Atividade Física Regular, Exercício de Curto Prazo, Saúde Mental e Bem-Estar Entre Estudantes Universitários

ORIGINAL RESEARCH
published: 26 May 2020

doi: 10.3389/fpsyg.2020.00509
Regular Physical Activity, Short-Term

Exercise, Mental Health, and
Well-Being Among University
Students: The Results of an Online
and a Laboratory Study
Cornelia Herbert* , Friedrich Meixner, Christine Wiebking and Verena Gilg
Department of Applied Emotion and Motivation Psychology, Institute of Psychology and Education, Ulm University, Ulm,
Germany
The health benefits of regular physical activity and aerobic exercise are undisputed in
the literature. The present series of pilot studies had two major objectives: (a) examine
Edited by: mental health, well-being, and regular physical activity of university students and (b)
Changiz Mohiyeddini,
explore the potential health benefits of short-term aerobic exercise on university students
Oakland University William Beaumont
School of Medicine, United States in an online and a laboratory study. Mental health and well-being were measured before
Reviewed by: (Time 1, T1) and after (Time 2, T2) a 6 week (online study) and 2 week (laboratory study)
Rytis Pakrosnis, low- to moderate-intensity aerobic exercise intervention. Mental health and well-being
Vytautas Magnus University, Lithuania
Daniel Benjamin Fassnacht,
were assessed using standardized self-report measures of depression, anxiety, positive
Flinders University, Australia and negative affect, perceived stress and coping strategies, body dissatisfaction, and
*Correspondence: quality of life. The effects of the aerobic exercise were compared to a cognitive non-
Cornelia Herbert
exercise control condition (online study), motor coordination exercise (laboratory study),
[email protected]
and a waiting list (online and laboratory). A total of 185 university students were recruited
Specialty section: from German universities at T1. Further, 74 (women: n = 67) students completed the
This article was submitted to
6-week intervention. Similarly, 32 (women: n = 30) participants completed the 2 week
Health Psychology,
a section of the journal intervention (laboratory study). At T1, 36.6% of the students (women and men) reported
Frontiers in Psychology experiencing depressive symptoms. 41.83% of them (women and men) had high levels
Received: 15 August 2019 of state anxiety. All the students reported experiencing stress (e.g., due to uncertainty
Accepted: 03 March 2020
Published: 26 May 2020
related to factors such as their finances, job, and social relationships). At T1, regular
Citation:
physical activity was negatively correlated with self-reported depression, anxiety, and
Herbert C, Meixner F, Wiebking C perceived psychosomatic stress and positively correlated with quality of life and positive
and Gilg V (2020) Regular Physical
affect. Among women, cardiovascular fitness (operationalized as resting heart rate
Activity, Short-Term Exercise, Mental
Health, and Well-Being Among variability) was negatively correlated with self-reported anxiety (state) and depression
University Students: The Results of an at T1 (laboratory study). The 6 week aerobic exercise intervention resulted in significant
Online and a Laboratory Study.
Front. Psychol. 11:509.
improvements in self-reported depression, overall perceived stress, and perceived stress
doi: 10.3389/fpsyg.2020.00509 due to uncertainty. The present results confirm that there is a relationship between
Frontiers in Psychology | www.frontiersin.org 1 May 2020 | Volume 11 | Article 509

Herbert et al. Exercise and Health in University Students
regular physical activity, cardiovascular fitness, mental health, and well-being among
university students. They support the hypothesis that short-term aerobic exercise
interventions can act as buffer against depression and perceived stress in university
students after 6 weeks of aerobic exercise of low to moderate intensity.
Keywords: physical activity, aerobic exercise, cardiovascular fitness, mental health, depression, stress, well-
being, university students
INTRODUCTION recommended to reduce the lifetime risk for chronic diseases

or unhealthy weight gain and improve cardiovascular fitness
Health Benefits of Regular Physical (Haskell et al., 2007; World Health Organization [WHO], 2010;
Activity and Exercise American College of Sports Medicine, 2013).
The health benefits of regular physical activity and exercise The aforementioned recommendations of the WHO and
are undisputed in the literature. Particularly large health ACSM are based on global epidemiologic health indicators
benefits have been reported among individuals who have (e.g., morbidity rates, mortality risk) or lifetime risk for certain
experienced significant losses in their psychological and somatic diseases including cancer and cardiovascular diseases.
physical functions as a result of chronic diseases such The question of whether the same exercise recommendations
as cardiovascular disease, diabetes, cancer, hypertension, are valid for the prevention of mental health and well-being
obesity, depression, and osteoporosis (for an overview, see continues to be debated.
Taylor et al., 1985; Paluska and Schwenk, 2000; Penedo
and Dahn, 2005; Haskell et al., 2007; Knapen et al., 2015; Effects of Exercise on Mental Health and
Ruegsegger and Booth, 2018). Among such patient groups Well-Being
whose symptom severity requires secondary and tertiary In the literature, the terms mental health and well-being are used
prevention, significant improvements in cardiovascular fitness as umbrella terms to refer to psychological, mental, cognitive,
and self-reported mood, anxiety, and depressive symptoms and affective factors that enhance or impair the functioning of
can be achieved by regularly engaging in physical activity. a person. Accordingly, psychological, subjective, and overall well-
Regular physical activity and exercise have also been found to being have been identified as major contributors to mental health.
result in lower vulnerability to psychological stressors during This perspective concurs with theoretical definitions of well-
periods of increased workload and cognitive performance being, which emphasize the absence of mental and physical illness
under pressure among these patient groups (Norris et al., 1992; (for reviews, see Diener and Ryan, 2009). Psychological models
Stults-Kolehmainen and Sinha, 2014). and theories of well-being correspondingly emphasize that well-
Past studies have demonstrated significant effects of being is related to optimal experiences and functioning of both
aerobic exercise (e.g., endurance exercises such as walking, the body and mind (e.g., Ryan and Deci, 2001). Consequently,
swimming, treadmill running, and cycling) on mental past studies (including meta-analytic studies and reviews) on the
and physical health indicators using quasi-experimental relationships between physical activity, exercise, mental health,
between-subjects (i.e., comparisons of physically active and and well-being have investigated the effects of physical activity
sedentary control groups) and within-subjects designs (i.e., and exercise on a broad range of variables including depression,
comparisons of the same groups before and after exercise anxiety, mood/affect, stress, body image/body dissatisfaction, and
interventions). However, the exercise intensity and duration quality of life (Scully et al., 1998; Biddle et al., 2000; Paluska
at which the health-related effects of exercise reach statistical and Schwenk, 2000). In the remainder of this manuscript,
significance have been found to vary substantially across the broader term well-being will be used to refer to the
studies, samples (i.e., patients vs. healthy participants), and positive effects that exercise has on the factors (i.e., anxiety,
people of different ages and gender (for an overview, see depression, and perceived stress) that negatively impact mental
Gerber and Pühse, 2009; Stoll and Ziemainz, 2012). The health and well-being.
observed effects may also depend on the methods used
to measure exercise-related health gains (e.g., self-report, Self-Reported Anxiety
behavioral, neurophysiological). In their meta-analytic study, Petruzzello et al. (1991) summarized
According to the international recommendations of the the results of more than 124 studies that had investigated the
World Health Organization (WHO) and American College effects of acute and regular aerobic and anaerobic exercise on
of Sports Medicine (ACSM), healthy adults should engage in mental health, well-being, and anxiety, in particular (Petruzzello
(a) moderate-intensity aerobic exercise (∼75% of the maximal et al., 1991). The results revealed that only moderate- to high-
oxygen consumption (VO2 max) = 3–6 metabolic equivalents intensity aerobic exercise had resulted in significant changes
(METs)) for 30 min a day, 5 days a week, or (b) vigorous- in self-reported anxiety symptoms. Further, these effects were
intensity aerobic exercise (>75% of the VO2 max > 6 independent of gender, age, and physical health status. Recent
METs) for 20 min a day, 3 days a week to maintain their meta-analytic findings suggest that acute bouts of exercise can
physical health. Further, additional bouts of exercise have been reduce state anxiety (Ensari et al., 2015). Aerobic exercise

exceeding 21 min is associated with significant anxiolytic bodily and brain functions (as mentioned earlier). Therefore,
effects on self-reported state and trait anxiety after 10 weeks one would expect a relationship between aerobic exercise and
of regular exercise. However, effect sizes for exercise-induced stress. Influential theoretical models such as the cross-stressor
psychophysiological changes that are related to anxiety symptoms adaptation hypothesis (Sothmann et al., 1996) propose that
have been found to be much smaller than those reported for acute aerobic exercise poses a physical stressor to the body
self-report measures (Petruzzello et al., 1991). Recent meta- and brain, which, when recurrent, results in an adaptation
analytic findings support the notion that aerobic exercise is of the body’s stress response. Since the body’s stress system
particularly effective in reducing anxiety among non-clinical is also attuned to respond to psychological stressors, it is
samples, but the effect sizes have been found to be small expected that aerobic exercise will result in cross-stressor
(Rebar et al., 2015). Concerning clinically relevant anxiety tolerance and, consequently, act as a buffer against stress
symptoms, exercise interventions do not have the same effects in general, irrespective of whether caused by physical or
that psychopharmaceutic treatments for anxiety do (Carek psychological factors. Laboratory experiments that have (a)
et al., 2011). However, aerobic exercise has been found to explored changes in the psychophysiological indicators of
be effective in alleviating several anxiety (e.g., generalized the body’s stress response to acute psychological stressors
anxiety, panic, obsessive-compulsive disorder, social phobia) during and after aerobic exercise and (b) compared physically
and stress-related disorders (posttraumatic stress disorder; active individuals and inactive controls have demonstrated
Stubbs et al., 2017). empirical support for the cross-stressor adaptation hypothesis
(e.g., Childs and de Wit, 2014; for an overview, see Gerber
Self-Reported Depression and Pühse, 2009). A few weeks of moderate-intensity aerobic
The largest changes in self-reported depressive symptoms appear exercise has been linked to better cardiovascular recovery
to result from engagement in moderate- to vigorous-intensity from psychological stress among healthy men and women
aerobic exercise. The acute antidepressive effects of aerobic (Gerber and Pühse, 2009).
exercise have been confirmed in clinical randomized controlled Currently, little is known about changes in subjective stress
trials in which depressive patients were assigned to receive perception. Similar to mental health domains (e.g., mood,
either an exercise intervention, psychotherapy, or both (for depression, anxiety), it is neither clear nor certain whether
recent meta-analyses e.g., Schuch et al., 2016; Morres et al., exercise-induced physiological and psychological adaptation
2019). Thus, the effects of regular aerobic exercise on self- to stress are causally related among healthy individuals. In
reported depressive symptoms can be as strong as those other words, it is not clear whether exercise-induced physical
of psychotherapeutic or psychopharmacological antidepressive adaptation to stress is a prerequisite for improvements in mental
treatments (for reviews, see Carek et al., 2011; Stoll and Ziemainz, health and well-being among healthy people. In addition, it is
2012). Despite the impressive effects of exercise on depression unclear whether the effects of exercise on mental health and
among patients with acute major depression, the potential of well-being are specific to aerobic exercise.
aerobic exercise as a means of depression prevention is far Even though the aforementioned meta-analytic findings have
less clear. Moreover, the frequency, duration, and intensity reported moderate effect sizes, past studies that have examined
of exercise that is required to protect an individual from dose-effect relationships have often yielded inconsistent findings
depressive symptoms in the short and long run continues to that vary depending on the intensity, type, and duration of
be debated (Larun, 1996; Dunn et al., 2005; Harvey et al., exercise. With regard to the subjective stress perception, many
2018). Regular moderate- to high-intensity, vigorous aerobic different types of exercises can reduce the level of perceived
exercise during adolescence and moderate- or even low-intensity stress among healthy individuals who experience moderate
regular aerobic exercise (e.g., 3 METs) during adulthood have to high levels of stress. Beneficial effects have been reported
been found to be particularly effective in this regard (Harvey for short- and long-term aerobic exercise, anaerobic exercise,
et al., 2018). According to recent meta-meta-analytic findings metabolically less-demanding activities (e.g., yoga, relaxation,
(Rebar et al., 2015), low- to moderate-intensity aerobic exercise somatic awareness training), and even a combination of different
has moderate effects on the severity of depressive symptoms exercise types (e.g., Neves et al., 2014; Stults-Kolehmainen
among non-clinical populations (age > 18 years) after supervised and Sinha, 2014). The effects appear to be independent of
or unsupervised training. This protective effect of even low- the overall daily physical activity behavior of individuals
intensity aerobic exercise may be attributable to the exercise- (e.g., Norris et al., 1992; Magalhaes, 2016). This suggests
induced release of the neurotrophic growth factors that are that regular physical activity and exercise can alter subjective
responsible for nerve growth and synaptic plasticity in the brain, stress perception, irrespective of one’s psychophysiological
particularly in the brain regions that display significant changes stress adaptation.
in neural activity and structural changes during depression (e.g., From a psychological perspective, different explanations
hippocampus; for an overview, see Cotman and Engesser-Cesar, have been offered to account for the short-term effects of
2002; Carek et al., 2011). exercise on mental health and well-being during and after
engagement in exercise. The factors to which these effects
Stress Reactivity and Subjective Stress Perceptions have been attributed range from time outs (i.e., duration of
Cognitive, affective, and bodily-related physiological processes time for which an individual is not preoccupied with stressors,
are interlinked in the brain. Further, aerobic exercise influences anxiety-inducing factors, and worries) to improvements

in self-efficacy and physical self-concept (including body with strict time regimes and highly demanding learning
image) and a reduction in body dissatisfaction. Further, schedules. This makes it difficult for them to seek additional
there are gender differences in body dissatisfaction. In time-consuming exercise options that will allow them to
particular, women tend to be more dissatisfied with their lead a moderately to highly physically active lifestyle over
bodies (in terms of size, shape, and weight), compared to the course of a regular university day or week. International
men (Fiske et al., 2014; Karazsia et al., 2017). Moreover, body studies have revealed that approximately half of all students
dissatisfaction is a major risk factor for the development of do not meet the WHO and ACSM’s exercise recommendations
eating disorders, particularly in women (Stice and Shaw, 2002), for gaining health benefits (Irwin, 2004). Moreover, there
including female university students (e.g., Herbert et al., is evidence to suggest that physical activity, exercise, and
2013). Relatedly, there is evidence to suggest that women stress are reciprocally related and that stress, irrespective of
are especially motivated to participate in regular exercise whether it is objectively measured or subjectively perceived,
programs as a result of their higher levels of body dampens exercise behaviors (Stults-Kolehmainen and
dissatisfaction and concerns about their body weight and Sinha, 2014; Magalhaes, 2016). In addition, psychological
shape (Kilpatrick et al., 2005). stress can also significantly and negatively affect exercise
and motor performance by impairing working memory,
concentration, and motor control and, in the case of
Mental Health and Well-Being Among vigorous-intensity exercise, increase the risk of injuries
University Students (Stults-Kolehmainen and Sinha, 2014).
University students report high levels of perceived stress Taken together, there is an urgent need to develop
and cognitive workload. Recent findings suggest that student physical activity and exercise interventions to promote
counseling centers have been witnessing an increasing number mental health and well-being among university students.
of help-seeking students (for an overview, see Brown, 2018). The interventions should fit into their daily working
Moreover, according to recent surveys, every fifth university schedule and demands and also fulfill the criteria of being
student experiences mental health problems, which he/she evidence-based. It is crucial for exercise programs that are
is reportedly unable to cope with independently (University designed for university students to (a) be time-efficient,
Student Mental Health Survey, 2018). Recent surveys conducted (b) require minimal effort and entail minimal injury
among German university students (e.g., TK-Forsa-Survey, risk, (c) control for exercise type, intensity, and duration,
2012) have revealed that one out of five students provide and (d) allow them to exercise, even when they have an
affirmative responses to questions that assess depressive overscheduled working day.
symptoms and depression severity. Although first-year freshmen
are particularly vulnerable to stress and stress-induced depressive
and anxiety symptoms (e.g., Ackermann and Schumann, Aims of the Present Series of Pilot
2010; Farrer et al., 2016), stressors are highly prevalent Studies
among all groups of students because they continuously In accordance with the aforementioned findings,
experience stress that is caused by regular examinations, recommendations, and objectives, the present series of
fixed deadlines, and the constant need to perform well to pilot studies had two major aims: (a) to investigate mental
increase their likelihood of later academic achievement. health, well-being and regular physical activity behavior among
Several studies already found positive correlations between university students and (b) to explore the potential effects of
stress and illness in university students on the one hand short-term weekly aerobic exercise interventions on mental
and between perceived stress, anxiety and depression on the health and well-being among university students. Given the
other hand (e.g., Tosevski et al., 2010; Farrer et al., 2016). discrepancies in the dose-effect relationships and effect sizes that
The relationship between stress and mental health, most past studies on exercise and physical activity have reported (see
notably depression, is not specific to students of a particular section Introduction), a within-subjects pre-post intervention
university or educational system. Instead, this relationship design was used in the present series of studies to (a) examine
has been reported among students worldwide (e.g., Ibrahim the relationships between regular physical activity, mental
et al., 2013). Thus, principally, any student, irrespective of health, and well-being before the exercise intervention and
his/her culture, might be affected. Nonetheless, students with (b) ascertain the health benefits of exercise (i.e., by comparing
higher levels of perceived stress are at a significantly higher pre-intervention and post-intervention health indicators). To
risk for mental disorders and physical illnesses than the better understand the effects of aerobic exercise on mental health
average student. Presumably, this may be the case because such and well-being among university students, a randomized control
students tend to also engage in detrimental and maladaptive design was chosen, in which the aerobic exercise intervention
health behaviors to cope with stress (e.g., Mahmoud et al., was compared to a waiting list, a cognitive intervention or a
2012). Stressed students are also less physically active than motor skills-related exercise (motor coordination). To ascertain
their less-stressed counterparts (Nguyen-Michel et al., 2006; the role of exercise type and duration and the context within
Mahmoud et al., 2012). which exercise is practiced, the following two studies were
Despite a wealth of options of university sports programs, conducted: the 6 week online pilot study (i.e., participants
many if not all students perceive themselves confronted exercised in their own homes) and the 2 week laboratory pilot

study (i.e., participants exercised under controlled laboratory registered for the laboratory study (30 women, 2 men; mean
conditions). Moreover, in contradistinction to past surveys, age = 22.03 years, SD = 2.32). All participants provided
standardized self-report measures were used to assess mental written informed consent. All of them completed the first
health and well-being in both the studies. Specifically, self- set of measurements at time 1 (T1) and completed an
reported depression, anxiety, perceived stress and coping, body online questionnaire, which included questionnaires that
dissatisfaction, and quality of life were measured. In addition, assessed mental health, well-being, and engagement in
cardiovascular fitness served as an objective measure in the regular physical activity. Subsequently, their responses were
laboratory study. screened to identify missing data and verify their eligibility for
Taken together, the following key questions were investigated: inclusion in the study sample (i.e., based on the inclusion and
exclusion criteria).
(1) Are mental health and well-being related to regular
physical activity among university students? In particular, Online Pilot Study
do university students report experiencing depressive Among those who registered for the online study (N = 153),
symptoms, anxiety, and stress? Are these effects correlated 19 individuals were excluded either because their data
with their regular physical activity behavior? contained missing values or based on the exclusion criteria.
(2) Can short-term aerobic exercise act as a buffer against Further, 43 participants withdrew their participation after
perceived stress and promote mental health and well-being T1 measurements. Therefore, 91 participants were included
in university students after 6 weeks of low to moderate in the study protocol and randomly allocated to one of
regular exercise? three groups. Random allocation was undertaken using a
(3) If yes, will the effects be specific to aerobic exercise (i.e., random event generator. Thirty participants were assigned
when compared to a cognitive intervention)? to the exercise intervention group, 30 participants were
(4) Will exercise-induced changes in mental health and well- assigned to the expressive writing group (i.e., cognitive
being be accompanied by changes in cardiovascular fitness intervention), and 31 participants were assigned to the
after 2 weeks of regular exercise? Will the effects be waiting list control group. Those assigned to the exercise
specific to aerobic exercise (i.e., when compared to an intervention group participated on average in 11.05 of the
exercise intervention that involves motor coordination 12 exercise sessions (range = 8–12, SD = 1.18). Further,
components)? those assigned to the expressive writing group participated
on average in 11.29 of 12 writing sessions (range = 8–12,
SD = 1.08). There was no statistically significant difference
MATERIALS AND METHODS in the number of participated sessions between the two
groups (p > 0.1).
Participants, Initial and Final Sample Only the data of those who finished the intervention (i.e.,
Sizes, Inclusion and Exclusion Criteria, exercise or writing intervention), completed all the weekly
and Dropouts sessions, and participated in measurements taken at time 2 (T2)
Participants were recruited by circulating advertisements on were included in the final analysis. Consequently, the data of
the internet and posting them on online university-specific 74 participants (67 women, 7 men) were included in the data
platforms. The advertisements targeted volunteers who were analysis. Specifically, 19, 24, and 31 of them had been assigned
not members of sports programs and athletes who engaged to the exercise, expressive writing, and (waiting list) control
in regular aerobic exercise, received endurance training, or group, respectively.
had been participating in sports competitions. The exclusion
criteria were as follows: (a) age < 18 years, (b) regular Laboratory Pilot Study
consumption of illegal substances, (c) former or current diagnosis In the laboratory pilot study, 32 university students (30 women,
of or reception of treatment for psychiatric or neurological 2 men) were included in the study protocol and randomly
disorders, (d) a history of cardiovascular or respiratory diseases allocated to one of the three groups. Because of the skewed gender
including diabetes, (e) pregnancy, (f) former or current physical distribution, the data of the two male participants were excluded
impairments that can hamper engagement in even low- from analyses. Therefore, the final all-female sample consisted
intensity exercises (e.g., injuries, physical handicaps). The same of 30 university students (exercise: n = 10, motor coordination:
inclusion and exclusion criteria were used in the online and n = 11, waiting list: n = 9).
laboratory pilot study. Figure 1 presents an overview of the protocol of the
In total, 185 university students (157 women, 28 randomized controlled trial, the initial and final samples included
men; mean age = 22.54 years, SD = 2.93) were willing in the pilot studies, and the dropouts.
to participate in the studies1 . A total of 153 university The participants of the online study were afforded the
students (127 women; mean age = 23.05 years, SD = 3.54) opportunity to participate in a raffle. They were informed
registered for the online study, and 32 university students that the winners would win a voucher worth 20 euros,
which could be exchanged for things such as sports
1
Additionally, 5 participants were interested in participating in the online study, equipment and communication devices. The participants
but they did not complete any of the study measures. of the laboratory study were reimbursed individually. They

FIGURE 1 | Overview of the study protocol of the randomized controlled trial and the initial and final samples including dropouts.
received 50 euros as compensation because they were definitions. Only exercises that (a) focused on cardiovascular
required to come to the university campus to participate in and muscular endurance, (b) required use of key arm and leg
the exercise intervention. muscles for prolonged periods of time, and (c) were related to
physical health-related fitness were included (Caspersen et al.,
1985). Two different variations of the exercise program were
Exercise Program available: Ex1 and Ex2. Tables 1A,B provide an overview of
In accordance with past findings (see Introduction), the the exercises that were included in Ex1 and Ex2, respectively.
exercise program focused on aerobic exercise. With regard to Ex1 and Ex2 were provided for three different durations:
the exercise format, exercises were chosen that would allow 8, 12, and 16 min. Ex1 and Ex2 included 1 min warm-
students to engage in low- to moderate-intensity exercise up and 1 min cool-down stretching exercises. The intensity
despite their overscheduled working days. This enhanced the of the 16 min aerobic exercises that Ex1 and Ex2 included
participation of university students who were less intrinsically was piloted using a sample of 10 university students (9
motivated to engage in regular exercise, could not afford women). Specifically, the effects of the exercise on cardiovascular
to enroll in fitness or sports courses, and/or wished to endurance were assessed using maximal changes in mean
exercise without expending too much effort (e.g., at home). heart rate as an empirical estimate (Tanaka et al., 2001).
Therefore, the exercises were videotaped, and a female and As shown in Table 2, among these ten participants, the
male university student served as the exercise models. In aerobic exercises (Ex1 and Ex2) fell within the range for
addition, auditory instructions (read by a female instructor) moderate-intensity exercise.
and videos were provided as a part of the supervised
exercise training.
Figure 2 depicts an example of the exercises that were included Procedure and Study Design
in the supervised video-based exercise program. As mentioned earlier (see Materials and Methods), the
Several commercial online exercise and physical fitness effects of aerobic exercise on mental health and well-
programs that promise maximal physical fitness benefits within being were examined in an online and a laboratory study.
minimal amounts of time are available to a broad range In the online pilot study and in the laboratory study,
of users. The aerobic exercises used in this study were T1 and T2 measurements were compared to ascertain
designed in accordance with scientific recommendations and the effects of the exercise intervention. The type and

FIGURE 2 | Example of the video-based exercise program (Ex1, Ex2).
intensity of the aerobic exercises were the same across in Ex1 or Ex2. With regard to the weekly sessions, the
the two studies. participants always practiced on the same days (i.e., Mondays
and Thursdays). They were free to practice either in the
Online Pilot Study morning, afternoon, or evening. They were provided with a
In the online pilot study, the exercise consisted of Ex1 link to the website on which the exercise program could be
(Table 1A) and Ex2 (Table 1B). The exercise videos were viewed on a computer, tablet, or smartphone. Before each
presented online to the participants, so that they could exercise session, an email was sent to the participants to remind them
at home. Each participant was required to practice these to participate in the session and ensure that they exercise
exercises two times a week for 6 weeks. The intensity of the in accordance with the predefined weekly training schedule
exercises was increased every 2 weeks, thereby resulting in a (see Table 3).
total of 12 sessions (i.e., four 8 min sessions, four 12 min
sessions, and four 16 min sessions), which entailed engagement
TABLE 1B | Aerobic exercise, variant 2 (Ex2).
hop on the spot 20 s

TABLE 1A | Aerobic exercise, variant 1 (Ex1).
turn in hips while jumping 15 s
warm-up
run on the spot 20 s stand upright, hands on hips and do a butt kick 15 s
turn in hips while running 15 s exercise
warm-up
stand upright, hands on hips and do a butt kick 15 s arms to the front while jumping 20 s
exercise arm circles
continuous hopping on the spot

windmill arm rotation exercise 20 s
30/45/60 s per exercise (= intensity I/II/III)

uppercuts alternating arms/legs/sides
raise arms overhead
continuous jog on the spot
overhead (air) punches

air punches to the side lateral side jumps/side-to-side jumps with arms
alternating arms/legs/sides
air punches to the front crossed

front kicks squat with side taps
exercise
exercise
high knees x jumps

diagonal kicks, wrist/toe touches arm circles
raise arms overhead uppercuts
air punches to the side overhead (air) punches
air punches to the front lateral side jumps/side-to-side jumps with arms
front kicks crossed
high knees squat with side taps
diagonal kicks, wrist/toe touches x jumps
run on the spot, shake out arms 15 s wiggle on tiptoe, lift heels 15 s
cool-down
cool-down
standing straddle stretch with arms hanging loose 15 s standing straddle stretch, shake out thighs 15 s
upper body twist and dynamic stretching to the side 15 s arms reach slowly overhead, stretching arms 15 s
upper body twist, stretching to the side including 15 s upper body twist, stretching to the side including 15 s
arms arms
8/12/16 min 8/12/16 min
Exercise 1 (Ex1) comprised warm-up, exercise and cool-down intervals. The Exercise 2 (Ex2) comprised warm-up, exercise- and cool-down intervals. The
duration of each of the 10 exercises determined the total duration of the exercise. duration of each of the 10 exercises determined the total duration of the exercise.

TABLE 2 | Overview of the pilot data investigating the intensity of the aerobic exercise (Ex1) and (Ex2).
age activity/week exercise duration age-dependent HR-range of

(years) (hours) (Ex1 = 1, Ex2 = 2) (minutes) HRmax moderate activity meanHR maxHR MET-minutes
Min Max
24 5 1 16 191.2 114.72 133.84 124 157 48–64

24 3 2 16 191.2 114.72 133.84 130 167 48–64
28 1 1 16 188.4 113.04 131.88 125 175 48–64
28 3 2 16 188.4 113.04 131.88 135 149 64–128
28 – 1 16 188.4 113.04 131.88 134 171 64–128
28 – 2 16 188.4 113.04 131.88 140 165 64–128
24 4 2 16 191.2 114.72 133.84 143 – 64–128
23 – 2 16 191.9 115.14 134.33 140 – 64–128
27 5 1 16 189.1 113.46 132.37 110 120 48–64
33 4 1 16 184.9 110.94 129.43 122 140 48–64
16 min duration. HRmax represents age-dependent HRmax values (Tanaka et al., 2001).
TABLE 3 | Overview of the experimental design and the exercise schedule of the online pilot study.
T1 measurement group online study 6 weeks (2 sessions every week) T2 measurement
week 1 week 2 week 3 week 4 week 5 week 6
Mo Th Mo Th Mo Th Mo Th Mo Th Mo Th
self-report aerobic exercise: 8 min 8 min 8 min 8 min 12 min 12 min 12 min 12 min 16 min 16 min 16 min 16 min self-report
questionnaire duration (min) questionnaire
(online) aerobic exercise: Ex1 Ex2 Ex1 Ex2 Ex1 Ex2 Ex1 Ex2 Ex1 Ex2 Ex1 Ex2 (online)
Ex1 vs. Ex2
expressive writing 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min 15 min
control/waiting list - - - - - - - - - - - -
To evaluate the specificity of the effects of the online list/control group did not receive any instructions. However,
exercise program on mental health and well-being, a they were sent weekly reminders about when the online
cognitive intervention (i.e., 6 weeks of expressive writing) exercises would begin. Table 3 provides an overview of the
was provided to one group of participants (i.e., in addition training schedule.
to the waiting list control group). Expressive writing
has been used frequently and successfully in health care Laboratory Pilot Study
programs as a cognitive intervention for stress and emotion Similar to the online pilot study, the laboratory pilot study
regulation. Its efficacy has been demonstrated using consisted of Ex1 and Ex2. In contradistinction to the online
different populations, including university students (for an study, the participants of this study were required to come
overview, see Baikie and Wilhelm, 2005; Lepore, 2006). to the laboratory and practice the exercises twice a week
In the expressive writing condition, the participants were across 2 weeks. Similar to the online study, the duration
asked to write about their most stressful weekly event for of the exercises was systematically increased across the 2
15 min, twice a week. Similar to the exercise intervention weeks, thereby resulting in five exercise sessions that comprised
condition, these participants were also reminded about one 8 min, two 12 min, and two 16 min exercise sessions,
the weekly writing session, and they were expected to respectively (Table 4).
participate in these sessions in accordance with a predefined To examine the specificity of the effects of aerobic exercise
schedule (i.e., Mondays and Thursdays) for approximately on mental health and well-being, three groups were included
6 weeks. They were provided with a link to the website in the experimental design of the laboratory pilot study
on which their personal online diary was hosted. They (i.e., similar to the online study). The first group received
were also provided with instructions that corresponded to the online aerobic exercise intervention, which has been
the standard protocol for expressive writing (e.g., Baikie described in the preceding section. The second group received
and Wilhelm, 2005). They were asked to write about a motor coordination exercise intervention. In accordance
their most distressing weekly events as expressively as with scientific definitions, this intervention focused on motor
possible, without paying attention to style or grammar, skills related to motor coordination and balance rather than
for approximately 15 min. The participants of the waiting aspects related to endurance (Caspersen et al., 1985). An

TABLE 4 | Overview of the experimental design and the exercise schedule of the laboratory pilot study.
T1 measurement group laboratory study (2–3 sessions every week) T2 measurement
week 1 week 2
self-report questionnaire aerobic exercise 8 min 12 min 12 min 16 min 16 min self-report questionnaire
(online), cardiovascular duration (Ex1 or Ex2) (online), cardiovascular
fitness, motor skills motor coordination 8 min 12 min 12 min 16 min 16 min fitness, motor skills
control/waiting list - - - - -
overview of the motor coordination exercise intervention is Measures of Mental Health and
presented in Table 5. Consistent with the design of the Well-Being: Online and Laboratory Pilot
online study, a waiting list control group was included
in the laboratory study as well. Weekly exercise sessions Study
were scheduled in such a way that the participants who The participants of the online and laboratory pilot study received
were assigned to receive the aerobic exercise and motor the same standardized self-report measures of mental health and
coordination interventions always visited the laboratory on well-being. These self-report assessments were administered at
the same days and at the same time. They were provided T1 (i.e., before participants were randomly assigned to either the
with detailed instructions before they began practicing the intervention or waiting list groups) and T2 (i.e., at the end of the
exercises. The participants of the waiting list/control group intervention/waiting period; see Figure 1). In the online study
did not engage in any exercise, but weekly reminders about as well as in the laboratory study, T1 measurement was set to 6
the commencement of the interventions were sent to them. weeks after the start of the summer term. Hence, T1 measurement
An overview of the laboratory training schedule is presented and T2 measurement included a time period in which academic
in Table 4. performance can be characterized as high.
Mental health and well-being as well as regular physical
activity were assessed using standardized self-report measures
of the severity of depressive symptoms, state and trait
TABLE 5 | Overview on the motor coordination exercise comprising six exercises anxiety, positive and negative affect, stress, quality of life, and
of varying duration. physical activity behaviors. The severity of depressive symptoms
run on the spot 15 s was assessed using the Beck Depression Inventory (BDI-II;
warm-up
stand upright, hands on hips and do a butt kick exercise 15 s Hautzinger et al., 2010), trait and state anxiety was assessed
high knees 15 s using the State-Trait Anxiety Inventory (STAI; Spielberger et al.,
squats with arms extended to the front 15 s
2001), and positive and negative affect was assessed using the
“crane exercise” (on one leg, knee slightly bent, arms out
Positive and Negative Affect Schedule (PANAS; Watson et al.,
to the sides)
1988). Both the trait and state PANAS scales were used. The
alternate leg
state scale assesses positive and negative affect at a given
short break, gently shake out arms and legs
motor coordination, executed on balance board
point in time. Using cutoff values, scores of the BDI-II and

standing on toes (on both feet)

STAI can be used to classify participants into different groups
based on the severity of their depressive symptoms and anxiety
standing on heels
levels. Scores of the BDI-II can be classified as follows: no,
standing on one leg (other leg bent up, arms form a V
minimal, mild, and moderate to severe depressive symptoms.
above head) The STAI cutoff scores can be used to distinguish between
alternate leg participants with low and high levels of trait and state anxiety.
short break, gently shake out arms and legs Specifically, cutoff scores of 40 (state) and 44 (trait) can be
“tree in the wind” (stand on both legs, knees slightly bend, used to differentiate between healthy adults and those with
arms straight overhead, bend upper body to one side, anxiety disorders (e.g., Julian, 2011). The state subscale of the
changeover every 5 s) STAI assesses bodily symptoms that are typically associated with
short break, gently shake out arms and legs the arousal of the autonomic nervous system (e.g., tension,
lunges (stand on one leg, the other leg is moved in nervousness, worry, activation). In contrast, the trait subscale
semi-circles around the balance board)
assesses “anxiety proneness” and anxiety symptoms in general.
alternate leg
Perceived stress and coping strategies were measured using the
Stress and Coping Inventory (SCI; Satow, 2012). Its subscales
cool-down
place hands on legs and gently pat 15 s

assess the perceived stress that is caused by (a) uncertainty
shake out legs 15 s
(e.g., financial uncertainty, job uncertainty, including university
arms reach slowly overhead, stretching arms 2 × 15 s
and academic career family and friends), (b) excessive demands
8/12/16 min
(i.e., resulting from work, social life), and (c) the actual experience

of negative life events (e.g., job loss). Subscale and composite the Beuker-Stemper test (e.g., Stemper, 2016; Bös, 2017) was
scale scores (i.e., sum of subscale scores) can be computed. used. This test battery consists of different exercise tests that
The SCI also assesses 13 different psychosomatic symptoms measure various aspects of motor performance, including motor
of stress such as headache, stomach ache, nightmares, and coordination, muscle strength, motor speed, and maximal power
sexual disinterest. The coping strategies assessed by the SCI exercise (e.g., vertical jumps)3 .
can be divided into two types: positive and negative coping
strategies. Examples of positive coping strategies are positive Data Analysis
thinking, active coping (e.g., trying to address the causes of The data analytic procedure used in this study is described in the
stress), and social support seeking. Examples of negative coping following sections.
strategies are alcohol and drug consumption to relieve stress. The
WHOQOL-BREF (Whoqol Group, 1998) was used to measure Mental Health, Well-Being and Relationship With
quality of life. The WHOQOL-BREF assesses well-being by Regular Physical Activity and Cardiovascular Fitness
measuring quality of life across different life domains, including at T1
satisfaction with physical health, well-being (i.e., psychological First, the data of all the participants who had registered for
domain), social relationships, and environmental factors (e.g., the online study (N = 153) and laboratory study (n = 30, all-
financial resources). female sample) were analyzed to determine their mental health
Regular physical activity was assessed using the Global status and level of well-being and examine the relationship
Physical Activity Questionnaire (GPAQ, WHO; Armstrong and between these variables and the regular physical activity behavior
Bull, 2006). The GPAQ assesses sedentary behaviors and yields of university students at T1 (i.e., before the commencement
scores for three domains of physical activity (i.e., activity at work, of the interventions). Descriptive statistics were computed to
travel to and from places, recreational activities). Additionally, ascertain the severity of their depressive and anxiety symptoms,
body image was assessed using the body dissatisfaction subscale their level of perceived stress, and the extent to which they
of the Eating Disorder Inventory (EDI-2; Garner, 1991). This used different coping strategies, and examine their quality of
assessment measures eating disorder-relevant concerns about life, positive and negative affect, body image concerns (body
body weight and shape. dissatisfaction), and their physical activity behavior. For all
Table 6 provides an overview of the self-report measures the analyses, the data were analyzed based on the gender
(including their reliability coefficients) that were used in the and the academic degree that the participants were pursuing.
two pilot studies. Group differences were examined using one-way analysis of
variance (ANOVA) (i.e., >2 groups, e.g., academic degree) and
Additional Measures: Cardiovascular Fitness, independent-samples t-test (i.e., 2 groups, e.g., gender). The
Motivation, and Intervention Effectiveness Wilcoxon rank-sum test (W) was used as a non-parametric
At the end of the intervention, the participants of the online alternative. When the assumption of the analysis for the ANOVA
study were asked to indicate how motivated they were to continue were not met, the Kruskal-Wallis test (H) was used. Partial
exercising or writing after the completion of their 6 week eta-squared (ηp 2 ), Cohen’s d, and correlation (r) coefficients
interventions. Moreover, they were required to rate the extent to served as measures of effect size. Second, the relationships
which they believed that exercising or writing had enhanced their between self-reported physical activity and depression, anxiety,
well-being and alleviated their stress. Responses were recorded positive and negative affect, perceived stress, coping, and
on a 5-point Likert scale that ranged from 1 (not at all) to 5 body dissatisfaction (i.e., indicators of mental health and
(absolutely true). well-being) at T1 were examined by conducting Pearson’s
In the laboratory study, the resting heart rate variability correlation analyses (two-tailed). Because the sample size was
(HRV) of each participant (i.e., those assigned to the exercise small, data obtained from the participants of the laboratory
intervention, motor coordination intervention, and control study were analyzed using Spearman’s rho. In addition, in
group) was measured at T1 and T2 to determine the the laboratory study, Spearman’s correlation coefficients (two-
cardiovascular fitness level at T1 and detect exercise-induced tailed) were computed to examine the relationships between
changes in cardiovascular fitness (i.e., based on changes in resting cardiovascular fitness (mean resting HRV), mental health, and
HRV) from T1 to T2. They were seated in a comfortable chair well-being at T1.
with their arms resting on their knees. They were instructed
to relax and reduce any cognitive strain during the assessment. Effects of Aerobic Exercise on Mental
Heart rate was measured using a 3-lead electrocardiogram
(ECG) with 1000 Hz via a mobile device (BioRadio, Great Health and Well-Being
Lakes NeuroTechnologies)2 and recorded for 10 min at rest Next, the effects of the aerobic exercise intervention on self-
(i.e., eyes open (EO): 5 min, eyes closed (EC): 5 min), in reported depressive symptoms, anxiety symptoms, positive and
accordance with an in-house standardized protocol for HRV negative affect, perceived stress, coping strategies, quality of life,
measurement. To explore the differential effects of the two 3
The 12 min aerobic (endurance) exercise subtest of the Beuker-Stemper test
exercise interventions (aerobic exercise vs. motor coordination),
battery was not used in the laboratory study. Instead, a motor balance test was
used (i.e., participants were required to stand on a dynamic board and maintain
2
https://glneurotech.com/bioradio/ their balance for as long as possible).

TABLE 6 | Assessment of mental health and well-being.
concept type of questionnaire total no. of items subscales used in current reliability (Cronbach’s alpha) of the
study (no. of items) questionnaires and subscales used in
the online study and the laboratory
study
depression Beck Depression Inventory (BDI-II), German 21 total score (21) 0.84 (n = 36 patients with major depression)
version (Hautzinger et al., 2010) 0.90 (n = 52 patients with major depression
leaving hospital)
0.89 (n = 315 non-clinical control group)
(see Kühner et al., 2007)
anxiety State-Trait Anxiety Inventory (STAI), German 40 state anxiety (20) state anxiety
version (Laux et al., 1981) 0.91 (n = 244 male control group, age
range 15–29 years)
0.91 (n = 342 female control group, age
0.90 (n = 171 male students)
0.92 (n = 222 female students)
trait anxiety
trait anxiety (20) 0.89 (n = 244 male control group, age
0.92 (n = 342 female control group, age
0.90 (n = 171 male students)
0.90 (n = 222 female students)
stress Stress Coping Inventory (SCI) (Satow, 2012) 54 stress (n = 5220 control subjects)
overall stress (21) 0.82
uncertainty (7) 0.72
excessive demands (7) 0.69
loss experience (7) 0.69
psychosomatic symptoms (13) 0.86
coping
positive thinking (4) 0.74
active stress reduction (4) 0.74
social support (4) 0.88
belief/religion (4) 0.78
alcohol/cigarette consumption (4) 0.75
mood/affect Positive and Negative Affect Schedule 20 state positive affect (10) 0.85 (n = 349 control subjects)
(PANAS) (Watson et al., 1988), German state negative affect (10) 0.86 (n = 349 control subjects)
version (Krohne et al., 1996)
trait positive affect (10) 0.84 (n = 480 control subjects)
trait negative affect (10) 0.86 (n = 480 control subjects)
physical activity Global Physical Activity Questionnaire 16 physical activity retest-reliability (total score) across studies:
(GPAQ) (Armstrong and Bull, 2006) - when working (6) r = 0.58–0.89 (Keating et al., 2019)
- when traveling (3)
- during leisure time (6)
sedentary time (1)
quality of life WHOQOL-BREF (Whoqol Group, 1998) 26 total score (26) subscales: (n = 2073 subjects)
physical health 0.77
well-being 0.78
social relationship 0.82
environment 0.87
body Eating Disorder Inventory (EDI-2), German 64 body dissatisfaction (9) 0.88 (n = 246 patients with anorexia
dissatisfaction short version (Thiel and Paul, 1988) nervosa, n = 217 patients with bulimia
nervosa)
0.89 (n = 186 female control group)
0.84 (n = 102 male control group)
Overview of the self-report questionnaires used in the two pilot studies. Reliability indices are reported where available.
and body dissatisfaction were examined. Effects were analyzed With regard to the online pilot study, pre-post and
pre to post (T1-T2) exercise and in comparison to expressive group comparisons (exercise intervention, expressive writing
writing (online pilot study) or motor coordination (laboratory intervention, control group) were undertaken and the interaction
study), or the control group (waiting list; online pilot study and between the two factors, “time” (T1 vs. T2) and “group,” was
laboratory pilot study). examined using mixed-design ANOVA. Group served as the

between-subjects factor, and time served as the within-subjects participants obtained scores that lay below the cutoff score that is
factor. When the assumptions of ANOVA were violated, a used to detect clinically relevant symptoms (see section Measures
robust analysis for mixed designs, which has been described by of Mental Health and Well-Being: Online and Laboratory Pilot
Wilcox (2005), was used. Independent- and dependent-samples Study), and 45 (29.41%) of them scored above the clinical cutoff
t-tests (parametric and non-parametric alternatives) were used score. Moreover, 89 (58.17%) participants obtained low scores
to undertake pairwise comparisons, including the data of the on the state anxiety subscale, and 64 (41.83%) of them obtained
final sample (n = 74). All p-values reported in this article high scores on the state anxiety subscale. The severity of their
are uncorrected values, unless otherwise specified. Bonferroni trait, F(3, 149) = 0.60, p = 0.613, ηp 2 = 0.012, and state anxiety,
correction was applied for multiple comparisons of post hoc F(3, 149) = 1.18, p = 0.32, ηp 2 = 0.023, was unrelated to the
tests of the ANOVAs. The samples used in the laboratory pilot academic degree that they were pursuing. Gender differences in
study were small. Therefore, pre-post and group comparisons state (women: n = 127, M = 39.28, SD = 8.90; men: n = 26,
(i.e., exercise intervention, motor coordination intervention, and M = 41.08, SD = 9.56), W = 1474, p = 0.391, r = −0.07, and trait
waiting list control group) were examined using only non- anxiety (women: n = 127, M = 39.32, SD = 10.40; men: n = 26,
parametric tests (i.e., for independent and dependent samples), M = 39.42, SD = 9.27), W = 1613, p = 0.855, r = −0.02, were
namely, the Mann-Whitney U test and Wilcoxon test (Z). Partial not significant.
eta-squared (ηp 2 ) and Cohen’s d values served as measures of The initial sample (N = 153) obtained mean scores that
effect size. All variables were checked for normality prior to ranged from 1.20 to 4.80 (M = 2.82, SD = 0.68, median = 2.80),
statistical analysis. and from 1.30 to 4.80 (M = 3.22, SD = 0.66, median = 3.20)
All statistical analyses were conducted using SPSS (IBM), the on the measures that were used to assess state and trait
software package “R,” and Statistica (statsoft.com). positive affect (PANAS), respectively. When compared to positive
affect (Table 8), the participants reported lower levels of state
(range = 1.00–3.30, M = 1.41, SD = 0.48, median = 1.20) and
RESULTS trait negative affect (range = 1.00–4.30, M = 1.83, SD = 0.62,
median = 1.70). Positive affect (state and trait) was unrelated
Descriptive statistics for the T1 measurements of the initial to the academic degrees that they were pursuing, state positive:
sample of the online (N = 153) and laboratory (N = 30; all- F(3, 149) = 0.78, p = 0.51, ηp 2 = 0.015; trait positive: F(3,
female sample) pilot study and the final sample of the online 149) = 0.10, p = 0.96, ηp 2 = 0.002. The academic degrees that
study (N = 74) are summarized in Tables 7, 8. they were pursuing had no effect on their state, H(3) = 0.51,
p = 0.91, ηp 2 = 0.017, or trait negative affect, F(3, 149) = 0.72,
Online Pilot Study (Initial Sample: n = 153) p = 0.54, ηp 2 = 0.014. Gender differences in state (women:
Mental Health, Well-Being, and Regular Physical n = 127, M = 2.84, SD = 0.65; men: n = 26, M = 2.72,
Activity at T1 SD = 0.80), t(151) = 0.82, p = 0.416, d = 0.18, and trait positive
Depression, anxiety, and affect affect (women: n = 127, M = 3.25, SD = 0.66; men: n = 26,
Among the participants of the initial sample, scores on the BDI-II M = 3.04, SD = 0.63), t(151) = 1.50, p = 0.136, d = 0.32, and state
(N = 153) ranged from 0 to 36 (i.e., from no depressive symptoms (women: n = 127, M = 1.40, SD = 0.47; men: n = 26, M = 1.47,
to severe/major depressive symptoms), and the mean was 7.73 SD = 0.51), W = 1431.5, p = 0.282, r = −0.09, and trait negative
(SD = 6.51, median = 6.00). Further, 97 (63.40%) participants affect (women: n = 127, M = 1.82, SD = 0.60; men: n = 26,
obtained scores that ranged from 0 to 8 (i.e., no depressive M = 1.87, SD = 0.72), W = 1628, p = 0.913, r = −0.01, were
symptoms), 26 (16.99%) of them reported minimal depressive not significant.
symptoms (range = 9–13), 22 (14.38%) of them reported mild
depressive symptoms (range = 14–19), 7 (4.58%) of them Perceived Stress and Coping
reported moderate depressive symptoms (range = 20–28), and 1 As can be inferred from Table 8, the scores that the participants
(0.65%) participant reported severe/major depressive symptoms (N = 153) of the initial sample obtained on the SCI revealed
(>29). The severity of depressive symptoms was unrelated to the that they had been experiencing stress due to uncertainty
academic degrees that they were pursuing (bachelor’s vs. master’s (e.g., financial uncertainty, job uncertainty, and uncertainty
vs. “staatsexamen” vs. “other” degrees), H(3) = 0.80, p > 0.8, about other domains of life such as academic performance,
ηp 2 = 0.015. There was no significant gender difference (women: career, family, and friends) and excessive demands (e.g., work,
n = 127, M = 7.77, SD = 6.63; men: n = 26, M = 7.54, SD = 6.00), social life). Perceived stress due to uncertainty and excessive
W = 1650.5, p = 1, r = 0. demands was greater than perceived stress due to actual
Figure 3 provides an overview of the severity of the depressive experiences of negative life events (e.g., job loss) within this
symptoms (in percentages) reported by the participants of the sample (uncertainty: M = 21.22, SD = 7.40; excessive demands:
initial sample at T1. M = 19.21, SD = 6.46; loss experience: M = 9.98, SD = 3.85).
As shown in Table 7, scores on the trait anxiety subscale Women and men did not differ in the amount of overall
of the STAI (n = 153) ranged from 20 to 69 (M = 39.33, reported stress symptoms (global scores on the SCI: women:
SD = 10.18, median = 38.00), and scores on the state anxiety n = 127, M = 50.80, SD = 14.83; men: n = 26, M = 48.50,
subscale (n = 153) ranged from 22 to 65 (M = 39.59, SD = 9.01, SD = 15.55), t(151) = 0.72, p = 0.475, d = 0.15, and women
median = 39.00). With regard to trait anxiety, 108 (70.59%) and men scored equally high in psychosomatic symptoms

Frontiers in Psychology | www.frontiersin.org
Herbert et al.
TABLE 7 | Assessment of mental health and well-being at T1.
regular physical activity

depression anxiety state anxiety trait quality of life body dissatisfaction body dissatisfaction sedentary time (work, travel, leisure)
age BDI STAI state STAI trait WHOQOL EDI, female EDI, male GPAQ GPAQ
(years) (0–63) (20–80) (20–80) (%) (0–40) (0–40) (min/week) (min/week)
online initial sample at T1 23.05 (3.54) 7.73 (6.51) 39.59 (9.01) 39.33 (10.18) 67.61 (9.70) 29.92 (9.52) 21.13 (6.68) 3129 (1114.40) 765.70 (623.59)
(n = 153) (n = 153) (n = 153) (n = 153) (n = 153) (n = 147) (n = 118) (n = 24) (n = 139) (n = 141)
final sample at T1 22.84 (4.10) 7.18 (6.35) 39.59 (9.01) 39.31 (9.86) 74.75 (10.35) 30.21 (9.18) 17.14 (5.55) 3102 (1157.20) 697.50 (720.22)
(n = 74) (n = 74) (n = 74) (n = 74) (n = 74) (n = 74) (n = 67) (n = 7) (n = 74) (n = 74)
laboratory final (all-female) 22.10 (2.33) 4.33 (3.86) 35.87 (6.12) 38.97 (8.22) 75.91 (9.08) 30.17 (9.37) – 3208.33 (1324.60) 500.20 (323.92)
sample at T1 (n = 30) (n = 30) (n =30) (n = 30) (n = 30) (n =30) (n = 30) (n = 30)
(n =30)
excessive loss psychosomatic coping: positive coping: active stress coping: social coping: alcohol/
overall stress uncertainty demands experience symptoms thinking reduction support cigarettes consumption
13
SCI: sum score SCI SCI SCI SCI SCI SCI SCI SCI
uncertainty, (7–49) (7–49) (7–49) (13–52) (4–16) (4–16) (4–16) (4–16)
demands, loss
online initial sample at T1 50.41 (14.93) 21.22 (7.40) 19.21 (6.46) 9.98 (3.85) 23.52 (6.47) 11.19 (2.07) 10.44 (2.74) 13.81 (2.25) 6.12 (2.51)
(n = 153) (n = 153) (n = 153) (n = 153) (n = 153) (n = 153) (n = 153) (n = 153) (n = 153) (n = 153)
final sample at T1 50.54 (13.95) 21.66 (7.23) 19.43 (5.51) 9.45 (3.59) 23.72 (6.27) 10.95 (1.98) 10.55 (2.70) 13.86 (2.01) 5.81 (2.47)
(n = 74) (n = 74) (n = 74) (n = 74) (n = 74) (n = 74) (n = 74) (n = 74) (n = 74) (n = 74)
laboratory final (all-female) 43.00 (10.19) 18.27 (5.34) 16.97 (5.01) 7.77 (1.52) 21.37 (4.51) 10.87 (2.03) 10.67 (2.48) 14.30 (2.15) 5.73 (2.02)
sample at T1 (n = 30) (n = 30) (n = 30) (n = 30) (n = 30) (n = 30) (n = 30) (n = 30) (n = 30)
(n = 30)
Group means and standard deviations (SD in brackets) are provided for the initial sample (online study), and the final samples taking part in the online pilot study (upper rows), and the laboratory study (lower rows).
Scores are provided for T1 measurement. Sample description at T1 includes age and self-report measures. Self-report measures include self-reported depression (BDI, sum score), anxiety (STAI, state and trait sum
Exercise and Health in University Students

scores), body dissatisfaction (EDI – sum score, body dissatisfaction scale), perceived stress and coping (SCI, sum scores include overall stress, subscales and coping strategies), quality of life (WHOQOL-BREF, includes
overall quality of life, satisfaction with physical health, well-being, social relations and environment), positive and negative affect (trait and state), and physical activity (GPAQ). The range of the scores for the questionnaires
May 2020 | Volume 11 | Article 509
and subscales is reported in brackets.

Group means and standard deviations (SD in brackets) are provided for the initial sample (online study), and the final samples taking part in the online pilot study (upper rows), and the laboratory study (lower rows).
Scores are provided for T1 measurement. Sample description at T1 includes age and self-report measures. Self-report measures include self-reported depression (BDI, sum score), anxiety (STAI, state and trait sum
scores), body dissatisfaction (EDI – sum score, body dissatisfaction scale), perceived stress and coping (SCI, sum scores include overall stress, subscales and coping strategies), quality of life (WHOQOL-BREF, includes
overall quality of life, satisfaction with physical health, well-being, social relations and environment), positive and negative affect (trait and state), and physical activity (GPAQ). The range of the scores for the questionnaires
including different psychosomatic symptoms such as headache,
negative state
1.41 (0.48)
1.36 (0.44)
1.24 (0.27)
(n = 153)
stomachache, nightmares, sexual disinterest (women: n = 127,
PANAS
(n = 74)
(n = 30)
affect
(1–5)
M = 23.84, SD = 6.42; men: n = 26, M = 21.96, SD = 6.61),
W = 1930, p = 0.176, r = 0.11. Positive coping strategies
included positive thinking, active coping (e.g., trying to resolve
the causes of stress) or social support seeking. Negative coping
positive state
2.87 (0.64)
2.82 (0.68)
2.82 (0.73)
(n = 153)
strategies included alcohol and drug consumption for stress
PANAS
(n = 74)
(n = 30)
affect
(1-5)
relaxation. Overall, positive coping strategies were reported

more often than negative coping strategies (see Table 8). Social
support seeking emerged as the most frequently used positive
coping strategy. Notably, female participants tended to use this
negative trait
1.83 (0.62)
1.79 (0.58)
2.48 (0.46)
(n = 153)
PANAS
positive coping strategy significantly more frequently than male

(n = 74)
(n = 30)
affect
(1-5)
participants did (women: n = 127, M = 14.07, SD = 2.12;

men: n = 26, M = 12.54, SD = 2.50), W = 2283, p < 0.01,
r = 0.25. Alcohol consumption and cigarette smoking, which
are negative coping strategies, were more frequently reported
positive trait
3.22 (0.66)
3.22 (0.62)
2.39 (0.38)
(n = 153)
PANAS
(n = 74)
(n = 30)
by male students than by female students (women: n = 127,

affect
(1-5)
M = 5.92, SD = 2.59; men: n = 26, M = 7.12, SD = 1.86),

W = 989.5, p < 0.001, r = −0.27. The academic degrees that
they were pursuing did not have a significant effect on overall
perceived stress, F(3, 149) = 1.06, p = 0.368, ηp 2 = 0.021,
environment factors
or psychosomatic symptoms, F(3, 149) = 0.13, p = 0.940,

quality of life
79.79 (10.21)
77.55 (12.34)
77.62 (11.27)
WHOQOL
(n = 147)
ηp 2 = 0.003. With regard to positive coping strategies, the

(n = 74)
(n =30)
(%)
academic degrees that the participants were pursuing had

no effect on positive thinking, F(3, 149) = 0.75, p = 0.524,
ηp 2 = 0.015, and social support seeking, H(3) = 2.00, p = 0.572,
ηp 2 = 0.007. However, with regard to active stress reduction,
there were differences between the groups that were pursuing
different academic degrees, H(3) = 8.25, p < 0.05, ηp 2 = 0.035.
quality of life social
71.88 (19.56)
72.63 (18.17)
70.28 (16.48)
Specifically, the observed difference was significantly greater

WHOQOL
relations
(n = 147)
(n = 74)
(n = 30)
among students who were pursuing a master’s degree than among

(%)
those who were pursuing a bachelor’s degree (bachelor’s degree:

M = 9.96, SD = 2.60; master’s degree: M = 11.64, SD = 3.23).
No significant difference emerged for alcohol consumption,
which is a negative coping strategy, H(3) = 5.85, p = 0.119,
ηp 2 = 0.017.
quality of life
69.42 (14.91)
70.21 (14.49)
71.53 (11.27)
well-being
WHOQOL
(n = 147)
(n = 74)
(n = 30)
(%)
TABLE 8 | Assessment of mental health and well-being at T1.
satisfaction health
quality of life
78.30 (12.71)
78.52 (11.89)
82.02 (9.45)
WHOQOL
(n = 147)
(n = 30)
(n =74)
(%)
and subscales is reported in brackets.

initial sample at
final (all-female)
final sample at
sample at T1
T1 (n =153)
T1 (n = 74)
(n = 30)
FIGURE 3 | Distribution of the severity of depressive symptoms (BDI-II) (online

pilot study; T1; n = 153): 0–8 (no depressive symptoms), 9–13 (minimal
laboratory
depressive symptoms, 14-19 (mild depressive symptoms), 20–28 (moderate

online
depressive symptoms), >29 (severe/major depressive symptoms).

Quality of Life Moreover, overall physical activity and sedentary time did
It can be inferred from Table 8 that there were differences not differ across the groups that differed in the academic
between the four major domains of self-reported quality of life degrees that they were pursuing, overall physical activity:
(WHOQOL-BREF; n = 147). The participants were reportedly H(3) = 3.17, p = 0.366, ηp 2 = 0.008; sedentary time: H(3) = 5.03,
more satisfied with their environment (e.g., financial resources, p = 0.170, ηp 2 = 0.002.
health, and social care: M = 77.55, SD = 12.34), and their
physical health (M = 78.30, SD = 12.71) than with their level of Relationships Between Regular Physical Activity,
well-being (psychological domain: M = 69.42, SD = 14.91) and Mental Health, and Well-Being
social relationships (M = 71.88, SD = 19.56), F(3, 438) = 20.12, Correlation analysis revealed that there were significant
p < 0.001, ηp 2 = 0.12. This pattern did not differ between relationships between overall physical activity (GPAQ) and self-
the groups pursuing different academic degrees or between the reported depression, r = −0.22, p < 0.05. Overall physical activity
female and male participants, all ps > 0.1. was also negatively correlated with state, r = −0.27, p < 0.001,
and trait anxiety, r = −0.26, p < 0.001, and body dissatisfaction,
Body Dissatisfaction r = −0.21, p < 0.05. It was also positively correlated with positive
On the assessment that was used to assess body dissatisfaction affect, trait: r = 0.28, p < 0.001; state: r = 0.30, p < 0.005.
(EDI-2), the participants (n = 142) obtained a mean score of A significant negative correlation emerged between overall
28.44 (SD = 9.67). Further, consistent with the literature (also physical activity and psychosomatic stress symptoms, r = −0.21,
see Table 7), female university students obtained significantly p < 0.01. Overall physical activity was positively correlated
higher scores than their male counterparts (women: M = 29.92, with quality of life, sum score: r = 0.27, p < 0.001, the different
SD = 9.52; men: M = 21.13, SD = 6.68), t(140) = 4.31, domains across which it was measured, namely, physical
p < 0.001, d = 0.97. health, r = 0.20, p < 0.001, well-being, psychological domain:
r = 0.31, p < 0.005, and social relationships, r = 0.17, p < 0.05,
Regular Physical Activity and coping, r = 0.17, p < 0.05, and marginally with support
Table 7 presents descriptive statistics (n = 141) for composite seeking, r = 0.16, p = 0.059. These correlations emerged among
scores (i.e., physical activity across the three domains of daily T1 measurements, which were collected using the following
life, namely, activity at work, travel to and from places, and standardized assessments: the BDI-II, STAI (trait and state
recreational activities) on the GPAQ, which is based on the anxiety), EDI-2 (body dissatisfaction), WHOQOL-BREF, SCI,
recommendations of the WHO. Notably, their time spent and PANAS (trait and state affect).
sitting was higher than the recommended duration. Their
average time spent sitting was reportedly 7.45 h/day, and this Short-Term Aerobic Exercise, Mental
amounted to an average of 3129 min/week (SD = 1114.40).
The mean durations for which they engaged in physical
Health, and Well-Being (Online Study;
activity (i.e., minutes per week) were as follows: moderate- n = 74, Final Sample)
intensity activity at work = 160.40 min/week, vigorous- Exercise, Depression, Anxiety, and Affect
intensity activity at work = 38.44 min/week, travel to and There was a significant interaction between time and group for
from places = 239.78 min/week, moderate-intensity recreational depression, F(2, 71) = 5.23, p < 0.005, ηp 2 = 0.13. Specifically,
activities = 158.60 min/week, and vigorous-intensity recreational
activities during leisure time = 168.00 min/week. These durations
amounted to a total of 765.70 min/week (SD = 623.59). Further,
124 (87.32%) participants did not engage in vigorous-intensity
activity at work, and 78 (54.93%) participants did not engage
in moderate-intensity activity at work. Additionally, 34 (23.94%)
and 38 (26.76%) participants did not engage in vigorous- and
moderate-intensity activity during their leisure time, respectively.
With regard to the total duration for which they engaged
in physical activity on a weekly basis (i.e., including activity
at work, during transport, and leisure time), 21 (14.79%)
participants did not meet the WHO criterion of 150 min of
moderate-intensity physical activity, and 7 (4.93%) of them did
not meet the WHO criterion of 75 min of vigorous-intensity
physical activity. The participants achieved less than 600 MET-
minutes per week. Gender differences in sedentary behaviors
(i.e., per week) were not significant (women: M = 3108.12, FIGURE 4 | Comparison of BDI-II scores across time (T1 vs. T2) and between
SD = 1020.55; men: M = 3232.17, SD = 1527.17), W = 1317.5, experimental conditions (online pilot study: aerobic exercise group, expressive
writing group, control group/waiting list). Vertical bars denote ± standard
p = 0.927, r = −0.01. The same was found for overall physical
errors. Significant differences between T1 and T2 are indicated (*p ≤ 0.05;
activity per week (women: M = 753.80, SD = 606.48; men: **p ≤ 0.01; ***p ≤ 0.001).
M = 824, SD = 712.51), W = 1316, p = 0.631, r = −0.04.

there was a decrease in self-reported depressive symptoms

between T1 and T2 among the participants assigned to the
exercise intervention group, t(18) = 3.38, p < 0.005, d = 0.62.
As shown in Figure 4, at T1, the participants of the aerobic
exercise group scored on average two scores higher on the
BDI-II than the participants of the expressive writing group
or the participants of the waiting list control group. This
difference was not statistically different, F(1, 72) = 1.70, p > 0.1,
ηp 2 = 0.04. Comparisons of descriptive statistics revealed that,
among those assigned to the aerobic exercise intervention group,
73.68% demonstrated improvements in depressive symptoms
between T1 and T2. Among those assigned to the expressive
writing intervention group, 45.8% demonstrated improvements
in depressive symptoms between T1 and T2. In contrast, only
36.6% of the waiting list control participants demonstrated
improvements in depressive symptoms between T1 and T2. The FIGURE 5 | Participants’ ratings of enjoyment, subjective effectiveness of the
difference scores (T1 vs. T2) were significantly different between intervention and exertion (online pilot study: aerobic exercise group, expressive
the three groups, F(2, 71) = 5.23, p ≤ 0.01, ηp 2 = 0.13. writing group). Vertical bars denote ± standard errors. Significant differences
between groups are indicated (*p ≤ 0.05; **p ≤ 0.01; ***p ≤ 0.001).
Time had a main effect on state anxiety, F(1, 71) = 14.16,
p < 0.001, ηp 2 = 0.06. Specifically, there was an increase in
state anxiety between T1 and T2. The interaction between time
and group was marginally significant, F(2, 71) = 2.50, p = 0.090, ηp 2 = 0.02, and there was a marginally significant interaction
ηp 2 = 0.02, as did the main effect of group, F(2, 71) = 2.45, between time and group, F(2, 71) = 2.54, p = 0.086, ηp 2 = 0.02. No
p = 0.094, ηp 2 = 0.04. Post hoc tests revealed a marginally significant main or interaction effects emerged for psychosomatic
significant difference between the exercise and expressive writing stress symptoms, the experience of loss, and coping strategies,
intervention groups at T2 (exercise: M = 40.90, SD = 8.69; all ps > 0.05.
expressive writing: M = 48.79, SD = 12.88), p = 0.083. There were
no significant effects for trait anxiety. Neither their main effects Exercise and Quality of Life
nor the interaction effect on trait anxiety was significant, group: No significant main effect emerged for any of the quality of life
Q = 0.89, p = 0.423; time: Q = 0.95, p = 0.336; group × time: domains, all ps > 0.05. Further, none of the interaction effects
Q = 1.34, p = 0.281. were significant, all ps > 0.05.
With regard to both positive and negative affect (state), the
main effect of time was significant, state positive affect: F(1, Exercise and Body Dissatisfaction
71) = 5.10, p < 0.05, ηp 2 = 0.02; state negative affect: Q = 8.83, Time had a significant main effect on body dissatisfaction (EDI-
p < 0.01. Positive affect had decreased and negative affect had 2), F(2, 71) = 5.18, p < 0.05, η2 = 0.004. All the groups
increased by the end of the 6-week intervention, and this trend demonstrated similar slight decreases in their level of body
did not differ across the three groups. Time: Q = 5.35, p < 0.05 dissatisfaction over time (i.e., from T1 to T2).
and group: Q = 4.52, p < 0.05 had significant main effects on trait
positive and negative affect, respectively. Manipulation Check: Motivation and Intervention
Effectiveness
Exercise, Perceived Stress, and Stress Coping At T2, the participants of the aerobic exercise and expressive
With regard to overall stress perception (perceived stress), there writing intervention groups were required to indicate how
was a significant change in scores across time, F(1, 71) = 15.80, motivated they were to continue exercising or writing and rated
p < 0.001, ηp 2 = 0.04, and the interaction between time and the effectiveness of the intervention that they had received (i.e.,
group was significant, F(2, 71) = 5.69, p < 0.01, ηp 2 = 0.03. exercising or writing) in enhancing well-being and alleviating
Overall, perceived stress (sum of the scores yielded by the four perceived stress. The participants of the exercise and the
subscales of the SCI) significantly decreased between T1 and T2, expressive writing intervention groups reported that they enjoyed
and this trend was particularly pronounced among the exercise taking part in the intervention. However, when compared to the
intervention group participants, t(18) = 4.37, p < 0.001, d = 0.72. participants of the expressive writing intervention group, those
Perceived stress caused by uncertainty significantly increased who belonged to the aerobic exercise intervention group were
between T1 and T2 (time), F(1, 71) = 23.94, p < 0.001, ηp 2 = 0.25. significantly more motivated to continue exercising, t(41) = 4.10,
Further, the interaction between time and group, F(2, 71) = 5.39, p < 0.001, d = 1.23. Moreover, as shown in Figure 5, the extent
p < 0.01, ηp 2 = 0.13, was significant. Specifically, there was a to which the intervention was perceived to have been effective in
reduction in perceived stress due to uncertainty only among the alleviating stress, t(41) = 2.03, p < 0.05, d = 0.63, and enhancing
aerobic exercise intervention group participants, t(18) = 5.15, well-being, t(41) = 2.10, p < 0.05, d = 0.65, was greater among
p < 0.001, d = 0.77. Time had a significant main effect on the exercise intervention group participants than among the
stress due to excessive demands, F(1, 71) = 4.75, p < 0.05, expressive writing intervention group participants (Figure 5).

Laboratory Pilot Study (n = 30, perceived stress, affect, quality of life, and coping) yielded a few
All-Female Sample) significant findings. The motor coordination intervention group
demonstrated a significant decrease in social support seeking
Mental Health, Well-Being, and Regular Physical
from T1 to T2, Z = −2.13, p < 0.05, d = 1.68. The waiting list
Activity at T1
control group demonstrated a significant decrease for quality of
Depression, anxiety, affect, perceived stress, body life related environmental factors, Z = −2.08, p = < 0.05, d = 1.92,
dissatisfaction, and quality of life and a marginal decrease in state positive affect, Z = −1.68,
It can be inferred from Table 7 that, at T1, self-reported p = 0.092, d = 1.35, between T1 and T2.
depressive symptoms (BDI-II) were less severe in the sample Comparisons between the three groups at T2 showed the
of the laboratory pilot study than in the online study sample. following results. At T2, the aerobic exercise and motor
Specifically, 25 (83.3%) of them had no depressive symptoms, coordination intervention groups did not differ significantly from
and 5 (16.7%) of them reported minimal symptoms. None the waiting list control group in the following variables: self-
of them reported moderate or clinically relevant depressive reported depression (aerobic exercise: M = 4.20, SD = 5.87
symptoms (M = 4.33, SD = 3.86, median = 4.00). At T1, vs. waiting list: M = 5.22, SD = 3.83, U = 35.50, p > 0.3,
both samples reported similar levels of trait anxiety, but state d = 0.62; motor coordination: M = 2.27, SD = 4.00 vs. waiting
anxiety levels were lower in the laboratory study sample than list: U = 27.50, p = 0.095, d = 0.80) and state (aerobic exercise:
in the online study sample (Table 7). In the all-female sample M = 41.00, SD = 9.98 vs. waiting list: M = 38.22, SD = 3.83,
the all-female sample of the laboratory study, 9 (30%) and 7 U = 38.00, p > 0.1, d = 0.27; motor coordination: M = 34.90,
(23.3%) participants obtained high scores on the assessments SD = 6.71 vs. waiting list: U = 29.50, p > 0.1, d = 0.72) and
that were used to measure state and trait anxiety, respectively. trait anxiety (aerobic exercise: M = 38.90, SD = 6.14 vs. waiting
Differences in positive and negative affect, quality of life, and list: M = 38.00, SD = 9.31, U = 40.50, p > 0.1, d = 0.17; motor
body dissatisfaction between the two samples were not significant coordination: M = 36.36, SD = 7.76 vs. waiting list: U = 46.00,
(Tables 7, 8). Similar to the results that emerged for the online p > 0.1, d = 0.12).
study sample, the participants of the laboratory study were more Differences between the aerobic exercise and waiting list
stressed because of uncertainty and excessive work demands than control group were significant for trait positive affect (aerobic
because of actual experiences of negative life events (Table 8). exercise: M = 2.47, SD = 0.25 vs. waiting list: M = 2.09,
SD = 0.37, U = 17.00, p < 0.05, d = 1.23), marginally significant
Physical Activity, Cardiovascular Fitness, Mental
for state positive affect (aerobic exercise: M = 2.94, SD = 0.73
Health, and Well-Being vs. waiting list: M = 2.38, SD = 0.054, U = 23.50, p = 0.079,
Similar to the online study sample, the laboratory study d = 0.88), and significant for social support seeking (aerobic
sample’s average time spent sitting was 7.6 h/day. The mean exercise: M = 13.20, SD = 2.15 vs. waiting list: M = 15.0, SD = 1.58,
durations for which they engaged in physical activity (i.e., U = 23.50, p < 0.05, d = 1.06). When compared to the waiting
per week) were as follows (total: M = 500.17 min/week, list control group, the motor coordination intervention group
SD = 323.92): activity at work = 57.17 min/week, travel obtained significantly higher scores on the assessment that was
to and from places = 189.20 min/week, and leisure-time used to assess trait positive affect (motor coordination: M = 2.43,
activity = 253.80 min/week. Referring to the WHO’s SD = 0.32), U = 23.50, p ≤ 0.05, d = 0.99, and marginally lower
recommended levels of physical activity, 9 (30%) of them engaged scores on the assessment that was used to measure social support
in < 150 min of moderate-intensity activity, and 2 (6.7%) of seeking (motor coordination: M = 13.64, SD = 2.11), U = 26.50,
them engaged in < 75 min of vigorous-intensity activity. p = 0.080, d = 0.85.
Their regular physical activity behavior (GPAQ; calculated There was no significant change in cardiovascular fitness
as MET-minutes per week) was significantly and negatively [resting HRV-HF (n.u.)] between T1 and T2. However, at T2,
correlated with coping strategies, social support seeking: HRV values [HRV-HF (n.u.), EO] were lower for the participants
r = −0.392, p = 0.032, at T1. Cardiovascular fitness [HRV-HF of the waiting list group than the aerobic exercise and motor
(n.u.), EO] at T1 was significantly and negatively correlated with coordination intervention groups (waiting list: M = 27.40,
self-reported state anxiety, r = −0.509, p < 0.005, and marginally SD = 12.75 vs. aerobic exercise: M = 46.10, SD = 21.36,
negatively correlated with self-reported depression, r = −0.328, U = 20.00, p ≤ 0.05, d = 1.06; waiting list vs. motor coordination:
p = 0.077. Significant negative correlations emerged for negative M = 46.72, SD = 13.50, U = 13.00, p ≤ 0.005, d = 1.58).
state affect, r = −0.362, p < 0.05, and marginally significant Similar albeit marginally significant findings emerged for EC
positive correlations emerged for one quality of life domain, HRV-HF (n.u.) measurements (waiting list: M = 27.03, SD = 22.06
namely, social relationships, r = 0.345, p = 0.062. vs. aerobic exercise: M = 48.05, SD = 24.48, U = 24.00,
p = 0.095, d = 0.86; waiting list vs. motor coordination:
Effects of Short-Term Aerobic Exercise M = 46.38, SD = 15.71, U = 26.00, p = 0.080, d = 0.87).
on Well-Being Group differences in motor performance were not significant
At T1, there was no significant difference between the aerobic at T2. However, the motor coordination intervention showed
exercise intervention, motor coordination intervention, and significant improvements in motor performance on the balance
waiting list control group. Within-group comparisons (T1 vs. board (i.e., T1 vs. T2), which was included as subtest in the
T2) of T1 and T2 measurements (i.e., depression, anxiety, Beuker-Stemper test battery [number of ground contacts (errors):

T1: M = 21.16, SD = 6.30 vs. T2: M = 16.3, SD = 3.91, Z = 2.05, the severity of depressive symptoms did not vary as a function
p < 0.05, d = 1.57]. of gender or the academic degrees that the participants were
pursuing. Further, there were no significant differences in BDI-
II scores between the all-female sample of the laboratory study
DISCUSSION (N = 30) and the sample of the online study, which consisted
of men and women. In addition, their anxiety scores were
University students experience high cognitive workloads comparable to the norms that have been reported for college
throughout the entire duration of their academic programs. students and young adults. Nevertheless, at T1, 41.83% of the
Recent surveys have revealed that up to 25% of university participants of the initial sample (which included both women
students feel so psychologically stressed that they are unable to and men) scored above the cutoff scores that have previously
independently cope; they also experience anxiety and depressive been reported for state anxiety (e.g., Julian, 2011). Women
symptoms (e.g., TK-Forsa-Survey, 2012; University Student were overrepresented in the online study sample. This trend
Mental Health Survey, 2018). In addition, at universities, is consistent with past observations regarding online studies
weekly working schedules follow a strict time regime with and research on exercise. Specifically, when compared to men,
daily lectures and courses and exams. Taken together, this can women have been found to be more willing to participate in
promote sedentary behaviors among university students in online studies (e.g., Smith, 2008), especially those that pertain to
the long run. Epidemiological studies have found that physical exercise, health, and well-being (Kilpatrick et al., 2005).
inactivity and sedentary behavior are major risk factors for Past studies on the mental health and well-being of university
mortality and chronic diseases (e.g., Same et al., 2016; Young students have been using samples of students who had contacted
et al., 2016). The present series of pilot studies examined the the health counseling service providers of their university to seek
relationships between mental health, well-being, and regular help for private or psychological problems (e.g., Thees et al., 2012;
physical activity among university students. Furthermore, they Heilmann et al., 2015). Many such studies have been conducted
examined the extent to which short-term aerobic exercise using samples of medical students because psychological stress
interventions (i.e., 2–6 weeks of regular engagement in low- and academic demands are more pronounced among such
to moderate-intensity aerobic exercise) act as a buffer against individuals (Dahlin et al., 2005). Therefore, past findings may be
perceived stress, anxiety, and depression and promote well- specific to particular groups of students, including those who are
being (e.g., affect, quality of life). Mental health and well-being already at high risk for stress-related disorders. In comparison,
were assessed using self-report measures of the severity of the students who participated in this study were not selected
depressive symptoms, state and trait anxiety, positive and based on the academic degree that they were pursuing or existing
negative affect, perceived stress, coping strategies, quality of health problems. In contrast, only students without a clinical
life, body dissatisfaction, and self-reported regular physical diagnosis of neurological, somatic, and psychiatric disorders were
activity. The effectiveness of the intervention was ascertained eligible to participate in the present series of pilot studies. As
by comparing T1 and T2 measurements. The samples were the current findings may be representative of the population
undergraduate and graduate students, who were recruited from of students without chronic health conditions, it is alarming
German universities. They either participated in an online study, that 36.6% of the participants of the online study (i.e., female
which lasted for 6 weeks, or in a laboratory study, which lasted and male university students) reported depressive symptoms and
for 2 weeks and required them to visit the laboratory. In the that 41.83% of them reportedly had high levels of state anxiety.
online study as well as in the laboratory study, short-term aerobic Recent online surveys on the mental health of university students
exercise comprised low to moderate intensity aerobic exercise have reported similarly high rates (see section Introduction:
and effects were compared to control conditions comprising Mental Health and Well-Being Among University Students). The
a cognitive intervention (online study), motor coordination results of the present online pilot study are also in accordance
exercise (laboratory study) and waiting list (online study and with the findings of very recent studies. Similar to the present
laboratory study). study, these studies examined the mental health and well-being
of university students using standardized self-report measures
Mental Health and Well-Being Among rather than open-ended questions (e.g., surveys). Further, similar
University Students to the present study, these studies have been conducted among
Online and Laboratory Pilot Study university students without any history of mental disorders (e.g.,
The present results are consistent with the findings of recent Farrer et al., 2016). This is also true of the all-female sample
health surveys on mental health and well-being. Overall, 36.6% of the laboratory pilot study because they had no history of
of the participants of the online study, who were recruited health complaints or mental disorders. Overall, this sample of
from different universities in Germany, reported minimal and female university students reported lower levels of depression
mild (31.3%) or moderate (4.58%) to severe (0.65%) depressive than the online sample (i.e., the scores that 16.7% of the 30
symptoms (i.e., as measured by the BDI-II) at T1 (i.e., before female students obtained on the BDI-II were indicative of low
the commencement of the interventions). The BDI-II assesses to moderate depressive symptoms), and 30% of them reported
the severity of depressive symptoms during the past 2 weeks. high levels of state anxiety (i.e., when compared to 41.83% of
Typically, women have a higher risk of developing major the participants of the online study sample). These findings (i.e.,
depressive disorder than men do. In the online study (N = 153), lower levels of depression and state anxiety) may be valid only

among undergraduate students and freshmen because 26 of the stress symptoms (e.g., Taylor et al., 1985; Paluska and Schwenk,
30 female participants were first-year undergraduate students. 2000; Penedo and Dahn, 2005). Moreover, short-term exercise
With regard to perceived stress, all the students reported interventions may have beneficial effects on the mental health and
experiencing chronic stress due to uncertainty (i.e., financial well-being of university students. The results of the pilot studies,
uncertainty, job uncertainty, uncertainty about other domains of which are discussed in the following sections, partially support
life such as career, family, and friends) and excessive demands this interpretation.
(e.g., related to work and social life). These two types of stressors
might be major contributors to the consistently high levels
of stress that university students experience throughout the
Effects of the Short-Term Aerobic
entire duration of their academic program. Accordingly, all the Exercise Intervention on Mental Health
participants of the online study reported experiencing several and Well-Being
psychosomatic symptoms. With regard to their quality of life, The 6 week low- to moderate-intensity aerobic exercise
they were more satisfied with their environments and physical intervention significantly decreased depressive symptoms among
health than with their well-being and social relationships. This the female and male participants of the online study sample
finding supports the contention that university students are (i.e., between T1 and T2). Among those assigned to the
sensitive to and aware of the psychological factors that promote aerobic exercise intervention condition, 73.68% demonstrated
and impair their well-being and mental health. improvements in depressive symptoms between T1 and T2. The
Further research is needed to determine the generalizability aerobic exercise group scored at T1 on average two points higher
of the present findings to the larger population of university on the BDI-II than the expressive writing group or the waiting
students (e.g., those in other countries). Nevertheless, the present list. However, this difference was not statistically significant.
findings are true of those without any history of health problems. From a clinical perspective, the mean scores obtained by the
Thus, the findings of the present series of pilot studies may also aerobic exercise group participants at T1 were indicative of
be true of university students without a history of psychiatric, minimal depressive symptoms. In contrast, the scores obtained
mental, and somatic disorders. by the participants of the other two groups were indicative of
a relative absence of depressive symptoms at T1. Therefore,
short-term aerobic exercise interventions may be particularly
Physical Activity, Mental Health, and effective in reducing the severity of depressive symptoms among
Well-Being Among University Students university students who already report depressive symptoms for
Among the male and female participants of the online study, a constant time at T1. The validity of this speculation should be
none of whom had any history of psychiatric disorders, tested in future studies using larger cohorts of university students.
self-reported engagement in regular physical activity at T1 In addition, the 6 week low- to moderate-intensity aerobic
was significantly and negatively correlated with self-reported exercise intervention resulted in significant improvements
depression, trait and state anxiety, psychosomatic symptoms, in perceived stress between T1 and T2 (within-subjects
and body dissatisfaction. Furthermore, physical activity was comparisons). Notably, perceived stress due to uncertainty
positively correlated with positive affect and the following quality increased between T1 and T2 (i.e., effect of time), but this
of life domains: satisfaction with physical health, well-being, and change was less pronounced among the participants assigned
social relationships. to the aerobic exercise intervention group. This supports the
The present findings support the contention that there is contention that engagement in aerobic exercise serves as a
a relationship between regular physical activity, mental health, buffer against psychological stress among university students
and well-being among university students. Importantly, this (e.g., Kim and McKenzie, 2014; Magalhaes, 2016). This effect
relationship was already confirmed using T1 measurements. was specific to the aerobic exercise intervention. Thus, among
Therefore, this relationship is independent of the effects of the university students, aerobic exercise appears to be more efficient
exercise intervention and any of the control interventions that in regulating perceived stress than other interventions such
were used in this study. This suggests that regular physical as cognitive interventions (e.g., expressive writing). However,
activity significantly enhances mental health and well-being the 6 week aerobic exercise intervention did not alleviate the
among university students whose average time spent sitting is psychosomatic symptoms of perceived stress. Further, those
approximately 7.5 h per day. assigned to the exercise intervention group did not demonstrate
These correlational results cannot be treated as evidence of significant changes in quality of life when compared to the
causal relationships, but the aforementioned correlations suggest waiting list control and expressive writing intervention groups.
that regular physical activity protects university students from The participants assigned to the exercise and expressive writing
mental health problems. Indeed, it was associated with lower intervention groups reported that the intervention that they
levels of depression, anxiety, and psychosomatic stress and better had received (i.e., exercise or expressive writing) alleviated their
quality of life across the following domains: physical health, well- stress and enhanced their well-being. However, the perceived
being, and social relationships. This interpretation concurs with contributions of their respective interventions to stress regulation
past findings, which suggest that physically active people report and well-being were greater among those assigned to the
lower levels of depression and anxiety and that physical activity, exercise intervention group than among those assigned to the
in general, can prevent or alleviate depression, anxiety, and expressive writing intervention group. Moreover, as mentioned

earlier, only the 6 week exercise intervention was effective in exercises included in the motor coordination intervention
decreasing the overall level of perceived stress, especially stress (i.e., balance, agility, and coordination) were selected in
caused by uncertainty. accordance with the recommendations of the ACSM (Garber
There were no significant changes in anxiety scores between et al., 2011; American College of Sports Medicine, 2013),
T1 and T2 (i.e., within-subjects comparisons) in any of the three which aims to promote the maintenance of motor skills
groups. However, state anxiety scores at T2 were lower among and executive functions across the developmental life span
those assigned to the exercise intervention group than among and especially among older adults. The maximal duration
those assigned to the expressive writing intervention or waiting and intensity of the motor coordination exercises were
list control group. Recent meta-analytic studies have found that lower than those that the ACSM has recommended for
even a single bout of exercise can significantly reduce state anxiety motor skills-related exercise training (20–30 min per day).
(Ensari et al., 2015). However, the anxiolytic effects of aerobic Nevertheless, the participants assigned to the motor coordination
exercise become evident only after a minimum of 10 weeks of intervention group demonstrated significant improvements
regular engagement in 21 min aerobic exercise sessions (e.g., in motor balance (which was assessed using the balance-
Petruzzello et al., 1991). board subtest). Thus, aerobic exercise appears to be effective
Past findings on the dose-effect relationship between aerobic in enhancing the well-being of university students, and
exercise and mental health parameters are less consistent. Health- other types of exercises (e.g., motor coordination exercises)
related exercise recommendations (e.g., WHO, ACSM) are appear to have unique effects on cognitive and motor
disproportionately founded upon their physical health benefits performance. In this experimental study, an all-female sample
than on their contribution to mental health and well-being. With was used to examine the effects of the motor coordination
regard to depression, it is well established that regular exercise and aerobic exercise interventions. Therefore, future studies
(aerobic and anaerobic exercise) has marked antidepressant should test the present findings using larger samples of
effects on patients with clinical manifestations of depressive university students that include both women and men. Further,
symptoms (for an overview, see Morres et al., 2019). However, future studies should use less conservative inclusion and
little is known about the antidepressant effects of exercise on exclusion criteria. Indeed, in the present series of pilot
mild, minimal, and moderate subclinical depressive symptoms. studies, only participants who completed the interventions were
Although a small sample was used in the laboratory study, a included in the sample.
comparison of the results of the present series of pilot studies
revealed that six but not 2 weeks of regular engagement in low- to Cardiovascular Effects
moderate-intensity aerobic exercise can significantly alleviate the The laboratory study examined exercise-induced changes in
subclinical depressive symptoms of healthy university students cardiovascular fitness. At T1 and T2, resting HRV was measured
(both men and women) without a history of depression. These using non-invasive recordings of the ECG (III-lead-ECG), which
effects were evident only after regular engagement in low- to served as psychophysiological indicator of cardiovascular fitness.
moderate-intensity aerobic exercise for 6 weeks. This observation At rest, HRV is under sympathetic and parasympathetic (vagal)
concurs with recent recommendations, which underscore the control. Because high-frequency (HF) modulations (0.15–0.4 Hz)
need to not only explore the therapeutic effects of low- to of the R-R interval of the human heart are regulated through
moderate-intensity aerobic exercise among clinical populations top-down innervations by the parasympathetic (vagal) nerve, the
but also test the effectiveness of aerobic exercise in promoting HRV-HF (n.u.) band of HRV is frequently used as a marker
mental health and well-being. The present series of pilot studies of cardiovascular fitness (e.g., Perini and Veicsteinas, 2003;
on mental health, well-being, and the effects of physical activity Oliveira et al., 2018; Singh et al., 2018). Moreover, changes
and short-term low- to moderate-intensity aerobic exercise on in HRV-HF (n.u.) are indicative of exercise-induced adaption
university students are first steps in this direction. in cardiovascular regulation. This would be accompanied by
One of the limitations of the present pilot studies is the an increase in resting HRV-HF (n.u.) (pre-post), which in
use of small samples. However, a pre-post design and a turn would suggest that regular aerobic exercise facilitates
randomized controlled trial and well-controlled online and cardiac vagal tone on the heart at rest. In healthy individuals,
laboratory study protocols were used. Therefore, this study cardiovascular fitness improves after 6 weeks of regular
can serve as a model for future studies. This design allowed engagement in moderate-intensity aerobic exercise (Hottenrott,
to disentangle the quasi-experimental effects of self-reported 2006). This explains why the participants of the laboratory study
physical activity from the effects of the short-term aerobic demonstrated no significant changes in cardiovascular fitness
exercise intervention on mental health and well-being. At the after the 2 week low- to moderate-intensity aerobic exercise
same time, it allowed to compare the effects of the short- intervention. Interestingly, in the all-female sample, resting HRV-
term aerobic exercise to those of stress-relieving cognitive HF (n.u.) was negatively correlated with self-reported state
(i.e., expressive writing) and other types of exercise (i.e., anxiety and negative affect and marginally significantly and
motor coordination) interventions. Expressive writing has been negatively correlated with self-reported depressive symptoms at
used in cognitive behavioral therapy, in cognitive stress- T1. Moreover, at T2, the cardiovascular fitness of the participants
prevention and self-regulation programs in students and patient assigned to the two exercise intervention groups was better
samples including multiple or single sessions (e.g., Baikie than those assigned to the waiting list control group. This
and Wilhelm, 2005; Lepore, 2006; Herbert et al., 2019). The finding underscores the role that cardiovascular fitness plays in

the mental health and well-being of female university students. universities to promote mental health and well-being among
Replication studies should aim to further examine the validity university students in the short (i.e., during the course of their
of these findings. academic program) and long term.
CONCLUSION AND FUTURE OUTLOOK DATA AVAILABILITY STATEMENT

The present series of pilot studies answer four major questions. The data supporting the conclusions of this article will be
None of these questions has been addressed in sufficient made available by the corresponding author, without undue
detail in previous studies. The present findings regarding the reservation, to any qualified researcher.
mental health and well-being of university students, which
were derived using standardized questionnaires, are alarming
because they concur with the results of larger online surveys. ETHICS STATEMENT
In this study, physical activity was significantly related to self-
reported depressive symptoms, anxiety, positive affect, and The experimental protocol, design of the exercise intervention,
quality of life, irrespective of the gender of the participants and its laboratory assessment were reviewed and approved by
and the academic degrees that they were pursuing. These the local ethics committee of Ulm University4 . The participants
findings underscore the important role that physical activity of the online study and the laboratory study provided their
plays in the well-being of university students. Furthermore, written informed consent to participate in the study. Written
they confirm that regular engagement in low- to moderate- informed consent was obtained from the individual for the
intensity aerobic exercises for 6 weeks is effective in alleviating publication of any potentially identifiable images or data included
subclinical depressive symptoms and perceived stress among in this article.
university students without a history of depression and
health concerns. Short-term aerobic exercise interventions
may be more effective in promoting the mental health AUTHOR CONTRIBUTIONS
and well-being of students than cognitive interventions are.
CH drafted and wrote the manuscript and revised it for
Therefore, low- to moderate-intensity exercise (e.g., as the
intellectual content. CH developed, conceptualized and designed
one used in the present study) should be incorporated into
the two studies, the experimental designs, the exercise training
daily university schedules. Delivering the exercise programs
programs and the RCT for the exercise and cognitive intervention
used in this study as online video tutorials may allow
reported in this manuscript (online and laboratory design).
university students to practice these exercises in the comfort
CH developed the standardized protocol for HRV measurement
of their own homes and at a time that is convenient to
at rest. CH supervised and contributed to data collection
them. This is also a cost-effective means of reaching less
and data preprocessing (online and laboratory study). CH
intrinsically motivated students and increasing their likelihood
performed data methods and data interpretation. CH, FM,
of engagement in regular exercise. With regard to the role of
and VG performed the statistical data analysis of the online
monetary incentives in motivating individuals to participate
study. FM performed the piloting of the n = 10 sample for
in studies on mental health and well-being, women have
estimation of max. heart rate. CH and CW performed the
been found to be more likely to participate in online studies,
statistical data analysis of the laboratory study. Tables and
especially those that are related to health. Moreover, high
Figures were created by FM, CW and revised by CH. English
monetary incentives and incentives with low probabilities
translations for the exercises in the Tables 1A,B, 5 were
of payoffs (e.g., lotteries or raffles) have positive effects on
provided by FM and CW.
study compliance (e.g., Zutlevics, 2016; Vlaev et al., 2019).
Different incentives were offered in the two pilot studies (i.e.,
online study: raffle vs. laboratory study: individual monetary
FUNDING
rewards), but they may have had similar effects on potential
participants’ motivation to participate. In this regard, offering The study was funded by the budgetary resources of the
evidence-based exercise programs in classrooms (e.g., by Department of Applied Emotion and Motivation Psychology,
incorporating exercise breaks into weekly lectures and courses Ulm University, Germany.
and implementing them either directly or through online
modules) may be effective in increasing university students’
motivation to increase their regular physical activity behaviors, ACKNOWLEDGMENTS
despite their overscheduled work days. Despite constant progress
within the field of health management and a wealth of available We would like to thank our student assistants (bachelor
exercise options, corresponding initiatives to provide structured and master) for help with data collection and for help with
health management exercise interventions to university students (physiological) data preprocessing.
remain sparse (e.g., Brown, 2018). The present findings
underscore the need to implement exercise interventions in 4
https://www.uni-ulm.de/einrichtungen/ethikkommission-der-universitaet-ulm/

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ORIGINAL RESEARCH

published: 26 May 2020

Regular Physical Activity, Short-Term

Frontiers in Psychology | www.frontiersin.org 1 May 2020 | Volume 11 | Article 509

INTRODUCTION recommended to reduce the lifetime risk for chronic diseases

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FIGURE 2 | Example of the video-based exercise program (Ex1, Ex2).

hop on the spot 20 s

continuous hopping on the spot

30/45/60 s per exercise (= intensity I/II/III)

overhead (air) punches

air punches to the front crossed

high knees x jumps

Frontiers in Psychology | www.frontiersin.org 7 May 2020 | Volume 11 | Article 509

age activity/week exercise duration age-dependent HR-range of

24 5 1 16 191.2 114.72 133.84 124 157 48–64

T1 measurement group online study 6 weeks (2 sessions every week) T2 measurement

week 1 week 2 week 3 week 4 week 5 week 6

Frontiers in Psychology | www.frontiersin.org 8 May 2020 | Volume 11 | Article 509

T1 measurement group laboratory study (2–3 sessions every week) T2 measurement

point in time. Using cutoff values, scores of the BDI-II and

standing on toes (on both feet)

place hands on legs and gently pat 15 s

Frontiers in Psychology | www.frontiersin.org 9 May 2020 | Volume 11 | Article 509

Frontiers in Psychology | www.frontiersin.org 10 May 2020 | Volume 11 | Article 509

TABLE 6 | Assessment of mental health and well-being.

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regular physical activity

Exercise and Health in University Students

and subscales is reported in brackets.

relaxation. Overall, positive coping strategies were reported

positive coping strategy significantly more frequently than male

participants did (women: n = 127, M = 14.07, SD = 2.12;

by male students than by female students (women: n = 127,

M = 5.92, SD = 2.59; men: n = 26, M = 7.12, SD = 1.86),

or psychosomatic symptoms, F(3, 149) = 0.13, p = 0.940,

ηp 2 = 0.003. With regard to positive coping strategies, the

academic degrees that the participants were pursuing had

Specifically, the observed difference was significantly greater

among students who were pursuing a master’s degree than among

those who were pursuing a bachelor’s degree (bachelor’s degree:

and subscales is reported in brackets.

FIGURE 3 | Distribution of the severity of depressive symptoms (BDI-II) (online

depressive symptoms, 14-19 (mild depressive symptoms), 20–28 (moderate

depressive symptoms), >29 (severe/major depressive symptoms).

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there was a decrease in self-reported depressive symptoms

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CONCLUSION AND FUTURE OUTLOOK DATA AVAILABILITY STATEMENT