key: cord-0834939-j4glqbta
authors: Abrantes, Lívia Carvalho Sette; de Souza de Morais, Núbia; Gonçalves, Vivian Siqueira Santos; Ribeiro, Sarah Aparecida Vieira; de Oliveira Sediyama, Catarina Maria Nogueira; do Carmo Castro Franceschini, Sylvia; dos Santos Amorim, Paulo Roberto; Priore, Silvia Eloiza
title: Physical activity and quality of life among college students without comorbidities for cardiometabolic diseases: systematic review and meta-analysis
date: 2021-11-20
journal: Qual Life Res
DOI: 10.1007/s11136-021-03035-5
sha: d66bb2872eedafb0d83f909e28070ad50b87ccb9
doc_id: 834939
cord_uid: j4glqbta

PURPOSE: To systematically review studies on the relationship between physical activity (PA) and quality of life (QOL) in university students without comorbidities for cardiometabolic diseases from around the world. METHODS: We included observational studies with university students of both sexes, from public or private institutions, and that investigated the association or correlation between physical activity and quality of life among these students, without delimitation of date, language, or location. Reviews, letters to the editors, studies with qualitative methodologies, case studies, book chapters, articles with college students who had some specific disease or condition, such as obesity, diabetes, and others; studies with children of parents with chronic diseases, and those that were institutions aimed only at very specific populations, were excluded. Meta-analysis was calculated. RESULTS: Thirty studies, consisting of 19,731 students, were included. The most commonly used instruments to assess the quality of life of the university population were the Quality of Life Questionnaire—short version (WHOQOL-BREF), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The International Physical Activity Questionnaire (IPAQ) was the most commonly used instrument to assess PA. For the meta-analysis, 22 studies were included. Weak but positive correlations were found between PA and the QOL domains: physical health (0.16. 95% CI 0.11 0.22; I(2) = 99.96%); mental health (0.14; 95% CI 0.07–0.20; I(2) = 99.97%); social relations (0.24, 95% CI 0.08–0. 38; I(2) = 99.99%); environment (0.23, 95% CI 0.14–0.32; I(2) = 99.90%); vitality (0.17. 95% CI 0.15–0.20; I(2) = 99.49%) pain (0.02. 95% CI − 0.02 to 0.12; I(2) = 99.96%); QOL and PA (0.21, 95% CI 0.08–0.34; I(2) = 99.99%).An association of R = 0.60 (95% CI 0.25–0.95; I(2) = 85.61%) was found between QOL and PA in total. CONCLUSION: The results of our study showed a weak but positive relationship between physical activity and overall quality of life in college students, and also between PA and the domains of QL: physical health, social relationships, mental health, environment, and vitality, in this same population. It is important to study this population, since risk behaviors in this phase tend to perpetuate in the other phases of life.

Physical inactivity is a public health problem worldwide. It is estimated that in 2017, 31.1% of the world adult population was below the American College of Sports Medicine recommendations (150 min of moderate physical activity (PA)/week or 75 min of vigorous PA/week) for PA practice [1] [2] [3] . According to the World Health Organization, sedentary lifestyles favor the onset of non-communicable diseases and injuries (NCDs) and are one of the factors responsible for most deaths caused by these diseases [4] .

In addition, the literature shows that PA practice is related to improved health, well-being, an improved biochemical profile, as well as positively influencing mood and anxiety. PA contributes to reducing the risk of NCDs and improving quality of life (QoL) [1, [5] [6] [7] .

A longitudinal study conducted from 1997 to 2014 with a representative sample of US adults showed that individuals who engaged in at least 150 min of moderate-intensity aerobic PA, 75 min of vigorous-intensity aerobic PA per week, or a combination of the two, with moderate muscle strengthening activities twice a week or more, had a lower risk of all-cause mortality compared to those who did not exercise regularly [8] . Kallio et al. (2020) [9] observed that during two years of follow-up at school, students showed a reduction in daily PA time, with a consequent increase in sedentary time. These results demonstrate that with an increase in time spent studying as individuals age, there is a reduction in time allocated to PA.

It is important to consider that academic life brings great challenges and difficulties. It is a period when most students move to another city or even state, often leaving their parents' home for the first time and becoming responsible for themselves. Still, with the increased time spent on studies and extracurricular activities at university, leisure time is restricted, which leads to the interruption or reduction of PA practice upon entering higher education [10, 11] . Corroborating this information, a survey conducted in 23 countries showed that the prevalence of physically inactive university students ranged from 21.9 to 80.6% [12] [13] [14] .

It is noteworthy that increased physical inactivity coincides with higher rates of obesity, increasing the risk of health problems, and reducing the QoL of individuals [15] . QoL can be assessed by different domains: physical; mental; environmental; social relationships; access to food, health and education; pain; housing; commuting; in addition to financial issues [16] . It can be affected by various factors, such as the individual's routine and the stages they are in. Therefore, higher education and all the changes arising from it can influence the QoL of college students [17] [18] [19] . Encouraging PA should be one of the world's public policy priorities, especially in middle-income countries. Its practice is beneficial at any age, but it is important to pay attention to some population groups, such as these students, due to the challenges they face during this period of life. Moreover, the behaviors adopted and consolidated during this period tend to remain in during the other stages of life, influencing future health [15, 20] .

Given the above, it is important to better understand PA as a factor influencing the QoL of college students around the world. After searching the literature, no studies were found to provide a comprehensive overview of this relationship, thus a systematic review with meta-analysis on this subject may help fill this gap. Given this context, our aim was to systematically review studies on the relationship between physical activity (PA) and quality of life (QOL) in university students without comorbidities for cardiometabolic diseases from around the world.

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist [21] . This review was registered in the International Prospective Registry of Systematic Reviews (PROS-PERO): Number CRD42020197289.

Studies with university students of both sexes were included; of any educational institution, whether public or private. Studies that investigated the correlation or association between levels of physical activity and quality of life in general or between domains of it, published on any dates, languages, or locations.

Review articles, letters to the editors, studies with qualitative methodologies, case studies, book chapters, articles with university students who had some specific disease or condition, such as obesity, diabetes, among others; studies with children of parents with chronic diseases, and those directed only to very specific populations were excluded.

The search strategy was developed based on the list of recommendations from the Peer Review of Electronic Search Strategies (PRESS) [22] and later sent for review to two researchers with experience in Systematic Reviews.

To search for the studies, the following databases were used: MEDLINE, LILACS, Embase, Scopus, Web of Science, Google Scholar and ProQuest Dissertation & Theses Global.

The search strategy used for MEDLINE was as follows: ( (Observational OR "Observational Study" OR Survey OR "Cross-sectional" OR Cohort OR "Case-control" OR Intervention OR "Intervention study" OR "Clinical Trial" OR "Clinical study" OR "Randomized controlled trial" OR RCT OR Association OR Relationship OR Correlation). For the other six databases, the search strategy was adapted according to their peculiarities (Appendix 1).

The searches started and ended in August 2020. In addition, the references of the included articles were inspected in order to identify qualified articles for review.

The selection of studies was performed in two stages, by two researchers independently (LCSA and NSM). In the first stage, articles were selected by title and abstract. Always following the eligibility criteria. In the second, the selected ones were read in full and selected. Then, the two researchers met to resolve any disagreements about the selection. In addition, a search was performed in the reference lists of selected articles. The participation of a third researcher was not necessary, as all discrepancies between the two main ones were resolved. When there was an absence of information in the articles, the authors were contacted at least twice in order to obtain this data.

Subsequently, the characteristics of the studies were organized into three tables containing information as follows: Author and year; study country; sample (n sample, sex and age); study design, aim of the study; instruments for assessing physical activity and quality of life and their respective final or domain scores; statistical test used, adjustment variables, main results, and finally the following question: "Is physical activity related to quality of life?".

The critical tool recommended by the Joanna Briggs Institute for adapted cross-sectional studies was used to assess the risk of bias [23] .

The tool consists of eight questions: "Inclusion criteria clearly defined in the sample"; "Subjects of study and environment described in detail"; "Exposure measured in a valid and reliable way"; "Clearly defined objectives and inclusion and exclusion criteria"; "Confounding factors identified"; "Strategies for dealing with confounding factors"; "Results measured in a valid and reliable way"; "Adequate statistical analysis" [23] .

The questions were answered as "yes", "no", "unclear", or "not applicable". If all answers are "yes", in all items, the risk of bias will be low and if any item is classified as "no", a high risk of bias will be expected [23] . The evaluation of risk of bias was not used as eligibility criteria for inclusion of articles.

When quantitative data were available, meta-analyses were performed to: (1) verify the correlation between the scores of the instruments for assessing QOL (and its components) and the practice of PA (Always having analyzed the highest level of physical activity practice, when this data was available in the original articles); and (2) estimate the magnitude of the association between the scores of the instruments for assessing QOL and the practice of PA.

Random models were used for meta-analysis, with effect estimation using the Maximum Likelihood method (Maximum-likelihood). The meta-analysis random effects assumes that different studies estimate different intervention effects, although related [24, 25] , which agrees with our data.

In the case of studies where the measure of effect was the correlation, the authors did not present the error estimates (Standard Error, Standard Deviation, Confidence Interval, or Variance) necessary for their performance. Thus, we proceeded to obtain the correlation coefficient (r) transformed to the z-value [26] , where: Z = 0.5 * ln ((1 + r) / (1-r)).

(ln: natural log; r: correlation coefficient). The z-value was used because it presents a normal approximate distribution and its variance can be estimated by the formula (ref): Variance = 1 / (n-3) (n = number of participants for each article).

After summarizing the results and calculating the respective Confidence Intervals (95% CI), the measurements were again transformed into a correlation coefficient for better interpretation of the results and presented using Forest Graphics.

For studies that investigated the association between exposures and outcomes of interest through regression analysis, the summary measure was presented using the β coefficient, accompanied by the respective 95% CI.

The heterogeneity of treatment effects between studies was tested using the Chi-square method (p < 0.10) [27] and its magnitude using I 2 . Due to the reduced number of studies included in the meta-analysis, it was not possible to perform meta-regression and analysis of publication bias, according to the recommendation of protocols by Cochrane [25] . All tests were performed using the Stata Software, version 16, serial number 301606311865, using the "meta" command. Figure 1 shows the steps for selecting articles and those included in the review. Appendix 2 shows the excluded articles and the reason for the exclusion of each one [3, 5, .

There was no response from the contacted authors to obtain missing data. Table 1 shows the general characteristics of the studies. After the analysis, 30 articles were included, all with cross-sectional design. With individuals of both sexes and published in the years 2011 to 2020.

The studies were developed in several countries around the world: Brazil [7, 70, 71] ; the USA [14, [72] [73] [74] [75] [76] [77] ]; Turkey [78] [79] [80] [81] ; Korea [82, 83] ; China [13, 84] ; Croatia [85, 86] ; Taiwan [12] ; Pakistan [87] ; South Africa [88] ; Colombia [89] ; Italy [90] ; Venezuela [91] ; Poland [92] ; Serbia [93] ; Iran [94] ; and Vietnam [95] . The total sample was 19,731 individuals. The general objective of each study and other characteristics are shown in Table 1 .

The risk of bias assessment was carried out by two researchers (LCSA e NSM), independently and at the end of it, both met to agree to resolve the differences, without the need for the participation of a third researcher (Appendix 3).

Of the 8 parameters evaluated in the 30 selected studies, four had only "yes" answers: Exposure measured in a valid and reliable way; Objective criteria and standard for measurement; Results measured in a valid and reliable way; Appropriate statistical analysis. Among the studies, seven [13, 14, 74, 75, 77, 81, 85] met all the parameters evaluated ( Fig. 2) . Tables 2 and 3 show the results of the relationship between physical activity and quality of life in university students, showing the various instruments used to evaluate the variables of interest, types of statistical tests used; the adjustment variables and the main outcomes found.

Among the selected studies, the most used instruments to assess the quality of life of the university population were the Quality of Life Questionnaire-short version (WHOQOL-BREF), used by nine studies [70, 71, 78, 79, [81] [82] [83] [84] 95] and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), also used by nine articles [12, 75, 80, 85, 87, 90, 91, 93] .

The International Physical Activity Questionnaire (IPAQ) was the most used instrument to assess physical activity among university students. It was used by 14 of the 30 studies evaluated [13, 70, 73, 76, 78-80, 83, 85-87, 89, 90, 92] . The other instruments used to assess quality of life (QOL) and physical activity (PA) and the score obtained in each one are presented in more detail in Table 2 . Table 3 shows the type of statistical test used (association or correlation), in addition to the adjustment variables. As Snedden et al. [14] Association Sex, Year in school;

Significant differences in the MCS were observed between the levels of sport and PA; but not on the PCS. After controlling for the sex variable, a positive relationship was found between the increase in sport and the level of PA HRQoL. Mastery-approach, masteryavoidance, performance-approach, and performance-avoidance goal orientations were all positively related to one another with no to moderate correlation coefficients. PA had low positive correlations with the mastery approach and performance-approach goal orientations but no correlations with the mastery-avoidance and performanceavoidance goal orientations. HRQoL had low negative correlations with the mastery-avoidance and performance avoidance goal orientations but had a low positive relation with the mastery approach goal orientation and physical activity YES. (General QoL; mastery approach; performance-approach goal orientations.)

Zhang et al. [76] Association Enjoyment; barrier self-efficacy; family support; friend support; crime safety The pleasure of physical activity was positively related to barrier self-efficacy, social support from family and friends, physical activity, physical and psychosocial functioning of HRQoL well as the main results, and the answers to the question "IS PA PRACTICE RELATED TO THE BEST QOL?". In all studies, the practice of physical activity by university students was related to the improvement of their quality of life, in at least one assessed domain. Chang and collaborators (2016) [12] found in their results that a higher frequency of physical exercises correlated with higher Mental Component Summary (MCS) scores.

GE and collaborators (2019) [13] and SNEDDEN and collaborators (2019) [14] , also found positive results between physical activity and Physical Component Summary (PCS) and Mental Component Summary (MCS). Their results found that a higher score for PCS and MCS indicated a better Health Related Quality of Life (HRQOL) and a positive relationship between increased sport and PA level and greater MCS, respectively. The other results are presented in more detail in Table 2 .

The analyzed data were divided into subgroups, according to the common outcomes of the selected articles. They were separated into seven subgroups according to quality of life: Physical Health; Mental health; Social relationships; Environment; Vitality; Pain; General (AF vs QV).

A meta-analysis was performed for each item of quality of life mentioned above. Due to the lack of data in the articles, 22 were included. Weak but significant correlations were found.

The correlation between physical activity and the physical health domain was 0.16 (95% CI: 0.11 0.22; I 2 = 99.96%) (Fig. 3) ; between physical activity and mental health was 0.14 (95% CI: 0.07-0.20; I 2 = 99.97%) (Fig. 4) ; physical activity and social relations: 0.24 (95% CI 0.08-0.38; I 2 = 99.99%) (Fig. 5) ; physical activity and the environmental domain: 0.23 (95% CI 0.14-0.32; I 2 = 99.90%) (Fig.  6) ; physical activity and vitality: 0.17 (95% CI 0.15-0.20; I 2 = 99.49%) (Fig. 7) physical activity and pain: 0.02 (95% CI − 0.02 to 0.12; I 2 = 99.96%) (Fig. 8) and correlation between physical activity and overall quality of life: 0.21 (95% CI 0.08-0.34; I 2 = 99.99%) (Fig. 9 ). An association of β = 0.60 (95% CI 0.25-0.95; I 2 = 85.61%) was found between physical activity and general quality of life (Fig. 10 ).

This review assessed the relationship between physical activity and quality of life in college students. Our overall results showed weak but positive relationships and associations between PA practice on QoL of these students in several countries around the world. These results underline the importance of encouraging physical activity through policies and actions targeting this audience, and also encouraging the use of universities/faculties themselves, as many of these institutions have adequate physical space and trained professionals or academics for this type of activity [96] [97] [98] .

The results of the individual studies showed that students with better levels of PA had better HRQOL scores. The benefits of PA are well known and can directly affect QoL: it helps in the prevention and treatment of chronic diseases; it positively influences sleep quality, physical and mental health, stress and anxiety; it favors social relationships; it helps motor balance; among many others [10, 99] . These findings are in agreement with other previous systematic reviews that have also evaluated the relationship between PA and QL in adults in general [100, 101] ; children and adolescents [102] and the elderly [103] , showing the positive influence of this relationship and other populations.

Our meta-analysis revealed significant associations between PA and global QoL. And significant correlations between PA and global QoL, and PA and the domains: physical, mental, social relations, environment, vitality in higher education students. High heterogeneity was found in all analyses, which may be due to methodological causes, since the analyses were composed entirely of cross-sectional studies, where these methodological differences are expected, since the study includes articles developed in several countries around the world, since each population has its own characteristics and peculiarities [104, 105] .

We found positive correlations between PA and mental health: 0.24 (95% CI 0.08-0.38; I 2 = 99.99%. In this sense, Román-Mata et al. [99] evaluated 1095 university students from Andalusia and Melilla. In this study, the authors observed that the total resilience score was lower in those who reported being physically inactive (x − = 3.58 ± 0.752) compared to those who practiced physical activity (x − = 3.92 ± 0.706) (p < 0.05). Still, when considering psychological distress, the authors found that, similarly, the lowest values of psychological distress were presented by those who practice physical activity (x − = 2.14 ± 0.672), compared to those who did not perform any activity (x − = 2.53 ± 0.702).

In this perspective, Chow and Choi [106] carried out a study with 416 university students from Hong Kong and found that there was a positive correlation between physical activity and mental health (r = 0.258; p < 0.01). Furthermore, the results showed that the physical activity score was one of the predictors of a positive mental health status (β = 0.032; 95% CI 0.016-0.048; p < 0.001). These findings emphasize the importance of an active life during all stages, but especially, during higher education, where these individuals undergo significant changes in their lives. Evidence points out that regular physical activity brings benefits for functioning and physical fitness, is able to reduce stress, positively influence self-esteem and cognitive functioning, which are essential elements for good mental health [107, 108] . Wu et al. (2015) [109] found that, among 4747 Chinese university students, high screen time (> 2 h/day) was positively correlated with anxiety, depression, psychopathological symptoms, and poor sleep quality. In addition, there were progressive increases in protective effects against depression, psychopathological symptoms, and poor sleep quality with increasing levels of physical activity. In addition, the authors found that participants with high PA and low screen time had the lowest risk of psychopathological symptoms (OR = 0.46, 95% CI 0.32-0.67) and poor sleep quality compared to the other groups (OR = 0.50, 95% CI 0.30-0.82).

Similarly, another study conducted with 617 Indian university students showed that the participants' physical activity levels (moderate and high) were inversely associated with anxiety scores (OR = 0.16 and 0.96; p = 0.001) and of depression (OR = 0.11 and 0.96; p = 0.001). Also, poor sleep quality was positively associated with anxiety (OR = 1.38) and depression OR = 1.58 (p = 0.001) [110] . These results suggest that greater sedentary behavior, represented by screen time, and lower PA level are related to the development of anxiety, depression, psychopathological symptoms, and poorer sleep quality. These are factors that can influence the quality of life of individuals.

In our results, positive correlations were also found between PA and vitality (0.17. 95% CI 0.15-0.20; I 2 = 99.49%). Vitality is one of the domains of QL, it is used in determining Mental Component Summary (MCS) and Physical Component Summary (PCS) scores [111] . Corroborating our results, even though with another population, Puetz (2006) [112] , conducted a literature review, where he searched for epidemiological studies that examined the association between PA and feelings of energy and fatigue in individuals with a mean age of 49.4 ± 10 years; and in his results he found that higher risks of low vitality were associated with less active lifestyles.

It is important to consider that with the COVID-19 pandemic, caused by (SARS)-CoV-2, it caused negative effects in the general population worldwide. Recent studies show that physical activity can help improve and maintain the mental health of individuals, even in periods of social isolation. Ozdemir et al. (2020) [113] carried out a study eight High PA X QoL selfassessment-general total weeks after the announcement of the first case in Turkey in which they evaluated 2301 adults aged 20 to 75. The authors found that only 6.9% of the sample were physically active, there was a positive relationship between physical activity levels and quality of life, while there was a negative relationship between levels of physical activity, depression, and anxiety (p < 0.05). Also, when physically active and inactive participants were compared, a difference was observed for the variables of general health status and physical and psychological health status (p < 0.05).

Another study carried out with 645 Chinese adults showed that there was a reduction in the practice of PA during the pandemic, whereas before, 49.3% performed some PA from 2 to 4 times a week and 26.1% more than five times a week. However, 64.8% of participants engaged in little physical activity (i.e., less than 600 MET-min/week) during the COVID-19 pandemic. Only 18.0% and 17.2%, respectively, of the participants practiced moderate and high levels of physical activity. Furthermore, the results indicated that there was an increase in the average time of sedentary lifestyle from the pre-COVID-19 period (M = 5.4, SD = 2.9) to the COVID-19 pandemic period (M = 5.8, SD = 4.6), (t(644) = − 2.6, p < 0.05). In addition, there was a reduction in the scores for the physical and mental components related to quality of life (75.3; SD = 16.6 and 66.6; SD = 19.3, respectively). Finally, more than half of participants (53.6%) reported moderate levels of perceived stress during the COVID-19 pandemic [114] .

Considering the university population, the suspension of in-person classes, the longer time at home and the need to adapt to a new model of remote classes may have contributed to the worsening of these individuals' mental health. In addition, social isolation and the closing of gyms may have influenced this population to reduce or discontinue physical activity. In this sense, Gallo et al. (2020) [114] compared the practice of physical activity among university students in Australia and found that there was a reduction in the time spent walking between men and women from 2018/2019 to 2020 (p < 0.05). Also, fewer participants reached "sufficient" levels of activity in 2020, compared to 2018/2019 (p < 0.05). These results may highlight the importance of public health strategies designed to encourage the adoption of healthy lifestyle habits in order to improve and maintain health and quality of life at the population level.

It should also be noted that systematic reviews are high quality sources of information; they provide a relevant synthesis of results, covering as many articles as possible to answer the research question. Their sample includes a significant number of people; in a diverse way; bringing representativeness to the population studied. In addition, the cost of its development is low; most often it requires as work the authors' research and writing time, without any additional cost, as with original articles. It is a very useful tool for evidence-based clinical practice, and can be used as a source of research for the development and evaluation of policies, actions and programs in the management of municipalities, states or countries [113, 114] .

One of the limitations of this study was the heterogeneity of the methodologies used in the articles, which were all cross-sectional, making it difficult to carry out other complementary statistical analysis. In addition, many times they were not taken by the authors as being marked as an error (Standard Error, Standard Deviation, Confidence Interval or Variance), and it was also required to perform meta-analyses. As these are only cross-sectional studies, it is not possible to state that physical activity improves quality of life, and further studies are needed, especially of the longitudinal type that allow this monitoring.

Another limitation is due to the fact that studies may have been included or excluded due to the way the instrument was described by the authors of the original articles and, therefore, they were selected according to the terms used in the search strategy of this review. Some examples are original articles that used instruments such as "Satisfaction with Life Scale" or similar and were included even though satisfaction with life was not a search term. As occurred with others who used the SF-36, and do not refer to it as "Quality of life", but rather as health status or similar expressions.

This systematic review was carried out using the most current recommended methods for this type of study. It followed PRISMA [21] , and was registered with PROSPERO. In addition, the PRESS [22] checklist was also used. The selection of the studies took place independently and several databases were used in order to achieve a large number of studies. Grey literature was also consulted. When necessary, the authors were contacted in order to obtain answers regarding the articles. There were no studies similar to this one, of systematic review and meta-analysis found in the literature.

The results of our study showed weak but positive relationships between physical activity and overall quality of life of college students and also between PA and the domains of QoL: physical health, social relationships, mental health, environment and vitality, in this same population. These may alert to the need to increasingly study this population, as they undergo intense changes and behaviors that tend to perpetuate into other life stages, and may also highlight the

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Health behaviors, self-rated health, and quality of life: A study among first-year Swedish University Students

Associations between healthy lifestyle behaviors and academic performance in U.S. undergraduates: a secondary analysis of the American College Health Association's National College Health Assessment II

Assessment of health-promoting lifestyle profile in Japanese university students

Are effects from a brief multiple behavior intervention for college

Investigation of physical activity levels of undergraduate students

Physical activity as a factor to improve the quality of student life

The relationship between physical aspects of quality of life and extreme levels of regular physical activity in adults

Leisure time physical activity and quality of life in medical students: results from a multicenter study

Ecological Analysis of Physical Activity and Health-related Quality of Life in Female College Students., thesis

The Relationship Between Health-Related Quality Of Life

Physical activity and quality of life among university students: Exploring self-efficacy, self-esteem, and affect as potential mediators

The Effect of Physical Activity on The Health-Related Quality of Life of College Students. Dissertation

College students' physical activity and health-related quality of life: An achievement goal perspective

Ecological analysis of college women's physical activity and health-related quality of life

Quality of life and physical activity among university students

Physical activity level and quality of life of university students

Relationship between physical activity, functional capacity, quality of life and sleep quality in healthy subjects

The participation of university students in physical activities based on sport and the effect of the students'quality of life on academic achievement and socialisation

Relationships between physical activity, health status and quality of life of university students

Associations between physical activity, stress, interpersonal relationship and quality of life in university students

Health promoting lifestyle and quality of life among Chinese nursing students. Primary Health Care

Physical activity, health-related quality of life and musculoskeletal pain among students of physiotherapy and social sciences in Eastern Croatia-cross-sectional survey

Domain-specific physical activity and health-related quality of life in university students

Interaction of physical activity, mental health and quality of life: A study on university students in Pakistan

Physical activity and psychosomatic related health problems as correlates of quality of life among university students

Factores Asociados/Quality of life In college students evaluation of associated factors

Physical activity levels and health-related quality of life in young Italian population

Preliminary results quality of life, physical activity, and sedentary behavior in college students

Physical activity, sedentary behavior, and quality of life among university students

Factors associated with healthrelated quality of life among Belgrade University students

Lifestyle, quality of life and physical activity barriers among female students of Kerman University of

Effect of sociodemographic factors on quality of life of medical students in southern Vietnam: A survey using the WHOQOL-BREF assessment

Níveis de atividade física e estágios de mudança de comportamento de universitários da área de saúde. Revista Brasileira de Atividade Física & Saúde

A universidade promotora de saúde e as mudanças na formação profissional

Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: A systematic review and meta-analysis

Benefits of physical activity and its associations with resilience, emotional intelligence, and psychological distress in University Students from Southern Spain

Physical activity level and health-related quality of life in the general adult population: a systematic review

Association between physical activity and quality of life in adults

The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review

Como avaliar criticamente revisões sistemáticas e metanálises? Revista Brasileira de Terapia Intensiva

Metanálise: Um Guia Prático

Assessing the mental health, physical activity levels, and resilience of today's junior college students in self-financing institutions. International Journal of Environmental Research and Public Health

Resilience to suicide ideation: A cross-cultural test of the buffering hipótese

Os efeitos da atividade física e aptidão física no desempenho das crianças e resultados cognitivos: Uma meta-análise

Low physical activity and high screen time can increase the risks of mental health problems and poor sleep quality among Chinese college students

Physical activity and sleep quality in relation to mental health among college students

Associações entre Aptidão Cardiorrespiratória e Qualidade de Vida Relacionada à Saúde

Physical activity and feelings of energy and fatigue: Epidemiological evidence

The role of physical activity on mental health and quality of life during COVID-19 outbreak: A crosssectional study

Physical activity, health-related quality of life, and stress among the chinese adult population during the COVID-19 pandemic

The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian University Students

Lívia Carvalho Sette Abrantes 1,2 · Núbia de Souza