Running head: THE EFFECTS OF EXERCISE ON COLLEGE

STUDENTS 1

Question: What are the positive effects of exercise on obese college students?

Lauren Makosky

Danielle McMinn

Jacalyn Patterson

Kyle Rocco

Youngstown State University

NURS 3749 Nursing Research

Mrs. Molly Roche

Summer 2016
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Introduction

The purpose of this research related project is to describe what a literature

review of research articles reviewed by BSN nursing students in an undergraduate

nursing research class revealed about the effects of obesity in college students. This

research group consisting of four students critically read 12 articles on the

relationship of obesity and exercise related to health risk behaviors, human

physiology data, motivation and benefits of exercise. This class assignment is being

implemented to assist in learning the research process and its importance to

nursing practice. The concept of health promotion was chosen by the class to

increase the understanding of this topic with college students. Health promotion

was chosen as an important concept in Healthy People 2020. Through poster

presentations students will share current knowledge about their findings and

implications for nursing practice.

Literature Review

The objective of each research article is to prove how exercise greatly affects

the obesity rates in college students. The following topics that will be discussed

include health risk behaviors, human physiology data, motivation, and the benefits

of exercise. Health risk behaviors such as binge eating, stress, and living on or off

campus while going to college has contributed to obesity. Three research articles

used surveys to obtain this data. Obesity and exercise play a major role in the bodies

physiology. The three research articles focused on BMI, bodyweight, nutrition, and

physical activity. Two research studies took two different results of college students

to compare each set in order to prove that exercise is important to a person’s

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physiology and health. The last research study only used one qualitative

questionnaire regarding knowledge of physical activity. The next articles that were

reviewed dealt with the motivation of college students to exercise. Since this is a

subjective value all of the experiments used a survey and follow up questions. All

three-research articles consisted of intrinsic and extrinsic motivation for exercise

and were qualitative. Lastly, the benefits of exercise in the research articles entailed

self-esteem, body image, self-care, and self-efficacy. Data was obtained through

survey and intervention. The populations of all research articles were of college

students that lived either on or off campus. Each research study had participants’

volunteer and maintained ethical standards. The results are further discussed how

these four topics eliminate obesity and promote health.

Health Risk Behaviors

What comes to mind when one thinks of a college student? The numerous

answers that are available include knowledge, debt, loans, that hippie girl down the

hall with her guitar. She hasn’t worn shoes in a week. Gross! Did you think of stress?

Stress is a common emotion that most college students would describe themselves

as. In turn, stress causes students to do what is commonly referred to as “stress eat.”

Stress eating before exams, while writing eighteen page papers or while trying to

force themselves to stay awake during a three hour lecture class. I will now discuss

how binge-eating, stress, and living situations effects obesity on college students.

Stress eating is commonly referred to as binge eating. According to Leonard,

Phillips, Veroneau & Weeder (2014), Binge eating is “eating a large amount of food

in a short period of time while experiencing a subjective loss of control” (p. 445).
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This disorder is relevant across the world, but is commonly known to affect both

male and female college aged students. Leonard et al., (2014) described several

studies that were aimed to investigate binge eating which allowed them to associate

weight control behaviors in a sample of overweight and obese college students.

During this study, an email was sent out inviting 7,500 undergraduate students to

participate in an online survey. It was a voluntary survey, so only 2,073 students

completed it. Each student was asked if within the last thirty days, they experienced

an episode of binge eating. Depending on their responses, those who answered yes,

were then asked a series of open ended questions. As a result of the study, nearly

38% of female students and 31.4% of male students admitted to experiencing binge

eating in the last thirty days (Leonard et al., 2014). These findings indicate 1/3 of

the sample. It is very important to continue developing a better understanding of

binge eating in obese and overweight college students that may lead to better

outcomes that can be implemented to reduce the rates of obesity and the associated

health risks.

Another health risk behavior associated with obesity amongst college

students is stress. The transition from high school to college is an important

transition where risks of obesity increases and long term behaviors are determined.

According to Laska, Lytle & Pelletier (2016), “There is growing research on the

correlation and possible physiological and behavioral mechanisms between stress

and obesity risk” (p. 139). This particular study reached out to three neighboring

community colleges through email, on campus posters and information tables.

Amongst the students who accepted to participate in the study, only 46% were
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eligible and enrolled in the study. The student’s height and weight was calculated to

indicate each students BMI. Next, the participants completed a survey that

measured their habits, such as eating and activity patterns, tobacco and alcohol use,

sleep and stress. Using the Choen Perceived Stress Scale, stress is measured on a

scale ranged from 0-16. they were able to measure the participants stress level.

However, there were no similarities with the exception of the amount of sleep the

participants received each night. According to Laska et al. (2016), nearly half of the

people in the sample were overweight, 27% were nonwhite, and 2/3 were female.

The average stress level in this study was 5.4 (Laska, et al., 2016). Because stress

predominantly effects college students, it is important to promote strategies that

reduce stress which may include stress management curricula. Their hypothesis

that students engaged in more health risk behaviors due to stress resulting in

obesity was found to be true.

After examining the effects of binge eating and stress imposes on one’s health,

it is important to determine whether living on or off campus truly matters. College

students are gaining weight at a rate of almost six times that of the general

population (Davis, Maggs & Morgan 2012). But why? Typically, most college

students eating habits include very little fruits, vegetables and dietary fiber.

Therefore, they are generally eating fast foods and consuming alcohol. A study was

done which allowed first year, first time and full time college students to participate.

It must be completed for fourteen consecutive days and was repeated for six

semesters. The participants were asked to report the number of times they are fruit

or other veggies, drank pop, worked out, watched TV and other various activities.
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Amongst the 746 students who participated in this study, 98.1% lived on campus in

residence hall during semester one but by semester seven, 12.3% living in residence

halls (Davis et al., 2012). Most students who lived off campus typically lived in

apartments or houses. As a result, participants who lived off campus were found to

eat less fruits and vegetables and participate in less physical activity than those who

live on campus.

Human Physiology Data

Everyone knows the mythical phrase “freshman fifteen” among incoming

college students. This article payed close attention to the unhealthy lifestyles and

the change of certain habits on students starting their first year in college from

September to December. Faas, Groen, Hanck, Neisingh, Prak, and Vos (2015)

measured 1,095 student’s body weight and BMI values in their study. All students

were taught how to record each measurement and all were submitted anonymously.

At the end of their research study they used comprehensive statistical analysis on

the data to present the results. Faas et al. (2015) found that, “students had a mean

weight gain of 1.1kg and an average BMI gain of 0.35” (p. 229). These results show

that weight gain is becoming an epidemic in college students due to their lack of

nutritional eating habits and exercise. The students focused their time on snacking

throughout the day, skipping breakfast, consuming alcohol, having no variety in

their meals, and avoiding exercise (Faas et al., 2015). This led to the study’s results

of an increase in BMI and body weight. Faas et al. (2015) believes that, “this

however, may be a challenge, as students with an unhealthier lifestyle were less

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willing to change their behaviors” (p. 234). Obesity is becoming a major problem for

college students due to their lack of health promotion and exercise.

Klewer, Kugler, Lehmann and Lindeman (2014), researched BMI along with

physical activity among nursing college students. According to Klewer et al. said,

“for health care professionals in particular, it is necessary to identify with a healthy

lifestyle in order to serve as a role model for patients” (para. 6). Health promotion

has become an important aspect in the medical world and nursing students need to

be role models for their patients and to simply benefit their own health. This

research study used a 12 page questionnaire regarding each student’s BMI and

physical activity in 2008 and in 2013. The researchers questioned 266 nursing

students in 2008 and then 259 nursing students in 2013 to compare the different

results while using the exact same questionnaire (Klewer et al., 2014). The research

study and questionnaire was approved by the school’s committee and was voluntary

and anonymous for all of the nursing students. Klewer et al. (2014) found that in

2008, 7.1% nursing students were underweight, 72.9% were normal, 15.8% were

overweight, and 3.0% were obese according to the BMI scale. In 2013, 4.2% of

nursing students were underweight, 64.1% were normal, 24.3% were overweight,

and 7.3% were obese according to the BMI scale (Klewer et al., 2014).

The results show a dramatic increase in BMI among nursing students in 2013

compared to 2008 showing more nursing students being overweight or obese. The

other part of this research study was to look at the physical activity among the

nursing students. In 2008, 12.8% exercised less than an hour a week, 36.1%

exercised between one and two hours a week, 20.3% exercised between two and
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four hours a week, and 30.5% exercised more than four hours a week (Klewer et al.,

2014). In 2013, 14.3% exercised less than an hour a week, 33.6% exercised

between one and two hours a week, 26.3% exercised between two and four hours a

week, and 25.5% exercised more than four hours a week (Klewer et al., 2014).

There was a slight increase in exercising between two to four hours a week and

exercising for less than an hour a week from 2008 to 2013. On the other hand, there

was a decrease from 2008 to 2013 in exercising for more than four hours a week

and between one to two hours a week. This evidence shows that more nursing

students are getting less physical activity and having higher BMI scores, which is

contributing to the obesity rate among college students. This is a major concern and

college students need to be getting at least 150 minutes of moderate exercise or 75

minutes of intense exercise per week (Klewer et al., 2014). The proper amount of

exercise is key to preventing and defeating high obesity rates.

Obesity has become more prevalent in our country recently and it is due to

the lack of proper knowledge on how to correctly diet and exercise. College

students are the main focus because they get out of their comfort zone and routine

which leads to unhealthy lifestyle changes. Ferkel, Griffin, Judge, and Stodden

(2014) explain this by saying, “self-efficacy was found to be the strongest

psychological predictor of PA [physical activity], and lack of time, fatigue, weakness,

bad weather, lack of facilities, and lack of exercise partners were found to be

negatively associated with levels of PA” (p. 221). Ferkel et al. (2014) further

investigated the behaviors and attitudes of exercise among 3,169 college students

by sending out surveys to four different colleges. They used a qualitative

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questionnaire that was voluntary and anonymous. The researchers wanted to see if

there was a correlation between the amounts of physical education courses taken

and the increased amounts of exercise in students. Ferkel et al. (2014) found that,

“students [had] a more positive outlook and motivation to improve PA” (p. 228).

Their research study indicated that the more knowledge a student had on the

importance of exercise the more willing that student would be to exercise

appropriately and to take care of their overall health. Ferkel et al. (2014) believe

that the, “lack of PA continues to contribute to the high prevalence of overweight

and obese individuals” (p.229). Their evidence proves that there is a need for

knowledge about physical activity for people to properly exercise according to their

body type in order to prevent the many diseases associated with obesity. Health

promotion has become a major key in eliminating obesity and needs to be further

taught and instructed to college students in order to terminate this epidemic.

Motivation

The study “Using Facebook and Text Messaging to Deliver a Weight Loss

Program to College Students” by Melissa A. Napolitano (2012), and associates

examines a pilot study that uses social media to encourage weight loss. The study

was conducted to counteract obesity on college campuses. 52 students were

selected from a college campus and assigned to one of three groups. All participants

completed a series of questions online. Then the participants were put into one of

three groups. One group was just added to Facebook. The second group was placed

on Facebook with text messaging and personal feed back. The third group was

placed on a waiting list. The initial screening was reduced to the participants whose
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BMI levels were from 32 to 57. The group in the Facebook Plus program was given a

guidebook, as well as goals that were texted to them. Also this group was given a

buddy (not in the survey) who would be notified and told to encourage the

participants, if they did not meet their goals. The Facebook participants joined a

private Facebook group. The private Facebook group posted useful information

about weight loss. The participants were allowed to post questions and comments.

The data showed that 97% of the participants found this group to be useful and

would recommend it to a friend, 96% of these students did remain in the study for

the entire eight-week program.

The Facebook Plus participants lost significantly more weight then the group

who was placed on the waiting list and the group who was just posted on Facebook.

As far as the researchers know, this is the first study of its kind. This study showed

the effects of dieting and exercises. This study had an effective re-tension rate and it

did not cost much to conduct the study. This is feasible for colleges to participate in,

if proven effective. This study had a few glaring weaknesses. First, this study only

included 57 students, whose BMI range was between 25 and 35. Also, the vast

majority of survey students were women. Lastly, the survey had no way to

determine how many students viewed the Facebook group on a daily basis, other

then to post comments. Further research needs to be conducted to see what affects

it had on the actual students weight loss, as well as, more studies showing the long

term effects of this study.

In the “Role of High School Physical Activity Experiences in College Students’

Physical Activity Motivation” by Joseph S. Madonna and associates the study tested
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the role of past physical activity in students and its effect on future physical activity

during their freshmen year of college. The experimenter based their experiment on

a self-autonomy theory that dealt with intrinsic and extrinsic values. Intrinsic values

are reasons why people do things that are normally personal and are free of social

influences; these are often associated with a high sense of self and confidence.

Extrinsic values are values that are reasons people due things that come from

outside sources such as social norms or pressure from family and parents and can

be a cause of low self esteem if a person feels they do not fit in or can not express

themselves freely. Intrinsic values are also associated with higher levels of

autonomy (free will). Normally intrinsic sources are more important to person then

extrinsic reasons, but not always.

In this experiment the researcher hypothesized that students who

participated in competitive sports would have a higher confidence level and be

more likely to exercise in College freshmen year. The hypothesis also predicted that

college students who only exercised in high school or who played non competitive

sports would exercise less in college and would have an intrinsic reason to exercise

such as to look good. The surveyor chose this topic of research and this area of

development because it is the first time in many peoples’ lives where they chose to

stop exercising due to many factors. The surveyor sent out to 3880 out of 4000

freshmen at a university in the fall semester of the students who received the survey

121 chose to participate. Of these students 91 were female this was not the intent

but an unforeseen occurrence. The survey asked what kind of physical activity they

were involved in with categories such as recreational sports, completive sports and
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physical exercise and how confident they felt in doing each of these. The survey also

asked broadly what type of exercise the participant was performing.

The researcher added a confidence level because they associated competitive

sports with high intrinsic values, which are associated with high levels of autonomy.

On the contrary, the researcher believed that people who only exercised would do

so due to extrinsic reasons, which they associated with low levels of autonomy. The

results of the survey supported part of the researchers’ hypothesis while refuting

other parts of it. The survey showed that people who competed in calmative sports

in high school were more likely to participate in some form of physical activity in

college. The survey also showed that all forms of exercise seem to raise confidence

and autonomy or at the very least do not cause lower levels of self-confidence.

However, resistance exercise such as weight lifting had the largest positive effect on

autonomy. The researcher believes that further research is needed into the effects of

different types of exercise on a persons self confidence and autonomy as well as

more studies that show the long term effects of these types of exercises. Despite

being an interesting study into the reasons behind college students the study had a

few weaknesses and limitations.

Firstly, only 121 students who were mostly female participated. This is not a

very large sample group and females are over represented in this sample group.

Secondly, the study cannot verify the authenticity of the answers students

submitted since it was a self-report survey a person could answer the survey

differently then how they feel unknowingly and the researcher would not know. The

survey questions could also be misread or misleading, for example someone may
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believe that a recreational sport is a competitive sport or report a type of exercise as

a different classification then the researcher intended. The study also has

limitations. We cannot track the students over the course of college to see if their

autonomy changes or the effect exercise has on autonomy long term.

The study “Exposure to Weight-Stigmatizing Media: Effects on Exercise

Intentions, Motivations and Behavior” by Rebecca L. Pearl (2015), and associates

explored the effects of Behavior and weight stigmatizing the media on exercise. The

study was done due to the large amount of media consumed in America, and the

negative portrayal of over-weight people. The study wanted to see what affects this

has on experiences in weight loss. The experiment was done exclusively on 75

women to try to repeat previous experiments of this kind. The participants were

given a survey asking them questions about their perceptions of over-weight people,

why they exercise and why the exercise. The women were split into two groups

and shown videos. The experimental group was shown weight- Stigmatizing videos

and the control group was shown weight neutral videos. A week later, both groups

were emailed a five-minute survey asking them the same types of questions. The

survey revealed that people who viewed the weight-stigmatizing material were

more likely to associate obesity to self-responsibility, but more likely to dismiss

themselves from it. Also, they were more likely to exercise for extrinsic reasons and

less automaticity. They were more likely to engage in unhealthy weight-loss, too.

A short-term effect from the group that viewed the weight-stigmatizing

video was that these women were more willing to exercise. However, the later

survey shows that they were less willing to exercise then the women who viewed
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the neutral video. The study showed facts we need to consider. For example, weight

loss may be harming some people and the way nurses talk about weight loss. Also,

the survey showed that the media does not consider genetic responsibilities for

obesity and their causes. Many people do consider obesity a choice. We as nurses

need to explain healthy weight loss and we need to support patients we fall short of

their goals. This survey did have some weaknesses, like asking open-ended

questions on the questioner. Also, the study was conducted on women who were

mostly white. Lastly, the study did not verify whether or not the participants

exercised, as they claim they did.

Benefits of Exercise

In a heterogenic group of mostly Caucasian mid-western female college

students, exercise is viewed as beneficial with not many barriers. It shows that for

those who are already exercising, the benefits of exercise are high. While the study

showed that both groups had a decline in their benefits and barriers, they believe

these are not of significance. When comparing the results of this study to the study

conducted in 1998 by Kennedy et al. there are important differences that could

account for the lack of change in the Exercise Benefits/Barrier Scale (EBBS) scores.

First, the benefits scores were high since the highest score is 172. Compared

to the Kennedy et al. (1998) study members had a score of 135 after a 9-month

exercise program, while the group of this study started with a 135 baseline. The

implication is that in this study there was no improvement in the total or benefits

scores. Second, the members of this study had an average age of 19 years compared

to the average age of 60 years for the Kennedy study (1998). The clinical implication
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is that this study members’ level of activity has not started to decline. It has been

said that the rate of decline in physical activity starts in those ages 18-24 years. The

results of this study show that the decline in activity may occur when people are not

in school. Third, there was a difference in the physical activity level before to the 9-

month exercise program. In the Kennedy study (1998), members had to be

sedentary in their physical activity before the research. Sedentary status was

determined by personal interview. All of the participants in both groups were

exercising at least 1-2 days per week at baseline. This study is consistent with

research that shows EBBS scores are high for people exercising.

In another study done by Bienemy, Dellinger, Hutchinson, Rami and

Singleton (2011), students were asked to document their actions related to eating

and exercising after their intervention. Of the 30 students that responded 13 said

their food/caloric intake was less than it was at the beginning of the study. Also, 18

of the 30 responding contributors reported they were walking more. The

assumption is that they saw some benefit from these actions and showed self-

efficacy in changing unhealthy behaviors. In order to find out the status of students

in regard to their BMI, they reported their weight and height and their BMIs were

calculated. Almost half of the students who provided necessary information were

overweight. These results were not unexpected in the view of the initial observation

of students. Only 17% of the 47 students were satisfied with their body image, most

students said that their body image showed a larger size then they wished to be.

In this study, correlation coefficients were calculated between BMI category

and measures of self-esteem, body image, self-care, and self-efficacy at the beginning
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of the study and after the intervention. The results showed that students who were

unhappy with their body type were likely to be overweight, and participants with a

greater BMI had lower self-efficacy beliefs about regulating exercise habits.

Apparent self-efficacy for goal completion will determine goals set, how much effort

to extend, how long they will stay in the face of difficulties and their resilience to

failures. The results of the studies show that students should be encouraged to

achieve self-efficacy in order to help attain goals.

Self-care at the beginning of the study was correlated with self-efficacy to

regulate exercise and self-efficacy to regulate eating habits. Self-care post

intervention was correlated with pre-and post intervention scores of self-efficacy to

regulate exercise but only with post intervention of self-efficacy to regulate eating

habits. The greater their self efficacy, the more individuals will believe they can

follow a self-care regimen for eating and exercising and can achieve their ideal body

image. The purpose of this study was to see how a 15-week campus based lifestyle

modification program would affect the obesity on college students in regard with

self-efficacy and physical activity. The results showed very large improvements in

physical activity with obese students, including doing 30 minutes of physical

activity, and joining flexibility training, resistance/strength training activities. Those

results were very positive being that the main reason for obese college students is

due to not exercising.

Evidence today shows that talking about obesity and making programs could

increase their physical activity and fitness for a short time, but this usually

decreases as time goes on. Studies in the future should include many follow-ups to
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see if people are still doing these programs after the program ends. Since this study

was done during the spring semester and there is not many students on campus

during the summer, there were many barriers that were faced that were not

covered by the program. On campus programs in the future should include advocate

sessions, follow-up communication and also other social support tools to help

promote successful behavior change in students year round.

Conclusion

Obesity has become a major health problem among college students, leading to

a tremendous amount of diseases. There are many health risk behaviors one should

be aware of. Exercise, nutrition, and proper knowledge are needed in order to end

the sky rocketing rates of obesity. The research showed that nurses need to

continuously be motivated and remind patients of the benefits of exercise. Each

research study maintained ethical standards and properly carried out the results.

The only critique about the data collection of each article would be that each person

submitted their information, which could end up being biased and slightly altering

the results. It was more feasible to have self-reported data. However, there is

adequate knowledge and information needed to direct a change in obesity rates.

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