Wellness and Stress in First Year Medical Students, Impact of Exercise Patterns and Barriers to Exercise

Abstract

Wellness and Stress in First-year Medical Students, Impact of Exercise Patterns and Barriers to Exercise

Heather Zimmerman BS,1 Ana Danko BS,1 Masako Matsunaga PhD,1 and Richard Kasuya MD1

1 University of Hawai’i John A. Burns School of Medicine

Abstract

Introduction: Exercise promotes both physical and mental health by reducing anxiety, stress, and depression while also boosting executive function.1,2 Recent studies indicate that medical students experience significant increases in stress and a noticeable decline in mental and emotional well-being throughout the first year.3 Given its benefits, regular physical activity may play a valuable role in managing these challenges.

Objective: To examine wellness and stress levels among first-year medical students and identify modifiable behaviors that might contribute.

Methods: A voluntary, 4-point Likert survey was newly constructed, which considered various aspects of student wellness and stress, with attention paid to the time of day to identify any relationships or patterns. Responses were categorized as follows: 1 = very poor to 4 = very well; 1 = very stressed to 4 = very relaxed. The survey was administered to two cohorts of first-year students in successive years at one medical school—additional close-ended questions centered on physical exercise habits and barriers to exercise, including categorical barriers. Responses were analyzed by determining the mean, standard deviation, frequency, and percentage. Students were then stratified based on categorical responses, which the study group conjectured may affect outcomes (Pre-class Exerciser vs. Non-Pre-Class Exerciser; Exerciser vs. Non-Exerciser; Barriers to Exercise vs. No barriers to Exercise; On-Campus Exerciser vs. Non-On-Campus Exerciser), and differences in wellness/stress responses between groups were analyzed using Welch’s two t-tests and Fisher’s exact tests.

Results: The data included survey responses from 53 out of 154 eligible students (34% response rate). On average, students generally felt “well,” including in the moment of the survey (mean Likert 3.09, 3.06); however, on average, they reported feeling “poor” the prior day and upon awakening (mean Likert 2.83, 2.79). Regarding stress, on average, they felt “stressed” in all temporal scenarios presented (generally, in the moment, upon awakening, prior day). Sixty-six percent of respondents reported engaging in exercise, with 73% facing one or more barriers to exercise. Most reported not exercising before class (83%), and 70% had never attended on-campus exercise classes. Pre-class Exercisers reported feeling “very well” (67%) or “well” (11%) upon awakening, which was a higher response compared to Non Pre-class Exercisers (p=0.005). However, overall, differences in wellness and stress levels between the stratified groups were not observed.

Discussion: First-year medical students were selected for this survey due to their temporal proximity to pre-medical training. Most students felt their wellness and stress levels were below the optimized level (defined by Likert scale response of 3 or above) regardless of their exercise habits or barriers to exercise. The exception is that pre-class exercisers had higher wellness upon awakening compared to non-pre-class exercisers. Interestingly, those who faced barriers to exercise reported feeling less stressed than non-barrier students the prior day, which may be explained by curricular structure differences, such as differences in coursework on the day of administration or the prior day. Importantly, most students were still able to exercise despite reporting barriers. Based on these results, further studies should explore ways for students to improve wellness and reduce stress, including strategies beyond increasing physical activity levels. Relationships between specific barriers, stress levels, and wellness could also be examined. A limitation of this study was that it did not use a pre-validated survey tool. Additionally, wellness and stress were not defined for the survey takers and, therefore, subjective. Future studies should attempt to remedy this and consider expanding the survey to other stages of medical training. Reported barriers should also be analyzed beyond frequencies, and solutions analyzed.

Target Audience: Medical educators, organizational wellness directors

Acknowledgments: The project described was supported by the JABSOM Office of the Dean. MM was partially supported by the U54MD007601 (Ola HAWAII) and U54GM138062 (PIKO) grant from the National Institute of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

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