Psychological, environmental and social factors which influence and impact upon health, fitness and wellbeing

Katharine Bradford

BA (Hons) Sport, Coaching and Physical Education

Abstract

It is well established that physical activity can play a major role in improving an individual’s health, fitness, and wellbeing. The aim of this report was to investigate the psychological, environmental, and social factors which influence the health, fitness and wellbeing of 18-year-old university student ‘Hannah’ (see demographic overview). The case study investigates different factors that may impact her health, fitness and wellbeing, whilst exploring how physical activity could improve these. Bioelectrical impedance analysis, the beep test and Beck’s depression inventory were used to assess Hannah’s health, fitness and wellbeing. The report highlights how and why psychological, environmental and social factors negatively impact Hannah’s life, whilst explaining the role that exercise can have in public health improvement. The report concludes that physical activity is valuable in improving measures of health, fitness, and wellbeing. Future research should continue to explore the benefits of physical activity, and the impact which psychological, environmental and social factors have upon health, fitness and wellbeing, helping to improve public health.

Demographic overview

Hannah is an 18-year-old female who was born and raised in Rotherham, South Yorkshire. She has recently moved to student accommodation to start her first year at Hull University studying Geography. She shares her student accommodation with 2 females and 2 males. Hannah has a family history of mental health issues, low income and unemployment. Hannah’s mother also passed away when she was 14 years old and has lived with her father since.

Psychological, environmental and social factors which influence and impact upon health, fitness and wellbeing

Psychological factors:

Depression

Depression is a common illness worldwide, with an estimated 3.8% of the population experiencing depression, including 5.0% of adults (World Health Organisation, 2021). The causes of depression are widely documented, and it has been found that the most consistently reported and influential predictors of depression are a major life event and a family history of depression (Monroe et al., 2014). In Hannah’s case, a major life event that she experienced was her mother passing away when she was 14 years old. Because of this, some of Hannah’s family members developed depression and Hannah’s adolescent years were greatly affected. Now Hannah has just started university, she is experiencing symptoms of depression herself. A study by Worsley et al. (2021) found that low feelings of belonging and being uncomfortable were related to a higher prevalence of anxiety, loneliness and depression in students living in university accommodation. Furthermore, bad relationships with accommodation peers and the avoidance of communal areas 23

were linked to higher levels of depression (Worsley et al., 2021). Hannah has spent most of her time in her room and isolates herself from her fellow residents. In terms of her wellbeing, she has lost motivation and is experiencing low self-esteem. She is also experiencing low energy levels and disturbed sleep. Due to these symptoms, Hannah is not taking part in any physical activity and her current diet is poor.

Stress

Stress is a further psychological factor that impacts an individual’s health, fitness and wellbeing. Stress has been defined as a state of anxiety which is produced when responsibilities and events exceed an individual’s coping capabilities (Seaward, 2017). Findings suggest that depression is cyclical in nature, and that depressive symptoms are intertwined with stress and negative thinking (Rubenstein et al., 2015). As Hannah has low motivation due to her depressive symptoms, she is struggling to complete university work, which in turn is leading her to feel stressed and overwhelmed. The effects of stress on an individual’s health can have a big impact. The raised levels of blood pressure and stress hormones, as well as the consistent surge in heart rate, can take a toll on the body and increase the risks of hypertension, strokes or heart attacks (American Psychological Association, 2018). In terms of fitness, stress can have a negative effect on physical activity levels. A study by Bray & Born (2004) found that the stress of transitioning from secondary school to university is predictive of a decline in exercise. This finding correlates to Hannah’s current situation, where the stress of moving away from home to new unfamiliar university accommodation may impact her motivation and willingness to partake in physical activity.

Environmental factors:

Local facilities

Lack of access to appropriate facilities has been linked to a decrease in physical activity levels among individuals (Sallis et al., 1990). Hannah’s university accommodation is located in an area that is isolated from university facilities, such as libraries and the student union, as well as public facilities like parks and gyms. Due to the distance, the ease of accessibility is low which negatively impacts Hannah’s motivation to visit places and engage in things. In terms of Hannah’s health, her diet has been poor since moving to university due to the local fast food and takeaway facilities available near her accommodation. A study by Li et al. (2009) highlighted that a large density of fast food outlets in an area was associated with unhealthy lifestyles and an increased risk of obesity. Because Hannah does not have the motivation to cook, she seeks easier alternatives and chooses to eat a high volume of fast food. Paired with minimal exercise, Hannah is at risk of weight gain and other health implications because of this. Furthermore, Hannah’s socialisation will also be affected by the lack of local facilities in her area due to the missed opportunities to meet new peers and friends at the student union or at gyms. This in turn affects her wellbeing as she will feel isolated from university events and lonely from lack of friends.

Living environments

Hannah’s living environments have also impacted her health, fitness and wellbeing. Her room in her accommodation is small, compact and has no windows. Existing literature has highlighted how lighting (natural or artificial) can be associated directly and indirectly with psychological, physical and physiological health outcomes (Codinhoto et al., 2009). Due to the lack of natural light, Hannah gets feelings of claustrophobia in her room as she is unable to view her surroundings outside of the accommodation, thus a feeling of detachment from everyday life occurs. Furthermore, whilst Hannah was living at home, the space in her living room meant that she could partake and enjoy at-home workouts. Now she is confined to her small room, this is not possible to do and so her fitness levels have dropped since moving.

Social factors:

Social interactions

Regular social interactions are beneficial for an individual’s mental health and wellbeing. Past studies have found that negative social interactions and relationships increase the risk of anxiety and depression (Teo et al., 2013). As Hannah has not had many social interactions since being at university, she is experiencing the negative effects this can bring on her wellbeing, such as feelings of loneliness and isolation. This can then evolve into mental health issues, which could be an explanation for Hannah’s symptoms of depression. In terms of fitness and exercise, a study by VanKim & Nelson (2013) found that the positive benefits of vigorous physical activity on mental health and fitness arises through a pathway of socialising. Similarly, Sallis et al. (2007) found that being involved with active people influenced physical activity among individuals. As Hannah has not been connected to anyone that is physically active thus far at university, she cannot benefit from the positives that this can bring in terms of her fitness.

Peers

The influence of peers can further impact one’s health, fitness and wellbeing. Peer pressure has been shown to be a key contributor to negative behaviours, such as serious offending and drug and alcohol use (Chassin et al., 2004). In terms of Hannah’s flat mates, they engage in heavy drinking and drug use and have often tried to peer pressure Hannah into taking drugs. This makes Hannah feel uncomfortable and therefore leads her to isolate herself from them. Hannah’s flat mates are also not very physically active, therefore the chances of gaining any fitness related benefits from her peers are reduced as she has no one to exercise with (Sallis et al., 2007).

Three techniques that could be used to assess Hannah’s health, fitness and wellbeing

Methods of testing an individual’s health, fitness and wellbeing

The three tests that were chosen to assess Hannah’s health, fitness and wellbeing were Bioelectrical Impedance Analysis (BIA), the beep test and Beck’s Depression Inventory (BDI-II). In terms of alternative testing methods, a Body Mass Index (BMI) calculation can be made to assess a person’s health by taking height (m) and weight (kg) and using the formula kg/m2 to work out ones BMI score (Weir & Jan, 2019). This score can then be compared to the BMI ranges to see which category a person is under in terms of being underweight, a healthy weight, overweight or obese. BMI is an inexpensive method that is easy to carry out (Hu, 2008), however, a limitation is that it does not take individual variations into account, such as high muscle mass in individuals. Therefore, BMI should not be the sole means of categorising a person as obese or underweight (Weir & Jan, 2019). For this reason, this method was not chosen to measure Hannah’s health. In terms of the alternatives for fitness testing, the Timed Up and Go Test (TUG) is a test of balance that is commonly used to examine functional mobility and probability for falls among older adults (Shumway-Cook et al., 2000). Because this test is mainly aimed at the older population, it would not be a beneficial test to assess Hannah’s fitness levels due to her being 18 years old. The Oxford Happiness Questionnaire (OHQ) was a test that was considered to assess Hannah’s wellbeing, as it is a useful tool to measure personal happiness (Medvedev et al., 2017). However, as Hannah seems to be experiencing symptoms of depression, it was concluded that the BDI-II questionnaire was more suited towards her current personal issues.

Health assessment – Bioelectrical Impedance Analysis (BIA)

A Bioelectrical Impedance Device (BID) was used to assess Hannah’s health by measuring her body fat percentage. BIA determines an individual’s body composition by using mild electrical currents that flow through the body and pass-through muscle and fat tissues. Due to their differing water content, the electrical current passes through the tissues at different speeds, thus the BID is able to calculate the impedance of the current and estimate body composition (Walter-Kroker et al., 2011). This method is widely used by researchers and clinicians to estimate body composition in adults and children; it is known to be safe and non-invasive for the individual (Kushner, 1992). The normative values for body fat percentage in women is shown in table 1.

From completing a BIA, Hannah’s body fat percentage was 28% which would put her in the acceptable category in terms of the body fat percentage norms for women. As Hannah is edging towards the obese category, it is vital that she acknowledges the health risks that a high body fat percentage can bring and how she can improve this. Implementing new lifestyle choices, such as physical activity and an improved diet, are steps she can take to minimise these risks. BIA was an appropriate testing method due to its simple, inexpensive and quick technique (Walter-Kroker et al., 2011), however when critiquing the method, Buckinx et al. (2015) found that the hydration status of the study subjects was a big factor when measuring body fat using BIA. If Hannah was dehydrated while analysis was being completed, this may have affected her percentage score and therefore reliability would have to be questioned.

Fitness assessment – Beep test

The test chosen to assess Hannah’s fitness levels was the beep test, which is a multi-stage fitness test used to examine cardiovascular fitness and maximum oxygen uptake (VO2 max) (Mullineaux, 2001). The test was created by Leger et al. (1988) which consists of 21 levels, and each level contains a different number of shuttles. The test involves running between two marked areas placed 20 meters apart, at an increasing pace as directed by the beeps. The test ends when the participators can no longer keep pace, or level 21 has been completed (Otieno & Mutwol, 2019). Table 2 shows the normative data for females completing the beep test.

Scores are represented using dot notation, e.g. a score of level 11, shuttle 8 would be represented as 11.8.

Hannah’s beep test score was 5.1 which suggests that her fitness levels are between poor and average when comparing it to the normative data. Poor fitness levels could have a negative effect on Hannah in terms of her physical and mental health, therefore it would be beneficial for her to partake in more exercise to improve her aerobic fitness. The beep test was an appropriate test to assess Hannah’s fitness levels due to the reliability it brings for measuring VO2 max (James et al., 2005), and the simple and cheap methodology means the data collection can be a smooth process (Tomkinson et al., 2017). However, a limitation of the beep test is the dependability on participant motivation levels (James et al., 2005). If Hannah was feeling down or unmotivated before and during the test, this could have affected her results as she would not feel driven to carry on and push herself to her maximum potential. To potentially resolve this issue for future beep tests, researchers could implement a pre-test questionnaire for each participant to complete, in order to assess their motivation and mood levels.

Wellbeing assessment – Beck Depression Inventory second edition (BDI-II)

BDI-II is a 21-item self-report questionnaire that is intended to assess the existence and severity of symptoms of depression, which is relevant to Hannah and her current mental health and wellbeing. The questions relate to symptoms of depression within the ‘past two weeks, including today’ and are rated from 0 to 3. The scores are then summed to create a total ranging from 0 to 63, with higher totals reflecting greater severity (Whisman & Richardson, 2015). Past research has shown that the measure is internally reliable and successfully distinguishes between depressed and nondepressed subjects (Dozois & Covin, 2004). Table 3 shows the depression severity which depends on the total score an individual gets on the BDI-II questionnaire.

From Hannah’s total score of 26, this would put her towards the higher end of the moderate scale in terms of her depression, which is having a big impact on her mental health and wellbeing.

Why exercise could play a key part in public health improvement and wellbeing

Exercise and public health overview

The benefits of exercise have been largely documented in the research literature. The vast number of physical, psychological and social advantages one can achieve by having a physically active lifestyle are well researched and acknowledged (Haskell et al., 2009). In the UK, people are 20% less active now compared to activity levels in the 1960s. If current trends continue, people will be 35% less active by 2030 (Chief Medical Officer, 2016). In the present day, there is a greater need to partake in additional exercise due to technological advances and societal changes. The increase in car usage is a leading factor for the decrease in physical activity levels in the UK; 69% of households did not own a car in 1961, but by 2012 this had decreased to 25% (Chief Medical Officer, 2016). The question should therefore remain on how to tackle low levels of physical activity, and to further reinstate and broadcast the benefits of exercise on public health and wellbeing

Mental health

In England, 1 in 4 people will experience a mental health problem each year (Mind, 2020). Research has repeatedly suggested that exercise can significantly improve mental health conditions such as depression, anxiety and stress (DiLorenzo et al., 1999; Paluska & Schwenk, 2000; Wipfli et al., 2011). In recent years, there has been a rise in the prescription of antidepressant medication, which has had a large impact on the increase in government health spending (López-Torres Hidalgo, 2019). Individuals on antidepressant medication may also experience negative side effects, therefore it is reasonable to assume that testing alternative methods, such as exercise, for the treatment of mental health issues is of great benefit for public health and expenditure. As Hannah scored moderately on the BDI-II, physical activity may act as a possible solution for improving her mental health. As research shows, important endorphins are secreted when exercising which aid the brain in reducing pain and causing euphoria (Dishman & O’Connor, 2009). This therefore helps to reduce an individual’s anxiety and depression levels. On the contrary, exercise may also have a negative impact on one’s mental health. For example, individuals may become overly obsessive or addicted to exercise. This can result in serious mental illnesses, such as body dysmorphia and eating disorders (Joy et al., 2016; Raglin, 1990). However, one could argue that most things come with differing amounts of risk, therefore it may be beneficial for Hannah to individually assess her susceptibility to the risks mentioned previously.

Physical health

Physical inactivity has been shown to increase an individual’s susceptibility to various diseases, such as: obesity; osteoporosis; cardiovascular disease; type 2 diabetes; respiratory disease; breast cancer; and colon cancer (Gaetano, 2016). Thus, it is important that regular physical activity is implemented in an individual’s daily routine to minimise these risks. Excessive body weight that leads to being overweight or obese in individuals has been shown to be linked with numerous health-related conditions, including cardiovascular disease, some forms of cancer, diabetes and musculoskeletal disorders (Jensen et al., 2014). The issue of obesity is a significant public health concern not only in the UK but around the world, thus, the question on how to tackle this matter has been greatly discussed. Physical activity has been proven to be an important lifestyle behaviour for healthy weight maintenance and influencing both the prevention and treatment of obesity and individuals who are overweight (Jakicic et al., 2018). In terms of Hannah and her current body composition, the BIA indicated that she was in the acceptable category in terms of her body fat percentage. Therefore, it would be beneficial for Hannah to participate in some form of moderate to vigorous exercise so she does not fall into the obese category and be open to the risks that are attributed to obesity. Regular exercise has also been linked to delaying the onset of dementia and Alzheimer disease. Larson et al. (2006) investigated this theory among 1740 participants who were older than 65 years old without cognitive impairment. The results from the study found a positive correlation between physical activity and delaying the onset of these disorders amongst elderly individuals, which further supports the value of exercise among the population. However, a limitation of this study were the self-report methods used. This could have caused recall bias among the participants where they may have exaggerated the activities carried out (Ainslie et al., 2003; Sallis & Saelens, 2000), thus potentially effecting the reliability of the results. On the other hand, the study has good supporting evidence from previous studies. Lindsay et al. (2002) also stated that regular physical activity was associated with a reduced risk of Alzheimer disease in a 5-year prospective cohort study. In terms of the biological reasoning behind these findings, the past studies have explained that regular exercise brings enhanced cerebral blood circulation and oxygen distribution to regions of the brain (Calcombe et al., 2004; Rogers et al., 1990), therefore conserving cognitive bases in later life. On the contrary, a study by Wang et al. (2002) completed a 6.4-year longitudinal study in a population of elderly individuals living in Stockholm, Sweden, and found no significant associations between exercise and risk of dementia.

Exercise and wellbeing overview

Physical activity has great potential to enhance an individual’s wellbeing. Research shows that involvement in regular exercise can help in improving self-esteem and reducing stress and anxiety (Salmon, 2001). It can also have a strong impact on mood, as studied by Kanning & Schlicht (2010), who found that participants had a heightened feeling of contentedness, awareness, and calmness after partaking in physical activity compared to when they were inactive. They also stated that the effect of exercise on mood was most impactful when mood was initially low.

Increased self-esteem

Self-esteem has been defined as an individual’s assessment of the self (Rosenberg, 1986). Self-esteem is particularly important for an individual to lead a successful and satisfying life, as well as constituting an essential aspect of psychological wellbeing (Rosenberg, 2015). In terms of physical activity and self-esteem, Sonstroem & Morgan (1989) outlined that exercising promotes self-esteem through physical acceptance, physical competence and perceptions of self-efficacy. Supporting this framework, physical activity has been linked with higher levels of self-esteem among middle-aged and healthy adults (Alfermann & Stoll, 2000). Moreover, two more studies have recognised substantial increases in self-esteem following completion of exercise training (Barton et al., 2012; Legrand, 2014). To critique the relationship between exercise and self-esteem, one could also argue that physical activity could have a negative impact on self-esteem. Some individuals may be susceptible to becoming dependent and obsessive with exercise and may get emotionally invested with personal goals. If these personal objectives are not met, it could have a negative impact on a person’s confidence and self-esteem (Hockin-Boyers & Warin, 2021). However, in terms of Hannah and her low self-esteem, the research provided indicates that the benefits outweigh the risks, and that Hannah may benefit from taking part in a form of physical activity in order to improve her personal self-esteem issues. In doing so, she may see changes to her confidence levels, which in turn could help with her feelings of isolation and loneliness by being more involved with university peers and opportunities.

Improved cognitive functions

An individual’s cognitive functions refers to multiple mental abilities such as: memory, problem solving, learning, decision making, reasoning, thinking, and attention (Fisher et al., 2019). Cognitive functions serve as an important role in everyday behaviours and social settings, such as remembering faces and voices (Nouchi & Kawashima, 2014). There have been many studies which have researched the relationship between physical exercise and cognitive functions. These studies show similar findings that demonstrate exercise affecting brain plasticity and influencing cognition and wellbeing (Weinberg & Gould, 2019). Both clinical and experimental studies have reported that physical activity encourages structural and functional changes in the brain, leading to both biological and psychological benefits (Mandolesi et al., 2018).

Increased social interactions

Physical activity has also been shown to increase social interactions. Existing literature highlights the relevance exercise has in forming social relations and encouraging prosocial behaviours (Di Bartolomeo & Papa, 2019). A study by Pawlowski et al. (2018) suggests that partaking in a sports group has a positive impact on individual health and prosocial attitudes. Furthermore, Walseth (2006) found that being involved in team sports and having face-to-face contact among fellow members created feelings of belonging and a strong sense of involvement within the community. As a result, the evolution of support between members not only inside but outside the sports context was created. Forming these social relationships can in turn help to increase individual physical activity levels. Resnick et al. (2002) found that support given by friends was statistically significant in influencing exercise indirectly. Further findings have similarly been reported with self-efficacy expectations acting as a link between social support and physical activity participation (Duncan & McAuley, 1993; O’Brien-Cousins, 1996). The behaviours that are frequently exhibited as social support (emotional, appraisal, informational or instrumental), as found by Berkman (1995), are compatible with self-efficacy expectations that were theorised by Bandura (1997). Explicitly, verbal encouragement by friends in an exercise setting may strengthen self-efficacy expectations and said friends could serve as role models to individuals to help increase participation in physical activity. To compare this to Hannah, social interaction could play a key role in improving her mental and physical health. Supportive peers would help Hannah feel less isolated and increase her involvement in university. She would also have people that she could exercise with, which diminishes her worry of walking/running alone.

Conclusion

The report has evidenced the value that exercise can have on individuals. The plethora of past literature identifying the effectiveness of physical activity on health, fitness and wellbeing has hoped to have been highlighted in the present report to further push the narrative of exercise benefits. Future research should continue to identify and study the positives of physical activity, and further investigate the psychological, environmental and social influences that impact health, fitness and wellbeing to help improve activity levels in the population.

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