summarized the situation as

“(Laughing), Seriously! The Virus is making a joke on us, truly this is the worst of situations I can ever imagine, I am so negative about the situation we are in, I am in… everyone in….you know how stressful it is for me to know that I am unable to practise. You know as a clinician how hard it is to be like this. Though I am still a student but think likewise, harsh situation madam, extra precautions for everything, negative, too much negative. This time would be a memorable time for generations; sorry my tone has become louder I am kind of in agony, all credits to this so called CORONA.”

S/he, however, further commented that

“my experience throughout the past few months in this Corona Era is so negative but myself-perception or I would say how I am taking myself now from earlier has meaningfully changed now. You know, I am someone who is giving time to myself, exploring my hobbies, giving time to leisure, learning kitchen skills, learning new dishes, becoming a chef besides being a dentist you know. So, for me, myself, I am so positive with regards to myself.”

It is therefore evident that increased experiences with an initial unfamiliar situation initiate the coping mechanisms within an individual, which is reflected in the changed perception of their own self, and reappraisal of the situation in a more positive manner.

Shifting Focus on Substitutes of Gym Workout and Equipment

With the positive change in perception, individuals started to think about their normal routine and tried to find ways to substitute their normal activities. They started trying to shift their exercises from gym to other available places and using alternatives to gym equipment for their fitness activities. The statement of participant 20 indicated how shifting from gym-based exercises to yoga practices was an effective alternative for coping with the habitual compulsion for gym exercises.

“Since I get a pace back again for my physical fitness in this lockdown, I have made a shift to yoga, especially the power yoga in the morning time. I prefer doing meditation as well. Earlier I never used to practise the same but now I have seen videos of some asanas good for health, I am following them and practising them. It’s a shift for peace I guess. I tried something new and found my gym addiction could be controlled or moderated by taking out time for yoga and meditation even after COVID.”

Similarly, participant 17 reported her/his shift to high-intensity workouts at home.

“See, as you might know not everyone has exercise equipment at home which we used to have in gym. So, I prefer those exercises which require less or zero weights say jumping jacks, skipping.”

After resuming motivation, in order to stay physically active and fit, participants actively engaged in the process of finding alternatives to their routine physical exercise equipment. Participant 14 reported shifting to alternatives to heavy weights

“I personally was too much dependent on equipment to exercise in the gym. Now there is no option left because even online, the 5 and 10 kg weights are out of stock, And, nearby stores are either closed or you can’t go out. So, for me it was tough but I searched the internet, the social media, talked to fitness experts and used some ‘JUGAAD’ at home. So, they are using buckets, big water bottles and skipping ropes. I had 10 kg iron rods of water pipeline spare at my home, I am using that and these are helpful and I guess need of the hour.”

Social Media Dependence

One of the major shifts in the individuals’ lives during this pandemic was the increased social media dependence. As a result of social distancing, people were spending more time online to virtually connect with others and stream entertainment. In the backdrop, the COVID-19 pandemic led to an increase in the time spent on social media that helped people kill time. Participant 12 reported the benefits as well as the drawbacks of this social media dependence.

“Social-media is a mixed feeling platform. I mean at one hand it keeps me updated with the happening around; the facilities promised by the government; and… it keeps me connected with the world. But on the other, it irritates me a lot, a lot of misinformation creates a worry in you. So yes, there is a dual objective of this social media.”

However, participant 4 viewed this increased dependence on social media as an effective strategy to break the silence and to overcome the monotonous days.

“Our life has given us so much time ……., I mean I have so much spare time but besides that, I have a monotonous schedule every day, so social media keeps me busy, for example, web series suggestion and reviews, movies suggestion and reviews, video games, etc. Also, on the one hand, I do not get bored as one day I am learning some planting technique at home through media, the other day something to cook, some family or friend sharing his/her recipe, hobby ideas, craft ideas, writing, etc. Physical workout schedule helps me a lot. I am doing one thing useful at a time, and that keeps me busy.”

Similarly, participant 3 reported that

“Definitely social media has impacted my sitting schedule as I am just sitting for a long span of time, say while eating or talking to family. I am sitting scrolling YouTube, Facebook, WhatsApp, Instagram, one post after the other. It has become my habit now. I feel like I will only watch a single video or only this news but I end up spending 1 to 2 hours scrolling and watching. Seriously, it’s a habit now, but I am glad that workout is something I do in my schedule, which is so productive, and I really feel good about myself because of the physical fitness.”

However, participant 21 pointed out the experience of lack of emotional attachment, sympathy, and support resulting from the content consistently served by social media.

“Social media is full of content which reveal crime stories, life matters, relationships, suicides, etc. at a large scale. So many movie clips, videos, web series show a lot of crime, aggression or say anything on that. So, I feel now-a-days emotionally detached to any relationship, friendship or even to my family. If I receive their call, I would say yes okay fine, no further interest in how they are dealing or what they are experiencing. And if they ask I would say, so what, I am not a kid anymore. I lead my life you lead yours, definitely social media is making me someone I never used to be. In fact, my sister has become the same, though she is living with the family under the same roof. Earlier I was so sensitive to any suicide or crime. If I heard of that I would cry or be sad. I used to feel the pain of the victim. Now, I hear a story for real and I am like, yeah part of life, or you pay for deeds like that. No sympathy left I guess, so detached.”

However, what was more important was that social media was seen to be helping individuals in maintaining their daily fitness routines by providing them alternative fitness tools and techniques, the virtual company of other fitness freaks, and by helping them back, influencing others and getting influenced by others. Participant 6 reported that

“Social media has lots of side effects, but a good effect of it now-a-days for a gym freak like me is that social media provides videos of trainers, and other freaks working out at home or hostels. I can know now virtually how to maintain a schedule. They are sharing their experience, they are influencing me a lot, I am trying my best, and workout is helping me a lot.”

Favorable Attitude Toward Music as a Tool

Many participants also reported the use of music as an aid while exercising. Participant 7 reported that

“I have two schedules of exercise. If working out in the morning, I prefer soothing music, like that of birds chirping, or instrumental jazz. And if I am exercising in evening, I want to listen to EDM, that is electronic dance music, I have made a playlist of computerised music and listen to that in evening. I prefer music because it takes you to another world, which is needed the most now (exclaimed!) It creates an environment like that of a gym in my head, or say, I imagine I am in the gym, as I cut off all the surrounding voices.”

Similarly, participant 9 reported that

“I just love to have old-country music while I am exercising. It is a kind of genre of songs, the old country one, and sometimes I love random numbers of songs. It is needed because you can say it lets me focus, helps me to calm down. Also, when I am locked at home, it actually provides me a world free of distractions, just my own world, where there is no corona. Music is ultimate fun. If there is no music available I will not workout, because workout makes me happy and I really want to exercise effectively and enjoy it too.”

It is, therefore, evident that music is an important supporting tool that helps individuals relax and enjoy their original routine even when they are working out at home. Music is a powerful tool that recreates the same environment that participants used to have during their gym exercise times.

The COVID-19 pandemic has brought major upheaval in the life of every individual across the globe. It has hampered the day-to-day activities of almost all individuals including those who depend on gyms for their physical fitness routine. The present study was conducted with individuals for whom going to the gym was a routine activity so as to explore their experiences in terms of their perceptions of the pandemic situation and their ways of coping with COVID-19-induced uncertainties and health issues.

The findings of this study not only are consistent with a range of studies that have reported psychological health issues due to the COVID-19 pandemic and subsequent lockdown ( Hawryluck et al., 2004 ; Ammar et al., 2020a , b , c , d ; Chtourou et al., 2020 ; de Oliveira Neto et al., 2020 ; Shigemura et al., 2020 ; Varshney et al., 2020 ) but also go beyond those to suggest that, with time, individuals learn to adopt to situations in healthy and positive ways. Participants reported experiencing a significant change in their sleeping pattern, unexplained laziness, and mental fatigue, and having a general feeling of fear, anxiety, stress, and frustration due to home confinement, which impacted their motivation to find alternate ways to continue fitness exercises.

Other factors found responsible for the lack of fitness motivation were the absence of gym partners and the lack of gym environment, which were also considered as potential sources of gym motivation in earlier studies ( Sonstroem and Morgan, 1989 ; Sonstroem and Harlow, 1994 ; McAuley et al., 2000 ; Fox, 2003 ; Tamur, 2014 ). It is important to note that, being a social entity, people like the company of others and feel connected to each other. This feeling of connectedness is found to be associated with various psychological constructs such as persistence, motivation, self-esteem, self-efficacy, and physical as well as psychological health ( Scully et al., 1998 ; Proctor et al., 2011 ; Haslam et al., 2015 ; Begun et al., 2018 ). The absence of this feeling of connectedness that people were used to experiencing in a gym environment probably was one of the reasons for the lack of motivation for home exercise.

The findings of the study also indicated that although the participants’ perception of the pandemic situation was negative initially, their self-perception gradually improved toward a positive one, as they realized that they had enough time to look after themselves. Rauthmann et al. (2015) reported that environment and behavior, if different from the usual, lead to a negative situational perception. However, with an increase in time available to devote to oneself, perceptions change in a positive direction ( Karagiannidis et al., 2015 ). Such a change in perception is likely to promote the process of self-approval and find effective ways to deal with the current situation.

In the present study, a shift from the gym workout and fitness equipment toward substitutes is clearly visible during the latter part of the lockdown. After the initial confusion and passive wait for things to normalize, participants accepted the reality and started thinking about alternatives to exercises related to heavy gym equipment. Some of the alternatives listed by them included switching to yoga and meditation ( National Center for Complementary and Integrative Health, 2020 ), high-intensity workout at home, and lifting heavy buckets, big water bottles, and skipping. All these alternative arrangements not only helped individuals maintain their daily exercise routine but also contributed to their physical and mental health ( Jiménez-Pavón et al., 2020 ; Nicol et al., 2020 ). In fact, the American College of Sports Medicine had recommended 150–300 min of aerobic exercise per week and two sessions per week of moderate-intensity muscle strength exercises for people to be physically active during the COVID-19 pandemic ( Joy, 2020 ).

The mixed impact of social media usage and listening to music during exercise was also observed in this study. Results clearly indicate that participants found social media to be an effective medium to keep themselves up to date about the pandemic situation and to overcome the monotony of home confinement. Apart from this, participants also experienced a lack of emotional attachment, as face-to-face interaction during the said period was missing. This encouraged participants to use social media to get connected to people as well as to witness their regular activities, which they were missing otherwise. Several studies in the past have argued that social support boosts motivation for training and can increase up to 35% more adherence to a physical exercise program ( Rhodes et al., 2001 ) and that it can be an additional strategy to make exercise events more interactive and less dissociated from afferent body responses (heart rate, breathing), which in turn results in more positive training experience ( Kravitz and Furst, 1991 ; Pridgeon and Grogan, 2012 ).

Social media was also used as a platform to know about virtual fitness techniques and opportunities for online training for physical exercise. Ammar et al. (2020d) demonstrated 15% higher use of Information and Communications Technology (ICT) during the COVID-19 confinement duration, which indicates higher use of social media and app use for home-based fitness activities ( Tate et al., 2015 ; Ammar et al., 2020a ).

Furthermore, participants also found that listening to music was an effective aid to keep themselves engaged as they exercised. This also supports the finding that music helps people to continue their fitness workout for a significantly longer period of time ( Thakare et al., 2017 ). A series of studies have shown that music creates an ergogenic effect during physical and cognitive performance and is linked to heightened motivation and engagement and lower levels of stress, anxiety, and depression ( Chtourou et al., 2015 ). In their recent meta-analytic review Terry et al. (2020) have concluded that listening to music during physical activity boosts positive affective valence and results in improved physical engagement and enhanced physiological responses. It is therefore clearly evident that listening to music while doing physical exercise during the current pandemic has enabled people to focus on the exercise without any distraction from the home setting and has enabled them to create their own world, where there is no COVID-19.

To conclude, the findings of the study indicate that the perceptions and social media habits of fitness freaks, who were hitting gyms for a regular workout before the lockdown, were greatly impacted by the COVID-19 pandemic. They also experienced psychological health issues during the initial phase of the pandemic. However, they gradually changed their dependence on gym-based workout and switched to alternative exercises that helped them greatly to restore their mental and physical health.

Implications and Future Suggestions

The present study shows that despite the initial experience of anxiety and fear and the lack of motivation to engage in physical exercise at home, fitness freaks were able to shift to home exercises and were greatly supported by social media uses and listening to music. One could argue that this study only included fitness freaks who find it difficult to detach themselves from physical activities for a long time, and this was probably the reason for their shift to home-based exercises. However, there is no doubt that the findings of this study have demonstrated that if performed regularly, physical exercise has the potential to mitigate the ill physical as well as psychological effects of the COVID-19 pandemic. The findings of this study, therefore, could be extended to the common public to also persuade them to engage in physical fitness exercises, which would result not only in a better physical health but also in an enhanced psychological health and well-being. The findings of this study strengthen the recommendations made by researchers and organizations (for details see Chtourou et al., 2020 ; World Health Organization [WHO], 2020 ) to engage in home-based exercises (including, but not limited to, aerobic activities, balance and flexibility exercises, and muscular strength and endurance training) for about 150–180 min per week; to use social media, music, and/or similar techniques to increase adherence to physical exercises; and to practice dancing and yoga to reduce stress, anxiety, and depression, and even improve the quality of sleep ( Chennaoui et al., 2015 ; Chtourou et al., 2015 ). It is also noted that one should start physical exercise and its alternatives in a progressive manner and must adhere to his/her fitness levels for choosing the amount and intensity of these exercises.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher.

Ethics Statement

All procedures followed in this study were in accordance with the APA’s ethical standards and with the Helsinki Declaration of 1964 and its later amendments. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

HK, TS, and YA conceptualized the study. HK and TS prepared study protocols. HK collected data, conducted initial data analysis, and wrote the first draft. TS, SM, and YA finalized data analysis, reviewed, and commented on the draft manuscript. HK, TS, SM, and YA contributed to the preparation of the final draft. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords : COVID-19, physical fitness, exercise, lockdown, gym workout

Citation: Kaur H, Singh T, Arya YK and Mittal S (2020) Physical Fitness and Exercise During the COVID-19 Pandemic: A Qualitative Enquiry. Front. Psychol. 11:590172. doi: 10.3389/fpsyg.2020.590172

Received: 31 July 2020; Accepted: 06 October 2020; Published: 29 October 2020.

Reviewed by:

Copyright © 2020 Kaur, Singh, Arya and Mittal. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Tushar Singh, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Physical activity and physical fitness among university students—a systematic review.

1. Introduction

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Kljajević, V.; Stanković, M.; Đorđević, D.; Trkulja-Petković, D.; Jovanović, R.; Plazibat, K.; Oršolić, M.; Čurić, M.; Sporiš, G. Physical Activity and Physical Fitness among University Students—A Systematic Review. Int. J. Environ. Res. Public Health 2022 , 19 , 158. https://doi.org/10.3390/ijerph19010158

Kljajević V, Stanković M, Đorđević D, Trkulja-Petković D, Jovanović R, Plazibat K, Oršolić M, Čurić M, Sporiš G. Physical Activity and Physical Fitness among University Students—A Systematic Review. International Journal of Environmental Research and Public Health . 2022; 19(1):158. https://doi.org/10.3390/ijerph19010158

Kljajević, Vidran, Mima Stanković, Dušan Đorđević, Drena Trkulja-Petković, Rade Jovanović, Kristian Plazibat, Mario Oršolić, Mijo Čurić, and Goran Sporiš. 2022. "Physical Activity and Physical Fitness among University Students—A Systematic Review" International Journal of Environmental Research and Public Health 19, no. 1: 158. https://doi.org/10.3390/ijerph19010158

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Health Thesis Statemen

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Navigating the intricate landscape of health topics requires a well-structured thesis statement to anchor your essay. Whether delving into public health policies or examining medical advancements, crafting a compelling health thesis statement is crucial. This guide delves into exemplary health thesis statement examples, providing insights into their composition. Additionally, it offers practical tips on constructing powerful statements that not only capture the essence of your research but also engage readers from the outset.

What is the Health Thesis Statement? – Definition

A health thesis statement is a concise declaration that outlines the main argument or purpose of an essay or research paper thesis statement focused on health-related topics. It serves as a roadmap for the reader, indicating the central idea that the paper will explore, discuss, or analyze within the realm of health, medicine, wellness, or related fields.

What is an Example of a Medical/Health Thesis Statement?

Example: “The implementation of comprehensive public health campaigns is imperative in curbing the escalating rates of obesity and promoting healthier lifestyle choices among children and adolescents.”

In this example, the final thesis statement succinctly highlights the importance of public health initiatives as a means to address a specific health issue (obesity) and advocate for healthier behaviors among a targeted demographic (children and adolescents).

100 Health Thesis Statement Examples

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Discover a comprehensive collection of 100 distinct health thesis statement examples across various healthcare realms. From telemedicine’s impact on accessibility to genetic research’s potential for personalized medicine, delve into obesity, mental health, antibiotic resistance, opioid epidemic solutions, and more. Explore these examples that shed light on pressing health concerns, innovative strategies, and crucial policy considerations. You may also be interested to browse through our other  speech thesis statement .

• Childhood Obesity : “Effective school-based nutrition programs are pivotal in combating childhood obesity, fostering healthy habits, and reducing the risk of long-term health complications.”
• Mental Health Stigma : “Raising awareness through media campaigns and educational initiatives is paramount in eradicating mental health stigma, promoting early intervention, and improving overall well-being.”
• Universal Healthcare : “The implementation of universal healthcare systems positively impacts population health, ensuring access to necessary medical services for all citizens.”
• Elderly Care : “Creating comprehensive elderly care programs that encompass medical, social, and emotional support enhances the quality of life for aging populations.”
• Cancer Research : “Increased funding and collaboration in cancer research expedite advancements in treatment options and improve survival rates for patients.”
• Maternal Health : “Elevating maternal health through accessible prenatal care, education, and support systems reduces maternal mortality rates and improves neonatal outcomes.”
• Vaccination Policies : “Mandatory vaccination policies safeguard public health by curbing preventable diseases and maintaining herd immunity.”
• Epidemic Preparedness : “Developing robust epidemic preparedness plans and international cooperation mechanisms is crucial for timely responses to emerging health threats.”
• Access to Medications : “Ensuring equitable access to essential medications, especially in low-income regions, is pivotal for preventing unnecessary deaths and improving overall health outcomes.”
• Healthy Lifestyle Promotion : “Educational campaigns promoting exercise, balanced nutrition, and stress management play a key role in fostering healthier lifestyles and preventing chronic diseases.”
• Health Disparities : “Addressing health disparities through community-based interventions and equitable healthcare access contributes to a fairer distribution of health resources.”
• Elderly Mental Health : “Prioritizing mental health services for the elderly population reduces depression, anxiety, and cognitive decline, enhancing their overall quality of life.”
• Genetic Counseling : “Accessible genetic counseling services empower individuals to make informed decisions about their health, family planning, and potential genetic risks.”
• Substance Abuse Treatment : “Expanding availability and affordability of substance abuse treatment facilities and programs is pivotal in combating addiction and reducing its societal impact.”
• Patient Empowerment : “Empowering patients through health literacy initiatives fosters informed decision-making, improving treatment adherence and overall health outcomes.”
• Environmental Health : “Implementing stricter environmental regulations reduces exposure to pollutants, protecting public health and mitigating the risk of respiratory illnesses.”
• Digital Health Records : “The widespread adoption of digital health records streamlines patient information management, enhancing communication among healthcare providers and improving patient care.”
• Healthy Aging : “Promoting active lifestyles, social engagement, and cognitive stimulation among the elderly population contributes to healthier aging and reduced age-related health issues.”
• Telehealth Ethics : “Ethical considerations in telehealth services include patient privacy, data security, and maintaining the quality of remote medical consultations.”
• Public Health Campaigns : “Strategically designed public health campaigns raise awareness about prevalent health issues, motivating individuals to adopt healthier behaviors and seek preventive care.”
• Nutrition Education : “Integrating nutrition education into school curricula equips students with essential dietary knowledge, reducing the risk of nutrition-related health problems.”
• Healthcare Infrastructure : “Investments in healthcare infrastructure, including medical facilities and trained personnel, enhance healthcare access and quality, particularly in underserved regions.”
• Mental Health Support in Schools : “Introducing comprehensive mental health support systems in schools nurtures emotional well-being, reduces academic stress, and promotes healthy student development.”
• Antibiotic Stewardship : “Implementing antibiotic stewardship programs in healthcare facilities preserves the effectiveness of antibiotics, curbing the rise of antibiotic-resistant infections.”
• Health Education in Rural Areas : “Expanding health education initiatives in rural communities bridges the information gap, enabling residents to make informed health choices.”
• Global Health Initiatives : “International collaboration on global health initiatives bolsters disease surveillance, preparedness, and response to protect global populations from health threats.”
• Access to Clean Water : “Ensuring access to clean water and sanitation facilities improves public health by preventing waterborne diseases and enhancing overall hygiene.”
• Telemedicine and Mental Health : “Leveraging telemedicine for mental health services increases access to therapy and counseling, particularly for individuals in remote areas.”
• Chronic Disease Management : “Comprehensive chronic disease management programs enhance patients’ quality of life by providing personalized care plans and consistent medical support.”
• Healthcare Workforce Diversity : “Promoting diversity within the healthcare workforce enhances cultural competence, patient-provider communication, and overall healthcare quality.”
• Community Health Centers : “Establishing community health centers in underserved neighborhoods ensures accessible primary care services, reducing health disparities and emergency room utilization.”
• Youth Health Education : “Incorporating comprehensive health education in schools equips young people with knowledge about reproductive health, substance abuse prevention, and mental well-being.”
• Dietary Guidelines : “Implementing evidence-based dietary guidelines and promoting healthy eating habits contribute to reducing obesity rates and preventing chronic diseases.”
• Healthcare Innovation : “Investing in healthcare innovation, such as telemedicine platforms and wearable health technologies, transforms patient care delivery and monitoring.”
• Pandemic Preparedness : “Effective pandemic preparedness plans involve cross-sector coordination, rapid response strategies, and transparent communication to protect global health security.”
• Maternal and Child Nutrition : “Prioritizing maternal and child nutrition through government programs and community initiatives leads to healthier pregnancies and better child development.”
• Health Literacy : “Improving health literacy through accessible health information and education empowers individuals to make informed decisions about their well-being.”
• Medical Research Funding : “Increased funding for medical research accelerates scientific discoveries, leading to breakthroughs in treatments and advancements in healthcare.”
• Reproductive Health Services : “Accessible reproductive health services, including family planning and maternal care, improve women’s health outcomes and support family well-being.”
• Obesity Prevention in Schools : “Introducing physical activity programs and nutritional education in schools prevents childhood obesity, laying the foundation for healthier lifestyles.”
• Global Vaccine Distribution : “Ensuring equitable global vaccine distribution addresses health disparities, protects vulnerable populations, and fosters international cooperation.”
• Healthcare Ethics : “Ethical considerations in healthcare decision-making encompass patient autonomy, informed consent, and equitable resource allocation.”
• Aging-in-Place Initiatives : “Aging-in-place programs that provide home modifications and community support enable elderly individuals to maintain independence and well-being.”
• E-Health Records Privacy : “Balancing the benefits of electronic health records with patients’ privacy concerns necessitates robust data security measures and patient consent protocols.”
• Tobacco Control : “Comprehensive tobacco control measures, including high taxation and anti-smoking campaigns, reduce tobacco consumption and related health risks.”
• Epidemiological Studies : “Conducting rigorous epidemiological studies informs public health policies, identifies risk factors, and guides disease prevention strategies.”
• Organ Transplant Policies : “Ethical organ transplant policies prioritize equitable organ allocation, ensuring fair access to life-saving treatments.”
• Workplace Wellness Programs : “Implementing workplace wellness programs promotes employee health, reduces absenteeism, and enhances productivity.”
• Emergency Medical Services : “Strengthening emergency medical services infrastructure ensures timely responses to medical crises, saving lives and reducing complications.”
• Healthcare Access for Undocumented Immigrants : “Expanding healthcare access for undocumented immigrants improves overall community health and prevents communicable disease outbreaks.”
• Primary Care Shortage Solutions : “Addressing primary care shortages through incentives for healthcare professionals and expanded training programs enhances access to basic medical services.”
• Patient-Centered Care : “Prioritizing patient-centered care emphasizes communication, shared decision-making, and respecting patients’ preferences in medical treatments.”
• Nutrition Labels Impact : “The effectiveness of clear and informative nutrition labels on packaged foods contributes to healthier dietary choices and reduced obesity rates.”
• Stress Management Strategies : “Promoting stress management techniques, such as mindfulness and relaxation, improves mental health and reduces the risk of stress-related illnesses.”
• Access to Reproductive Health Education : “Ensuring access to comprehensive reproductive health education empowers individuals to make informed decisions about their sexual and reproductive well-being.”
• Medical Waste Management : “Effective medical waste management practices protect both public health and the environment by preventing contamination and pollution.”
• Preventive Dental Care : “Prioritizing preventive dental care through community programs and education reduces oral health issues and associated healthcare costs.”
• Pharmaceutical Pricing Reform : “Addressing pharmaceutical pricing reform enhances medication affordability and ensures access to life-saving treatments for all.”
• Community Health Worker Role : “Empowering community health workers to provide education, support, and basic medical services improves healthcare access in underserved areas.”
• Healthcare Technology Adoption : “Adopting innovative healthcare technologies, such as AI-assisted diagnostics, enhances accuracy, efficiency, and patient outcomes in medical practices.”
• Elderly Falls Prevention : “Implementing falls prevention programs for the elderly population reduces injuries, hospitalizations, and healthcare costs, enhancing their overall well-being.”
• Healthcare Data Privacy Laws : “Stricter healthcare data privacy laws protect patients’ sensitive information, maintaining their trust and promoting transparent data management practices.”
• School Health Clinics : “Establishing health clinics in schools provides easy access to medical services for students, promoting early detection and timely treatment of health issues.”
• Healthcare Cultural Competence : “Cultivating cultural competence among healthcare professionals improves patient-provider communication, enhances trust, and reduces healthcare disparities.”
• Health Equity in Clinical Trials : “Ensuring health equity in clinical trials by diverse participant representation enhances the generalizability of research findings to different populations.”
• Digital Mental Health Interventions : “Utilizing digital mental health interventions, such as therapy apps, expands access to mental health services and reduces stigma surrounding seeking help.”
• Aging and Neurodegenerative Diseases : “Exploring the connection between aging and neurodegenerative diseases informs early interventions and treatment strategies to mitigate cognitive decline.”
• Healthcare Waste Reduction : “Implementing sustainable healthcare waste reduction measures decreases environmental impact and contributes to a greener healthcare industry.”
• Medical Ethics in End-of-Life Care : “Ethical considerations in end-of-life care decision-making ensure patient autonomy, quality of life, and respectful treatment choices.”
• Healthcare Interoperability : “Enhancing healthcare data interoperability between different medical systems and providers improves patient care coordination and information sharing.”
• Healthcare Disparities in Indigenous Communities : “Addressing healthcare disparities in Indigenous communities through culturally sensitive care and community engagement improves health outcomes.”
• Music Therapy in Healthcare : “Exploring the role of music therapy in healthcare settings reveals its positive effects on reducing pain, anxiety, and enhancing emotional well-being.”
• Healthcare Waste Management Policies : “Effective healthcare waste management policies regulate the disposal of medical waste, protecting both public health and the environment.”
• Agricultural Practices and Public Health : “Analyzing the impact of agricultural practices on public health highlights the connections between food production, environmental health, and nutrition.”
• Online Health Information Reliability : “Promoting the reliability of online health information through credible sources and fact-checking guides empowers individuals to make informed health decisions.”
• Neonatal Intensive Care : “Advancements in neonatal intensive care technology enhance premature infants’ chances of survival and long-term health.”
• Fitness Technology : “The integration of fitness technology in daily routines motivates individuals to engage in physical activity, promoting better cardiovascular health.”
• Climate Change and Health : “Examining the health effects of climate change emphasizes the need for mitigation strategies to protect communities from heat-related illnesses, vector-borne diseases, and other climate-related health risks.”
• Healthcare Cybersecurity : “Robust cybersecurity measures in healthcare systems safeguard patient data and protect against cyberattacks that can compromise medical records.”
• Healthcare Quality Metrics : “Evaluating healthcare quality through metrics such as patient satisfaction, outcomes, and safety indicators informs continuous improvement efforts in medical facilities.”
• Maternal Health Disparities : “Addressing maternal health disparities among different racial and socioeconomic groups through accessible prenatal care and support reduces maternal mortality rates.”
• Disaster Preparedness : “Effective disaster preparedness plans in healthcare facilities ensure timely responses during emergencies, minimizing casualties and maintaining patient care.”
• Sleep Health : “Promoting sleep health education emphasizes the importance of quality sleep in overall well-being, preventing sleep-related disorders and associated health issues.”
• Healthcare AI Ethics : “Navigating the ethical implications of using artificial intelligence in healthcare, such as diagnosis algorithms, safeguards patient privacy and accuracy.”
• Pediatric Nutrition : “Prioritizing pediatric nutrition education encourages healthy eating habits from a young age, reducing the risk of childhood obesity and related health concerns.”
• Mental Health in First Responders : “Providing mental health support for first responders acknowledges the psychological toll of their work, preventing burnout and trauma-related issues.”
• Healthcare Workforce Burnout : “Addressing healthcare workforce burnout through organizational support, manageable workloads, and mental health resources improves patient care quality.”
• Vaccine Hesitancy : “Effective strategies to address vaccine hesitancy involve transparent communication, education, and addressing concerns to maintain vaccination rates and community immunity.”
• Climate-Resilient Healthcare Facilities : “Designing climate-resilient healthcare facilities prepares medical centers to withstand extreme weather events and ensure continuous patient care.”
• Nutrition in Aging : “Emphasizing balanced nutrition among the elderly population supports healthy aging, preventing malnutrition-related health complications.”
• Medication Adherence Strategies : “Implementing medication adherence strategies, such as reminder systems and simplified regimens, improves treatment outcomes and reduces hospitalizations.”
• Crisis Intervention : “Effective crisis intervention strategies in mental health care prevent escalations, promote de-escalation techniques, and improve patient safety.”
• Healthcare Waste Recycling : “Promoting healthcare waste recycling initiatives reduces landfill waste, conserves resources, and minimizes the environmental impact of medical facilities.”
• Healthcare Financial Accessibility : “Strategies to enhance healthcare financial accessibility, such as sliding scale fees and insurance coverage expansion, ensure equitable care for all.”
• Palliative Care : “Prioritizing palliative care services improves patients’ quality of life by addressing pain management, symptom relief, and emotional support.”
• Healthcare and Artificial Intelligence : “Exploring the integration of artificial intelligence in diagnostics and treatment planning enhances medical accuracy and reduces human error.”
• Personalized Medicine : “Advancements in personalized medicine tailor treatments based on individual genetics and characteristics, leading to more precise and effective healthcare.”
• Patient Advocacy : “Empowering patients through education and advocacy training enables them to navigate the healthcare system and actively participate in their treatment decisions.”
• Healthcare Waste Reduction : “Promoting the reduction of healthcare waste through sustainable practices and responsible disposal methods minimizes environmental and health risks.”
• Complementary and Alternative Medicine : “Examining the efficacy and safety of complementary and alternative medicine approaches provides insights into their potential role in enhancing overall health and well-being.”

Thesis Statement Examples for Physical Health

Discover 10 unique good thesis statement examples that delve into physical health, from the impact of fitness technology on exercise motivation to the importance of nutrition education in preventing chronic illnesses. Explore these examples shedding light on the pivotal role of physical well-being in disease prevention and overall quality of life.

• Fitness Technology’s Influence : “The integration of fitness technology like wearable devices enhances physical health by fostering exercise adherence, tracking progress, and promoting active lifestyles.”
• Nutrition Education’s Role : “Incorporating comprehensive nutrition education in schools equips students with essential dietary knowledge, reducing the risk of nutrition-related health issues.”
• Active Lifestyle Promotion : “Public spaces and urban planning strategies that encourage physical activity contribute to community health and well-being, reducing sedentary behavior.”
• Sports Injuries Prevention : “Strategic implementation of sports injury prevention programs and adequate athlete conditioning minimizes the incidence of sports-related injuries, preserving physical well-being.”
• Physical Health in Workplace : “Prioritizing ergonomic design and promoting workplace physical activity positively impact employees’ physical health, reducing musculoskeletal issues and stress-related ailments.”
• Childhood Obesity Mitigation : “School-based interventions, including physical education and health education, play a pivotal role in mitigating childhood obesity and promoting lifelong physical health.”
• Outdoor Activity and Wellness : “Unstructured outdoor play, especially in natural settings, fosters children’s physical health, cognitive development, and emotional well-being.”
• Senior Nutrition and Mobility : “Tailored nutrition plans and physical activity interventions for seniors support physical health, mobility, and independence during the aging process.”
• Health Benefits of Active Commuting : “Promotion of active commuting modes such as walking and cycling improves cardiovascular health, reduces pollution, and enhances overall well-being.”
• Physical Health’s Longevity Impact : “Sustaining physical health through regular exercise, balanced nutrition, and preventive measures positively influences longevity, ensuring a higher quality of life.”

Thesis Statement Examples for Health Protocols

Explore 10 thesis statement examples that highlight the significance of health protocols, encompassing infection control in medical settings to the ethical guidelines for telemedicine practices. These examples underscore the pivotal role of health protocols in ensuring patient safety, maintaining effective healthcare practices, and preventing the spread of illnesses across various contexts.  You should also take a look at our  thesis statement for report .

• Infection Control and Patient Safety : “Rigorous infection control protocols in healthcare settings are paramount to patient safety, curbing healthcare-associated infections and maintaining quality care standards.”
• Evidence-Based Treatment Guidelines : “Adhering to evidence-based treatment guidelines enhances medical decision-making, improves patient outcomes, and promotes standardized, effective healthcare practices.”
• Ethics in Telemedicine : “Establishing ethical guidelines for telemedicine practices is crucial to ensure patient confidentiality, quality of care, and responsible remote medical consultations.”
• Emergency Response Preparedness : “Effective emergency response protocols in healthcare facilities ensure timely and coordinated actions, optimizing patient care, and minimizing potential harm.”
• Clinical Trial Integrity : “Stringent adherence to health protocols in clinical trials preserves data integrity, ensures participant safety, and upholds ethical principles in medical research.”
• Safety in Daycare Settings : “Implementing robust infection prevention protocols in daycare settings is vital to curb disease transmission, safeguarding the health of children and staff.”
• Privacy and E-Health : “Upholding stringent patient privacy protocols in electronic health records is paramount for data security, fostering trust, and maintaining confidentiality.”
• Hand Hygiene and Infection Prevention : “Promoting proper hand hygiene protocols among healthcare providers significantly reduces infection transmission risks, protecting both patients and medical personnel.”
• Food Safety in Restaurants : “Strict adherence to comprehensive food safety protocols within the restaurant industry is essential to prevent foodborne illnesses and ensure public health.”
• Pandemic Preparedness and Response : “Developing robust pandemic preparedness protocols, encompassing risk assessment and response strategies, is essential to effectively manage disease outbreaks and protect public health.”

Thesis Statement Examples on Health Benefits

Uncover 10 illuminating thesis statement examples exploring the diverse spectrum of health benefits, from the positive impact of green spaces on mental well-being to the advantages of mindfulness practices in stress reduction. Delve into these examples that underscore the profound influence of health-promoting activities on overall physical, mental, and emotional well-being.

• Nature’s Impact on Mental Health : “The presence of green spaces in urban environments positively influences mental health by reducing stress, enhancing mood, and fostering relaxation.”
• Mindfulness for Stress Reduction : “Incorporating mindfulness practices into daily routines promotes mental clarity, reduces stress, and improves overall emotional well-being.”
• Social Interaction’s Role : “Engaging in regular social interactions and fostering strong social connections contributes to mental well-being, combating feelings of loneliness and isolation.”
• Physical Activity’s Cognitive Benefits : “Participation in regular physical activity enhances cognitive function, memory retention, and overall brain health, promoting lifelong mental well-being.”
• Positive Effects of Laughter : “Laughter’s physiological and psychological benefits, including stress reduction and improved mood, have a direct impact on overall mental well-being.”
• Nutrition’s Impact on Mood : “Balanced nutrition and consumption of mood-enhancing nutrients play a pivotal role in regulating mood and promoting positive mental health.”
• Creative Expression and Emotional Well-Being : “Engaging in creative activities, such as art and music, provides an outlet for emotional expression and fosters psychological well-being.”
• Cultural Engagement’s Influence : “Participating in cultural and artistic activities enriches emotional well-being, promoting a sense of identity, belonging, and purpose.”
• Volunteering and Mental Health : “Volunteering contributes to improved mental well-being by fostering a sense of purpose, social connection, and positive self-esteem.”
• Emotional Benefits of Pet Ownership : “The companionship of pets provides emotional support, reduces stress, and positively impacts overall mental well-being.”

Thesis Statement Examples on Mental Health

Explore 10 thought-provoking thesis statement examples delving into various facets of mental health, from addressing stigma surrounding mental illnesses to advocating for increased mental health support in schools. These examples shed light on the importance of understanding, promoting, and prioritizing mental health to achieve holistic well-being.

• Stigma Reduction for Mental Health : “Challenging societal stigma surrounding mental health encourages open dialogue, fostering acceptance, and creating a supportive environment for individuals seeking help.”
• Mental Health Education in Schools : “Incorporating comprehensive mental health education in school curricula equips students with emotional coping skills, destigmatizes mental health discussions, and supports overall well-being.”
• Mental Health Awareness Campaigns : “Strategically designed mental health awareness campaigns raise public consciousness, reduce stigma, and promote early intervention and access to support.”
• Workplace Mental Health Initiatives : “Implementing workplace mental health programs, including stress management and emotional support, enhances employee well-being and job satisfaction.”
• Digital Mental Health Interventions : “Leveraging digital platforms for mental health interventions, such as therapy apps and online support groups, increases accessibility and reduces barriers to seeking help.”
• Impact of Social Media on Mental Health : “Examining the influence of social media on mental health highlights both positive and negative effects, guiding responsible usage and promoting well-being.”
• Mental Health Disparities : “Addressing mental health disparities among different demographics through culturally sensitive care and accessible services is crucial for equitable well-being.”
• Trauma-Informed Care : “Adopting trauma-informed care approaches in mental health settings acknowledges the impact of past trauma, ensuring respectful and effective treatment.”
• Positive Psychology Interventions : “Incorporating positive psychology interventions, such as gratitude practices and resilience training, enhances mental well-being and emotional resilience.”
• Mental Health Support for First Responders : “Recognizing the unique mental health challenges faced by first responders and providing tailored support services is essential for maintaining their well-being.”

Thesis Statement Examples on Covid-19

Explore 10 illuminating thesis statement examples focusing on various aspects of the Covid-19 pandemic, from the impact on mental health to the role of public health measures. Delve into these examples that highlight the interdisciplinary nature of addressing the pandemic’s challenges and implications on global health.

• Mental Health Crisis Amid Covid-19 : “The Covid-19 pandemic’s psychological toll underscores the urgency of implementing mental health support services and destigmatizing seeking help.”
• Role of Public Health Measures : “Analyzing the effectiveness of public health measures, including lockdowns and vaccination campaigns, in curbing the spread of Covid-19 highlights their pivotal role in pandemic control.”
• Equitable Access to Vaccines : “Ensuring equitable access to Covid-19 vaccines globally is vital to achieving widespread immunity, preventing new variants, and ending the pandemic.”
• Online Education’s Impact : “Exploring the challenges and opportunities of online education during the Covid-19 pandemic provides insights into its effects on students’ academic progress and mental well-being.”
• Economic Implications and Mental Health : “Investigating the economic consequences of the Covid-19 pandemic on mental health highlights the need for comprehensive social support systems and mental health resources.”
• Crisis Communication Strategies : “Evaluating effective crisis communication strategies during the Covid-19 pandemic underscores the importance of transparent information dissemination, fostering public trust.”
• Long-Term Health Effects : “Understanding the potential long-term health effects of Covid-19 on recovered individuals guides healthcare planning and underscores the importance of ongoing monitoring.”
• Digital Health Solutions : “Leveraging digital health solutions, such as telemedicine and contact tracing apps, plays a pivotal role in tracking and managing Covid-19 transmission.”
• Resilience Amid Adversity : “Exploring individual and community resilience strategies during the Covid-19 pandemic sheds light on coping mechanisms and adaptive behaviors in times of crisis.”
• Global Cooperation in Pandemic Response : “Assessing global cooperation and collaboration in pandemic response highlights the significance of international solidarity and coordination in managing global health crises.”

Nursing Thesis Statement Examples

Explore 10 insightful thesis statement examples that delve into the dynamic realm of nursing, from advocating for improved nurse-patient communication to addressing challenges in healthcare staffing. These examples emphasize the critical role of nursing professionals in patient care, healthcare systems, and the continuous pursuit of excellence in the field.

• Nurse-Patient Communication Enhancement : “Elevating nurse-patient communication through effective communication training programs improves patient satisfaction, treatment adherence, and overall healthcare outcomes.”
• Nursing Leadership Impact : “Empowering nursing leadership in healthcare institutions fosters improved patient care, interdisciplinary collaboration, and the cultivation of a positive work environment.”
• Challenges in Nursing Shortages : “Addressing nursing shortages through recruitment strategies, retention programs, and educational support enhances patient safety and healthcare system stability.”
• Evidence-Based Nursing Practices : “Promoting evidence-based nursing practices enhances patient care quality, ensuring that interventions are rooted in current research and best practices.”
• Nursing Role in Preventive Care : “Harnessing the nursing profession’s expertise in preventive care and patient education reduces disease burden and healthcare costs, emphasizing a proactive approach.”
• Nursing Advocacy and Patient Rights : “Nurse advocacy for patients’ rights and informed decision-making ensures ethical treatment, patient autonomy, and respectful healthcare experiences.”
• Nursing Ethics and Dilemmas : “Navigating ethical dilemmas in nursing, such as end-of-life care decisions, highlights the importance of ethical frameworks and interdisciplinary collaboration.”
• Telehealth Nursing Adaptation : “Adapting nursing practices to telehealth platforms requires specialized training and protocols to ensure safe, effective, and patient-centered remote care.”
• Nurse Educators’ Impact : “Nurse educators play a pivotal role in shaping the future of nursing by providing comprehensive education, fostering critical thinking, and promoting continuous learning.”
• Mental Health Nursing Expertise : “The specialized skills of mental health nurses in assessment, intervention, and patient support contribute significantly to addressing the growing mental health crisis.”

Thesis Statement Examples for Health and Wellness

Delve into 10 thesis statement examples that explore the interconnectedness of health and wellness, ranging from the integration of holistic well-being practices in healthcare to the significance of self-care in preventing burnout. These examples highlight the importance of fostering balance and proactive health measures for individuals and communities.

• Holistic Health Integration : “Incorporating holistic health practices, such as mindfulness and nutrition, within conventional healthcare models supports comprehensive well-being and disease prevention.”
• Self-Care’s Impact on Burnout : “Prioritizing self-care among healthcare professionals reduces burnout, enhances job satisfaction, and ensures high-quality patient care delivery.”
• Community Wellness Initiatives : “Community wellness programs that address physical, mental, and social well-being contribute to healthier populations and reduced healthcare burdens.”
• Wellness in Aging Populations : “Tailored wellness programs for the elderly population encompass physical activity, cognitive stimulation, and social engagement, promoting healthier aging.”
• Corporate Wellness Benefits : “Implementing corporate wellness programs enhances employee health, morale, and productivity, translating into lower healthcare costs and higher job satisfaction.”
• Nutrition’s Role in Wellness : “Prioritizing balanced nutrition through education and accessible food options plays a pivotal role in overall wellness and chronic disease prevention.”
• Mental and Emotional Well-Being : “Fostering mental and emotional well-being through therapy, support networks, and stress management positively impacts overall health and life satisfaction.”
• Wellness Tourism’s Rise : “Exploring the growth of wellness tourism underscores the demand for travel experiences that prioritize rejuvenation, relaxation, and holistic well-being.”
• Digital Health for Wellness : “Leveraging digital health platforms for wellness, such as wellness apps and wearable devices, empowers individuals to monitor and enhance their well-being.”
• Equitable Access to Wellness : “Promoting equitable access to wellness resources and facilities ensures that all individuals, regardless of socioeconomic status, can prioritize their health and well-being.”

What is a good thesis statement about mental health?

A thesis statement about mental health is a concise and clear declaration that encapsulates the main point or argument you’re making in your essay or research paper related to mental health. It serves as a roadmap for your readers, guiding them through the content and focus of your work. Crafting a strong thesis statement about mental health involves careful consideration of the topic and a clear understanding of the points you’ll discuss. Here’s how you can create a good thesis statement about mental health:

• Choose a Specific Focus : Mental health is a broad topic. Determine the specific aspect of mental health you want to explore, whether it’s the impact of stigma, the importance of access to treatment, the role of mental health in overall well-being, or another angle.
• Make a Debatable Assertion : A thesis statement should present an argument or perspective that can be debated or discussed. Avoid statements that are overly broad or universally accepted.
• Be Clear and Concise : Keep your thesis statement concise while conveying your main idea. It’s usually a single sentence that provides insight into the content of your paper.
• Provide Direction : Your thesis statement should indicate the direction your paper will take. It’s like a roadmap that tells your readers what to expect.
• Make it Strong : Strong thesis statements are specific, assertive, and supported by evidence. Don’t shy away from taking a clear stance on the topic.
• Revise and Refine : As you draft your paper, your understanding of the topic might evolve. Your thesis statement may need revision to accurately reflect your arguments.

How do you write a Health Thesis Statement? – Step by Step Guide

Crafting a strong health thesis statement requires a systematic approach. Follow these steps to create an effective health thesis statement:

• Choose a Health Topic : Select a specific health-related topic that interests you and aligns with your assignment or research objective.
• Narrow Down the Focus : Refine the topic to a specific aspect. Avoid overly broad statements; instead, zoom in on a particular issue.
• Identify Your Stance : Determine your perspective on the topic. Are you advocating for a particular solution, analyzing causes and effects, or comparing different viewpoints?
• Formulate a Debatable Assertion : Develop a clear and arguable statement that captures the essence of your position on the topic.
• Consider Counterarguments : Anticipate counterarguments and incorporate them into your thesis statement. This adds depth and acknowledges opposing views.
• Be Concise and Specific : Keep your thesis statement succinct while conveying the main point. Avoid vague language or generalities.
• Test for Clarity : Share your thesis statement with someone else to ensure it’s clear and understandable to an audience unfamiliar with the topic.
• Refine and Revise : Your thesis statement is not set in stone. As you research and write, you might find it necessary to revise and refine it to accurately reflect your evolving arguments.

Tips for Writing a Thesis Statement on Health Topics

Writing a thesis statement on health topics requires precision and careful consideration. Here are some tips to help you craft an effective thesis statement:

• Be Specific : Address a specific aspect of health rather than a broad topic. This allows for a more focused and insightful thesis statement.
• Take a Stance : Your thesis statement should present a clear perspective or argument. Avoid vague statements that don’t express a stance.
• Avoid Absolute Statements : Be cautious of using words like “always” or “never.” Instead, use language that acknowledges complexity and nuance.
• Incorporate Keywords : Include keywords that indicate the subject of your research, such as “nutrition,” “mental health,” “public health,” or other relevant terms.
• Preview Supporting Points : Your thesis statement can preview the main points or arguments you’ll discuss in your paper, providing readers with a roadmap.
• Revise as Necessary : Your thesis statement may evolve as you research and write. Don’t hesitate to revise it to accurately reflect your findings.
• Stay Focused : Ensure that your thesis statement remains directly relevant to your topic throughout your writing.

Remember that your thesis statement is the foundation of your paper. It guides your research and writing process, helping you stay on track and deliver a coherent argument.

Text prompt

• Instructive
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10 Examples of Public speaking

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• Open access
• Published: 11 May 2010

Systematic review of the health benefits of physical activity and fitness in school-aged children and youth

• Ian Janssen 1 , 2 &
• Allana G LeBlanc 1  

International Journal of Behavioral Nutrition and Physical Activity volume  7 , Article number:  40 ( 2010 ) Cite this article

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The purpose was to: 1) perform a systematic review of studies examining the relation between physical activity, fitness, and health in school-aged children and youth, and 2) make recommendations based on the findings.

The systematic review was limited to 7 health indicators: high blood cholesterol, high blood pressure, the metabolic syndrome, obesity, low bone density, depression, and injuries. Literature searches were conducted using predefined keywords in 6 key databases. A total of 11,088 potential papers were identified. The abstracts and full-text articles of potentially relevant papers were screened to determine eligibility. Data was abstracted for 113 outcomes from the 86 eligible papers. The evidence was graded for each health outcome using established criteria based on the quantity and quality of studies and strength of effect. The volume, intensity, and type of physical activity were considered.

Physical activity was associated with numerous health benefits. The dose-response relations observed in observational studies indicate that the more physical activity, the greater the health benefit. Results from experimental studies indicate that even modest amounts of physical activity can have health benefits in high-risk youngsters (e.g., obese). To achieve substantive health benefits, the physical activity should be of at least a moderate intensity. Vigorous intensity activities may provide even greater benefit. Aerobic-based activities had the greatest health benefit, other than for bone health, in which case high-impact weight bearing activities were required.

The following recommendations were made: 1) Children and youth 5-17 years of age should accumulate an average of at least 60 minutes per day and up to several hours of at least moderate intensity physical activity. Some of the health benefits can be achieved through an average of 30 minutes per day. [Level 2, Grade A] . 2) More vigorous intensity activities should be incorporated or added when possible, including activities that strengthen muscle and bone [Level 3, Grade B] . 3) Aerobic activities should make up the majority of the physical activity. Muscle and bone strengthening activities should be incorporated on at least 3 days of the week [Level 2, Grade A] .

Canada's first set of physical activity guidelines for children and youth were introduced in 2002 [ 1 , 2 ]. The basic recommendation within these guidelines was that children and youth, independent of their current physical activity level, should increase the time they spend on moderate-to-vigorous intensity physical activity by 30 minutes per day, and over a 5 month period progress to adding an additional 90 minutes of daily physical activity. Recently, a narrative literature review was conduced to provide an update on the evidence related to the biological and psycho-social health benefits of physical activity in school-aged children and youth which has accumulated since the publication of Canada's guidelines [ 3 ]. This narrative review explored whether Canada's physical activity guidelines for children and youth are appropriate, and made recommendations as to how the guidelines could be modified to reflect current knowledge.

Several other narrative reviews have examined the relation between physical activity and health in school aged children, a small sample of which are referenced here [ 4 – 8 ]. Although informative, narrative reviews have severe limitations. First and foremost, it is uncertain as to whether all of the relevant scientific evidence has been examined. The authors of a narrative review may be exclusive with the materials they review, and these materials may have been selected and interpreted in a biased manner. Thus, the reader is faced with uncertainty and doubt when interpreting a narrative review. The reader may be better served when the choices made in the review are explicit, transparent, clearly stated, and reproducible. This can be achieved through a systematic review. Systematic reviews attempt to reduce reviewer bias through the use of objective, reproducible criteria to select relevant publications, to synthesize and critically appraise the findings from these publications, and to employ defined evidence-based criteria when formulating recommendations [ 9 ].

The purpose of this report was to: 1) perform a systematic review of the evidence informing the relation between physical activity and health in school-aged children and youth, defined here as those aged 5-17 years; and 2) make recommendations on the appropriate volume, intensity, and type of physical activity for minimal and optimal health benefits in school-aged children and youth. A previously developed evaluation system was used to set the level of evidence and grade for the recommendations. This report was part of a much larger project around Canada's physical activity guidelines, and comparable systematic reviews for adults [ 10 ] and older adults [ 11 ] have also been published in the journal. Additional details on the scope and purpose of the larger project [ 12 ] and the interpretation of the recommendations from an independent expert panel [ 13 ] can also be found elsewhere in the journal.

Overview of existing physical activity guidelines for children and youth

Before conducting the systematic review, this paper provides a brief overview on existing physical activity guidelines for school-aged children, as well as an explanation of the scientific evidence that informed the guideline development process.

The publication of Canada's physical activity guidelines for children and youth in 2002 represented a joint effort of the Canadian Society for Exercise Physiology and Health Canada. Two sets of guidelines were published, one for children aged 6 to 9 years [ 2 ] and a second for youth aged 10 to14 years [ 1 ]. In addition to the physical activity guides, which highlighted the recommended physical activity levels for these two age groups, a number of other promotional and educational packages were developed, including family booklets [ 14 , 15 ], teacher booklets [ 16 , 17 ], as well as physical activity magazines for children [ 18 ] and youth [ 19 ].

The key recommendations within Canada's child and youth physical activity guides are:

Increase the time currently spent on physical activity by 30 minutes per day, and progress over approximately 5 months to 90 minutes more per day.

Physical activity can be accumulated throughout the day in periods of at least 5 to 10 minutes.

The 90 minute increase in physical activity should include 60 minutes of moderate activity (e.g., brisk walking, skating, bicycle riding) and 30 minutes of vigorous activity (e.g., running, basketball, soccer).

Participate in different types of physical activities - endurance, flexibility, and strength - to achieve the best health results.

Reduce non-active time spent on watching television and videos, playing computer games, and surfing the Internet. Start with 30 minutes less of such activities per day and progress over the course of approximately 5 months to 90 minutes less per day.

Many other countries and organizations have developed physical activity recommendations for school-aged children and youth, as recently summarized [ 3 ]. With few exceptions, these countries and organizations recommend that children and youth participate in at least 60 minutes of moderate-to-vigorous intensity physical activity on a daily basis. One of these recommendations was published in 2005 as part of a systematic review that linked physical activity to several health and behavioural outcomes in school-aged children and youth [ 20 ]. This systematic review was sponsored by the U.S. Centers for Disease Control and Prevention (CDC) and was developed by a multidisciplinary expert panel. The expert panel considered over 850 articles published in 2004 or earlier, identified by computerized database searches and by searching the bibliographies of the panellists' own libraries [ 20 ]. Based on conceptual definitions and inclusion and exclusion criteria developed by the panel, participants systematically evaluated relevant articles (primarily intervention studies) for each of the 14 health and behavioural outcomes considered. On the basis of their reviews, the panel provided a summary of the evidence for strength (strong, >60% of studies reviewed; moderate, 30-59% of studies reviewed; and weak, <30% of studies reviewed) and the direction (positive, null, or negative) of the effects of physical activity on each of the health and behavioural outcomes. The strength of evidence was judged from the statistical significance of the outcomes; it did not include other factors usually considered in systematic review, such as the effect sizes of physical activity and the quality and types of studies.

The expert panel reached the following conclusions: (i) Evidence-based data are strong to conclude that physical activity has beneficial effects on adiposity (within overweight and obese youth), musculoskeletal health and fitness, and several components of cardiovascular health. (ii) Evidence-based data are adequate to conclude that physical activity has beneficial effects on adiposity levels in those with a normal body weight, on blood pressure in normotensive youth, on plasma lipid and lipoproteins levels, on non-traditional cardiovascular risk factors (inflammatory markers, endothelial function and heart rate variability), and on several components of mental health (self-concept, anxiety and depression) [ 20 ]. A summary of evidence concerning the health outcomes examined by the expert panel is shown in Table 1 [Additional file 1 ]. The amount, intensity, and type of physical activity required to achieve the result, when clear, is also shown in the table.

In 2008 a second systematic review of literature examining the relation between physical activity and key fitness and health outcomes within school-aged children and youth was published. This systematic review was part of the "Physical Activity Guidelines for Americans" project that was undertaken by the Unites States Department of Health and Human Services [ 21 ]. Unlike the 2005 CDC sponsored systematic review that focused on intervention studies, the 2008 review considered both observational and experimental studies. The 2008 systematic review concluded that few studies have provided data on the dose-response relation between physical activity and various health and fitness outcomes in children and youth. However, substantial data indicate that health and fitness benefits will occur in most children and youth who participate in 60 or more minutes of moderate-to-vigorous physical activity on a daily basis. For children and youth to gain comprehensive health benefits they need to participate in the following types of physical activity on 3 or more days per week: vigorous aerobic exercise, resistance exercise, and weight-loading activities.

Although informative, the recommendations made within the 2005 and 2008 systematic reviews did not include a level of evidence or grade, which are now becoming a routine part of evidence based reviews. The level of evidence helps inform the reader about the strength of evidence that informed the recommendation. The grade considers the harms and benefits of implementing the intervention, and informs the reader about whether an intervention should be implemented.

Questions addressed in systematic review

The following questions were addressed in this systematic review:

1) How much (volume) physical activity is needed for minimal and optimal health benefits in school-aged children and youth? To address this question careful consideration was given to whether dose-response relations existed between physical activity and fitness with the various health outcomes, and if so, the pattern of these relations (e.g., linear, or curvilinear relations with large improvements in health occurring with limited increases in physical activity at the low end of the physical activity scale, or curvilinear relations with small improvements in health occurring with increases in physical activity at the low end of the physical activity scale).

2) What types of activity are needed to produce health benefits ? Specific consideration was given to what types of activity (aerobic, resistance, etc.) influenced the different health outcomes, and whether more than one type of activity would be needed for overall health and well-being.

3) What is the appropriate physical activity intensity ? Attention was given to the intensity of physical activity measured (observational studies) or prescribed (experimental studies). An underlying assumption was that children and youth would prefer lower intensity activities over higher intensity activities. Therefore, for higher intensity activities to be recommended over lower intensity activities there would need to be either: i) no evidence that low intensity activities were beneficial for health and evidence that higher intensity activities impacted health in a favorable manner, or ii) clear evidence that higher intensity activities impacted the health outcomes to a greater extent than lower intensity activities.

4) Do the effects of physical activity on health in school-aged children and youth vary by sex and/or age ? Results were examined to see if: i) the moderating effects of sex and/or age on the relations between physical activity and health were explored, and if not, iii) whether there were consistent patterns across studies (either statistically or in order of magnitude) that were suggestive of sex or age differences.

Eligibility criteria

This systematic review was limited to key indicators of different health outcomes known to be related to physical activity in school-aged children and youth. Decisions on what health outcomes to include in the systematic review were made by examining what outcomes were studied in previously conducted reviews of this nature [ 20 , 21 ] and in consultation with the Steering Committee for the Canadian Physical Activity Guidelines project. These key indicators consisted of:

High blood cholesterol, high blood pressure, and markers of the metabolic syndrome as a measure of cardiometabolic risk

Overweight/obesity as a measure of adiposity

Low bone density as a measure of skeletal health

Depression as a measure of mental health

Injuries as a negative health outcome of physical activity

We recognized that although cardiorespiratory and musculoskeletal fitness are partially genetic in origin, they are in large measure a reflection of physical activity participation in recent weeks and months [ 22 ]. Therefore, the systematic review also included studies that examined the relation between fitness and health. For our purposes, fitness was assumed to be a proxy measure of physical activity. Any studies evaluating the relationship between physical activity or fitness and one or more of the key health outcomes listed above within school-aged children and youth were eligible for inclusion.

In consultation with the Steering Committee of the Canadian Physical Activity Guidelines and Measurement Project and the authors who were completing the adult and older adult systematic reviews, a decision was made to limit the pediatric systematic review to: 1) studies examining the key health indicators above, and 2) for observational studies, the outcomes must have been measured in a dichotomous (yes or no) manner and presented as prevalences or ratio scores (odds ratio, relative risk, hazard ratio). This decision was made for three reasons: (i) to help ensure that the systematic review would be manageable in size and scope for a single research team to complete in a timely manner, (ii) to eliminate many of the observational studies with small sample sizes, and (iii) to ensure that the health outcomes, at least for the observational studies, were presented in a reasonably consistent pattern from study to study. This helped us to make comparisons between studies and to characterize the magnitude of effect for physical activity.

To further illustrate why the aforementioned limitations were put in place, consider the following. Within children and youth physical activity has been related to over two dozen different health outcomes. For adiposity alone, several adiposity measures have been considered including body weight, BMI, several skinfold and circumference measures, total body fat, and several specific body fat depots. Preliminary literature searches on adiposity - as measured using both continuous (e.g., body weight, BMI, visceral fat, skinfolds) and categorical (overweight/obese vs. normal weight) outcomes to capture the measures indicated above, revealed over 15,000 published papers. The results from these papers were presented in several formats including comparison of group means for continuous adiposity measures according to physical activity level, relations between continuous adiposity and physical activity measures which were presented in a variety of ways (e.g., r values, regression coefficients); comparison of group means for physical activity according to adiposity status; ratio scores (odds ratios, relative risks, hazard ratios) for the prediction of obesity status according to physical activity level; comparison of the prevalence of obesity according to physical activity level; etc. Without employing some criteria to limit the types of measures and outcomes, it would have been virtually impossible to synthesize the results from these studies.

Cross-sectional studies, case-control studies, cohort studies (prospective and retrospective) and intervention studies (including randomized and quasi experimental designs) were eligible for inclusion in the systematic review. Only published, English language studies including human participants were included. To be included studies had to be limited to school-aged children and youth between 5-17 years of age, or present data specifically for a subgroup of participants within this age range.

For the observational studies, there were no limitations placed on the form of physical activity (e.g., questionnaire, activity diary, pedometer, accelerometer) or fitness (cardiorespiratory or musculoskeletal fitness) measurements. For intervention studies, all cardiorespriatory and/or musculoskeletal based interventions were eligible for inclusion. Intervention studies were excluded if they included a dietary (e.g., caloric restriction) or other behavioral risk factor component (e.g., smoking cessation) that may have independently affected the health outcomes and subsequently made it impossible to distinguish the independent effect of the physical activity portion of the intervention.

Search strategy

Literature searches were conducted in MEDLINE (1950-January 2008, OVID Interface), EMBASE (1980-January 2008, OVID Interface), CINAHL (1982-January 2008, OVID Interface), PsycINFO (1967-January 2008, OVID Interface), all Evidence-Based Medicine Reviews (1991-January 2008, OVID Interface), and SPORTDiscus (up to January 2008, EBSCO Interface).

The electronic search strategies were executed by a single researcher (AB) under direction of the primary author (IJ). They were not restricted by publication type or study design; however, they were limited to human participants and English language. The following string of search terms were used for each of the study outcomes to identify physical activity related papers conducted within the age group of interest: ('physical activity' OR 'fitness' OR 'exercise' OR 'energy expenditure') AND ('child' OR 'adolescent' OR 'youth' OR 'juvenile'). The following search terms were added (e.g., AND) for the cholesterol search: ('high cholesterol' OR 'hypercholesterolemia' OR 'hyperlipidemia' OR 'dyslipidemia'). For hypertension the following search terms were added: ('high blood pressure' OR 'hypertension'). For metabolic syndrome the following search terms added: ('metabolic syndrome' OR 'syndrome X' OR 'deadly quartet' OR 'plurimetabolic syndrome' OR 'insulin resistance' OR 'insulin resistant'). For obesity the following search terms were added: ('obese' OR 'obesity' OR 'overweight'). For low bone mineral density the following search terms were added: ('bone density' OR 'bone strength' OR 'bone mass' OR 'bone mineral density'). For depression the following search terms were added: ('depression' OR 'mood disorder'). For injuries the following search terms were added: ('injury' OR 'injuries').

A total of 42 electronic searches were performed (7 health outcomes × 6 search engines) and the information from each search was saved as a text file that included all of the retrieved citations. Using SAS software version 9 (SAS Institute, Carry, NC), the text files were separated back into individual citations and exported into a Microsoft Access database. The database included the following information for each citation: unique identifier for the database, paper title, authors, journal name, volume and issue number, page numbers, and the abstract. See Figure 1 for an illustration of the Microsoft Access database form. Within the Microsoft Access database, duplicate citations - those citations that were identified in more than one of the search engines and/or for more than one of the health outcomes - were identified by a match of the title and were removed using automated procedures.

Copy of electronic abstract review form .

Screening of citations

After duplicate citations were removed from the Access database, the abstract of each citation was reviewed by a single reviewer to determine if it should be included within the systematic review. The full-text articles of all potentially relevant citations were obtained, and saved as Adobe-PDF files that were linked to the Access database. Whenever it was uncertain as to whether a citation was appropriate, the full-text copy was obtained. After the first reviewer screened the database, the citations that were deemed ineligible were reviewed by a second reviewer to determine if any potentially relevant citations were missed, and full-text copies of these citations were also obtained. Copies of all of the full-text articles were then reviewed by the two reviewers for inclusion criteria; if uncertain as whether or not to include an article, the article in question was reviewed again until a final decision was made.

Data abstraction

A single reviewer (AL) abstracted data from all eligible full-text citations using an electronic data abstraction form. Refer to Figure 2 for an illustration of electronic data abstraction form. The data abstraction was completed in a second Microsoft Access Database, which was linked to the first Microsoft Access Database using a unique identifier. The abstracted data included information on the study design, participants, details of the physical activity (or fitness) measures or interventions, and key findings. After data abstraction was completed, the information was checked by a second reviewer (IJ) and corrected when necessary.

Copy of electronic database abstraction form .

Assigning levels of evidence and formulation of recommendations

The goal was to use a rigorous, evidence-based approach to develop levels of evidence on the relation between physical activity and health in school-aged children that could be used to formulate recommendations for the specific volume, intensity, and type of physical activity needed. At present there is no universally accepted method for formulating evidence-based recommendations. In consultation with the Steering Committee for this project and the authors performing the systematic reviews in adults and older adults, we chose to use the process that was recently employed for the development of Canada's obesity prevention and management guidelines [ 23 ]. Within this system, the level of evidence for a recommendation is based on an objective appraisal of the literature according to a pre-specified scale as reflected by the study designs and quality. As shown in Table 2 [Additional file 2 ], the level of evidence can range from 1 (highest) to 4 (lowest). The grade for a recommendation reflects the level of evidence and several additional features, including: benefits and risks of physical activity participation, magnitude of the effects, cost of the intervention, and value of an intervention to an individual or population. As indicated in Table 3 [Additional file 3 ], the grade for the recommendation may be an A, B, or C. Note that while the level of evidence assigned is not necessarily linked to the corresponding grade, a high grade is less likely in the setting of low-quality of evidence.

Note that the level of evidence in the aforementioned grading system is based in part on the quality of the studies. This grading was particularly relevant for experimental studies wherein the level of evidence would change from Level 1 to Level 2 based on whether or not the randomized controlled trials (RCTs) have important limitations. A single investigator (IJ) assessed the quality of the RCTs included in this systematic review using the validated checklist developed by Downs and Black [ 24 ]. This 27-item checklist assess the quality of reporting (e.g., are the interventions of interest clearly described, have all the adverse events that may be a consequence of the intervention been reported), external validity (e.g., were the subjects representative of the population), internal validity (e.g., was an attempt made to blind those measuring the outcome, were the outcome measures accurate), selection bias (e.g., were the study subjects randomized, was randomization assignment concealed until recruitment was complete), and statistical power.

To evaluate the magnitude of effect of physical activity on the various health outcomes examined, in addition to statistical significance, the following criteria were applied to evaluate the strength of the ratio scores (odds ratio, relative risk, hazard ratio) for the observational studies. For positive associations 1.01-1.50 = weak association, 1.51-3.00 = moderate association, and 3.01 or higher = strong association. For negative associations: 0.71-0.99 = weak association, 0.41-0.70 = moderate association, 0.00-0.40 = strong association [ 25 ]. For the experimental studies, measures of effect were calculated based on Cohen's d, which was calculated as the difference between the pre- and post-treatment mean within a given treatment group divided by the average of the standard deviation of the pre- and post-treatment means [ 26 ]. Cohen's d effect measures ≥ 0.49 were considered to be weak, values ranging from 0.50-0.79 were considered to be moderate, and values ≥ 0.80 were considered to be strong [ 26 ]. Note that several experimental studies did not report the information required to calculate Cohen's d, and for these studies effect measures have not been presented.

When possible (e.g., at least 4 studies) we performed meta-analyses to calculate summary odds ratio and Cohen's d effect size measures for the observational and experimental studies, respectively [ 27 ]. These summary estimates represent a weighted average of the estimates provided in the various studies included in the meta-analysis. These meta-analyses were performed separately for each health outcomes, separately for observational and experimental studies, and separately based on type of physical activity measurement or exercise modality prescribed.

Literature review

The flow of citations through the systematic review process is shown in Figure 3 . For each of the 7 health outcomes, several citations were retrieved in more than one of the 6 search engines. After removing duplicates, a total of 437 citations were identified for cholesterol, 1151 for depression, 2505 for injury, 1181 for bone density, 1677 for blood pressure, 5824 for obesity, and 1677 for the metabolic syndrome. Thus, the grand total was 13174. Many of these 13174 citations were retrieved for 2 or more health outcomes, and after removing these duplicates there was a total of 11,088 unique citations. After the titles and abstracts of these 11,088 citations were reviewed, full-text copies of 454 potentially relevant citations were obtained and reviewed. Of these 454 citations, 86 unique citations passed the eligibility criteria and were included in the systematic review. Several of these 86 citations included results for 2 or more of the 7 relevant health outcomes.

Flow of articles through the systematic review .

Cholesterol and blood lipids

A total of 9 articles examining blood lipids and lipoproteins met the inclusion criteria. Only one of these studies was observational in nature [ 28 ]. This cross-sectional study was conducted on a representative sample (n = 3110) of 12-19 year old American adolescents and measured cardiorespiratory fitness using a submaximal treadmill test. The results indicated that unfit girls, defined as the lowest 20% fit, were 1.89 (95% confidence interval: 1.12-3.17) times more likely to have hypercholesterolemia and 1.03 (0.74-1.43) times more likely to have a low HDL-cholesterol by comparison to moderately and high fit girls. Unfit boys were 3.68 (2.55-5.31) times more likely to have hypercholesterolemia and 1.25 (0.79-1.95) times more likely to have a low HDL-cholesterol by comparison to moderately and high fit boys.

A total of 8 experimental studies (6 RCT, 2 non-randomized) examined the effect of exercise interventions on changes in blood lipids and lipoproteins, as summarized in Table 4 [Additional file 4 ] [ 29 – 36 ]. For the most part, these studies were limited to children and youth with high cholesterol levels [ 30 ] or obesity [ 29 , 32 , 34 , 36 ] at baseline. The sample sizes were quite small and only 2 of these interventions included more than 37 participants [ 32 , 36 ]. The interventions ranged from 6 to 24 weeks in duration and included anywhere from 1 to 4 hours per week (9-34 minutes per day on average) of prescribed exercise. Six of the 8 exercise programs included various forms of moderate-to-vigorous physical activity as explained in the methods sections of the papers.

The results from these intervention studies were mixed. The 5 studies that were based on aerobic exercise alone observed significant improvements in at least one lipid/lipoprotein variable. The summary effects size measures (95% confidence interval) for the aerobic exercise interventions were -3.03 (-3.22, -2.84) for triglycerides and 0.26 (0.03, 0.49) for HDL-cholesterol. The interventions that were based on resistance training [ 33 ] and circuit training [ 34 ] reported small and/or insignificant changes for all of the lipid/lipoprotein variables examined, and the effect sizes within these studies tended to be quite small (eg, <0.5). Not surprisingly, the interventions that produced significant changes were also based on the studies that employed the largest sample sizes. This suggests that many of the studies were underpowered.

Due to the design of these interventions (eg, only one dose of exercise prescribed in a given study), the nature of the dose-response relation between exercise and blood lipids in children and youth remains unclear. Furthermore, the interventions that produced favorable effects on blood lipids did not tend to prescribe higher volumes or intensities of exercise by comparison to the interventions that did not produce significant changes. The favorable interventions were, however, based on 'high risk' participants, implying that low volumes of moderate-to-vigorous exercise may be beneficial for youngsters at the greatest risk.

The effects of age and sex have not been adequately addressed in the existing literature. Thus, conclusions cannot be made on the moderating effects of these demographic characteristics on the relation between physical activity and blood lipids in school-aged children and youth.

High blood pressure

A total of 11 articles examining high blood pressure met the systematic review inclusion criteria. Three of these studies were observational in nature (2 cross-sectional, one prospective cohort) (Table 5) [Additional file 5 ] [ 28 , 37 , 38 ]. Of these 3 studies, one relied on self-reported measures of physical activity [ 37 ] and the remaining two measured cardiorespiratory fitness [ 28 , 38 ]. Within all 3 observational studies the relations between physical activity or fitness with hypertension were weak in magnitude (e.g., odds ratios <1.5), and in one case [ 28 ] was insignificant. Only one study examined more than 2 levels of physical activity or fitness (e.g., compared risk estimates across at least 3 groups), and thus was able to provide some insight into the dose-response relation. Within that study only participants within the least fit quartile were more likely to have hypertension relative to participants in the most fit quartile, a finding that was consistent in boys and girls [ 38 ].

Eight experimental studies, 4 of which were RCTs, examined the influence of exercise interventions on changes in blood pressure (Table 6) [Additional file 6 ] [ 29 , 33 , 34 , 39 – 43 ]. Most of these studies were limited to children and youth with high blood pressure [ 39 – 42 ] or obesity [ 29 , 34 ]. The sample sizes were quite small; only one of these studies included more than 37 participants [ 42 ]. The interventions ranged from 4 to 25 weeks in duration. With one exception [ 43 ], the interventions included between 60 to 180 minutes/week of prescribed exercise. This equates to 9 to 30 minutes/day when averaged over a week.

Despite the small sample sizes, the results from these intervention studies were positive with reports of significant reductions in systolic blood pressure in response to aerobic exercise training, with effect sizes that all tended to be large (>0.80) [ 29 , 39 , 41 – 43 ]. Two of the aerobic based interventions also reported significant reductions (~6% to 11%) in diastolic blood pressure [ 34 , 39 ]. The summary effect size measures for the aerobic exercise interventions were -1.39 (-2.53, -0.24) for systolic blood pressure and -0.39 (-1.72, 0.93) for diastolic blood pressure. Unlike the aerobic-based exercise programs, only two of the four studies that employed other training modalities, such as resistance exercise, reported a significant effect on blood pressure [ 33 , 40 ], with small to modest effect sizes being observed. The summary effect size measures for the non-aerobic exercise interventions were -0.61 (-2.27, 1.05) for systolic blood pressure and -0.51 (-2.18, 1.06) for diastolic blood pressure.

Because the aerobic exercise intervention studies prescribed similar volumes and intensities of exercise, and because they found comparable reductions in blood pressure, the effects of the volume and intensity (moderate vs. vigorous) of exercise on blood pressure remain unclear. Due to limited variations in the age of the participants in these studies, the effects of age on the relation between exercise and blood pressure remains unclear. Most of the studies included both males and females, suggesting that aerobic exercise is effective at controlling blood pressure within box sexes.

Metabolic syndrome

The metabolic syndrome has received considerable research attention in recent years in both adults and youngsters. Sixteen articles examining the metabolic syndrome met the inclusion criteria. The metabolic syndrome components (e.g., abdominal obesity, triglycerides, insulin, HDL-cholesterol, inflammatory markers, etc.) and criteria (e.g., cut-points used to define high-risk values) employed in these studies varied considerably. Eight of the 17 identified studies were observational in nature (7 cross-sectional, 1 prospective), as summarized in Table 7 [Additional file 7 ] [ 28 , 44 – 51 ]. Many of these observational studies examined large and heterogeneous samples of participants, suggesting that the findings are quite generalizable to the general population. Of the 3 cross-sectional studies that employed self-reported measures of physical activity, the reported relations with the metabolic syndrome were either weak or modest in strength, and all were non-significant [ 45 , 48 , 49 ]. The summary odds ratio for the least active group relative to the most active group in these 3 studies was 1.68 (95% confidence interval: 1.22, 2.31). By comparison, the study that used accelerometers to measure physical activity in an objective manner [ 51 ] and the 4 studies that used direct measures of cardiorespiratory fitness [ 28 , 46 , 47 , 50 ] all reported strong and significant relations with the metabolic syndrome. The summary odds ratio for the least fit group relative to the most fit group in the 4 studies that measured fitness was 6.79 (95% confidence interval: 5.11, 9.03). Further examination of these later studies revealed clear dose-response relations; however, the nature (e.g., linear or curvilinear) of the dose-response relation is unclear. In addition, comparison of the risk estimates in males and females suggests that the relation between physical activity and fitness with the metabolic syndrome is stronger in males. The influence of age on these relations remains uncertain.

Eight experimental studies, 5 of which were RCTs, examined the effect of exercise interventions on changes in markers of the metabolic syndrome, primarily in the form of fasting insulin and insulin resistance (Table 8) [Additional file 8 ] [ 32 – 34 , 36 , 52 – 55 ]. All but one of these studies was conducted in an overweight/obese sample [ 33 ]. The number of participants included in these studies was modest, with all but a single study being limited to 52 participants or less [ 36 ]. The exercise interventions ranged from 6 to 40 weeks in duration and included anywhere from 80 to 200 minutes per week (10-30 minutes per average day) of prescribed exercise. About half of the exercise programs were aerobic in nature.

The results from these 8 studies were mixed (Table 8). All of the 4 interventions that focused on aerobic exercise observed significant improvements in at least one of the insulin variables examined. Conversely, only one of the four interventions that employed resistance or circuit training observed any meaningful improvements [ 54 ]. The summary effect size measures (95% confidence interval) for fasting insulin in the aerobic and resistance exercise interventions were -0.60 (-1.71, 0.50) and -0.31 (-0.82, 0.19), respectively. No intervention studies systematically considered the influence of the dose or intensity of exercise, or sex and age effects, on markers of the metabolic syndrome. More research is needed to address these issues.

Overweight and obesity

The relation between physical activity and fitness with obesity in school-aged children and youth has been extensively studied. A total of 31 observational studies (24 cross-sectional, 3 prospective cohort, 2 case-control, 1 mixed) were retrieved that met the appropriate inclusion criteria, as summarized in Table 9 [Additional file 9 ] [ 56 – 86 ]. Overweight and obesity were classified using age- and gender-specific body mass index (BMI) criteria (e.g., BMI z-scores) in the majority of these observational studies. The majority of these studies assessed physical activity or sport participation using self- or parental-reported tools. These studies tended to report weak to modest relationships between physical activity and overweight/obesity, with many risk estimates being non-significant. Of the 25 available data points, the median odds ratio for overweight/obesity in the least active group relative to the most active group was 1.33. It is noteworthy that the studies that assessed moderate-to-vigorous intensity physical activities alone were more consistently and strongly related to obesity than the studies that included low intensity activities within the physical activity measure.

Four studies were identified that employed objective measures of physical activity, including one study that used pedometers [ 73 ] and 3 studies that used accelerometers [ 59 , 67 , 83 ]. These studies tended to report significant relations between physical activity with overweight/obesity that were strong in magnitude. Of the 8 available data points for cross-sectional findings, the median odds ratio was 3.79. An additional 4 studies measured the relation between cardiorespiratory fitness and obesity [ 75 , 76 , 82 ]. All of these studies reported significant relations between physical activity and fitness with overweight/obesity that were modest to strong in magnitude.

Several of the observational studies examining overweight and obesity presented analyses that were stratified by sex [ 56 – 58 , 60 , 64 , 67 , 71 , 73 – 75 , 77 , 79 , 81 ]. Although sex differences were rarely tested for using the appropriate statistical techniques, visual inspection of the risk estimates provided suggests that in 12 of the 14 studies the associations between physical activity and fitness with obesity were stronger in males than in females.

Many of the observational studies presented their results in a manner that permitted the dose-response relations with obesity to be examined [ 57 , 59 , 61 , 62 , 64 , 65 , 69 , 71 , 73 , 74 , 79 , 80 , 82 , 84 ]. From these studies it is apparent that a dose-response relation between physical activity and obesity exists. However, the pattern of this dose-response relation is unclear as some studies observed linear patterns and others observed curvilinear patterns.

In addition to the observational studies discussed above, 24 intervention studies, 17 of which were RCTs, examining changes in obesity measures were included in the systematic review (Table 10) [Additional file 10 ] [ 29 , 32 , 34 – 36 , 39 , 42 , 43 , 52 – 55 , 87 – 98 ]. It is important to note that in many of these studies the primary aim of the intervention was to improve other health measures (e.g., blood lipids, insulin resistance, and bone density) and not obesity measures per se . These studies examined several different measures of total (% fat, BMI, weight) and abdominal (waist circumference, trunk fat, visceral fat) adiposity. The studies ranged in length from 4 weeks to 2 years, with most being 4 to 6 months in duration. The amounts of exercise prescribed typically ranged from 2 to 3.5 hours per week, which averages out to 17 to 30 minutes per day. Half of the studies were limited to overweight and obese participants.

About 50% of the exercise interventions that were aerobic in nature observed significant changes in measures of BMI, total fat, and/or abdominal fat in response to training. Only 3 of the 17 studies that employed other training modalities (resistance training, circuit training, pilates, jumping exercises) observed significant improvements in measures of total fat, abdominal fat, or BMI in response to training. The effect sizes, even for the studies that found significant improvements, tended to be small (<0.50). For the interventions that were based on aerobic exercise, the summary effect size measures were -0.40 (-1.10, 0.31) for % body fat and -0.07 (-0.89, 0.75) for BMI. For the resistance exercise intervention, the summary effect size calculation for % body fat was -0.19 (-1.55, 1.18).

Variations in the effects of age, sex, and exercise dose on changes in obesity measures in response to exercise training have not been systematically addressed in the literature. Thus, no conclusions can be drawn on the potential moderating effects of these variables.

Bone mineral density

Many observational studies have examined the relation between physical activity and continuous measures of bone mineral density such as bone mineral content values in grams, bone density values in g/cm 2 , and cortical bone area measures in cm 2 (see review [ 99 ]). However, no observational studies in the literature search met the systematic review criteria of predicting a low bone mineral density as a dichotomous outcome.

As summarized in Table 11 [Additional file 11 ], a total of 11 experimental studies examining changes in bone mineral density in response to exercise training were retrieved in the systematic review [ 55 , 88 – 94 , 100 – 103 ]. Two of these studies presented identical data on the same group of participants, and were therefore presented as a single study in the table [ 101 , 102 ]. The physical activity programs employed in these interventions typically consisted of moderate-to-high strain anaerobic activities such as impact resistance training, high impact weight bearing, and jumping. These programs were performed anywhere from 3 to 60 minutes in length on at least 2 or 3 days of the week, and lasted from a few months to 2 years in duration.

The results from these studies, although not undisputed, indicate that as little as 10 minutes of moderate-to-high impact activities performed on as little as 2 or 3 days of the week can have a modest effect on bone mineral density when combined with more general weight bearing aerobic activities that are also beneficial for cardiovascular risk factors and obesity prevention (e.g., jogging, play, etc.).

Only 6 studies on depression and related symptoms met the inclusion criteria. Table 12 [Additional file 12 ] outlines the 3 observational studies [ 104 – 106 ]. These were all cross-sectional in design, used self-reported measures of physical activity, and reported small and insignificant [ 104 , 106 ] or modest [ 105 ] relations between physical activity and depression. Interestingly, within the later study the relation between physical activity and depression were more evident at a moderate intensity of physical activity than at a vigorous intensity of physical activity [ 105 ].

The 3 experimental studies that examined changes in depression [ 107 – 109 ], all of which were RCTs based on aerobic exercise, are outlined in Table 13 [Additional file 13 ]. The volume of exercise prescribed in these studies was very modest (60 to 90 minutes per week). All three of these studies observed significant improvements in at least one depressive symptom measure in response to 8 to 12 week exercise programs. The effect sizes were small to modest in these studies, with very broad 95% confidence intervals. One of the studies included both high intensity and moderate intensity exercise programs, and only the high intensity program resulted in significant improvements in depression scores in comparison to the control group, which performed flexibility exercises [ 108 ].

Injuries are a leading cause of disability and mortality in young people. It has been reported that approximately 50% of medically treated injuries within 6 th to 10 th grade Canadian youth occur during physical activity [ 110 ]. Thus, it is not surprising that there is an extensive literature on physical activity and injuries in the pediatric population (see review [ 111 ]). However, most of the published information is limited to groups of participants that have all been injured or groups of participants comprised entirely of athletes (eg, football players, ballet dancers).

Only 3 articles examining injury met the inclusion criteria for this systematic review [ 112 – 114 ]. These studies were all cross-sectional in nature and relied on self- or parental-reported measures of physical activity and sports participation (Table 14) [Additional file 14 ]. These studies examined medically treated injuries; however, limited or no information on the severity of and long-term recovery from these injuries was presented. All 3 of the studies reported higher rates of injury in physically active children and youth compared with inactive children and youth. Furthermore, within all 3 of the papers there was clear evidence of a dose-response relation between physical activity participation and the likelihood of injury. That is, as the physical activity level increased, the likelihood of injury increased in a graded fashion. One study assessed vigorous sports, and within that study the risk estimates for injury within the most active group would be considered high [ 114 ]. Conversely the risk estimates for injury were modest within the 2 studies that measured moderate-to-vigorous intensity activities [ 112 , 113 ]. The quality of the evidence for the injury outcome, which is based on cross-sectional studies, is limited as cross-sectional research only provides a low level of evidence. Follow-up (incidence) studies that also take into consideration the volume of sports participation would provide a more powerful level of evidence.

Quality assessment of RCTs

The RCTs that are listed within the summary tables contained several significant limitations. The study samples were small, and non-representative. Although few of the studies addressed the issue of statistical power, the lack of power was clearly an issue. Specifically, for a number of the health outcomes, the RCTs in which significant findings were observed were also the RCTs with the largest sample sizes. Almost without exception, the RCTs included in the systematic review did not report adverse events for the physical activity interventions (e.g., injuries), provided little or no detail on the drop-outs, and did not perform intent-to-treat analyses. Given the consistency of these limitations across studies, Level 2 was the highest level that could be assigned to any of the recommendations.

Recommendations based on systematic review

Recommendation #1

Children and youth 5-17 years of age should accumulate an average of at least 60 minutes per day and up to several hours of at least moderate intensity physical activity. Some of the health benefits can be achieved through an average of 30 minutes per day. [Level 2, Grade A]

There is strong and consistent evidence based on experimental studies for several health outcomes that participating in as little as 2 or 3 hours of moderate-to-vigorously intense physical activity per week is associated with health benefits. Evidence from observational studies also demonstrates dose-response relations between physical activity and health, with differences in health risk between the least active (or fit) and the second least active (of fit) groups. Thus, it would seem appropriate to set minimal physical activity targets that reflect a low level of physical activity (see Recommendation #1). Furthermore, the current recommendation of 90 minutes more per day (Canadian) or 60 minutes per day (US, UK, Australian) may be quite intimidating, particularly for children and youth who are very inactive. From a behaviour modification perspective, having a target that seems out of reach may actually undermine physical activity participation [ 115 ].

That being said, with the exception of injuries, the dose-response evidence from observational studies for several health outcomes suggests that more physical activity will be better, and that additional health benefits can still be achieved at the higher end of the physical activity spectrum. Therefore, it would also seem appropriate to set higher physical activity targets (60 minutes and up to several hours) that would elicit more pronounced health benefits for those children and youth who are already somewhat active (see Recommendation #1). This approach is consistent with recommendations made by the U.S. National Association for Sports and Physical Education[ 116 ] and the Australia Department of Health and Ageing [ 117 ], both of whom have recommended that children and youth participate in at least 60 minutes, and up to several hours, of moderate to vigorous intensity physical activity every day.

This type of dual message provided in Recommendation #1 will hopefully encourage children and youth who are very inactive to engage in at least a modest amount of physical activity, while at the same time encourage moderately active children and youth to achieve even greater benefits by becoming more active. The minimal and optimal doses of physical activity required for good health in children and youth remain unclear, and more carefully conducted dose-responses studies are warranted in the pediatric age range.

Previous physical activity recommendations and guidelines for school-aged children and youth indicate that a high volume of physical activity needs to be performed everyday. The need for children and youth to engage in physical activity on a daily basis to maintain good health was not supported by the evidence reviewed here. In other words, it is unknown as to whether a child who accumulates 7 hours of activity over the week, with one hour being performed on each day, would have any greater health benefits than a child who accumulates 7 hours of activity over the week, with different amounts of activity being performed each day (including some days with no activity). Thus, the recommendation made in this systematic review calls for an "average" of at least 60 minutes per day instead of at least 60 minutes everyday. Future studies need to address whether a "days per week" recommendation is warranted. In addition, future studies within children and youth should consider whether the daily physical activity needs to be accumulated in bouts of at least a few minutes in duration (eg, 5 or 10 minutes). Most children accumulate the majority of their physical activity in a very sporadic manner (eg, a couple of minutes here and there), and new evidence suggests that this sporadic pattern of activity may not be as beneficial as bouts of activity that last at least 5 minutes in length [ 118 ].

Given the positive effect of physical activity on 6 of the 7 health outcomes examined, including observations from several large and diverse samples, this Recommendation was assigned a Grade A.

Recommendation #2

More vigorous intensity activities should be incorporated or added when possible, including activities that strengthen muscle and bone. [Level 3, Grade B] .

Moderate intensity activity in children and youth has been defined in a variety of ways, depending on the method chosen to measure physical activity. The lower threshold of moderate intensity activity is usually defined as 4 METS (4 × resting metabolic rate), although it is not uncommon for investigators to use 3 METS. In general, the lower threshold of vigorous intensity activity is usually defined as 7 METS (7 × resting metabolic rate) in children.

The majority of observational studies have focused on measuring moderate-to-vigorous intensity physical activity. Furthermore, the relations between overall physical activity (including low intensity activities) and obesity do not appear to be as strong or consistent as the relations between moderate-to-vigorous intensity activity and obesity. In addition, the intervention studies included within this systematic review almost exclusively prescribed physical activity of at least a moderate intensity. Thus, while it is clear that moderate and vigorous intensity activities are associated with many health benefits, the same is not true for low intensity activity. Therefore, Recommendation #1 indicates that the physical activity should be of at least a moderate intensity. More consideration on the impact of low intensity activities on health should be given in future studies.

The next question to address is whether vigorous intensity activities provide benefits above and beyond that of moderate intensity activities. Regrettably, few studies have systematically addressed this question. The available information suggests that vigorous intensity activities provide additional health benefits beyond modest intensity activities. Furthermore, many of the experimental studies that observed significant changes in the health variables examined prescribed exercise that would fall within the vigorous intensity or upper-end of the moderate intensity range. Recommendation #2, therefore, suggests that vigorous intensity activities should be included when possible. This recommendation was assigned a lower level of evidence (Level 3) because of the limited amount of evidence and the inconsistency in the evidence that is available. This recommendation was given a lower grade (Grade C) because of the potential increase in injury risk associated with more vigorous intensity activities and sports. However, the injury data is weak and future studies, particularly intervention studies, should examine and report on injuries associated with physical activity in children.

Recommendation #3

Aerobic activities should make up the majority of the physical activity. Muscle and bone strengthening activities should be incorporated on at least 3 days of the week. [Level 2, Grade A] .

Many of the health outcomes examined, particularly obesity and the cardiometabolic health measures, responded almost exclusively to aerobic exercise interventions. It is also likely that most of the activity that was captured in the observational studies was aerobic in nature. Recommendation #3 therefore suggests that physical activity should focus on aerobic activities. However, bone health was more favorably affected by modest amounts of resistance training and other high-impact activities (jumping) that were performed on at least 2 or 3 days of the week. Thus, this recommendation indicates that a small amount of bone strengthening activities should be incorporated.

Limitations

This systematic review has several limitations, many of which related to practical issues around conducting the study (e.g., budgetary, human resource, and time constraints). First, because we did not include unpublished studies and studies that were published in a language other than English, and because we did not perform an extensive cross-referencing of the references lists from the papers that were retrieved in the electronic databases, several relevant papers may be been excluded. Second, the review was limited to 7 health outcomes and did not include several other outcomes that may be relevant for children and youth such as academic performance, emerging cardiometabolic risk factors (e.g., endothelial function, inflammatory markers), risky and aggressive behaviours (e.g., substance use and abuse, bullying and fighting), and measures of mental health and well-being outside of depression. Third, a large percentage of observational studies in the area were excluded because they did not report their findings in a dichotomous manner. Together, these limitations may have biased the Results and Recommendations that were made. Nonetheless, despite these limitations and the differences in methodology employed, the recommendations made here are remarkably comparable to the recommendations for children and youth that were part of the recently completed "Physical Activity Guidelines for Americans" project [ 21 ]. The reader is referred to the Expert Panel report for a more comprehensive discussion of the limitations of this systematic review [ 13 ].

In summary, the findings of this systematic review confirm that physical activity is associated with numerous health benefits in school-aged children and youth. The dose-response relations between physical activity and health that were observed in several observational studies suggest that the more physical activity, the greater the health benefit. However, the results from several experimental studies suggested that even modest amounts of physical activity can have tremendous health benefits in high-risk youngsters (e.g., obese, high blood pressure). To achieve substantive health benefits, the physical activity should be of at least a moderate intensity, and it should be recognized that vigorous intensity activities may provide an even greater benefit. Aerobic-based activities that stress the cardiovascular and respiratory systems have the greatest health benefit, other than for bone health, in which case high-impact weight bearing activities are required.

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Acknowledgements

Production of this paper has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. The leadership and administrative assistance was provided by the Canadian Society for Exercise Physiology.

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Production of this paper has been made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. I Janssen has received honoraria, speaker fees, and consulting fees from several non-profit organizations, including the Public Health Agency of Canada, that have an interest in physical activity and health.

Authors' contributions

IJ designed the methods, assisted with the completion of the systematic review, and drafted the manuscript. AB lead most of the components of the systematic review and helped drafts some of the methodology sections of the paper.

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Electronic supplementary material

12966_2009_346_moesm1_esm.doc.

Additional file 1: Table 1. Association between physical activity and health and behavioural outcomes in children and youth. (DOC 78 KB)

Additional file 2: Table 2. Criteria for assigning a level of evidence to recommendations. (DOC 50 KB)

Additional file 3: table 3. criteria for assigning a grade to recommendations. (doc 50 kb), 12966_2009_346_moesm4_esm.doc.

Additional file 4: Table 4. Experimental studies examining the influence of exercise on changes in traditional blood lipids and lipoproteins in school-aged children and youth. (DOC 158 KB)

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Additional file 5: Table 5. Observational studies examining the relation between physical activity and fitness with hypertension in school-aged children and youth. (DOC 86 KB)

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Additional file 6: Table 6. Experimental studies examining the influence of exercise on changes in blood pressure in school-aged children and youth. (DOC 133 KB)

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Additional file 7: Table 7. Observational studies examining the relation between physical activity and fitness with the metabolic syndrome in school-aged children and youth. (DOC 154 KB)

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Additional file 8: Table 8. Experimental studies examining the influence of exercise on changes in markers of the metabolic syndrome (insulin resistance) in school-aged children and youth. (DOC 125 KB)

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Additional file 9: Table 9. Observational studies examining the relation between physical activity and fitness with obesity in school-aged children and youth. (DOC 458 KB)

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Additional file 10: Table 10. Experimental studies examining the influence of exercise on changes in obesity measures in school-aged children and youth. (DOC 360 KB)

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Additional file 11: Table 11. Experimental studies examining the influence of exercise on changes in bone mineral density in school-aged children and youth. (DOC 190 KB)

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Additional file 12: Table 12. Observational studies examining the relation between physical activity and fitness with depression in school-aged children and youth. (DOC 80 KB)

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Additional file 13: Table 13. Experimental studies examining the influence of exercise on changes in measures of depression in school-aged children and youth. (DOC 91 KB)

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Additional file 14: Table 14. Observational studies examining the relation between physical activity and fitness with injury in school-aged children and youth. (DOC 114 KB)

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Janssen, I., LeBlanc, A.G. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 7 , 40 (2010). https://doi.org/10.1186/1479-5868-7-40

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Received : 20 July 2009

Accepted : 11 May 2010

Published : 11 May 2010

DOI : https://doi.org/10.1186/1479-5868-7-40

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Introduction

Importance of understanding the study, literature review.

Increased levels of obesity and poor health standards among students across the United States (US) has brought a lot of focus to student health and more so, the effects of bad health on academic performance (Chomitz, 2009, p. 30).

However, the debate on the correlation between health and academic performance has long been done and concluded. On the other hand, the debate on the correlation between physical activities (as a significant health facet for students) and academic performance is only emerging.

The benefits of regular physical exercise have been widely acknowledged throughout health and medical circles. For instance, research studies done on animals have come to a conclusion that physical exercising increases neural development while other closely related similar studies have affirmed that physical exercising leads to a more excellent development of neuronal synapses (Grissom, 2005, p. 1).

Increased physical activity has also been affirmed to reduce stress levels and equally reduce anxiety, not only among students but also in the general human population as well. These factors have been associated with increased academic performance.

In fact, there has been evidence of upcoming research studies suggesting that the lack of physical exercise or inactivity may in the near future overtake the detrimental effects tobacco is known to have on human beings (Grissom, 2005, p. 1).

Some sections of the media have also identified that survivors of cancer have a higher likelihood of preventing the occurrence of the disease if they regularly exercise and observe a healthy diet.

These findings are likely to develop a new relationship between the learning environment and student cognitive development, but more questions still linger on whether the relationship between physical exercises and academic achievement can be linked to academic performance when standardized tests are applicable (Kirk, 2006, p. 203).

This point of view is shared by Grissom (2005) who notes that “Few studies have used standardized fitness measures and standardized test scores in large urban populations or examined the relationship of academic achievement and fitness among elementary and middle school students” (p. 3).

However, the same level of optimism about physical exercising in the media and health circles is not evidenced in the educational field as it is in other disciplines as well.

In fact, in educational circles, physical education is seen as an extracurricular activity and if there is increased pressure on teachers to improve academic results, often, physical education is the first to be cut-back so that more time is created for other academic activities.

Many researchers are against this sort of trend because they explain that if physical education exposes a positive correlation with academic excellence, then it would no longer be perceived as an extracurricular activity (Grissom, 2005, p. 1).

This study primarily relies on this point of view because apart from the obvious health benefits associated with physical education, there is still a direct link it has to academic excellence.

There has been very minimal research done to establish the relationship between physical fitness and academic achievement and those that exist have significant methodology problems that eventually result in the occurrence of significant doubts about their findings.

Those that have had a conclusive finding have, however, suffered the problem of obtaining credible data to support their arguments and therefore, their conclusions are not as strong as they should be.

Nonetheless, one of the main factors why many researchers have hit a dead-end in establishing the relationship between physical fitness and academic achievement is because of the fact that it is difficult to obtain valid and reliable measures for both physical fitness and academic excellence. Because of this challenge, this study will make use of the state testing criteria for both variables (academic achievement and physical fitness).

From the understanding of the relationship between academic excellence and physical exercise, educationists can, therefore, be directed on the best channels to direct their resources. Considering the importance of this study in the establishment of positive academic outcomes in schools, this study establishes that there is a positive correlation between physical exercising and academic achievement.

Understanding the relationship between physical fitness and academic achievement is very important for educationists and parents alike because it ensures they are aware of the dynamics that relate to the two variables and how it may affect students and children respectively.

Teachers and educationists may find the information quite useful in drawing up an effective program that basically integrates both variables for optimum results (Science Daily, 2010, p. 4). In other words, they can be able to quickly strike a balance between physical and academic activities for optimum results.

This also entails facilitating the development of the right program mixes and policy balances which are overly sensitive to the upheaval of education standards.

Also considering most educators are normally under immense pressure to improve academic performance in light of scarce educational resources, this study’s findings are likely to point such people in the right direction by identifying possible areas of effective resource allocation that will consequently lead to the proper utilization of academic resources (Science Daily, 2010, p. 4).

Time is one such resource and many schools are often faced with the dilemma of allocating time to the most productive functional areas of education.

From the understanding of the contribution physical education brings to academic performance, time can, therefore, be allocated to physical education if it is established that it has a significant contribution to academic performance, or on the contrary, time can be cut back if it is established that it does not have a significant contribution to academic performance.

Since most educators have often been criticized for not providing holistic education and only focused on academic performance, the findings of this study will be useful to educators and policymakers in establishing the extent through which physical education will affect academic performance because physical fitness is an element of learning that encompasses a holistic education demanded by most people (Science Daily, 2010, p. 4).

Moreover, its impact on academic performance will be accurately quantified because academic performance is normally perceived to be the pinnacle of education and most learning institutions would not compromise it if they do not have a correct assessment of the impact physical education has on it (academic success).

Moreover, in today’s current era of increased competition, many learning institutions have been observed to cut back on the time allocated to physical education in order to have a competitive advantage over others institutions and so the information derived from this study will be useful to learning institutions which do not intend to take this strategy while still uphold good academic performance (Science Daily, 2010, p. 4).

The concern about children health has been a new issue of concern not only in educational circles but also in social circles. More so, there have been increased concerns about the increased rate of obesity among children and new research studies presented at the American’s Heart Association forum suggest that physical health concerns among students is correlated to the level of academic achievement (Cottrell, 2010).

There have been closely related research studies done by Cottrell, an educational researcher at Wood County in America who was trying to establish the relationship between body mass index and academic performance.

He suggested that students who had better grades (above average) in Mathematics, science and social studies were in an overall good physical state of fitness while those who were not in functional physical fitness (in a period of two years) performed poorly in academics for the two years studied (Chomitz, 2009, p. 30).

In affirmation of his findings, he explained that “The take-home message from this study is that we want our kids to be fit as long as possible and it will show in their academic performance” (Cottrell, 2010, p. 31). He further reiterated that “But if we can intervene on those children who are not necessarily fit and get them to fit levels physically, we may also see their academic performance increase” (Cottrell, 2010, p. 32).

In complementing these findings, auxiliary studies (still done by Cottrell) suggested that students who regularly took part in physical exercises were bound to have very vibrant adulthood (Cottrell, 2010).

In response to these findings, it was established by the American heart association that students should do at least an hour of physical exercising a day so that they are in a fit position to enhance their youth and improve their academic performance altogether (Science Daily, 2010).

In summing their findings, Medical News (2011) concluded that “The study suggests that focusing more on physical fitness and physical education in school would result in healthier, happier and smarter children” (p. 11). However, studies done by Grissom (2005) expose an interesting underlying premise behind this positive correlation.

In detail, he exposes the fact that the positive correlation between physical fitness and academic success is strongest among female students than males (Grissom, 2005). In the same manner, he observes that the positive correlation between physical fitness and academic achievement is also more evident among higher socioeconomic status than lower strata.

Grissom was also involved in another co relational research study presented in the year 2005 and aimed at investigating the relationship between academic achievement and physical fitness.

The research study affirmed that there was a strong relationship between physical fitness and academic achievement (California Department of Education, 2005, p. 1). This conclusion sought to validate previous research findings which also established the positive correlation between physical fitness and academic achievement.

The study was done with the knowledge that, previous studies established a positive relationship between academic achievement and physical fitness, but it was nevertheless done because previous research evidence acknowledged a missing causal relationship between the two variables.

To support the research’s findings, data relating to a previous physical fitness test undertaken in the state of California during the year 2004 were used. The data used was obtained from the Fitnessgram test, which is the standard California test used to evaluate students’ fitness levels.

The test was administered from February to May of the year 2004 and it was administered to a large sample size of students sought from fifth, seventh and ninth grades. The students were sought from selected public schools in the state of California. With regards to the subject areas studied and the administration time-frame, California Department of Education (2005) explains that,

“The CST scores were measures of academic achievement in English–language arts, mathematics, history-social science, and science. The CSTs were administered in spring 2004 to students in the second grade through the eleventh grade in California public schools” (p. 6).

Before the test was undertaken, the demographical information of the respondents was collected according to the requirements of two testing programs used in the study (PFT and CST). The demographic data was used to create matching files to be equated to the various testing criteria of the PFT and CST.

The files which posed a matching score had to have data relating to a respondent’s fitnessgram test and the CST test. In this regard, it was easier to compare data relating to PFT and CST.

However, the PFT score determined six aspects of a respondent’s fitness including “the aerobic capacity, body composition, abdominal strength, trunk strength, upper body strength and flexibility” (California Department of Education, 2005, p. 7).

These parameters abound, the performance of the respondents was determined in two levels, “(1) in the healthy fitness zone, which means students met or exceeded the fitness target, or (2) needs improvement, which means students failed to meet the fitness target” (California Department of Education, 2005, p. 10).

The PFT scores, therefore, ranged from zero to six, meaning that, if a respondent scored one on the fitness score, he or she would only have satisfied one of the fitness criteria. In the same regard, if a respondent scored six on the fitness score, he or she should have satisfied all the fitness criteria guidelines. In finalizing the methodological application of the research, California Department of Education (2005) establishes that:

“Analyses first calculated the mean scale scores for the CST in English–language arts and the CST in mathematics for each overall PFT score. Second, analysis of variance (ANOVA) and linear regression was used to test the statistical significance of the relationship between the overall PFT and achievement scores” (p. 10).

From the above methodology, it was established that, when the PFT scores improved, there was a resultant improvement in the scores of English language test.

It was further established that, for students who did not meet the average scale score of the English language, a score of 311 was recorded on the fitness scale (for fifth graders), while students from the seventh and ninth graders who also satisfied the above requirements scored and average of 300 and 304 ( for seventh and ninth graders respectively). Moreover, the California Department of Education (2005) establishes that:

“The average scale score on the CST in English–language arts for fifth-grade students who achieved all six fitness standards was 355. The same scale score for seventh and ninth graders was 350 and 352, respectively. The change in average scale scores on the CST in English–language arts from those who achieved none of the fitness standards to those who achieved all six was around 50 points” (p. 12).

These test results showed that there was a positive relationship between physical fitness and academic achievement because as one variable increased, so did the other. The mathematics scale scores showed nothing different with the English studies because as the PFT studies improved, the CST scale scores improved as well.

This result shows that, there was a strong consistency in the results evidenced from mathematics and English test scores. However, in determining this outcome, it is essential to acknowledge that the analysis of variance and linear regression was important in establishing the statistical validity of the findings.

In undertaking the research study, there was concern among the researchers to investigate if there were any significant variations in the character of the respondents (which would ultimately affect the relationship between physical fitness and academic achievement) (California Department of Education, 2005, p. 16).

In this regard, the population sample was later broken down into subgroups of girls and boys. It was later established that, there was a consistency of outcome in determining the relationship between physical fitness and academic achievement because the relationship between fitness and academic achievement was consistent across the genders.

However, though this relationship was considered solid up to this point, it was evidenced that, the change in achievement scores was greater for girls than for boys.

Socioeconomic status was also used as a parameter for establishing the relationship between physical fitness and academic achievement and the National school lunch program acted as a proxy for the parameter. Through this proxy, it was established that students who received free lunch came from a lower socioeconomic status and those who did not, came from a higher socioeconomic status.

The same positive relationship between physical fitness and academic achievement was still observed under this parameter, but it was established that the rate of scores in academic achievement was higher for students who were under the National school lunch program as compared to those who were not (California Department of Education, 2005, p. 14).

The outcome of the study was predictably similar for mathematics and English test scores and in the same manner, the results of seventh and fifth-graders were consistent with the results of the fifth graders.

Collectively, the results showed that the positive relationship between physical fitness and academic achievement was stronger for girls than for boys and in the same manner, it was stronger for students from a higher socioeconomic status than for students from a lower socioeconomic status.

The biggest strength for the conclusions derived from this study emanates from the fact that, the researchers used the analysis of variance and linear regression as a test of the statistical difference of the conclusions derived.

Both linear regression and the analysis of variance helped validate the data derived from the findings because linear regression in isolation implements a statistical model that when relationships between independent and dependent relationships almost develop a linear relationship, optimal results will be achieved, but in the same manner, linear relationships can be inappropriately used to model nonlinear relationships if caution is not taken.

Grissom was also involved in another co relational research study (cited in Grissom, 2005) aimed at investigating the relationship between academic achievement and physical fitness.

The objective of this research study was the same as the previous research study cited in this article because it was aimed at evaluating the relationship between physical fitness and academic achievement, although different parameters were used.

For instance, although the study used the Fitnessgram test, scores derived from this measure was compared to the standard achievement test which is an independent from of standardized test used to evaluate student performance.

The respondents were also fifth, seventh and ninth graders, just like the previous study, but they amounted to 884,174 students, which was a large sample size for the study. The students were selected from California public schools through the state requirements for the Fitnessgram test.

The large population sampled is a great strength of the study because it is affirmed that, large samples of study add to the credibility of the conclusion to be derived from a study because they expose a lot of variations in the conclusions derived.

Moreover, there are fewer chances of error occurrence when large samples are used. Another strength evidenced from this study is the fact that, it relied on the Fitnessgram test, which is guaranteed by the California law as credible and accurate. In fact, Grissom (2005) explains that:

“…During the month of February, March, April, or May, the governing board of each School district maintaining any of grades five, seven and nine shall administer to each pupil in those grades the physical performance test designated by the state board of education” (p. 19).

These regulations expose the fact that, the Fitnessgram scores were consistent and standardized. Moreover, the Fitnessgram test has several options which ensure that performance tasks are effectively completed with ease. For example, it offered unique features to ensure even disabled students are able to complete the task; the same way, other students do.

This feature ensured that, the conclusion derived from the study was holistic. In this study, the Fitnessgram test was used to measure five fitness aspects: “aerobic capacity, body composition, flexibility, trunk strength, and upper body strength” (Grissom, 2005, p. 19).

In obtaining accurate data for the above parameters, the Fitnessgram test was designed to collect data by requiring students to complete “one option from aerobic capacity, one option from body composition, the curl-up test, the trunk lift test, one option from upper body strength and one option from flexibility” (Grissom, 2005, p. 19).

To add to the strengths of the findings obtained from this research study, it is essential to acknowledge that, the standards envisioned in the Fitnessgram test were validated by the Cooper institute of Aerobics research with the performance classified into two divisions: where students met the healthy division target and where the students failed to meet the fitness target (Grissom, 2005, p. 20).

The score ranged from zero to six; whereby zero meant no target was reached and six meant all targets were attained. In collecting data regarding the Fitnessgram test, PFT and STAR programs were used. As a result, matched files were created; whereby data regarding the matched files were used to account for the PFT scores and standardized achievement scores.

The standardized test came in handy during the collection of demographical information regarding the respondents because information such as the birth date and gender were clearly documented. However, in the collection of such demographical data, there was a slight possibility of the occurrence of errors as is explained by Grissom (2005) that:

“As such, these data were used to evaluate the relationship between overall scores on the PFT and the standardized achievement tests. There could be errors in the matching process, but there was no reason to believe matching errors biased the results” (p. 20).

The study also established that, the relationship between physical fitness and academic achievement was consistently positive; meaning that, as the scores in the fitness scale improved, the scores in the academic scale also improved.

The researchers also did a subgroup study on the different demographical parameters of the sample population and consequently came up with socioeconomic status and gender as the defining parameters.

The criteria to segregate the population along socioeconomic lines was the same as the previous 2005 study mentioned in this article because it was established that, students who enrolled in the school lunch feeding program was from a lower socioeconomic status and those who did not, were from a higher socioeconomic status.

In this regard, the study established that, the intensity of the relationship between academic achievement and physical fitness was stronger for female respondents than male respondents and therefore, in the same manner; the relationship was stronger in higher socioeconomic groups as opposed to lower socioeconomic groups. Nonetheless, the researchers identified that:

“there may be other mental aspects attributed to the improvement in academic performance than just physical fitness. The average test score by way of PFT was an average of the indicator relationship between fitness and achievement but to validate the statistical significance of the findings, the analysis of variance was used to validate the relationship between overall PFT score and the achievement scores” (Grissom, 2005, p. 21).

Only students who had complete sores on the PFT tests had their results tabulated because there would have been some inconsistencies observed in the conclusions if there were test results below six included in the findings.

If this was done, it would mean that, there would be incomplete test scores included in the study and this would have dented the validity of the study because the minimal competency for the study would not have been attained.

ANOVA tests affirmed that there was a statistically significant relationship between physical fitness and academic achievement. However, it was acknowledged that, this positive correlation was also subject to other variables not mentioned in the study.

For example, it was established that the positive correlation between physical fitness and academic achievement in students from higher socioeconomic groups could have been brought about by the fact that, children from a higher socioeconomic status have better health, hail from a background of higher academic achievement and generally live in better human conditions which probably contribute to their better physical fitness levels (Grissom, 2005).

On the other hand, students who hail from a lower socioeconomic status are more likely to suffer family turmoil, and their households are bound to be more unstable when compared to students hailing from a higher socioeconomic status.

Such students are also likely to live in deplorable conditions which ultimately affect their health and have less social supportive networks. Generally, they are also likely to have less cognitive enriching environments because of a collection of the above factors or a combination of two or more factors (Grissom, 2005, p. 22).

In the same regard, it was established that, despite the positive correlation between physical fitness and academic achievement, causality cannot be established from this relationship. Grissom (2005) explains that:

“There was no time or logical ordering that automatically leads from one event to the other. It is just as logical to believe that mental capacity affects physical ability. For example, there is evidence that mental stress can lower the effectiveness of the immune system” (p. 21).

From this analysis, it was affirmed that, the study only represented a preliminary analysis into the relationship existing between academic achievement and physical fitness, but it was also affirmed that the study’s findings presented an excellent ground for the development of future models and theories defining the relationship between academic achievement and physical fitness.

Experimental designs were also identified to fail to expose the causality underlying various co relational relationships because they were assumed to be premature and bound to fail to expose the underlying factors affecting the relationship between physical fitness and academic achievement.

This fact was supported by the assumption that, it was extremely difficult to increase academic achievement in subsequent time-frames (Grissom, 2005). Nonetheless, these insights were not an argument against experimental designs because conclusively, the study established that, there was a positive relationship between academic achievement and physical fitness.

Other research studies done to dig deeper into the specific areas of academic achievement showed that academic achievement was noted to improve most in mathematics and science subjects. In the same studies, it was established that there was no significant improvement in performance of subjects other than the two.

For instance, in Canada, it was established that an increase of physical exercises of one hour each day resulted in a significant improvement in mathematics scores for second, third, fourth, fifths and sixth graders (Chomitz, 2009, p. 35).

It was also established that there was no significant changes of academic performance in other subject areas. However, for some reason, the studies caution users from making direct conclusions about the positive correlation between physical exercising and mathematics.

New York City’s health department has also reiterated the fact that physically fit students are bound to outperform their colleagues who are sedentary when it comes to academic performance.

These findings had been derived from research studies evaluating the relationship among high school students using the state’s test measurement criterion – the NYC Fitnessgram (Harutyunyan, 2009, p. 1). The study was necessitated by the rising obesity levels among children in New York.

The statistics exposed that about 21% of students at kindergarten level (all through to the 8 th grade) were obese and comprehensively, it was estimated that the city’s total student population had an obesity prevalence rate of approximately 18% (Harutyunyan, 2009, p. 1).

It was estimated that children who highly performed on both variables in the NYC fitness score tremendously outperformed those who got a poor score in the fitness program scale. The difference was characterized by 36 percentile points (Harutyunyan, 2009, p. 1).

After it was established that there was a positive correlation between physical activities and academic excellence, the city’s educational administrators decided to sensitize parents on the benefits of eating healthy foods and allocating at least 60 minutes a day of their children’s time to exercising.

A number of activities were identified as appropriate exercises parents could encourage their children to engage in (they included, cycling, dancing skipping the rope, playing basketball, or even taking a simple walk). Among these factors, a host of other recommendations were identified to be helpful in improving the students’ activity levels.

They included limiting the time students spent on the computers (and more so the internet). This also included television and video game use. The second recommendation advanced to parents was to prepare healthy foods for their children, such as vegetables and fruits, at least two times a day.

It was also recommended that the children should not drink beverages that have a lot of calories like sodas or juice; instead they should consume low-fat milk and water. Parents were also advised to encourage their children to avoid unhealthy foods and consider the healthy foods and diets provided at school.

The above findings can be explained by Scheuer (2003, p. 3) who identifies the fact that physical exercises significantly boost students’ brain nourishment, and revitalizes the students’ brain function to eventually increase the student’s ability to perform well in cognitive learning exercises.

Complimentary findings have also established that physical exercising among students increases students’ self-esteem, concentration and encourages better behavior, thereby leading to an increased positive attitude among students who fall within this category (Bailey, 2000, p. 75).

However, there has not been a strong relationship established to link the above-mentioned factors with excellent academic performance, although it is presumed that students with high self-esteem, better behavior and high concentration levels are likely to perform better than those who do not share the same attributes.

However, it has been affirmed that physical exercising is bound to increase academic achievement more effectively in the short run rather than the long run. Interesting studies done on older adults note that physical activity is likely to increase cognitive function among this group of students, in the same way, it does younger students (Scheuer, 2003, p. 3).

This observation, therefore, explains the findings observed by Cottrell because it was further established that physical exercising was bound to increase brain attributes which facilitated increased cerebral blood flow in the brain (which obviously complimented cognitive learning) (Corbin, 2010, p. 64).

In addition, it was also established that increased physical exercising was bound to improve hormonal imbalance and therefore, instances of better nutritional intake among students were bound to be boosted.

This observation was seconded by research studies cited in (Medical News, 2011) which suggested that “a trio of studies presented at the 2001 Society for Neuroscience Conference suggest that regular exercise can improve cognitive function and increase levels of substances in the brain responsible for maintaining the health of neurons” (p. 2).

These findings are also supported by other similar findings by Darla Castelli, an American professor in Illinois (cited in Medical News, 2011) who establishes that “students’ total fitness, as measured by passing all 5 components of the Fitnessgram, positively correlated with academic achievement, measured by the standardized Illinois State Achievement Test, particularly Mathematics and Science” (p. 5).

Brain functions were further identified to improve significantly due to increased physical exercises because there were increased instances of energy generation brought about by physical exercises because physical exercises provided a break from the boring classroom environment, therefore resulting in higher attention levels among students. In conclusion to these findings, Medical News (2011) recommends that:

“Enhanced brain function, energy levels, body builds/perceptions, self-esteem, and behavior have been attributed to physical activity and to improved academic performance.

One cannot make direct correlations from the information offered. However, it is obvious that many positive relationships have been suggested. Perhaps instead of decreasing physical activity, school officials should consider developing enhanced physical activity programs” (p. 3).

Studies were done by John Gardner center (cited in Gardner, 2009, p. 1) also show a positive correlation between physical fitness and academic performance based on demographical factors. Comprehensively, they identify that students who managed to pass the California Physical fitness test also showed similar higher performance in the state’s standardized test (Rahl, 2010, p. 81).

It was further established that the positive relationship exhibited between physical exercising and positive academic outcomes did not start at the time the studies were done, but at a year before the studies were undertaken. Moreover, upon close follow-up of the research, it was established that the same observations were evidenced throughout the academic life of the studied students (Gardner, 2009, p. 1).

Since the study was undertaken within two years, it was affirmed that students who showed increased physical activity between their fifth and seventh grades showed a significant increase in academic achievement as well, but the opposite was observed with students whose physical fitness declined within the two years.

However, it was established that the academic achievement observed among highly fit students was only evident when general fitness was studied and not a specific fitness measure (Gardner, 2009, p. 1).

Regardless of the conclusions derived from the above findings, it should not be assumed that physical fitness is the magical solution to students who do not enjoy the high academic performance (Biddle, 2008, p. 186). For instance, students who take part in educational programs hampered by limited facilities cannot enjoy high academic excellence even if they are physically fit.

To reiterate this sentiment, Biddle (2008) notes that “We’re not suggesting that if we run more laps, it will make us smarter…but there does appear to be a correlation” (p. 4). This fact, therefore, implies that academic achievement is just one segment of the academic achievement puzzle.

Because of the interesting intrigues about physical fitness and academic achievement, it is affirmed that a number of strategies can be adopted to improve students’ fitness even though a learning institution may be faced with other educational problems such as a lack of resources.

For starters, learning institutions should endeavor to maximize existing opportunities in the school curriculum to improve the physical fitness of the students. This can be achieved by making use of the instructional time available for teachers in effecting physical education through the integration of physical fitness activities with other subject activities (Gardner, 2009, p. 1).

This recommendation has been touted by many educationists after it was established that students find the above strategy quite beneficial if the instructional time is used to undertake a given rigorous activity. Another alternative could be revamping the conventional school menu to give room for healthier diets (especially if there is very limited time to allocate for traditional physical exercising).

Expanding partnerships between communities and learning institutions has also been advanced as one way through which institutions of learning can provide fitness related programming which is out of the boundaries of normal instructional time (Gardner, 2009, p. 1).

The partnerships can be forged with community foundations, organization and even the state, through existing sport programs that may be beneficial to the students. Lastly, learning institutions can pursue a strategy of engaging the community to increase physical activity among the students.

The community also includes parental involvement which is very important in the exercise because parents normally wield a lot of control on their children and most of them are also mentors to their children in their own light.

This study contributes to the growing body of knowledge, which identifies that there is a positive correlation between physical fitness and academic achievement.

It is also important to note that most of the empirical evidence gathered in this study is derived from a number of socioeconomic parameters across the globe, meaning that the same conclusions have been evidenced in a number of places around the world and across a number of demographical strata.

There is a stronger evidence of a positive relationship between physical fitness and academic achievement when analyzed in a number of subjects but more especially mathematics and sciences. The reason this observation is stronger in this group of subjects is not yet established and perhaps this should be the new frontier for future research studies.

Although not many studies bother to touch on the real factors behind the positive relationship between physical exercising and academic performance, there is already speculation among educational circles that personal motivation may be a factor to watch considering physical exercising may actually portray a sense of personal achievement which may be mirrored through academic achievement (Chomitz, 2009, p. 35).

This means that students who are highly motivated at a personal level may as well strive to expose the same in physical exercising as well as academic excellence.

Secondly, there has been speculation that physical activity may actually be a mirror of overall fitness of health where factors like nutrition, physical and weight status may actually portray a healthy student and such parameters are likely to lead to high academic achievement.

This would essentially mean that academic achievement is probably evidenced because of overall good health as opposed to physical activity per se. In fact, there are already existing research studies exposing the link between good health and high academic achievement where factors like weight status, food sufficiency and such as general health status have been studied.

This should be analyzed as its own distinct area of study and therefore, its conclusions should not be augmented when analyzing physical fitness as a distinct, independent variable.

However, it should also be acknowledged that various socioeconomic parameters play a significant role in the increase of academic standards. This analysis is essential because numerous studies have consistently mentioned the input of a student’s background because it extensively determines students’ academic performance.

This also poses as a new area of research considering the relationship between physical fitness and academic performance could be done based on various socioeconomic statuses.

Conclusively, this study points out that there is a positive correlation between physical exercising and academic achievement. Expressly, it also identifies how learning institutions can be able to maximize this benefit through partnerships, effective utilization of institutional time and such like factors.

Allocating at least an hour a day to physical exercises is a commendable move according to medical experts because it improves brain activity and this consequently leads to an improvement of academic standards.

Thus, in light of the positive influences physical activities have on academic progression it is in order to recommend that learning institutions should allocate more time to physical activities to improve educational performance because there is an obvious positive correlation between physical exercising and academic achievement.

Bailey, R. (2000). Teaching Physical Education 5-11 . New York: Continuum International Publishing Group.

Biddle, S. (2008). Psychology of Physical Activity: Determinants, Well-Being, and Interventions. London: Routledge.

California Department of Education. (2005) A Study of the Relationship Between Physical Fitness and Academic Achievement in California Using 2004 Test Results. Web.

Chomitz, V. (2009). Is There a Relationship between Physical Fitness And Academic Achievement? Positive Results from Public School Children in the Northeastern United States. Journal of School Health , 79(1), 30-36.

Corbin, C. (2010). Fitness for Life: Elementary School Guide for Wellness Coordinators . New York: Human Kinetics.

Cottrell. (2010). Students’ Physical Fitness Associated With Academic Achievement ; Organized Physical Activity . Web.

Gardner, J. (2009). Exploring the Link between Physical Fitness and Academic Achievement . Web.

Grissom, J. (2005). Physical Fitness and Academic Achievement. Journal of Exercise Physiology , 8(1), 11-24.

Harutyunyan, R. (2009). Physical Fitness Associated With Higher Academic Achievement . Web.

Kirk, D. (2006). The Handbook of Physical Education . London: SAGE. Medical News. (2011). Strong Relationship between Kids Academic Achievement And Fitness . Web.

Rahl, R. (2010). Physical Activity and Health Guidelines: Recommendations for Various Ages, Fitness Levels, and Conditions from 57 Authoritative Sources . New York: Human Kinetics.

Scheuer, L. J. (2003). Does Physical Activity Influence Academic Performance? Web.

Science Daily. (2010). Students’ Physical Fitness Associated With Academic Achievement; Organized Physical Activity . Web.

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Home > USC Columbia > Public Health, Arnold School of > SPH_EXERCISE_SCIENCE > Exercise Science Theses and Dissertations

Exercise Science Theses and Dissertations

Theses/dissertations from 2024 2024.

Nutrition and Mental Health Related Factors Across Historically Black College and University Students , Nancy Anai Uriegas

Theses/Dissertations from 2023 2023

Leveraging Church Environments to Promote Rural Physical Activity and Healthy Eating , Kelsey Rothera Day

The Role of Environmental Context in Supporting Children’s 24- Hour Movement Behaviors; A Positive Deviance Perspective , Roddrick Dugger

Effects of Caffeine on Measures of Clinical Outcome and Recovery Following Mild Traumatic Brain Injury in Adolescents , Jacob Michael Eade

Sleep, Physical Activity, and Sedentary Time in the First Year Postpartum , Erin Elizabeth Kishman

Mechanisms of Social Stress Susceptibility and Resilience in Female Rats , Brittany Sara Pate

Predictors of Driving Performance Post-Stroke , Halle Elise Prine

A Randomized, Placebo Controlled, Double-Blind, Crossover Study to Evaluate the Effects of Two Novel Hydration Beverage Formulas on Rehydration in Healthy Adults , Nathaniel David Rhoades

Effect of Action Selection Demands on the Execution of Goal-Directed Reaches , James Garrison Riedy

An Examination of Inter-Limb Functional Asymmetry After a Fatiguing Bout of Exercise in High Level Soccer Players , Nestor Urrea

Causes and Consequences of the Risk of Generalizability Biases in Health Behavioral Interventions , Lauren von Klinggraeff

Exercise and Mental Health Over the Course of a Semester , Jamie Alexis Whitney

Theses/Dissertations from 2022 2022

Molecular Architecture of Cardiometabolic Responses to Regular Exercise , Jacob L. Barber

Relationships Among Sleep, Physical Activity, and Weight Status in Children and Adolescents , Agnes Bucko

Self Reported Cardiovascular Health and Health Behaviors in Women Veterans , Seth Byland

Sports Nutrition- and Strength and Conditioning-based Interventions to Bolster Health and Human Performance in Male and Female Tactical Personnel , Harry Paul Cintineo

Psychophysiological Biomarkers of Concussion Recovery , Adam Todd Harrison

The Effects of Exercise Training on Cholesterol Efflux Capacity in the HERITAGE Family Study , Joshua Adam Hawkins

Physical Activity and Stress Between American Students and Asian International Students at the University of South Carolina , Hao Lei

Effects of Positive Social Comparative Feedback During Practice on Motor Sequence Learning, Performance Expectancies, and Resting State Connectivity , Allison Foster Lewis

Using a Multi-Direction Reaching Approach to Investigate Fitts’ Law and the Effect of Attentional Focus on Motor Learning , Charles R. Smith

Impact of a Novel Marine Algae Supplement on Inflammatory and Immune Response After High-Intensity Exercise , Caroline Sara Vincenty

Theses/Dissertations from 2021 2021

Clinical Determinants of VO 2 max Response to Endurance Training: HERITAGE Family Study , Emanuel Ayala

The Influence of ADHD on Concussion in NCAA College Athletes , Brett Steven Gunn

The Relationship of Structured Environments With Children’s Body Composition and Obesogenic Behaviors , Ethan T. Hunt

Racial Disparities in Gestational Weight Gain, Body Mass Index, And Physical Activity During Pregnancy and After Delivery , Marcey Acacia Jiles

Strengthening the Evidence-Base of Youth Nutrition Programs: A Three Part Approach , Rebecca Kyryliuk

Multiple Processes Predict Motor Learning and Impairments After a Stroke , Christopher Michael Perry

Physical Activity and Sedentary Behavior During and After Pregnancy and Postpartum Weight Retention , Kaitlyn Taylor Ramey

The Influence of Sport Participation on Physical Activity in Youth , Emily R. Shull

Examination of Energy Needs and Female Athlete Triad Components in Competitive Cheerleaders , Allison Smith

Performance of the Wrist-worn Actigraph GT3X + in Measuring Physical Activity in Older Women , Michal Talley Smith

Effects of Basketball Exercise Simulation Test (BEST) On Landing Mechanics in Active Females , Madison Treece

Theses/Dissertations from 2020 2020

The Association of Exercise Training Modalities with Circulating Branched Chain Amino Acid and Ketone Body levels in Patients with Type 2 Diabetes , Ryan Andrew Flynn

Examination of Daily Steps in People With Parkinson’s Disease & Stroke: Two Steps Forward , Reed Handlery

Examination of Emergency Medical Services Activations for Sport- Related Injuries , Rebecca Marie Hirschhorn

Sex-Based Differences in Concussion Outcomes Among Adolescents and Young Adults , Jacob James Michael Kay

Piloting a Smartphone-Based Sedentary Behavior Reduction Intervention for Adults With Overweight or Obesity: Take a STAND 4 Health , Chelsea Larsen

Integrating Survivors of Stroke Into Cardiac Rehabilitation , Elizabeth Wherley Regan

Lipoprotein Discordance: Associations With Diabetes, Metabolic Syndrome, and Response to Exercise , Jonathan Joseph Pulama Kupaianaha Ruiz-Ramie

Characterizing Patterns of Adherence to Physical Activity Goals in Behavioral Weight Control , Melissa Lee Stansbury

Mental Health Prevalence and Biofeedback Intervention for Student- Athletes , Samantha Rose Weber

Theses/Dissertations from 2019 2019

Leveraging For-Cause Physical Activity Events for Physical Activity Promotion: An Investigation Using Self-Determination Theory , John A. Bernhart

Effect of TRB3 on Skeletal Muscle Mass Regulation and Exercise-Induced Adaptation , Ran Hee Choi

The Role of AMPK in the Regulation of Skeletal Muscle Proteostasis During Cancer Cachexia , Dennis K. Fix

Identification of Factors Contributing to Musculoskeletal Injuries in Military Basic Trainees , Amy Fraley Hand

Effects of Spinal Manipulation on Brain Activation in Individuals with Chronic Low Back Pain , Max K. Jordon

The Effect of Patient Financial Liability on Physical Therapy Utilization and Patient Reported Outcomes for Patients With Low Back Pain: An Instrumental Variable Analysis , Adam D. Lutz

Physical Activity of Preschoolers with Developmental Disabilities and Delays , Michaela A. Schenkelberg

Reproducibility and The Effects of Exercise on The Endurance Index , Michael Dean Smith, JR.

Differential Cholinergic Modulation of Prelimbic and Thalamic Input to the Basolateral Amygdala , Sarah Catherine Tryon

Theses/Dissertations from 2018 2018

The Effects of Exercise Training on Cardiovascular-related Circulating MicroRNAs , Jacob Luther Barber

Neighborhood Socioeconomic Environment and Its Influence on Cardiorespiratory Fitness and Physical Activity in Youth , Morgan N. Clennin

Calibration of an Accelerometer for Measurement of Very Light Intensity Physical Activity in Children , Joseph S. Gorab

The Effects Of Exercise Mode And Intensity On Energy Expenditure During And After Exercise In Resistance Trained Males , George Lewis Grieve

Enhancing Dancing: Examining The Potency Of A Combined Action Observation And Brain Stimulation Intervention , Melissa B. Kolar

The Effects Of Modifiable Lifestyle Behaviors On Lipoprotein Particle Concentration And Size , Ryan R. Porter

Cortical Damage and Disconnection Contribute to Post-Stroke Sensorimotor Impairment , Shafagh Yazdani

Theses/Dissertations from 2017 2017

Patterns Of Participation And Performance In Youth Baseball Players , Amanda Arnold

The Effect of Energy-Matched Exercise Intensity on Brain-Derived Neurotrophic Factor and Motor Learning , Jessica F. Baird

The Role of Exercise Dose on Ghrelin Concentration in Postmenopausal Women , Kimberly Bowyer

Children’s Obesogenic Behaviors During Summer Versus School , Keith Brazendale

The Effects of a Game Simulation on Muscle Activation and Knee Kinematics in Females , Geoffrey Collins

The Regulation of Glycoprotein130 Dependent Inflammatory Cytokines one Basal and Mechanical Stimuli Induced Protein Synthesis in Myotubes and Skeletal Muscles , Song Gao

Muscle Inflammatory Signaling Regulates Eccentric Contraction-Induced Protein Synthesis during Cancer Cachexia , Justin Perry Hardee

The Addition Of A Concurrent Bimanual Task Influences Postural Sway And Walking Speed Performance And Prioritization Across All Ages , Derek Matthew Liuzzo

Maternal Physical Activity and Cardiorespiratory Fitness During Pregnancy and its Relation to Infant Size , Samantha M. McDonald

Identifying Associations between Religious Commitment and Preventive Health Behaviors in a Southeastern Rural County , Nathan A. Peters

The Association Of Changes In Cardiorespiratory Fitness With Changes In Cardiometabolic Risk Factors , Leanna Marie Ross

The Nutrition Assistance Landscape in Afterschool Programs: Understanding the Gap between Research, Policy, and Practice , Falon Elizabet Tilley

Theses/Dissertations from 2016 2016

The Effects Of Exercise On Sleep Parameters Among Older Women , Charity B. Breneman

Exploring Children’s Physical Activity Levels Through Structure and Measurement , Jessica L. Chandler

Comparison of the Effects of Energy Flux on Metabolic Conditions and Satiety in Young Adults , Molly Madison DeMello

Role Of Altered Gut Microbiota In Tumor Development, Mucus Production And Inflammation In APC MIN/+ Mouse Model , Kamaljeet Kaur

Exploratory Analysis Of PTSD Severity And Objective Measures Of Physical Activity Among Combat Veterans , Danny O. Sauceda

Theses/Dissertations from 2015 2015

Healthy Eating and Physical Activity Environmental and Policy Assessment – Measurement Issues and Implications , Rahma Jamea Yousef Ajja

Metabotropic Receptor Modulation of Kainate Receptors in the Hippocampus , C'iana Patrice Cooper

The Recovery of Gut Barrier Function With Selenium Rich Diet in Acute DSS-Induced Colitis , Sarah Depaepe

The Role of Ovarian Function in the Progression of Cachexia in the APC MIN/+ Mouse , Kimbell Louise Hetzler

Factors Influencing Level of Implementation of Physical Activity Interventions in Youth-Serving Organizations , Yuen Yan Lau

Correlations Between White Matter Integrity, Structural Connectivity, And Upper and Lower Extremity Motor Function in Individuals With Chronic Stroke , Denise M. Peters

Cardiorespiratory Fitness, Body Fatness Effect on Submaximal Systolic Blood Pressure and Cardiovascular Prognosis among Young Adults , Vivek Kumar Prasad

Adiponectin and Selenium Rich Diet can act as a Complimentary Medicine in the Treatment of Intestinal and Chronic Inflammation Induced Colon Cancer , Arpit Saxena

Novel Drug 2-benzoyl-3-phenyl 6,7-dichloroquinoxaline 1,4-dioxide Induces Colon Cancer Cell Apoptosis Through HIF-1α Pathway , Alexander-Jacques Theodore Sougiannis

Patterns of Sedentary Behavior and Association with Health Risks Among African American Adults , Tatiana Y. Warren-Jones

Patient and Provider Perceptions of Weight Gain, Physical Activity, and Nutrition in Pregnancy , Kara M. Whitaker

Theses/Dissertations from 2014 2014

The Effects of Exercise Training on Cognitive Reserve and Cognitive Function in Healthy Older Women , Katie Marie Becofsky

The Effects of Arthritis Foundation’s “Walk With Ease” Program on Cognitive Function , Ryan S. Falck

Weight-Gain and Energy Balance , Benjamin Thomas Gordon

ROLE OF CHRONIC INFLAMMATION ON LIVER FUNCTION DURING CACHEXIA PROGRESSION IN THE APC MIN/+ MOUSE MODEL , Aditi Narsale

Longitudinal Evaluations of Objectively Measured Physical Activity: Capturing the Full Spectrum of Duration and Intensity , Amanda E. Paluch

The Regulation of Skeletal Muscle Mass and Mitochondrial Biogenesis by gp130/STAT3 Signaling during Cancer Cachexia , Melissa Puppa

Theses/Dissertations from 2013 2013

The Mechanisms of Posterior Shoulder Tightness and Effectiveness of Manual Therapy , Lane Brooks Bailey

Optimal Cooperation In Joint Action Tasks , Scott Michael Blanchette

Measuring Organizational Member Involvement In Physical Activity Coalitions Across the United States , Daniel Benjamin Bornstein

Outsmarting the Brain: Augmenting Motor Training with Non-invasive Brain Stimulation in Order to Facilitate Plasticity-Dependent, Functional Improvement within the Motor Cortex , Raymond Joseph Butts

The Association of Physical Fitness With Psychological Health Outcomes In Soldiers During Army Basic Combat Training , Shannon K. Crowley

An Investigation into the Influence of Dietary Saturated Fat and Quercetin Supplementation on Adiposity, Macrophage Behavior, Inflammation, and Non-Alcoholic Fatty-Liver Disease , Reilly Enos

The Effect of Radiation on Myofiber Properties in Mouse Skeletal Muscle , Dennis K. Fix

Exploring the Role of Culture and Race In Stroke Rehabilitation Disparities , Jennifaye Verdina Greene

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Digital Commons @ USF > Theses and Dissertations

Physical Education and Exercise Science Theses and Dissertations

Theses/dissertations from 2021 2021.

Warming Up and Cooling Down: Perceptions and Behaviors Associated with Aerobic Exercise , Balea J. Schumacher

Theses/Dissertations from 2020 2020

An Examination of Changes in Muscle Thickness, Isometric Strength, and Body Water Throughout the Menstrual Cycle , Tayla E. Kuehne

Theses/Dissertations from 2019 2019

Psychological Responses to High-Intensity Interval Training Exercise: A Comparison of Ungraded Running and Graded Walking , Abby Fleming

Theses/Dissertations from 2018 2018

The Effects of Music Choice on Perceptual and Physiological Responses to Treadmill Exercise , Taylor A. Shimshock

Theses/Dissertations from 2016 2016

The Effect of Exercise Order on Body Fat Loss During Concurrent Training , Tonya Lee Davis-Miller

Anti-Fat Attitudes and Weight Bias Internalization: An Investigation of How BMI Impacts Perceptions, Opinions and Attitudes , Laurie Schrider

Theses/Dissertations from 2014 2014

The Effect of Music Cadence on Step Frequency in the Recreational Runner , Micaela A. Galosky

The Hypertrophic Effects of Practical Vascular Blood Flow Restriction Training , John Francis O'halloran

Theses/Dissertations from 2013 2013

The Effects of Exercise Modality on State Body Image , Elizabeth Anne Hubbard

Perceptual Responses to High-Intensity Interval Training in Overweight and Sedentary Individuals , Nicholas Martinez

Comparisons of acute neuromuscular fatigue and recovery after maximal effort strength training using powerlifts , Nicholas Todd Theilen

Theses/Dissertations from 2012 2012

The Impact of Continuous and Discontinuous Cycle Exercise on Affect: An Examination of the Dual-Mode Model , Sam Greeley

Systematic review of core muscle electromyographic activity during physical fitness exercises , Jason Martuscello

Theses/Dissertations from 2011 2011

The Effect of Unexpected Exercise Duration on Rating of Perceived Exertion in an Untrained, Sedentary Population , Lisa M. Giblin

The Effect of Various Carbohydrate Supplements on Postprandial Blood Glucose Response in Female Soccer Players , Nina Pannoni

Middle School Physical Education Programs: A Comparison of Moderate to Vigorous Physical Activity in Sports Game Play , Marcia Ann Patience

The Effects of Pre-Exercise Carbohydrate Supplementation on Resistance Training Performance During an Acute Resistance Training Session , Kelly Raposo

Theses/Dissertations from 2010 2010

Effects of Fat-Free and 2% Chocolate Milk on Strength and Body Composition Following Resistance Training , Ashley T. Forsyth

Relationship Between Muscular Strength Testing to Dynamic Muscular Performance in Division One American Football Players , Johnathan Fuentes

Effects of Ingesting Fat Free and Low Fat Chocolate Milk After Resistance Training on Exercise Performance , Breanna Myers

Theses/Dissertations from 2009 2009

Effects of a Commercially Available Energy Drink on Anaerobic Performance , Jason J. Downing

The Impact of Wearable Weights on the Cardiovascular and Metabolic Responses to Treadmill Walking , Kristine M. Fallon

Six Fifth Grade Students Experiences Participating in Active Gaming during Physical Eduction Classes , Lisa Witherspoon Hansen

The impact of wearable weights on perceptual responses to treadmill walking , Ashley T. Kuczynski

The Preference of Protein Powders Among Adult Males and Females: A Protein Powder Taste Study , Joshua Manter

Caloric Expenditure and Substrate Utilization in Underwater Treadmill Running Versus Land-Based Treadmill Running , Courtney Schaal

Theses/Dissertations from 2008 2008

A Survey of NCAA Division 1 Strength and Conditioning Coaches- Characteristics and Opinions , Jeremy Powers

Theses/Dissertations from 2007 2007

Perceptions of group exercise participants based on body type, appearance and attractiveness of the instructor , Jennifer Mears

Theses/Dissertations from 2006 2006

Be active! An examination of social support's role in individual vs. team competition in worksite health promotion , Lauren Kriz

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