Relationship Between Self‐Esteem and Physical Activity in University Students. Gender Differences: Cross‐Sectional Study

Abstract

ABSTRACT

Background

The university period generally involves dropping out of sporting activities and higher levels of stress. However, studies addressing the consequences of these changes in the self‐esteem of university students are very scarce.

Aim

To determine the relationship between physical activity (PA), sedentary lifestyle and self‐esteem levels in university students, and to analyse the differences according to gender.

Design

Cross‐sectional online survey of 314 spanish university students.

Methods

Global self‐esteem was assessed with the Rosenberg self‐esteem scale. PA was measured using the short version of the International Physical Activity Questionnaire (IPAQ‐SF). An analysis of variance (ANOVA) model was used to evaluate differences between total self‐esteem values by PA categories (low‐moderate‐high). Pearson's correlation was used to analyse the association of global self‐esteem with the level of total PA and with a sedentary lifestyle.

Results

Physical activity, sedentary behaviour, and self‐esteem scores were higher in men than in women. High levels of PA were positively correlated to self‐esteem in the total sample; and sedentary behaviour was inversely correlated to self‐esteem in the total sample and women. The differences between men and women in self‐esteem were not significant in participants that engaged in vigorous PA.

Conclusions

Engaging in PA was related to better self‐esteem. A sedentary lifestyle had a greater impact on women's self‐esteem. When women engage in vigorous physical activity, their self‐esteem equals that of men. These findings could serve as a basis for developing strategies to promote mental health through physical activity.

Implications for the Profession and/or Patient Care

Our findings could help Mental Health Nurses, Community Health Nurses and university policymakers take steps to promote physical activity, with a gender perspective, within university curriculum enhancement strategies, with the goal of improving self‐esteem and mental health in young people during a critical period of transition to adulthood.

Impact (Addressing)

What problem did the study address?

This study addressed the relationship between the self‐esteem of university students and their physical activity levels, emphasising the role of sedentary behaviour and gender differences.

What were the main findings?

The practice of PA was associated with higher self‐esteem. The differences in self‐esteem between men and women were not significant among those who participated in vigorous physical activity. Additionally, a sedentary lifestyle had a greater negative impact on women's self‐esteem.

Where and on whom will the research have an impact?

The implementation of physical activity programs in the university setting is a key factor in improving students' self‐esteem. These programs should be designed from a gender perspective to better address students' specific needs.

Additionally, nurses, particularly those working in mental health and community health, play a critical role in promoting physical activity as a preventive and therapeutic strategy for mental health issues. Integrating physical activity recommendations into routine health assessments and university‐based interventions could facilitate the early identification of students at risk of low self‐esteem and associated mental health challenges.

From a nursing perspective, structured exercise programmes, active breaks during classes and active learning methodologies that incorporate physical movement with academic content could contribute to creating a healthier university environment and improving students' psychological well‐being.

Reporting Method

This study adhered to the reporting guidelines for observational studies according to the STROBE (Reporting of Observational Studies in Epidemiology) statement.

Patient or Public Contribution

No patient or public contribution.

Abbreviations

• IPAQ-SF
• International Physical Activity Questionnaire—Short Form
• METs
• Metabolic Equivalent of Task
• PA
• physical activity
• WHO
• World Health Organisation

Introduction

Self-esteem has been described as the degree to which individuals have positive feelings about themselves (Sonstroem and Morgan 1989). It reflects a person's evaluation of their self-worth and is closely related to how we relate to others and to the triumphs or successes we achieve in life (Liu et al. 2015). It is considered the evaluative component of self-concept (Sonstroem and Morgan 1989), which is understood as a person's perception of themselves in multiple aspects (Marsh and Shavelson 2010), as well as a cognitive variable highly relevant to psychological well-being (Rosenberg 1965).

The transition to university represents a critical period in young adults' development, characterised by significant lifestyle changes, increased stress levels (Acharya Pandey and Chalise 2015), and potential reductions in physical activity (Cocca et al. 2014). Mental health concerns among university students are growing, with low self-esteem recognised as a risk factor for anxiety, depression and decreased academic performance (Yang et al. 2023). While existing literature has established the relationship between physical activity and self-esteem in adolescents, there is a gap in understanding how this relationship manifests in university students and whether gender differences exist.

Background

High levels of self-esteem in young people have been related to better physical and mental health (Pazzaglia et al. 2020), including increased life satisfaction and improved health perception (Arsandaux et al. 2021). Conversely, low self-esteem predisposes one to the onset of depression, anxiety, suicidal ideation and eating problems (Lee and Hankin 2009; Mcgee and Williams 2000), and has been shown to be a cause rather than a consequence of several important life outcomes (Orth et al. 2012), making it a critical focus for health professionals.

In this context, the regular practice of physical activity (PA) has been shown to provide multiple benefits for physical and mental health in adolescents and young adults, positively affecting aspects such as well-being and quality of life (Hale et al. 2023; Marquez et al. 2020) or mental health (Pearce et al. 2022; Sampasa-Kanyinga et al. 2020).

Likewise, PA has been related to higher self-esteem in children and adolescents (Ekeland et al. 2005; Liu et al. 2015; Zamani Sani et al. 2016). In adults, participation in PA produces small significant improvements in global self-esteem (Spence et al. 2005), with larger effect sizes observed for those who experience significant changes in physical fitness and those who participate in exercise or healthy lifestyle programs. On the other hand, a sedentary lifestyle is an important determinant of health, independent of PA (de Rezen et al. 2014). It negatively affects several aspects of mental health, although its relationship to self-esteem is unclear (Hoare et al. 2016; Rodriguez-Ayllon et al. 2019).

In university students, these relationships between PA, sedentary lifestyle, and self-esteem have been little studied, and the role of gender and PA intensity in this relationship remains unclear. Self-esteem shows a decreasing trend from childhood to adolescence (Ahmed et al. 2016; Cai et al. 2014), but then increases until middle adulthood (Orth et al. 2012). Therefore, the age at which university studies are typically pursued is a critical transition period in which young people are exposed to major life changes (Engberg et al. 2012; Jensen Arnett and Jensen 2010), often in an unfamiliar social environment, which poses a particular threat to self-esteem (Chung et al. 2014). In addition, the demands of a college education can be stressful, which can have a negative impact on students' self-esteem (Acharya Pandey and Chalise 2015; Karaca et al. 2019; Yıldırım et al. 2017) and reduce their confidence in their abilities (Badiyepeymaie Jahromi et al. 2015; Yang and Zang 2022), their job satisfaction (Moore and Katz 1996), their decision-making skills, and their ability to adapt to new situations (Wemm and Wulfert 2017). In this context, as in children and adolescents, PA could act as a factor to improve self-esteem. Moreover, at this age, the amount of PA decreases (Cocca et al. 2014; Dumith et al. 2011; Ullrich-French et al. 2013) and, in general, young women are less physically active than young men (Moreno et al. 2020). Young women's self-esteem is also generally worse than that of their male counterparts (Kim and Kim 2003; Pop et al. 2022). If PA is related to self-esteem, lower activity levels in women may be partly responsible for gender differences in self-esteem.

Nursing professionals, particularly those in mental health and community health settings, play a key role in promoting lifestyle modifications, including PA, to support mental well-being (Li et al. 2018). Understanding the relationship between PA and self-esteem can inform nursing-led initiatives aimed at improving students' mental health through targeted interventions that encourage active lifestyles.

The Study

Aims and Objectives

The aim of the present study was to determine whether there is a relationship between engaging in PA, time spent in sedentary activities, and self-esteem levels in university students, and to analyse the differences according to gender.

Methods

Design, Sampling and Recruitment

This cross-sectional study involved spanish university students of both sexes, aged between 17 and 30 years. Three public universities in Spain were randomly selected. Non-probabilistic convenience sampling was performed by sending questionnaires by means of an electronic link provided by the professors on the virtual campus. The questionnaire was sent to a total of 450 students from 3 spanish universities, and 314 agreed to participate (70.2%). Before completing the questionnaires, and after receiving information about the objectives of the study and the data processing, the participants gave their written informed consent for their inclusion in the study. After consultation with the Institutional Review Board of the General University Hospital of Ciudad Real (Ciudad Real, Spain), once the methodological characteristics were assessed, and in accordance with national legislation, the present study was exempt from Institutional Review Board approval.

Instrument With Validity and Reliability

Global self-esteem was assessed with the Rosenberg self-esteem scale (Rosenberg 1965). This scale is considered one of the most widely used measures of global self-esteem (Schmitt and Allik 2005). It has been validated and extensively administered in Spain (Atienza et al. 2000; Morejón et al. 2004) and adapted to university students (Martín-Albo et al. 2007) with good internal consistency (Fleming and Courtney 1984; Gray-Little et al. 1997; Silber and Tippett 1965). It includes 10 items such as “I have a positive attitude towards myself” and “Sometimes I think I am not good at all.” Participants indicate the extent to which they agree or disagree with each statement on a 4-point Likert scale (1 = strongly disagree, 4 = strongly agree). For the purposes of analysis, the scale was considered to have a one-factor structure (Fleming and Courtney 1984; Shevlin et al. 1995). Half of the items are stated positively and the other half negatively. To determine the total score, those of the negatively stated items (2, 5, 6, 8, and 9) were inverted, and then all the items were added together (Morejón et al. 2004). The total score, therefore, ranged from 10 to 40. Higher scores on the scale indicated better overall self-esteem.

Physical activity was measured using the short version of the International Physical Activity Questionnaire (IPAQ-SF) (Booth 2000) adapted to Spanish (Rodríguez-Muñoz et al. 2017). It showed a specificity of r = 0.277; p < 0.05; 75% and a sensitivity of K = 0.33. This questionnaire includes 7 questions about the frequency (days per week), duration (time per day), and intensity (vigorous, moderate, and low) of PA, as well as the time spent in sedentary activities in the last 7 days. The total amount of weekly PA was registered in METs (Metabolic Equivalent of Task) per minute and week, calculated according to the method established in the IPAQ-SF instructions for the analysis and processing of questionnaire data (IPAQ Group 2005). PA levels were classified as follows: low (< 600 MET-min/week), moderate (≥ 600 MET-min/week), and high (≥ 3000 MET-min/week), following the same guidelines. The World Health Organisation (WHO) criteria were used to determine whether or not international PA recommendations were met. These set recommendations for adults of moderate aerobic PA for at least 150 to 300 min; or vigorous aerobic PA for at least 75 to 150 min; or a combination of both.

Data Analyses

The normal distribution of the variables was analysed using graphical procedures and the Kolmogorov–Smirnov test. When the variables did not follow a normal distribution, they were transformed using the inverse distribution function (Altman and Bland 1995; Bland and Altman 1996a, 1996b). Descriptive statistics were used to calculate frequencies and percentages by gender, PA categorised according to intensity, and university degree. Means and standard deviations were calculated for age, global self-esteem, PA level (MET-min/week), PA frequency (h/week), and weekly hours dedicated to sedentary activities by gender. Differences in variables were tested using the t-test. Univariate analysis was used to determine the relationships between self-esteem, the level of PA, and the weekly hours of PA according to the university degree. Associations of qualitative variables were tested using the chi-squared test. Pearson's correlation was used to analyse the association between global self-esteem and the level of total PA (MET-min/week) and sedentary lifestyle (h/week). An analysis of variance (ANOVA) model was used to assess differences between the mean values of total self-esteem by PA category (low-moderate-high). Cut-offs for meeting World Health Organisation (WHO) PA recommendations were set at 150 to 300 min of moderate PA per week (Bull et al. 2020). Statistical significance was set at p < 0.05 (two-tailed). All analyses were performed with SPSS for Windows 24.0 software (SPSS Inc., USA).

Results

Sample Description

Table 1 shows the descriptive characteristics of the sample. Of the 314 university students who agreed to participate, 208 (65.5%) were women and 106 (33.5%) were men. There were no significant differences in mean age between women (20.65 years; SD = 1.98) and men (21.59 years; SD = 2.13). The degree courses in which most participants were enrolled were nursing (26.1%), engineering (18.8%), chemistry (9.2%), medicine (6.4%), business administration and management (5.7%), education (5.7%) and physiotherapy (4.1%).

TABLE 1 Descriptive characteristics of the sample.

	Total	Men	Women	p
Gender; n (%)	314	106 (33.54)	208 (65.82)
Age (years)	20.97 (2.07)	21.59 (2.13)	20.65 (1.98)	0.536
Field of study; n (%)
Business Management and Administration	18 (5.7)	6 (5.7)	12 (5.8)	0.002
Biology	5 (1.6)	0	5 (2.4)
Physical Activity and Sports Sciences	1 (0.3)	0	1 (0.5)
Audiovisual communication	5 (1.6)	3 (2.8)	2 (1.0)
Criminology	4 (1.3)	1 (0.9)	3 (1.4)
Law	3 (1)	0	3 (1.4)
Economy	5 (1.6)	2 (1.9)	3 (1.4)
Education	18 (5.7)	7 (6.6)	11 (5.3)
Nursing	82 (26.1)	21 (19.8)	61 (29.3)
Farmacy	2 (0.6)	1 (0.9)	1 (0.5)
Languages	10 (3.2)	1 (0.9)	9 (4.3)
Philosophy	2 (0.6)	0	2 (1.0)
Physics	1 (0.3)	0	1 (0.5)
Physiotherapy	13 (4.1)	3 (2.8)	10 (4.8)
History of Art	1 (0.3)	1 (0.9)	1 (0.5)
Computing	7 (2.2)	6 (5.7)	1 (0.5)
Engineering	59 (18.8)	35 (33.0)	24 (11.5)
Mathematics	3 (1)	0	3 (1.4)
Medicine	20 (6.4)	7 (6.6)	13 (6.3)
Psychology	4 (1.3)	0	4 (1.9)
Advertising	1 (0.3)	0	1 (0.5)
Chemistry	29 (9.2)	7 (6.6)	22 (10.6)
Labor relations	6 (1.9)	3 (2.8)	3 (1.4)
Tourism	3 (1.0)	0	3 (1.4)
Veterinary Science	2 (0.6)	0	2 (1.0)
No response	10 (3.2)	2 (1.9)	8 (3.8)
PA level; n (%)
Low	63 (20.1)	14 (13.2)	49 (23.6)	0.007
Moderate	130 (41.4)	39 (36.8)	91 (43.8)
High	121 (38.5)	53 (50.0)	68 (32.7)
Adherence to WHO PA recommendations; n (%)
Yes	137 (43.6)	57 (53.8)	80 (38.5)	0.010
No	177 (56.4)	49 (46.2)	128 (61.5)
Physical activity (MET-min/week); M (SD)	2935.43 (2910.61)	3797.89 (3499.32)	2495.91 (2454.26)	< 0.001
PA frequency (h/week); M (SD)	2.34 (1.83)	2.81 (1.98)	2.10 (1.71)	0.001
Sedentary activity (h/week); M (SD)	7.83 (4.25)	7.96 (3.60)	7.75 (4.57)	0.031
Self-esteem; M (SD)	27.70 (6.38)	29.01 (6.50)	27.09 (6.05)	0.009

Physical Activity

Men reported a significantly higher level of adherence to the WHO weekly PA recommendations (p = 0.010). Additionally, men reported higher levels of PA (p < 0.001), more hours of PA per week (p = 0.001), greater PA intensity (p = 0.007), and more hours dedicated to sedentary activities (p = 0.001) than women.

Self-Esteem

Mean scores for self-esteem were significantly higher in men (29.01; SD = 6.41) than in women (27.7; SD = 6.38) (p = 0.009) (Table 1). Sex differences for self-esteem were maintained when performing the analysis without participants with low PA levels (p = 0.006). However, when only participants of both sexes with vigorous PA were included in the analysis, the gender difference in self-esteem disappeared (p = 0.154).

Relationship Between the Variables

The mean levels of self-esteem and PA, hours of PA per week and sedentary hours per week, according to university grade, by gender, are shown in the Table S1. No differences in self-esteem levels were found according to the university degree course studied (p = 0.54 in men, p = 107 in women). PA levels and weekly PA time were not related to the university degree courses of study, in either men (p = 0.93 and p = 0.90, respectively), or women (p = 0.75 and p = 0.65, respectively). Likewise, the participants' degree course did not determine adherence with the WHO weekly PA time recommendations (p = 0.44 in men, p = 0.44 in women).

Higher levels of global PA were correlated with better self-esteem (r = 0.169; p = 0.003). Similarly, self-esteem was positively related to hours of weekly PA (r = 0.152; p = 0.007) and negatively related to hours spent in sedentary activities in the total sample (r = −0.134; p = 0.027). This relationship between sedentary time and self-esteem was significant in women (r = −0.161; p = 0.034), but not in men (p = 0.790) (Table 2). The ANOVA (Table 3) showed, for the total sample, that the main differences in self-esteem means were between students with low levels of PA and those performing vigorous (p = 0.02) and moderate (p = 0.031) PA. No differences in self-esteem means were observed between participants with moderate and high levels of PA (p = 0.46). In men, these differences were maintained for both low vs. moderate PA (p = 0.04) and low vs. high PA (p = 0.04). In women, the differences between self-esteem means and PA intensity levels were not significant.

TABLE 2 Correlation coefficients between self-esteem, PA level, weekly PA time, and weekly time spent in sedentary activities.

	Self-esteem
Total	Men	Women
r	p	r	p	r	p
Global PA (METs/min/week)	0.169	0.003	0.156	0.110	0.090	0.196
PA (h/week)	0.152	0.007	0.123	0.209	0.101	0.147
Sedentary (h/week)	−0.134	0.027	−0.028	0.791	−0.161	0.034

TABLE 3 Analysis of variance (ANOVA) for differences between participants' self-esteem levels and PA intensity levels.

	PA intensity level	MD	SE	p	CI (95%)
LL	UL
Total	Low/Moderate	−2.41	0.95	0.031	−4.65	−0.18
Low/High	−0.33	0.96	0.002	−5.60	−1.08
Moderate/High	−0.93	0.78	0.464	−2.77	0.92
Men	Low/Moderate	−4.85	1.98	0.042	−9.56	−0.39
Low/High	−4.70	1.91	0.041	−9.24	−0.16
Moderate/High	0.15	1.34	0.993	−3.04	3.34
Women	Low/Moderate	−1.21	1.07	0.493	−3.73	1.30
Low/High	−2.18	1.13	0.133	−4.84	0.49
Moderate/High	−0.97	0.97	0.577	−3.25	1.31

Discussion

This study examined the relationship between levels of PA and sedentary lifestyle and self-esteem among university students, as well as differences according to participants´ gender, the university course studied and intensity of the PA. In general, our data reveal that higher levels of PA were related to better self-esteem, with moderate or vigorous intensity PA being more beneficial, mainly in men. In contrast, spending more hours per week in sedentary activities was negatively related to self-esteem, mainly among women. Men showed higher levels of PA, more time spent in sedentary activities, and better self-esteem than women. This difference between men's and women's self-esteem disappeared in participants who engaged in vigorous PA. No differences were observed according to degree program.

Previous research provides evidence that physically active children and adolescents (Guddal et al. 2019; Lin et al. 2024) and healthy middle-aged adults (Alfermann and Stoll 2000; Sonstroem et al. 1994) have higher self-esteem and life satisfaction. In line with these results, our data confirm that this relationship is consistent among young adults in the university setting. The association between PA and self-esteem, in line with previous findings (Levy and Ebbeck 2005; Raudsepp et al. 2002), was influenced by the intensity of PA, showing greater benefits with moderate–vigorous intensity, whereas participation in light physical activity may not be sufficient to influence self-esteem (Levy and Ebbeck 2005). Regarding the type of PA, the literature suggests that team sports activities are associated with greater impact on self-esteem than individual activities (Eime et al. 2013). Arguably, those who participate in sports feel more competent and physically fitter (and perhaps more attractive) and, therefore, manifest higher self-esteem for their physical ability and physical appearance (Findlay and Coplan 2008; Marquez et al. 2024), as social support and perceived competence have been postulated as predictors of self-esteem levels (Harter 1987; Weiss 2000). At the same time, it should be taken into consideration that better self-esteem may be what predisposes people to initiate and sustain their participation in physical activities (Eime et al. 2013), since physical self-concept seems to be an important determinant of PA in young adults (Jekauc et al. 2019).

Variations by gender have been observed in this relationship. The data from this study suggest differences in the self-esteem values between men and women, although these differences disappear when participants of both sexes engage in vigorous PA. This might be related to changes in physical fitness being considered a significant moderator of the effect of exercise on global self-esteem (Spence et al. 2005). Therefore, participation in vigorous activities that lead to improved physical fitness may be more effective in improving self-esteem. Moreover, it is known that girls discover sport as a source of self-esteem earlier than boys, but boys benefit longer than girls from their participation in organised sports (Brettschneider 2001). Although it has been posited that PA improves self-esteem only in the short term (Biddle and Asare 2011; Ekeland et al. 2005), the fact that men continue to participate in sports beyond adolescence could facilitate the maintenance of benefits during their time at university.

On the other hand, our results show that a sedentary lifestyle is associated with poorer self-esteem in women, even though they spend fewer hours per week in sedentary activities than men. In the 18–29 age group, most individuals' inactive time is spent in front of a screen, either for study or leisure, with a predominant presence of the use of social networks (Auxier and Anderson 2021). Although the gender gap in access to social networks has narrowed, women are more likely to use social networks to compare themselves to others (Haferkamp et al. 2012). The literature suggests that regular use of social networks, especially image-centered platforms, which are more frequently visited by women (Auxier and Anderson 2021), reinforces the thin ideal (Papageorgiou et al. 2022; Stanley et al. 2015; Tiggemann and Miller 2010). This poses a significant risk in terms of dissatisfaction with physical appearance for both adolescent girls and young female university students (de Vries et al. 2016; Tiggemann and Slater 2013), which is negatively related to their self-esteem (Eşkisu et al. 2017; Hardit and Hannum 2012; Marcus et al. 1995; Neff and Vonk 2009). Moreover, recent findings have shown that Internet addiction is higher among female university students than among male students and is negatively related to PA and self-esteem (Zhihao et al. 2024).

Regarding the underlying mechanisms contributing to this relationship, the exercise and self-esteem model developed by Sonstroem and Morgan (Sonstroem et al. 1994) proposes that exercise behaviour is associated with global self-esteem through perceptions of self-efficacy, physical competence, and physical acceptance. Improved body image mediates the relationship between perceptions of physical competence and global self-esteem (Levy and Ebbeck 2005).

Strengths and Limitations

This study provides a gender perspective on the relationship between PA and self-esteem, considering factors such as the intensity of PA engaged in and weekly sedentary hours, including students from different university settings. Despite the strengths of the study, it presents some limitations. Firstly, this study was cross-sectional, and so it is not possible to establish cause–effect relationships or to assess changes in PA, sedentary lifestyle and self-esteem over time. Secondly, the sample may present a selection bias since it was based on an online questionnaire sent to the accessible sample and the participation of students enrolled in some degree courses was very low. Thirdly, variables that might mediate the relationship between PA and self-esteem, such as drug use, psychological counselling, or mainly, body mass index (BMI), were not included in the analysis. In this regard, previous studies (McAuley et al. 1997; Zamani Sani et al. 2016) have shown that PA is associated with self-esteem both directly and indirectly (through BMI). Therefore, it seems that BMI as a physical factor cannot directly affect self-esteem, although it may influence body image, and the latter can, in turn, improve self-esteem. Finally, PA was measured using a self-administered questionnaire, which may have led to participants overestimating their PA (Lee et al. 2011). Nonetheless, the IPAQ-SF has been shown to have reasonable measurement properties for estimating the PA levels of large samples of the adult population in a variety of settings (Craig et al. 2003).

Conclusion

To conclude, in a sample of university students from different disciplines, the practice of PA was related to better self-esteem. Men showed better self-esteem, higher levels of PA, and a greater number of hours per week spent in sedentary activities than women, regardless of the degree course they were enrolled in. However, a sedentary lifestyle had a greater impact on women's self-esteem. The differences in self-esteem between men and women were not significant among participants that engaged in vigorous PA. These results underscore the need for health professionals, particularly nurses, to advocate for PA as a key component of mental health promotion in university students. Given the increasing prevalence of mental health challenges in this population, incorporating PA into routine nursing assessments and interventions, with programmes of moderate-vigorous intensity, team sports, and the inclusion of active breaks in class activities or active learning methods that combine physical movement with academic lessons, could provide a valuable strategy for enhancing psychological well-being.

Mental health nurses can integrate PA recommendations into their clinical practice by conducting routine assessments of students' PA levels and sedentary behaviours. This would allow for early identification of individuals at risk of low self-esteem and associated mental health issues.

Furthermore, the gender-specific findings of this study suggest the need for targeted nursing interventions that consider the differential impacts of PA on self-esteem. Women, who tend to exhibit lower self-esteem and engage in less PA, may benefit from structured group-based exercise programmes designed to foster social support and motivation. Such initiatives, led by nurses, could be incorporated into university wellness programmes to create a supportive environment that encourages PA participation.

Author Contributions

Alberto Bermejo-Cantarero: conceptualisation, investigation, data curation, writing – original draft preparation, formal analysis, writing – reviewing and editing. Laura Velázquez-Ruiz: investigation, data curation, writing – original draft preparation. Cristina Romero-Blanco: investigation, writing – reviewing and editing. Raúl Expósito-González: investigation, writing – reviewing and editing. María Dolores Onieva-Zafra: investigation, writing – reviewing and editing. Julián Rodríguez-Almagro: investigation, writing – reviewing and editing. Mairena Sánchez-López: supervision, investigation, writing – reviewing and editing.

Acknowledgements

We would like to express our heartfelt gratitude to our dear colleagues from the University of Castilla-La Mancha. Their support and collaboration were crucial for the completion of this scientific article. We deeply appreciate the valuable discussions and constructive feedback they provided during the course of the research. Their enthusiasm and dedication to science were a constant source of inspiration for us.

Disclosure

The authors have checked to make sure that our submission conforms as applicable to the Journal's statistical guidelines. The methods used in the data analyses are suitably applied to their data within their study design and context, and the statistical findings have been implemented and interpreted correctly.

Ethics Statement

After consultation with the institutional review board of the Ciudad Real General University Hospital (Ciudad Real, Spain), we were notified that, once the methodological characteristics were assessed and in accordance with national legislation, the present study was exempt from approval by the institutional review board. All methods were carried out in accordance with relevant guidelines and regulations.

Consent

Participants gave written informed consent before participating in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

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