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1. Everybody in the group will paste a website/video link that is part of your research.

2. In a few sentences, explain the gist of the article/ video.

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2. In about 80 -100 words, come with a body paragraph that supports your thesis statements.
Remember to write in PEEL.

3. Find a picture that best explains your point too.

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I agree that Physical Health is ultimately an individual's responsibility. Regular physical activity can relieve stress, anxiety, depression and anger. Think of it as a happy pill with no side effects. Regular Physical activity is one of the best options to keep yourself healthy mentally and physically since its a natural mood lifter. Regular physical activity is proven to help prevent and manage noncommunicable diseases such as heart disease, stroke, diabetes and several cancers. It also helps prevent hypertension, maintain healthy body weight and can improve mental health, quality of life and well-being. It Helps people to quit smoking, Boosts energy level so you can get more done, Helps to manage stress and tension, Promotes a positive attitude and outlook, Helps to fall asleep faster and sleep more soundly, Improves self-image and self-confidence, Helps to spend more time outdoors. That is why I agree that Physical Health is ultimately an individual's responsibility if we want to live a healthy lifestyle.

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We know that staying active is one of the best ways to keep our bodies healthy. But did you know it can also improve your overall well-being and quality of life?

Here are just a few of the ways physical activity can help you feel better, look better and live better. Because, why not?

It's a natural mood lifter.

Regular physical activity can relieve stress, anxiety, depression and anger. You know that "feel good sensation" you get after doing something physical? Think of it as a happy pill with no side effects! Most people notice they feel better over time as physical activity becomes a regular part of their lives.

It keeps you physically fit and able.

Without regular activity, your body slowly loses its strength, stamina and ability to function properly. It's like the old saying: you don't stop moving from growing old, you grow old from stopping moving. Exercise increases muscle strength, which in turn increases your ability to do other physical activities.

It helps keep the doctor away.

Stand up when you eat your apple a day! Too much sitting and other sedentary activities can increase your risk of heart disease and stroke. One study showed that adults who watch more than 4 hours of television a day had an 80% higher risk of death from cardiovascular disease.

Being more active can help you:

lower your blood pressure

boost your levels of good cholesterol

improve blood flow (circulation)

keep your weight under control

prevent bone loss that can lead to osteoporosis

All of this can add up to fewer medical expenses, interventions and medications later in life!

It can help you live longer.

It's true, 70 is the new 60... but only if you're healthy. People who are physically active and at a healthy weight live about seven years longer than those who are not active and are obese. And the important part is that those extra years are generally healthier years! Staying active helps delay or prevent chronic illnesses and diseases associated with aging. So active adults maintain their quality of life and independence longer as they age.

Here are some other benefits you may get with regular physical activity:

Helps you quit smoking and stay tobacco-free.

Boosts your energy level so you can get more done.

Helps you manage stress and tension.

Promotes a positive attitude and outlook.

Helps you fall asleep faster and sleep more soundly.

Improves your self-image and self-confidence.

Helps you spend more time outdoors.

The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic activity each week. You can knock that out in just 30 minutes a day, 5 days a week. And every minute of moderate to vigorous activity counts toward your goal.

So, this is easy! Just move more, with more intensity, and sit less. You don't have to make big life changes to see the benefits. Just start building more activity into your day, one step at a time.

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Why is physical activity so important for health and well-being?

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There are so many reasons why regular activity boosts your health. Read to learn what those are and how you can incorporate exercise into your day.

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WHO set a priority objective called Universal Health Coverage or UHC, which has also been a major goal for most countries for their health reform projects. UHC works by ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.

# data[].attributes.attachment_link.readable_text
Abstract

This paper aims to discuss the current issue on responsibility on health and its effect on the New Zealand healthcare policy as well as in the international scale. This paper will also highlight on some types of international policy solutions used to deal with the question on who is more responsible for the health of the individuals.

Introduction

One of the biggest modern issues in healthcare today is the question on whose responsibility is the individual's health. This issue is still being debated over at present time especially because almost all first-world countries provide universal health care or free healthcare provision for all citizens and this is thought to have negative effects on a person's responsibility to look after his/her health.

Find out more

People are divided when it comes to their opinion on this. Some say that it is more reasonable to put the whole weight of the health responsibility on the individual's shoulder since most of the contributing factors to the diseases that plagued the world are related to the individual's lifestyle. However, this idea met a lot of oppositions, mostly stating that health does not only depend on the lifestyle factor, but also on genetic and environmental factors. That is where the society's responsibility comes in. This conflict of ideas greatly affects the national and international healthcare policy making.

In line with this, globally accepted policy interventions on education, tax benefits, respite care, business regulations and financial support are prepared to address this modern-day issue in healthcare. These solutions are implemented worldwide in different orders in terms of importance.

The impact of the issue on health responsibility on national and international healthcare policies

The World Health organization defines health policy as the decisions, plans and actions undertaken to achieve specific health care goals within a society. In addition, it can further achieve these things: define a vision for the future, build consensus, inform people and outline priorities and the expected roles of different groups (World Health Organization). As it is still uncertain who holds the responsibility for the individual's health, health planning and decision-making are affected too.

However, because the society can greatly benefit from a generally healthy community, the WHO set a priority objective called Universal Health Coverage or UHC, which has also been a major goal for most countries for their health reform projects. UHC works by ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services (World Health Organization).

This shows that although health is highly dependent on individual choices on lifestyle and beliefs, the society somehow still has a role to play in the health of its members. However, the question does not end there. There are still issues on cost effective strategic planning and health spending.

Cliché as it may sound, but prevention has always been better than cure, as it lessens the possibility of unnecessary pain and burden on the family and the person affected. That is why health advocates and experts are currently shifting their attention to health promotion such as sanitation, pollution control, food and drug safety, health education, disease surveillance, urban planning and occupational health. These measures help prevent diseases and promote a person's ultimate well-being, at the same time giving a person a choice between promotive or destructive health habits. For example, if the government increases awareness on proper sanitation by education and other activities, the people will know which habits promote and improve health but they still have the liberty to choose to adhere to poor sanitary practices. However, it will be much of their loss as individuals.

These actions also encourage individuals to make informed choices about their lifestyles. That way, their health also becomes their responsibility and they can achieve freedom in their decision-making. Therefore, a balance of the societal and individual responsibility will impact the healthcare policy making, in the national or international level, as it can easily outline the expected roles of different groups and individuals in the healthcare system. It should be clear which are the responsibilities or the individual and that of the society so that relevant and sound health policies can be made within New Zealand and internationally.

Here in New Zealand, the benefit culture is prevalent in the Maori population as most of them are unable to pay for health care cost. Some taxpayers are against being willing funders of healthcare for the Maori (and other Pakeha) as they believe in individualism as being responsible for one's self and his/her dependants. However, the Treaty of Waitangi's intention was to protect and maintain the well-being of all citizens, and its health implications relating to processes of good government and notions of participation and equity. Therefore, it is the government's responsibility to look after the health of the Maori populace.

The dilemma is that no matter how much effort the government puts into health promotion, the Maori people still have health habits and traditions that are unique to them and some will not understand. In this sense, health is still an individual's own choice and responsibility.

International policy intervention solutions to address the contemporary health issue highlighted in the case study

b.1. Education and Training

Aside from promoting access to healthcare, it is a very important societal role to promote health through education and training. Many health-related trainings and courses are made available worldwide due to the increased awareness of its importance. This kind of health promotion strategy is very cost-effective and will surely minimise the need for access to healthcare because if people are more knowledgeable about lifestyle and habits that promote well-being or total health, they will be more keen on avoiding diseases than treating diseases.

An example of this is the effort of New Zealand Red Cross to train adults, teens and even kids on first aid. This programme enables people of all ages to know how to handle emergency situations like making an emergency call and performing cardiopulmonary resuscitation. Knowing how to act in these situations lessens the panic and the mistakes committed in panic, therefore, saving the life of a person. This project of Red Cross is known all over the world.

There are also some other non-government organisations all over the world, like GHETS (Global Health through Education, Training and Service) who believe that well trained and supported doctors, nurses and allied health workers are key to sustainable change. That is why they support developing countries by innovations in education and service. Their aim is to train people about primary health and treatment of diseases common in their area (Global Health Workforce Alliance).

There is a hunger for health awareness all over the world that needs to be fed necessary information on health promotion like family planning, maternal health, vaccination, child development, sex education, occupational health and disease prevention. Government agencies and other organisations are working hand-in-hand to combat ignorance on health, therefore, prolonging and saving lives.

Other education and training programs that add quality to life and benefit the health of the people in the community are sanitation programs, clean air movement and food and drug safety. These programs are not only beneficial for one individual or a group but for all of the citizens. This is the reason why experts find these means more cost effective as it costs less but the paybacks are felt by the society as a whole.

In New Zealand, the Ministry of Health thought of a way to bridge the gap between Maori and non-Maori health and that is to have MÄori health providers that tend to deliver health and disability services to predominantly MÄori clients. To attract Maoris to study health and disability related courses, the Ministry of Health spearheaded the programme Hauora MÄori Scholarships that provide financial assistance to students who are undertaking or completing a course in health and disability studies that has been accredited by the New Zealand Qualifications Authority (Ministry of Health).

b.2. Tax benefits and payments to caregivers

Caregivers play a great role in improving and maintaining the health of individuals because as mentioned in the Journal of Medical Ethics, many of the other strategies address problems that are beyond the ability of individuals to deal with. Even though people have basic knowledge on taking care of themselves when they are well, most of them will have difficulty looking after themselves when they have illnesses. Leaving it to the professionals is a good idea.

Therefore, caregivers are very important to give help and protection to the compromised ones and it is only fair that they get benefits and enough payment for their services. Caregiving itself is a very expensive service, in part because of strong adverse selection phenomenon - the only people willing to pay for private sector caregiving services tend to be those families facing the most daunting care requirements for their family member. Caregivers continue to be the primary source of long-term caring for elders and other compromised people worldwide and as such, their unpaid work makes a valuable contribution to society and the economy, and touches a huge segment of the population.

New Zealand also has their way of attracting people to render caregiving services. Caregivers can file for income tax return too if their annual income from caregiving is over $17,500. On top of that, they also get benefits from the ACC (Accident Compensation Corporation) if they meet accidents at the workplace.

b.3. Respite Care

Respite care is the provision of short-term, temporary relief to those who are caring for family members who might otherwise require permanent placement in a facility outside the home. In New Zealand, these services are funded by the Ministry of Health to give family caregivers a break, and ensure that the person they are caring for gets the care and support they need in the meantime.

View our services

This clearly shows a balance of individual/familial and societal responsibility when it comes to the health of the people. The responsibility of the family and individual is encouraged as the client is not permanently put in a facility to have someone else take care of all his/her needs, but they are also assured that the government also has a role to play to support the client and the family/caregivers.

It would also be unhealthy for family members to be constantly exposed to the stress of taking care of a sick/unwell family member when they were not trained or skilled enough to. Respite care is one way of minimising stress and fatigue on the part of the family and fulfilment of society's obligation to take care of its members.

When the client is also on respite care, there will be better access to emergency services, laboratory and diagnostics and health teachings from professionals. Ensuring access to these is also an important social responsibility and the Ministry of Health paying for it is showing a sense of responsibility over the members of the society. This is also a good way to spend a portion of the national health budget as this is also very important.

Respite is also popular in all parts of the world as universal health provision is promoted in first-world countries

b.4. Business regulations combining work and care giving

Business regulations are provided by the government to take care of the business side of institutions and at the same time protecting the rights of the consumers and workers. All over the globe, businesses should be profitable while giving the service or product they promised to the consumers. This is also the same in the healthcare industry. While hospital, rest homes and respite care centers are mainly businesses, they are mandated by a government body to render safe and effective healthcare services and provide occupational health and safety guidelines for the workers.

The workplace is not always a safe place as simple mishaps can cause injuries and pose threats to the employees. In the healthcare setting, simple injuries like back pain and stress can incur a loss to the business and to the well-being of an employee. That is why regulatory bodies, like the Ministry of Business Innovation and Employment (New Zealand), emphasized the importance of occupational health and safety. This includes activities like identification and elimination of workplace hazards like needle-stick injuries, back injuries and infection.

It is also a requirement of the MBIE for business to provide contingency plan for emergencies like fire, earthquake, other forces of nature and technological failure. Aside from that, businesses are required to comply with building safety and access of the place by people with disabilities.

Caregiving is also an industry that not only requires physical safety, but it is also a requirement to provide culturally safe healthcare services, especially in places in the world where indigents are present and need as much care. Here in New Zealand, the Maoris have special health needs that are met only by knowing them and their culture. It is also essential to know their concepts of health and illness so that caregivers will know how to introduce treatment and health promotion to these people.

Another important thing that regulatory bodies are monitoring is the fact that caregivers should be free from contagious diseases or those that will affect their performance of the job and that they are really fit to do the job. For this purpose, health screens, as well as police checks are done prior to employment. Knowingly hiring someone who do not have the qualifications for the job is a violation of the consumer's rights.

b.5. Financial support and provision of pension credits for caregiving

Taking care of the caregivers is also like taking care of the individuals in the society. That is why international health care policies have provisions on care giving benefits like financial support and pension credits.

Financial support is offered to care givers mostly as reimbursement for the expenses incurred by the care giver while servicing clients. They are also automatically enrolled in a pension plan that will help them settle upon retirement.

These entitlements are causing a shift to the employment status of a lot of health care professionals. With these benefits, they feel valued and appreciated for all their hard work as helpers and protectors of the compromised ones. That way they also feel that help will come if they need it and that they, too, will be protected.

VI. Conclusion

Health, although it is an individual experience and responsibility, is likewise society's greatest asset. Just as parenthood is a shared responsibility of both mother and father, health should also be a collaborative effort between the individual and the society with the goal of achieving the highest possible level of wellness for all. Just like in a family, if all members are well and healthy, the family will most likely be functional and successful, as opposed to a sick one.

The basic unit in a society is the family and the basic unit in a family is the individual. Therefore, an individual's health is the health of the whole society. Individual health should be as important as other social matters. If one person is sick, it will create a ripple effect in the community as the family members are burdened by the illness and the community is somehow paying for the healthcare services. As each individual plays a role in the family and in the society, it is important to look after ourselves and for the government and other groups in the society to promote health and wellness.

Health is not only influenced by personal preferences and lifestyles alone, but also by the environmental and genetic factors, where the society can extend their help with. Health promotion activities like sanitation, pollution control, food and drug safety, health, disease surveillance, urban planning and occupational health will help lessen the threats to public health without having to spend on healthcare access.

As much as it is the individual's responsibility to practice good habits and lifestyle to acquire optimum health, it is also the society's task to set health goals and priorities for the community. Although healthcare access is very important and would most probably take a good share of the budget, other health promotion methods like research and education should also be given attention and funding. The caregiving industry should also be given a part of the budget allocation for health as care givers are very important people in restoring and maintaining health among the members of the community.

On the whole, health is a society's business as much as it is a personal responsibility. Working hand-in-hand with the community, it should be achieved by all members and the whole nation will benefit from it. Families, organisations and societies will function better with healthy and health-conscious people.

Bibliography

Global Health Workforce Alliance. (n.d.). Global Health Workforce Alliance: Members and Partners. Retrieved from Global Health Education Training & Service (GHETS), USA: http://www.who.int/workforcealliance/members_partners/member_list/ghets/en/

Ministry of Health. (n.d.). Ministry of Health. Retrieved from Maori Health: http://www.health.govt.nz/our-work/populations/maori-health

World Health Organization. (n.d.). World Health Organization. Retrieved from Health Topics: Health Policy: http://www.who.int/topics/health_policy/en/

World Health Organzation. (n.d.). World Health Organization: Health Systems. Retrieved from Universal Health Coverage: http://www.who.int/healthsystems/universal_health_coverage/en/

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# data[].attributes.attachment_link.title
Health: An Individual or Societal Responsibility?

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Abstract This paper aims to discuss the current issue on responsibility on health and its effect on the New Zealand healthcare policy as well as in the international scale. This paper will also highlight on some types of international policy solutions used to deal with the question on who is more responsible for the health of the individuals.

# data[].attributes.body
Lifestyle plays a major role in most of the illnesses in industrialised nations.Six of the 10 leading factors contributing to the global burden of disease are lifestyle related: unsafe sex, high blood pressure, tobacco use, alcohol use, high cholesterol and obesity.Lifestyle‐related illnesses also contribute to the rising costs of healthcare.Spending on healthcare accounts for about 16% of the gross domestic product in the USA, or US$1.9 trillion.

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1. The impact of the issue on health responsibility on national and international healthcare policies

The World Health organization defines health policy as the decisions, plans and actions undertaken to achieve specific health care goals within a society. In addition, it can further achieve these things: define a vision for the future, build consensus, inform people and outline priorities and the expected roles of different groups (World Health Organization). As it is still uncertain who holds the responsibility for the individual’s health, health planning and decision-making are affected too.

However, because the society can greatly benefit from a generally healthy community, the WHO set a priority objective called Universal Health Coverage or UHC, which has also been a major goal for most countries for their health reform projects. UHC works by ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services (World Health Organization).

This shows that although health is highly dependent on individual choices on lifestyle and beliefs, the society somehow still has a role to play in the health of its members. However, the question does not end there. There are still issues on cost effective strategic planning and health spending.

# data[].attributes.attachment_link.readable_text
Abstract

This paper aims to discuss the current issue on responsibility on health and its effect on the New Zealand healthcare policy as well as in the international scale. This paper will also highlight on some types of international policy solutions used to deal with the question on who is more responsible for the health of the individuals.

Introduction

One of the biggest modern issues in healthcare today is the question on whose responsibility is the individual's health. This issue is still being debated over at present time especially because almost all first-world countries provide universal health care or free healthcare provision for all citizens and this is thought to have negative effects on a person's responsibility to look after his/her health.

Find out more

People are divided when it comes to their opinion on this. Some say that it is more reasonable to put the whole weight of the health responsibility on the individual's shoulder since most of the contributing factors to the diseases that plagued the world are related to the individual's lifestyle. However, this idea met a lot of oppositions, mostly stating that health does not only depend on the lifestyle factor, but also on genetic and environmental factors. That is where the society's responsibility comes in. This conflict of ideas greatly affects the national and international healthcare policy making.

In line with this, globally accepted policy interventions on education, tax benefits, respite care, business regulations and financial support are prepared to address this modern-day issue in healthcare. These solutions are implemented worldwide in different orders in terms of importance.

The impact of the issue on health responsibility on national and international healthcare policies

The World Health organization defines health policy as the decisions, plans and actions undertaken to achieve specific health care goals within a society. In addition, it can further achieve these things: define a vision for the future, build consensus, inform people and outline priorities and the expected roles of different groups (World Health Organization). As it is still uncertain who holds the responsibility for the individual's health, health planning and decision-making are affected too.

However, because the society can greatly benefit from a generally healthy community, the WHO set a priority objective called Universal Health Coverage or UHC, which has also been a major goal for most countries for their health reform projects. UHC works by ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services (World Health Organization).

This shows that although health is highly dependent on individual choices on lifestyle and beliefs, the society somehow still has a role to play in the health of its members. However, the question does not end there. There are still issues on cost effective strategic planning and health spending.

Cliché as it may sound, but prevention has always been better than cure, as it lessens the possibility of unnecessary pain and burden on the family and the person affected. That is why health advocates and experts are currently shifting their attention to health promotion such as sanitation, pollution control, food and drug safety, health education, disease surveillance, urban planning and occupational health. These measures help prevent diseases and promote a person's ultimate well-being, at the same time giving a person a choice between promotive or destructive health habits. For example, if the government increases awareness on proper sanitation by education and other activities, the people will know which habits promote and improve health but they still have the liberty to choose to adhere to poor sanitary practices. However, it will be much of their loss as individuals.

These actions also encourage individuals to make informed choices about their lifestyles. That way, their health also becomes their responsibility and they can achieve freedom in their decision-making. Therefore, a balance of the societal and individual responsibility will impact the healthcare policy making, in the national or international level, as it can easily outline the expected roles of different groups and individuals in the healthcare system. It should be clear which are the responsibilities or the individual and that of the society so that relevant and sound health policies can be made within New Zealand and internationally.

Here in New Zealand, the benefit culture is prevalent in the Maori population as most of them are unable to pay for health care cost. Some taxpayers are against being willing funders of healthcare for the Maori (and other Pakeha) as they believe in individualism as being responsible for one's self and his/her dependants. However, the Treaty of Waitangi's intention was to protect and maintain the well-being of all citizens, and its health implications relating to processes of good government and notions of participation and equity. Therefore, it is the government's responsibility to look after the health of the Maori populace.

The dilemma is that no matter how much effort the government puts into health promotion, the Maori people still have health habits and traditions that are unique to them and some will not understand. In this sense, health is still an individual's own choice and responsibility.

International policy intervention solutions to address the contemporary health issue highlighted in the case study

b.1. Education and Training

Aside from promoting access to healthcare, it is a very important societal role to promote health through education and training. Many health-related trainings and courses are made available worldwide due to the increased awareness of its importance. This kind of health promotion strategy is very cost-effective and will surely minimise the need for access to healthcare because if people are more knowledgeable about lifestyle and habits that promote well-being or total health, they will be more keen on avoiding diseases than treating diseases.

An example of this is the effort of New Zealand Red Cross to train adults, teens and even kids on first aid. This programme enables people of all ages to know how to handle emergency situations like making an emergency call and performing cardiopulmonary resuscitation. Knowing how to act in these situations lessens the panic and the mistakes committed in panic, therefore, saving the life of a person. This project of Red Cross is known all over the world.

There are also some other non-government organisations all over the world, like GHETS (Global Health through Education, Training and Service) who believe that well trained and supported doctors, nurses and allied health workers are key to sustainable change. That is why they support developing countries by innovations in education and service. Their aim is to train people about primary health and treatment of diseases common in their area (Global Health Workforce Alliance).

There is a hunger for health awareness all over the world that needs to be fed necessary information on health promotion like family planning, maternal health, vaccination, child development, sex education, occupational health and disease prevention. Government agencies and other organisations are working hand-in-hand to combat ignorance on health, therefore, prolonging and saving lives.

Other education and training programs that add quality to life and benefit the health of the people in the community are sanitation programs, clean air movement and food and drug safety. These programs are not only beneficial for one individual or a group but for all of the citizens. This is the reason why experts find these means more cost effective as it costs less but the paybacks are felt by the society as a whole.

In New Zealand, the Ministry of Health thought of a way to bridge the gap between Maori and non-Maori health and that is to have MÄori health providers that tend to deliver health and disability services to predominantly MÄori clients. To attract Maoris to study health and disability related courses, the Ministry of Health spearheaded the programme Hauora MÄori Scholarships that provide financial assistance to students who are undertaking or completing a course in health and disability studies that has been accredited by the New Zealand Qualifications Authority (Ministry of Health).

b.2. Tax benefits and payments to caregivers

Caregivers play a great role in improving and maintaining the health of individuals because as mentioned in the Journal of Medical Ethics, many of the other strategies address problems that are beyond the ability of individuals to deal with. Even though people have basic knowledge on taking care of themselves when they are well, most of them will have difficulty looking after themselves when they have illnesses. Leaving it to the professionals is a good idea.

Therefore, caregivers are very important to give help and protection to the compromised ones and it is only fair that they get benefits and enough payment for their services. Caregiving itself is a very expensive service, in part because of strong adverse selection phenomenon - the only people willing to pay for private sector caregiving services tend to be those families facing the most daunting care requirements for their family member. Caregivers continue to be the primary source of long-term caring for elders and other compromised people worldwide and as such, their unpaid work makes a valuable contribution to society and the economy, and touches a huge segment of the population.

New Zealand also has their way of attracting people to render caregiving services. Caregivers can file for income tax return too if their annual income from caregiving is over $17,500. On top of that, they also get benefits from the ACC (Accident Compensation Corporation) if they meet accidents at the workplace.

b.3. Respite Care

Respite care is the provision of short-term, temporary relief to those who are caring for family members who might otherwise require permanent placement in a facility outside the home. In New Zealand, these services are funded by the Ministry of Health to give family caregivers a break, and ensure that the person they are caring for gets the care and support they need in the meantime.

View our services

This clearly shows a balance of individual/familial and societal responsibility when it comes to the health of the people. The responsibility of the family and individual is encouraged as the client is not permanently put in a facility to have someone else take care of all his/her needs, but they are also assured that the government also has a role to play to support the client and the family/caregivers.

It would also be unhealthy for family members to be constantly exposed to the stress of taking care of a sick/unwell family member when they were not trained or skilled enough to. Respite care is one way of minimising stress and fatigue on the part of the family and fulfilment of society's obligation to take care of its members.

When the client is also on respite care, there will be better access to emergency services, laboratory and diagnostics and health teachings from professionals. Ensuring access to these is also an important social responsibility and the Ministry of Health paying for it is showing a sense of responsibility over the members of the society. This is also a good way to spend a portion of the national health budget as this is also very important.

Respite is also popular in all parts of the world as universal health provision is promoted in first-world countries

b.4. Business regulations combining work and care giving

Business regulations are provided by the government to take care of the business side of institutions and at the same time protecting the rights of the consumers and workers. All over the globe, businesses should be profitable while giving the service or product they promised to the consumers. This is also the same in the healthcare industry. While hospital, rest homes and respite care centers are mainly businesses, they are mandated by a government body to render safe and effective healthcare services and provide occupational health and safety guidelines for the workers.

The workplace is not always a safe place as simple mishaps can cause injuries and pose threats to the employees. In the healthcare setting, simple injuries like back pain and stress can incur a loss to the business and to the well-being of an employee. That is why regulatory bodies, like the Ministry of Business Innovation and Employment (New Zealand), emphasized the importance of occupational health and safety. This includes activities like identification and elimination of workplace hazards like needle-stick injuries, back injuries and infection.

It is also a requirement of the MBIE for business to provide contingency plan for emergencies like fire, earthquake, other forces of nature and technological failure. Aside from that, businesses are required to comply with building safety and access of the place by people with disabilities.

Caregiving is also an industry that not only requires physical safety, but it is also a requirement to provide culturally safe healthcare services, especially in places in the world where indigents are present and need as much care. Here in New Zealand, the Maoris have special health needs that are met only by knowing them and their culture. It is also essential to know their concepts of health and illness so that caregivers will know how to introduce treatment and health promotion to these people.

Another important thing that regulatory bodies are monitoring is the fact that caregivers should be free from contagious diseases or those that will affect their performance of the job and that they are really fit to do the job. For this purpose, health screens, as well as police checks are done prior to employment. Knowingly hiring someone who do not have the qualifications for the job is a violation of the consumer's rights.

b.5. Financial support and provision of pension credits for caregiving

Taking care of the caregivers is also like taking care of the individuals in the society. That is why international health care policies have provisions on care giving benefits like financial support and pension credits.

Financial support is offered to care givers mostly as reimbursement for the expenses incurred by the care giver while servicing clients. They are also automatically enrolled in a pension plan that will help them settle upon retirement.

These entitlements are causing a shift to the employment status of a lot of health care professionals. With these benefits, they feel valued and appreciated for all their hard work as helpers and protectors of the compromised ones. That way they also feel that help will come if they need it and that they, too, will be protected.

VI. Conclusion

Health, although it is an individual experience and responsibility, is likewise society's greatest asset. Just as parenthood is a shared responsibility of both mother and father, health should also be a collaborative effort between the individual and the society with the goal of achieving the highest possible level of wellness for all. Just like in a family, if all members are well and healthy, the family will most likely be functional and successful, as opposed to a sick one.

The basic unit in a society is the family and the basic unit in a family is the individual. Therefore, an individual's health is the health of the whole society. Individual health should be as important as other social matters. If one person is sick, it will create a ripple effect in the community as the family members are burdened by the illness and the community is somehow paying for the healthcare services. As each individual plays a role in the family and in the society, it is important to look after ourselves and for the government and other groups in the society to promote health and wellness.

Health is not only influenced by personal preferences and lifestyles alone, but also by the environmental and genetic factors, where the society can extend their help with. Health promotion activities like sanitation, pollution control, food and drug safety, health, disease surveillance, urban planning and occupational health will help lessen the threats to public health without having to spend on healthcare access.

As much as it is the individual's responsibility to practice good habits and lifestyle to acquire optimum health, it is also the society's task to set health goals and priorities for the community. Although healthcare access is very important and would most probably take a good share of the budget, other health promotion methods like research and education should also be given attention and funding. The caregiving industry should also be given a part of the budget allocation for health as care givers are very important people in restoring and maintaining health among the members of the community.

On the whole, health is a society's business as much as it is a personal responsibility. Working hand-in-hand with the community, it should be achieved by all members and the whole nation will benefit from it. Families, organisations and societies will function better with healthy and health-conscious people.

Bibliography

Global Health Workforce Alliance. (n.d.). Global Health Workforce Alliance: Members and Partners. Retrieved from Global Health Education Training & Service (GHETS), USA: http://www.who.int/workforcealliance/members_partners/member_list/ghets/en/

Ministry of Health. (n.d.). Ministry of Health. Retrieved from Maori Health: http://www.health.govt.nz/our-work/populations/maori-health

World Health Organization. (n.d.). World Health Organization. Retrieved from Health Topics: Health Policy: http://www.who.int/topics/health_policy/en/

World Health Organzation. (n.d.). World Health Organization: Health Systems. Retrieved from Universal Health Coverage: http://www.who.int/healthsystems/universal_health_coverage/en/

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Health: An Individual or Societal Responsibility?

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Abstract This paper aims to discuss the current issue on responsibility on health and its effect on the New Zealand healthcare policy as well as in the international scale. This paper will also highlight on some types of international policy solutions used to deal with the question on who is more responsible for the health of the individuals.

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Health is still an individual's own choice and responsibility. This means becoming educated about our own health. The basic unit in society is the family and the basic unit in the family is the individual. Therefore, the health of the individual is the health of the whole society. The health of the individual should be as important as any other social matter. If a person is ill, it will create a ripple effect in the society as family members are burdened with the disease and the society somehow pays for health care services. Since each individual plays a role in the family and in society, it is important to take care of ourselves and for the government and other groups in society to promote health and well -being.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598168/ Information from this article.

Regular exercise and physical activity promotes strong muscles and bones. It improves respiratory, cardiovascular health, and overall health. Staying active can also help you maintain a healthy weight, reduce your risk for type 2 diabetes, heart disease, and reduce your risk for some cancers.

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Studies shown in this article will show some factors on how mental health can affect their physical health. Some studies have shown the benefit of regular activity and exercise.

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Department of Applied Emotion and Motivation Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany

The health benefits of regular physical activity and aerobic exercise are undisputed in the literature. The present series of pilot studies had two major objectives: (a) examine mental health, well-being, and regular physical activity of university students and (b) explore the potential health benefits of short-term aerobic exercise on university students in an online and a laboratory study. Mental health and well-being were measured before (Time 1, T1) and after (Time 2, T2) a 6 week (online study) and 2 week (laboratory study) low- to moderate-intensity aerobic exercise intervention. Mental health and well-being were assessed using standardized self-report measures of depression, anxiety, positive and negative affect, perceived stress and coping strategies, body dissatisfaction, and quality of life. The effects of the aerobic exercise were compared to a cognitive non-exercise control condition (online study), motor coordination exercise (laboratory study), and a waiting list (online and laboratory). A total of 185 university students were recruited from German universities at T1. Further, 74 (women: n = 67) students completed the 6-week intervention. Similarly, 32 (women: n = 30) participants completed the 2 week intervention (laboratory study). At T1, 36.6% of the students (women and men) reported experiencing depressive symptoms. 41.83% of them (women and men) had high levels of state anxiety. All the students reported experiencing stress (e.g., due to uncertainty related to factors such as their finances, job, and social relationships). At T1, regular physical activity was negatively correlated with self-reported depression, anxiety, and perceived psychosomatic stress and positively correlated with quality of life and positive affect. Among women, cardiovascular fitness (operationalized as resting heart rate variability) was negatively correlated with self-reported anxiety (state) and depression at T1 (laboratory study). The 6 week aerobic exercise intervention resulted in significant improvements in self-reported depression, overall perceived stress, and perceived stress due to uncertainty. The present results confirm that there is a relationship between regular physical activity, cardiovascular fitness, mental health, and well-being among university students. They support the hypothesis that short-term aerobic exercise interventions can act as buffer against depression and perceived stress in university students after 6 weeks of aerobic exercise of low to moderate intensity.

Introduction

Health Benefits of Regular Physical Activity and Exercise

The health benefits of regular physical activity and exercise are undisputed in the literature. Particularly large health benefits have been reported among individuals who have experienced significant losses in their psychological and physical functions as a result of chronic diseases such as cardiovascular disease, diabetes, cancer, hypertension, obesity, depression, and osteoporosis (for an overview, see Taylor et al., 1985; Paluska and Schwenk, 2000; Penedo and Dahn, 2005; Haskell et al., 2007; Knapen et al., 2015; Ruegsegger and Booth, 2018). Among such patient groups whose symptom severity requires secondary and tertiary prevention, significant improvements in cardiovascular fitness and self-reported mood, anxiety, and depressive symptoms can be achieved by regularly engaging in physical activity. Regular physical activity and exercise have also been found to result in lower vulnerability to psychological stressors during periods of increased workload and cognitive performance under pressure among these patient groups ( Norris et al., 1992; Stults-Kolehmainen and Sinha, 2014).

Past studies have demonstrated significant effects of aerobic exercise (e.g., endurance exercises such as walking, swimming, treadmill running, and cycling) on mental and physical health indicators using quasi-experimental between-subjects (i.e., comparisons of physically active and sedentary control groups) and within-subjects designs (i.e., comparisons of the same groups before and after exercise interventions). However, the exercise intensity and duration at which the health-related effects of exercise reach statistical significance have been found to vary substantially across studies, samples (i.e., patients vs. healthy participants), and people of different ages and gender (for an overview, see Gerber and Pühse, 2009; Stoll and Ziemainz, 2012). The observed effects may also depend on the methods used to measure exercise-related health gains (e.g., self-report, behavioral, neurophysiological).

According to the international recommendations of the World Health Organization (WHO) and American College of Sports Medicine (ACSM), healthy adults should engage in (a) moderate-intensity aerobic exercise (∼75% of the maximal oxygen consumption (VO ₂ max) = 3-6 metabolic equivalents (METs)) for 30 min a day, 5 days a week, or (b) vigorous-intensity aerobic exercise (>75% of the VO ₂ max > 6 METs) for 20 min a day, 3 days a week to maintain their physical health. Further, additional bouts of exercise have been recommended to reduce the lifetime risk for chronic diseases or unhealthy weight gain and improve cardiovascular fitness ( Haskell et al., 2007; World Health Organization [WHO], 2010; American College of Sports Medicine, 2013).

The aforementioned recommendations of the WHO and ACSM are based on global epidemiologic health indicators (e.g., morbidity rates, mortality risk) or lifetime risk for certain somatic diseases including cancer and cardiovascular diseases. The question of whether the same exercise recommendations are valid for the prevention of mental health and well-being continues to be debated.

Effects of Exercise on Mental Health and Well-Being

In the literature, the terms mental health and well-being are used as umbrella terms to refer to psychological, mental, cognitive, and affective factors that enhance or impair the functioning of a person. Accordingly, psychological, subjective, and overall well-being have been identified as major contributors to mental health. This perspective concurs with theoretical definitions of well-being, which emphasize the absence of mental and physical illness (for reviews, see Diener and Ryan, 2009). Psychological models and theories of well-being correspondingly emphasize that well-being is related to optimal experiences and functioning of both the body and mind (e.g., Ryan and Deci, 2001). Consequently, past studies (including meta-analytic studies and reviews) on the relationships between physical activity, exercise, mental health, and well-being have investigated the effects of physical activity and exercise on a broad range of variables including depression, anxiety, mood/affect, stress, body image/body dissatisfaction, and quality of life ( Scully et al., 1998; Biddle et al., 2000; Paluska and Schwenk, 2000). In the remainder of this manuscript, the broader term well-being will be used to refer to the positive effects that exercise has on the factors (i.e., anxiety, depression, and perceived stress) that negatively impact mental health and well-being.

Self-Reported Anxiety

In their meta-analytic study, Petruzzello et al. (1991) summarized the results of more than 124 studies that had investigated the effects of acute and regular aerobic and anaerobic exercise on mental health, well-being, and anxiety, in particular ( Petruzzello et al., 1991). The results revealed that only moderate- to high-intensity aerobic exercise had resulted in significant changes in self-reported anxiety symptoms. Further, these effects were independent of gender, age, and physical health status. Recent meta-analytic findings suggest that acute bouts of exercise can reduce state anxiety ( Ensari et al., 2015). Aerobic exercise exceeding 21 min is associated with significant anxiolytic effects on self-reported state and trait anxiety after 10 weeks of regular exercise. However, effect sizes for exercise-induced psychophysiological changes that are related to anxiety symptoms have been found to be much smaller than those reported for self-report measures ( Petruzzello et al., 1991). Recent meta-analytic findings support the notion that aerobic exercise is particularly effective in reducing anxiety among non-clinical samples, but the effect sizes have been found to be small ( Rebar et al., 2015). Concerning clinically relevant anxiety symptoms, exercise interventions do not have the same effects that psychopharmaceutic treatments for anxiety do ( Carek et al., 2011). However, aerobic exercise has been found to be effective in alleviating several anxiety (e.g., generalized anxiety, panic, obsessive-compulsive disorder, social phobia) and stress-related disorders (posttraumatic stress disorder; Stubbs et al., 2017).

Self-Reported Depression

The largest changes in self-reported depressive symptoms appear to result from engagement in moderate- to vigorous-intensity aerobic exercise. The acute antidepressive effects of aerobic exercise have been confirmed in clinical randomized controlled trials in which depressive patients were assigned to receive either an exercise intervention, psychotherapy, or both (for recent meta-analyses e.g., Schuch et al., 2016; Morres et al., 2019). Thus, the effects of regular aerobic exercise on self-reported depressive symptoms can be as strong as those of psychotherapeutic or psychopharmacological antidepressive treatments (for reviews, see Carek et al., 2011; Stoll and Ziemainz, 2012). Despite the impressive effects of exercise on depression among patients with acute major depression, the potential of aerobic exercise as a means of depression prevention is far less clear. Moreover, the frequency, duration, and intensity of exercise that is required to protect an individual from depressive symptoms in the short and long run continues to be debated ( Larun, 1996; Dunn et al., 2005; Harvey et al., 2018). Regular moderate- to high-intensity, vigorous aerobic exercise during adolescence and moderate- or even low-intensity regular aerobic exercise (e.g., 3 METs) during adulthood have been found to be particularly effective in this regard ( Harvey et al., 2018). According to recent meta-meta-analytic findings ( Rebar et al., 2015), low- to moderate-intensity aerobic exercise has moderate effects on the severity of depressive symptoms among non-clinical populations (age > 18 years) after supervised or unsupervised training. This protective effect of even low-intensity aerobic exercise may be attributable to the exercise-induced release of the neurotrophic growth factors that are responsible for nerve growth and synaptic plasticity in the brain, particularly in the brain regions that display significant changes in neural activity and structural changes during depression (e.g., hippocampus; for an overview, see Cotman and Engesser-Cesar, 2002; Carek et al., 2011).

Stress Reactivity and Subjective Stress Perceptions

Currently, little is known about changes in subjective stress perception. Similar to mental health domains (e.g., mood, depression, anxiety), it is neither clear nor certain whether exercise-induced physiological and psychological adaptation to stress are causally related among healthy individuals. In other words, it is not clear whether exercise-induced physical adaptation to stress is a prerequisite for improvements in mental health and well-being among healthy people. In addition, it is unclear whether the effects of exercise on mental health and well-being are specific to aerobic exercise.

From a psychological perspective, different explanations have been offered to account for the short-term effects of exercise on mental health and well-being during and after engagement in exercise. The factors to which these effects have been attributed range from time outs (i.e., duration of time for which an individual is not preoccupied with stressors, anxiety-inducing factors, and worries) to improvements in self-efficacy and physical self-concept (including body image) and a reduction in body dissatisfaction. Further, there are gender differences in body dissatisfaction. In particular, women tend to be more dissatisfied with their bodies (in terms of size, shape, and weight), compared to men ( Fiske et al., 2014; Karazsia et al., 2017). Moreover, body dissatisfaction is a major risk factor for the development of eating disorders, particularly in women ( Stice and Shaw, 2002), including female university students (e.g., Herbert et al., 2013). Relatedly, there is evidence to suggest that women are especially motivated to participate in regular exercise programs as a result of their higher levels of body dissatisfaction and concerns about their body weight and shape ( Kilpatrick et al., 2005).

Mental Health and Well-Being Among University Students

University students report high levels of perceived stress and cognitive workload. Recent findings suggest that student counseling centers have been witnessing an increasing number of help-seeking students (for an overview, see Brown, 2018). Moreover, according to recent surveys, every fifth university student experiences mental health problems, which he/she is reportedly unable to cope with independently ( University Student Mental Health Survey, 2018). Recent surveys conducted among German university students (e.g., TK-Forsa-Survey, 2012) have revealed that one out of five students provide affirmative responses to questions that assess depressive symptoms and depression severity. Although first-year freshmen are particularly vulnerable to stress and stress-induced depressive and anxiety symptoms (e.g., Ackermann and Schumann, 2010; Farrer et al., 2016), stressors are highly prevalent among all groups of students because they continuously experience stress that is caused by regular examinations, fixed deadlines, and the constant need to perform well to increase their likelihood of later academic achievement. Several studies already found positive correlations between stress and illness in university students on the one hand and between perceived stress, anxiety and depression on the other hand (e.g., Tosevski et al., 2010; Farrer et al., 2016). The relationship between stress and mental health, most notably depression, is not specific to students of a particular university or educational system. Instead, this relationship has been reported among students worldwide (e.g., Ibrahim et al., 2013). Thus, principally, any student, irrespective of his/her culture, might be affected. Nonetheless, students with higher levels of perceived stress are at a significantly higher risk for mental disorders and physical illnesses than the average student. Presumably, this may be the case because such students tend to also engage in detrimental and maladaptive health behaviors to cope with stress (e.g., Mahmoud et al., 2012). Stressed students are also less physically active than their less-stressed counterparts ( Nguyen-Michel et al., 2006; Mahmoud et al., 2012).

Taken together, there is an urgent need to develop physical activity and exercise interventions to promote mental health and well-being among university students. The interventions should fit into their daily working schedule and demands and also fulfill the criteria of being evidence-based. It is crucial for exercise programs that are designed for university students to (a) be time-efficient, (b) require minimal effort and entail minimal injury risk, (c) control for exercise type, intensity, and duration, and (d) allow them to exercise, even when they have an overscheduled working day.

Aims of the Present Series of Pilot Studies

In accordance with the aforementioned findings, recommendations, and objectives, the present series of pilot studies had two major aims: (a) to investigate mental health, well-being and regular physical activity behavior among university students and (b) to explore the potential effects of short-term weekly aerobic exercise interventions on mental health and well-being among university students. Given the discrepancies in the dose-effect relationships and effect sizes that past studies on exercise and physical activity have reported (see section Introduction), a within-subjects pre-post intervention design was used in the present series of studies to (a) examine the relationships between regular physical activity, mental health, and well-being before the exercise intervention and (b) ascertain the health benefits of exercise (i.e., by comparing pre-intervention and post-intervention health indicators). To better understand the effects of aerobic exercise on mental health and well-being among university students, a randomized control design was chosen, in which the aerobic exercise intervention was compared to a waiting list, a cognitive intervention or a motor skills-related exercise (motor coordination). To ascertain the role of exercise type and duration and the context within which exercise is practiced, the following two studies were conducted: the 6 week online pilot study (i.e., participants exercised in their own homes) and the 2 week laboratory pilot study (i.e., participants exercised under controlled laboratory conditions). Moreover, in contradistinction to past surveys, standardized self-report measures were used to assess mental health and well-being in both the studies. Specifically, self-reported depression, anxiety, perceived stress and coping, body dissatisfaction, and quality of life were measured. In addition, cardiovascular fitness served as an objective measure in the laboratory study.

Taken together, the following key questions were investigated:

(1) Are mental health and well-being related to regular physical activity among university students? In particular, do university students report experiencing depressive symptoms, anxiety, and stress? Are these effects correlated with their regular physical activity behavior?

(2) Can short-term aerobic exercise act as a buffer against perceived stress and promote mental health and well-being in university students after 6 weeks of low to moderate regular exercise?

(3) If yes, will the effects be specific to aerobic exercise (i.e., when compared to a cognitive intervention)?

(4) Will exercise-induced changes in mental health and well-being be accompanied by changes in cardiovascular fitness after 2 weeks of regular exercise? Will the effects be specific to aerobic exercise (i.e., when compared to an exercise intervention that involves motor coordination components)?

Materials and Methods

Participants, Initial and Final Sample Sizes, Inclusion and Exclusion Criteria, and Dropouts

Participants were recruited by circulating advertisements on the internet and posting them on online university-specific platforms. The advertisements targeted volunteers who were not members of sports programs and athletes who engaged in regular aerobic exercise, received endurance training, or had been participating in sports competitions. The exclusion criteria were as follows: (a) age < 18 years, (b) regular consumption of illegal substances, (c) former or current diagnosis of or reception of treatment for psychiatric or neurological disorders, (d) a history of cardiovascular or respiratory diseases including diabetes, (e) pregnancy, (f) former or current physical impairments that can hamper engagement in even low-intensity exercises (e.g., injuries, physical handicaps). The same inclusion and exclusion criteria were used in the online and laboratory pilot study.

In total, 185 university students (157 women, 28 men; mean age = 22.54 years, SD = 2.93) were willing to participate in the studies. A total of 153 university students (127 women; mean age = 23.05 years, SD = 3.54) registered for the online study, and 32 university students registered for the laboratory study (30 women, 2 men; mean age = 22.03 years, SD = 2.32). All participants provided written informed consent. All of them completed the first set of measurements at time 1 (T1) and completed an online questionnaire, which included questionnaires that assessed mental health, well-being, and engagement in regular physical activity. Subsequently, their responses were screened to identify missing data and verify their eligibility for inclusion in the study sample (i.e., based on the inclusion and exclusion criteria).

Online Pilot Study

Among those who registered for the online study ( N = 153), 19 individuals were excluded either because their data contained missing values or based on the exclusion criteria. Further, 43 participants withdrew their participation after T1 measurements. Therefore, 91 participants were included in the study protocol and randomly allocated to one of three groups. Random allocation was undertaken using a random event generator. Thirty participants were assigned to the exercise intervention group, 30 participants were assigned to the expressive writing group (i.e., cognitive intervention), and 31 participants were assigned to the waiting list control group. Those assigned to the exercise intervention group participated on average in 11.05 of the 12 exercise sessions (range = 8-12, SD = 1.18). Further, those assigned to the expressive writing group participated on average in 11.29 of 12 writing sessions (range = 8-12, SD = 1.08). There was no statistically significant difference in the number of participated sessions between the two groups ( p > 0.1).

Only the data of those who finished the intervention (i.e., exercise or writing intervention), completed all the weekly sessions, and participated in measurements taken at time 2 (T2) were included in the final analysis. Consequently, the data of 74 participants (67 women, 7 men) were included in the data analysis. Specifically, 19, 24, and 31 of them had been assigned to the exercise, expressive writing, and (waiting list) control group, respectively.

Laboratory Pilot Study

In the laboratory pilot study, 32 university students (30 women, 2 men) were included in the study protocol and randomly allocated to one of the three groups. Because of the skewed gender distribution, the data of the two male participants were excluded from analyses. Therefore, the final all-female sample consisted of 30 university students (exercise: n = 10, motor coordination: n = 11, waiting list: n = 9).

Figure 1 presents an overview of the protocol of the randomized controlled trial, the initial and final samples included in the pilot studies, and the dropouts.

The participants of the online study were afforded the opportunity to participate in a raffle. They were informed that the winners would win a voucher worth 20 euros, which could be exchanged for things such as sports equipment and communication devices. The participants of the laboratory study were reimbursed individually. They received 50 euros as compensation because they were required to come to the university campus to participate in the exercise intervention.

Exercise Program

In accordance with past findings (see Introduction), the exercise program focused on aerobic exercise. With regard to the exercise format, exercises were chosen that would allow students to engage in low- to moderate-intensity exercise despite their overscheduled working days. This enhanced the participation of university students who were less intrinsically motivated to engage in regular exercise, could not afford to enroll in fitness or sports courses, and/or wished to exercise without expending too much effort (e.g., at home). Therefore, the exercises were videotaped, and a female and male university student served as the exercise models. In addition, auditory instructions (read by a female instructor) and videos were provided as a part of the supervised exercise training.

Figure 2 depicts an example of the exercises that were included in the supervised video-based exercise program.

Several commercial online exercise and physical fitness programs that promise maximal physical fitness benefits within minimal amounts of time are available to a broad range of users. The aerobic exercises used in this study were designed in accordance with scientific recommendations and definitions. Only exercises that (a) focused on cardiovascular and muscular endurance, (b) required use of key arm and leg muscles for prolonged periods of time, and (c) were related to physical health-related fitness were included ( Caspersen et al., 1985). Two different variations of the exercise program were available: Ex1 and Ex2. Tables 1A, B provide an overview of the exercises that were included in Ex1 and Ex2, respectively. Ex1 and Ex2 were provided for three different durations: 8, 12, and 16 min. Ex1 and Ex2 included 1 min warm-up and 1 min cool-down stretching exercises. The intensity of the 16 min aerobic exercises that Ex1 and Ex2 included was piloted using a sample of 10 university students (9 women). Specifically, the effects of the exercise on cardiovascular endurance were assessed using maximal changes in mean heart rate as an empirical estimate ( Tanaka et al., 2001). As shown in Table 2, among these ten participants, the aerobic exercises (Ex1 and Ex2) fell within the range for moderate-intensity exercise.

Procedure and Study Design

As mentioned earlier (see Materials and Methods), the effects of aerobic exercise on mental health and well-being were examined in an online and a laboratory study. In the online pilot study and in the laboratory study, T1 and T2 measurements were compared to ascertain the effects of the exercise intervention. The type and intensity of the aerobic exercises were the same across the two studies.

Online Pilot Study

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

Laboratory Pilot Study

Similar to the online pilot study, the laboratory pilot study consisted of Ex1 and Ex2. In contradistinction to the online study, the participants of this study were required to come to the laboratory and practice the exercises twice a week across 2 weeks. Similar to the online study, the duration of the exercises was systematically increased across the 2 weeks, thereby resulting in five exercise sessions that comprised one 8 min, two 12 min, and two 16 min exercise sessions, respectively ( Table 4).

To examine the specificity of the effects of aerobic exercise on mental health and well-being, three groups were included in the experimental design of the laboratory pilot study (i.e., similar to the online study). The first group received the online aerobic exercise intervention, which has been described in the preceding section. The second group received a motor coordination exercise intervention. In accordance with scientific definitions, this intervention focused on motor skills related to motor coordination and balance rather than aspects related to endurance ( Caspersen et al., 1985). An overview of the motor coordination exercise intervention is presented in Table 5. Consistent with the design of the online study, a waiting list control group was included in the laboratory study as well. Weekly exercise sessions were scheduled in such a way that the participants who were assigned to receive the aerobic exercise and motor coordination interventions always visited the laboratory on the same days and at the same time. They were provided with detailed instructions before they began practicing the exercises. The participants of the waiting list/control group did not engage in any exercise, but weekly reminders about the commencement of the interventions were sent to them. An overview of the laboratory training schedule is presented in Table 4.

Measures of Mental Health and Well-Being: Online and Laboratory Pilot Study

The participants of the online and laboratory pilot study received the same standardized self-report measures of mental health and well-being. These self-report assessments were administered at T1 (i.e., before participants were randomly assigned to either the intervention or waiting list groups) and T2 (i.e., at the end of the intervention/waiting period; see Figure 1). In the online study as well as in the laboratory study, T1 measurement was set to 6 weeks after the start of the summer term. Hence, T1 measurement and T2 measurement included a time period in which academic performance can be characterized as high.

Mental health and well-being as well as regular physical activity were assessed using standardized self-report measures of the severity of depressive symptoms, state and trait anxiety, positive and negative affect, stress, quality of life, and physical activity behaviors. The severity of depressive symptoms was assessed using the Beck Depression Inventory (BDI-II; Hautzinger et al., 2010), trait and state anxiety was assessed using the State-Trait Anxiety Inventory (STAI; Spielberger et al., 2001), and positive and negative affect was assessed using the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988). Both the trait and state PANAS scales were used. The state scale assesses positive and negative affect at a given point in time. Using cutoff values, scores of the BDI-II and STAI can be used to classify participants into different groups based on the severity of their depressive symptoms and anxiety levels. Scores of the BDI-II can be classified as follows: no, minimal, mild, and moderate to severe depressive symptoms. The STAI cutoff scores can be used to distinguish between participants with low and high levels of trait and state anxiety. Specifically, cutoff scores of 40 (state) and 44 (trait) can be used to differentiate between healthy adults and those with anxiety disorders (e.g., Julian, 2011). The state subscale of the STAI assesses bodily symptoms that are typically associated with the arousal of the autonomic nervous system (e.g., tension, nervousness, worry, activation). In contrast, the trait subscale assesses "anxiety proneness" and anxiety symptoms in general. Perceived stress and coping strategies were measured using the Stress and Coping Inventory (SCI; Satow, 2012). Its subscales assess the perceived stress that is caused by (a) uncertainty (e.g., financial uncertainty, job uncertainty, including university and academic career family and friends), (b) excessive demands (i.e., resulting from work, social life), and (c) the actual experience of negative life events (e.g., job loss). Subscale and composite scale scores (i.e., sum of subscale scores) can be computed. The SCI also assesses 13 different psychosomatic symptoms of stress such as headache, stomach ache, nightmares, and sexual disinterest. The coping strategies assessed by the SCI can be divided into two types: positive and negative coping strategies. Examples of positive coping strategies are positive thinking, active coping (e.g., trying to address the causes of stress), and social support seeking. Examples of negative coping strategies are alcohol and drug consumption to relieve stress. The WHOQOL-BREF ( Whoqol Group, 1998) was used to measure quality of life. The WHOQOL-BREF assesses well-being by measuring quality of life across different life domains, including satisfaction with physical health, well-being (i.e., psychological domain), social relationships, and environmental factors (e.g., financial resources).

Regular physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ, WHO; Armstrong and Bull, 2006). The GPAQ assesses sedentary behaviors and yields scores for three domains of physical activity (i.e., activity at work, travel to and from places, recreational activities). Additionally, body image was assessed using the body dissatisfaction subscale of the Eating Disorder Inventory (EDI-2; Garner, 1991). This assessment measures eating disorder-relevant concerns about body weight and shape.

Table 6 provides an overview of the self-report measures (including their reliability coefficients) that were used in the two pilot studies.

Additional Measures: Cardiovascular Fitness, Motivation, and Intervention Effectiveness

At the end of the intervention, the participants of the online study were asked to indicate how motivated they were to continue exercising or writing after the completion of their 6 week interventions. Moreover, they were required to rate the extent to which they believed that exercising or writing had enhanced their well-being and alleviated their stress. Responses were recorded on a 5-point Likert scale that ranged from 1 (not at all) to 5 (absolutely true).

In the laboratory study, the resting heart rate variability (HRV) of each participant (i.e., those assigned to the exercise intervention, motor coordination intervention, and control group) was measured at T1 and T2 to determine the cardiovascular fitness level at T1 and detect exercise-induced changes in cardiovascular fitness (i.e., based on changes in resting HRV) from T1 to T2. They were seated in a comfortable chair with their arms resting on their knees. They were instructed to relax and reduce any cognitive strain during the assessment. Heart rate was measured using a 3-lead electrocardiogram (ECG) with 1000 Hz via a mobile device (BioRadio, Great Lakes NeuroTechnologies) and recorded for 10 min at rest (i.e., eyes open (EO): 5 min, eyes closed (EC): 5 min), in accordance with an in-house standardized protocol for HRV measurement. To explore the differential effects of the two exercise interventions (aerobic exercise vs. motor coordination), the Beuker-Stemper test (e.g., Stemper, 2016; Bös, 2017) was used. This test battery consists of different exercise tests that measure various aspects of motor performance, including motor coordination, muscle strength, motor speed, and maximal power exercise (e.g., vertical jumps).

Data Analysis

The data analytic procedure used in this study is described in the following sections.

Mental Health, Well-Being and Relationship With Regular Physical Activity and Cardiovascular Fitness at T1

First, the data of all the participants who had registered for the online study ( N = 153) and laboratory study ( n = 30, all-female sample) were analyzed to determine their mental health status and level of well-being and examine the relationship between these variables and the regular physical activity behavior of university students at T1 (i.e., before the commencement of the interventions). Descriptive statistics were computed to ascertain the severity of their depressive and anxiety symptoms, their level of perceived stress, and the extent to which they used different coping strategies, and examine their quality of life, positive and negative affect, body image concerns (body dissatisfaction), and their physical activity behavior. For all the analyses, the data were analyzed based on the gender and the academic degree that the participants were pursuing. Group differences were examined using one-way analysis of variance (ANOVA) (i.e., >2 groups, e.g., academic degree) and independent-samples t-test (i.e., 2 groups, e.g., gender). The Wilcoxon rank-sum test ( W) was used as a non-parametric alternative. When the assumption of the analysis for the ANOVA were not met, the Kruskal-Wallis test ( H) was used. Partial eta-squared (η ²), Cohen's d, and correlation ( r) coefficients served as measures of effect size. Second, the relationships between self-reported physical activity and depression, anxiety, positive and negative affect, perceived stress, coping, and body dissatisfaction (i.e., indicators of mental health and well-being) at T1 were examined by conducting Pearson's correlation analyses (two-tailed). Because the sample size was small, data obtained from the participants of the laboratory study were analyzed using Spearman's rho. In addition, in the laboratory study, Spearman's correlation coefficients (two-tailed) were computed to examine the relationships between cardiovascular fitness (mean resting HRV), mental health, and well-being at T1.

Effects of Aerobic Exercise on Mental Health and Well-Being

Next, the effects of the aerobic exercise intervention on self-reported depressive symptoms, anxiety symptoms, positive and negative affect, perceived stress, coping strategies, quality of life, and body dissatisfaction were examined. Effects were analyzed pre to post (T1-T2) exercise and in comparison to expressive writing (online pilot study) or motor coordination (laboratory study), or the control group (waiting list; online pilot study and laboratory pilot study).

With regard to the online pilot study, pre-post and group comparisons (exercise intervention, expressive writing intervention, control group) were undertaken and the interaction between the two factors, "time" (T1 vs. T2) and "group," was examined using mixed-design ANOVA. Group served as the between-subjects factor, and time served as the within-subjects factor. When the assumptions of ANOVA were violated, a robust analysis for mixed designs, which has been described by Wilcox (2005), was used. Independent- and dependent-samples t-tests (parametric and non-parametric alternatives) were used to undertake pairwise comparisons, including the data of the final sample ( n = 74). All p-values reported in this article are uncorrected values, unless otherwise specified. Bonferroni correction was applied for multiple comparisons of post hoc tests of the ANOVAs. The samples used in the laboratory pilot study were small. Therefore, pre-post and group comparisons (i.e., exercise intervention, motor coordination intervention, and waiting list control group) were examined using only non-parametric tests (i.e., for independent and dependent samples), namely, the Mann-Whitney U test and Wilcoxon test ( Z). Partial eta-squared (η ²) and Cohen's d values served as measures of effect size. All variables were checked for normality prior to statistical analysis.

All statistical analyses were conducted using SPSS (IBM), the software package "R," and Statistica ( statsoft.com).

Results

Descriptive statistics for the T1 measurements of the initial sample of the online ( N = 153) and laboratory ( N = 30; all-female sample) pilot study and the final sample of the online study ( N = 74) are summarized in Tables 7, 8.

Online Pilot Study (Initial Sample: n = 153)

Mental Health, Well-Being, and Regular Physical Activity at T1

Depression, anxiety, and affect

Among the participants of the initial sample, scores on the BDI-II ( N = 153) ranged from 0 to 36 (i.e., from no depressive symptoms to severe/major depressive symptoms), and the mean was 7.73 ( SD = 6.51, median = 6.00). Further, 97 (63.40%) participants obtained scores that ranged from 0 to 8 (i.e., no depressive symptoms), 26 (16.99%) of them reported minimal depressive symptoms (range = 9-13), 22 (14.38%) of them reported mild depressive symptoms (range = 14-19), 7 (4.58%) of them reported moderate depressive symptoms (range = 20-28), and 1 (0.65%) participant reported severe/major depressive symptoms (>29). The severity of depressive symptoms was unrelated to the academic degrees that they were pursuing (bachelor's vs. master's vs. "staatsexamen" vs. "other" degrees), H(3) = 0.80, p > 0.8, η ² = 0.015. There was no significant gender difference (women: n = 127, M = 7.77, SD = 6.63; men: n = 26, M = 7.54, SD = 6.00), W = 1650.5, p = 1, r = 0.

Figure 3 provides an overview of the severity of the depressive symptoms (in percentages) reported by the participants of the initial sample at T1.

Figure 3. Distribution of the severity of depressive symptoms (BDI-II) (online pilot study; T1; n = 153): 0-8 (no depressive symptoms), 9-13 (minimal depressive symptoms, 14-19 (mild depressive symptoms), 20-28 (moderate depressive symptoms), >29 (severe/major depressive symptoms).

As shown in Table 7, scores on the trait anxiety subscale of the STAI ( n = 153) ranged from 20 to 69 ( M = 39.33, SD = 10.18, median = 38.00), and scores on the state anxiety subscale ( n = 153) ranged from 22 to 65 ( M = 39.59, SD = 9.01, median = 39.00). With regard to trait anxiety, 108 (70.59%) participants obtained scores that lay below the cutoff score that is used to detect clinically relevant symptoms (see section Measures of Mental Health and Well-Being: Online and Laboratory Pilot Study), and 45 (29.41%) of them scored above the clinical cutoff score. Moreover, 89 (58.17%) participants obtained low scores on the state anxiety subscale, and 64 (41.83%) of them obtained high scores on the state anxiety subscale. The severity of their trait, F(3, 149) = 0.60, p = 0.613, η ² = 0.012, and state anxiety, F(3, 149) = 1.18, p = 0.32, η ² = 0.023, was unrelated to the academic degree that they were pursuing. Gender differences in state (women: n = 127, M = 39.28, SD = 8.90; men: n = 26, M = 41.08, SD = 9.56), W = 1474, p = 0.391, r = −0.07, and trait anxiety (women: n = 127, M = 39.32, SD = 10.40; men: n = 26, M = 39.42, SD = 9.27), W = 1613, p = 0.855, r = −0.02, were not significant.

The initial sample ( N = 153) obtained mean scores that ranged from 1.20 to 4.80 ( M = 2.82, SD = 0.68, median = 2.80), and from 1.30 to 4.80 ( M = 3.22, SD = 0.66, median = 3.20) on the measures that were used to assess state and trait positive affect (PANAS), respectively. When compared to positive affect ( Table 8), the participants reported lower levels of state (range = 1.00-3.30, M = 1.41, SD = 0.48, median = 1.20) and trait negative affect (range = 1.00-4.30, M = 1.83, SD = 0.62, median = 1.70). Positive affect (state and trait) was unrelated to the academic degrees that they were pursuing, state positive: F(3, 149) = 0.78, p = 0.51, η ² = 0.015; trait positive: F(3, 149) = 0.10, p = 0.96, η ² = 0.002. The academic degrees that they were pursuing had no effect on their state, H(3) = 0.51, p = 0.91, η ² = 0.017, or trait negative affect, F(3, 149) = 0.72, p = 0.54, η ² = 0.014. Gender differences in state (women: n = 127, M = 2.84, SD = 0.65; men: n = 26, M = 2.72, SD = 0.80), t(151) = 0.82, p = 0.416, d = 0.18, and trait positive affect (women: n = 127, M = 3.25, SD = 0.66; men: n = 26, M = 3.04, SD = 0.63), t(151) = 1.50, p = 0.136, d = 0.32, and state (women: n = 127, M = 1.40, SD = 0.47; men: n = 26, M = 1.47, SD = 0.51), W = 1431.5, p = 0.282, r = −0.09, and trait negative affect (women: n = 127, M = 1.82, SD = 0.60; men: n = 26, M = 1.87, SD = 0.72), W = 1628, p = 0.913, r = −0.01, were not significant.

Perceived Stress and Coping

As can be inferred from Table 8, the scores that the participants ( N = 153) of the initial sample obtained on the SCI revealed that they had been experiencing stress due to uncertainty (e.g., financial uncertainty, job uncertainty, and uncertainty about other domains of life such as academic performance, career, family, and friends) and excessive demands (e.g., work, social life). Perceived stress due to uncertainty and excessive demands was greater than perceived stress due to actual experiences of negative life events (e.g., job loss) within this sample (uncertainty: M = 21.22, SD = 7.40; excessive demands: M = 19.21, SD = 6.46; loss experience: M = 9.98, SD = 3.85). Women and men did not differ in the amount of overall reported stress symptoms (global scores on the SCI: women: n = 127, M = 50.80, SD = 14.83; men: n = 26, M = 48.50, SD = 15.55), t(151) = 0.72, p = 0.475, d = 0.15, and women and men scored equally high in psychosomatic symptoms including different psychosomatic symptoms such as headache, stomachache, nightmares, sexual disinterest (women: n = 127, M = 23.84, SD = 6.42; men: n = 26, M = 21.96, SD = 6.61), W = 1930, p = 0.176, r = 0.11. Positive coping strategies included positive thinking, active coping (e.g., trying to resolve the causes of stress) or social support seeking. Negative coping strategies included alcohol and drug consumption for stress relaxation. Overall, positive coping strategies were reported more often than negative coping strategies (see Table 8). Social support seeking emerged as the most frequently used positive coping strategy. Notably, female participants tended to use this positive coping strategy significantly more frequently than male participants did (women: n = 127, M = 14.07, SD = 2.12; men: n = 26, M = 12.54, SD = 2.50), W = 2283, p < 0.01, r = 0.25. Alcohol consumption and cigarette smoking, which are negative coping strategies, were more frequently reported by male students than by female students (women: n = 127, M = 5.92, SD = 2.59; men: n = 26, M = 7.12, SD = 1.86), W = 989.5, p < 0.001, r = −0.27. The academic degrees that they were pursuing did not have a significant effect on overall perceived stress, F(3, 149) = 1.06, p = 0.368, η ² = 0.021, or psychosomatic symptoms, F(3, 149) = 0.13, p = 0.940, η ² = 0.003. With regard to positive coping strategies, the academic degrees that the participants were pursuing had no effect on positive thinking, F(3, 149) = 0.75, p = 0.524, η ² = 0.015, and social support seeking, H(3) = 2.00, p = 0.572, η ² = 0.007. However, with regard to active stress reduction, there were differences between the groups that were pursuing different academic degrees, H(3) = 8.25, p < 0.05, η ² = 0.035. Specifically, the observed difference was significantly greater among students who were pursuing a master's degree than among those who were pursuing a bachelor's degree (bachelor's degree: M = 9.96, SD = 2.60; master's degree: M = 11.64, SD = 3.23). No significant difference emerged for alcohol consumption, which is a negative coping strategy, H(3) = 5.85, p = 0.119, η ² = 0.017.

Quality of Life

It can be inferred from Table 8 that there were differences between the four major domains of self-reported quality of life (WHOQOL-BREF; n = 147). The participants were reportedly more satisfied with their environment (e.g., financial resources, health, and social care: M = 77.55, SD = 12.34), and their physical health ( M = 78.30, SD = 12.71) than with their level of well-being (psychological domain: M = 69.42, SD = 14.91) and social relationships ( M = 71.88, SD = 19.56), F(3, 438) = 20.12, p < 0.001, η ² = 0.12. This pattern did not differ between the groups pursuing different academic degrees or between the female and male participants, all ps > 0.1.

Body Dissatisfaction

On the assessment that was used to assess body dissatisfaction (EDI-2), the participants ( n = 142) obtained a mean score of 28.44 ( SD = 9.67). Further, consistent with the literature (also see Table 7), female university students obtained significantly higher scores than their male counterparts (women: M = 29.92, SD = 9.52; men: M = 21.13, SD = 6.68), t(140) = 4.31, p < 0.001, d = 0.97.

Regular Physical Activity

Table 7 presents descriptive statistics ( n = 141) for composite scores (i.e., physical activity across the three domains of daily life, namely, activity at work, travel to and from places, and recreational activities) on the GPAQ, which is based on the recommendations of the WHO. Notably, their time spent sitting was higher than the recommended duration. Their average time spent sitting was reportedly 7.45 h/day, and this amounted to an average of 3129 min/week ( SD = 1114.40). The mean durations for which they engaged in physical activity (i.e., minutes per week) were as follows: moderate-intensity activity at work = 160.40 min/week, vigorous-intensity activity at work = 38.44 min/week, travel to and from places = 239.78 min/week, moderate-intensity recreational activities = 158.60 min/week, and vigorous-intensity recreational activities during leisure time = 168.00 min/week. These durations amounted to a total of 765.70 min/week ( SD = 623.59). Further, 124 (87.32%) participants did not engage in vigorous-intensity activity at work, and 78 (54.93%) participants did not engage in moderate-intensity activity at work. Additionally, 34 (23.94%) and 38 (26.76%) participants did not engage in vigorous- and moderate-intensity activity during their leisure time, respectively. With regard to the total duration for which they engaged in physical activity on a weekly basis (i.e., including activity at work, during transport, and leisure time), 21 (14.79%) participants did not meet the WHO criterion of 150 min of moderate-intensity physical activity, and 7 (4.93%) of them did not meet the WHO criterion of 75 min of vigorous-intensity physical activity. The participants achieved less than 600 MET-minutes per week. Gender differences in sedentary behaviors (i.e., per week) were not significant (women: M = 3108.12, SD = 1020.55; men: M = 3232.17, SD = 1527.17), W = 1317.5, p = 0.927, r = −0.01. The same was found for overall physical activity per week (women: M = 753.80, SD = 606.48; men: M = 824, SD = 712.51), W = 1316, p = 0.631, r = −0.04. Moreover, overall physical activity and sedentary time did not differ across the groups that differed in the academic degrees that they were pursuing, overall physical activity: H(3) = 3.17, p = 0.366, η ² = 0.008; sedentary time: H(3) = 5.03, p = 0.170, η ² = 0.002.

Relationships Between Regular Physical Activity, Mental Health, and Well-Being

Short-Term Aerobic Exercise, Mental Health, and Well-Being (Online Study; n = 74, Final Sample)

Exercise, Depression, Anxiety, and Affect

There was a significant interaction between time and group for depression, F(2, 71) = 5.23, p < 0.005, η ² = 0.13. Specifically, there was a decrease in self-reported depressive symptoms between T1 and T2 among the participants assigned to the exercise intervention group, t(18) = 3.38, p < 0.005, d = 0.62. As shown in Figure 4, at T1, the participants of the aerobic exercise group scored on average two scores higher on the BDI-II than the participants of the expressive writing group or the participants of the waiting list control group. This difference was not statistically different, F(1, 72) = 1.70, p > 0.1, η ² = 0.04. Comparisons of descriptive statistics revealed that, among those assigned to the aerobic exercise intervention group, 73.68% demonstrated improvements in depressive symptoms between T1 and T2. Among those assigned to the expressive writing intervention group, 45.8% demonstrated improvements in depressive symptoms between T1 and T2. In contrast, only 36.6% of the waiting list control participants demonstrated improvements in depressive symptoms between T1 and T2. The difference scores (T1 vs. T2) were significantly different between the three groups, F(2, 71) = 5.23, p ≤ 0.01, η ² = 0.13.

Figure 4. Comparison of BDI-II scores across time (T1 vs. T2) and between experimental conditions (online pilot study: aerobic exercise group, expressive writing group, control group/waiting list). Vertical bars denote ± standard errors. Significant differences between T1 and T2 are indicated (* p ≤ 0.05; ** p ≤ 0.01; *** p ≤ 0.001).

Time had a main effect on state anxiety, F(1, 71) = 14.16, p < 0.001, η ² = 0.06. Specifically, there was an increase in state anxiety between T1 and T2. The interaction between time and group was marginally significant, F(2, 71) = 2.50, p = 0.090, η ² = 0.02, as did the main effect of group, F(2, 71) = 2.45, p = 0.094, η ² = 0.04. Post hoc tests revealed a marginally significant difference between the exercise and expressive writing intervention groups at T2 (exercise: M = 40.90, SD = 8.69; expressive writing: M = 48.79, SD = 12.88), p = 0.083. There were no significant effects for trait anxiety. Neither their main effects nor the interaction effect on trait anxiety was significant, group: Q = 0.89, p = 0.423; time: Q = 0.95, p = 0.336; group × time: Q = 1.34, p = 0.281.

With regard to both positive and negative affect (state), the main effect of time was significant, state positive affect: F(1, 71) = 5.10, p < 0.05, η ² = 0.02; state negative affect: Q = 8.83, p < 0.01. Positive affect had decreased and negative affect had increased by the end of the 6-week intervention, and this trend did not differ across the three groups. Time: Q = 5.35, p < 0.05 and group: Q = 4.52, p < 0.05 had significant main effects on trait positive and negative affect, respectively.

Exercise, Perceived Stress, and Stress Coping

Exercise and Quality of Life

No significant main effect emerged for any of the quality of life domains, all ps > 0.05. Further, none of the interaction effects were significant, all p s > 0.05.

Exercise and Body Dissatisfaction

Time had a significant main effect on body dissatisfaction (EDI-2), F(2, 71) = 5.18, p < 0.05, η ² = 0.004. All the groups demonstrated similar slight decreases in their level of body dissatisfaction over time (i.e., from T1 to T2).

Manipulation Check: Motivation and Intervention Effectiveness

At T2, the participants of the aerobic exercise and expressive writing intervention groups were required to indicate how motivated they were to continue exercising or writing and rated the effectiveness of the intervention that they had received (i.e., exercising or writing) in enhancing well-being and alleviating perceived stress. The participants of the exercise and the expressive writing intervention groups reported that they enjoyed taking part in the intervention. However, when compared to the participants of the expressive writing intervention group, those who belonged to the aerobic exercise intervention group were significantly more motivated to continue exercising, t(41) = 4.10, p < 0.001, d = 1.23. Moreover, as shown in Figure 5, the extent to which the intervention was perceived to have been effective in alleviating stress, t(41) = 2.03, p < 0.05, d = 0.63, and enhancing well-being, t(41) = 2.10, p < 0.05, d = 0.65, was greater among the exercise intervention group participants than among the expressive writing intervention group participants ( Figure 5).

Figure 5. Participants' ratings of enjoyment, subjective effectiveness of the intervention and exertion (online pilot study: aerobic exercise group, expressive writing group). Vertical bars denote ± standard errors. Significant differences between groups are indicated (* p ≤ 0.05; ** p ≤ 0.01; *** p ≤ 0.001).

Laboratory Pilot Study (n = 30, All-Female Sample)

Mental Health, Well-Being, and Regular Physical Activity at T1

Depression, anxiety, affect, perceived stress, body dissatisfaction, and quality of life

It can be inferred from Table 7 that, at T1, self-reported depressive symptoms (BDI-II) were less severe in the sample of the laboratory pilot study than in the online study sample. Specifically, 25 (83.3%) of them had no depressive symptoms, and 5 (16.7%) of them reported minimal symptoms. None of them reported moderate or clinically relevant depressive symptoms ( M = 4.33, SD = 3.86, median = 4.00). At T1, both samples reported similar levels of trait anxiety, but state anxiety levels were lower in the laboratory study sample than in the online study sample ( Table 7). In the all-female sample the all-female sample of the laboratory study, 9 (30%) and 7 (23.3%) participants obtained high scores on the assessments that were used to measure state and trait anxiety, respectively. Differences in positive and negative affect, quality of life, and body dissatisfaction between the two samples were not significant ( Tables 7, 8). Similar to the results that emerged for the online study sample, the participants of the laboratory study were more stressed because of uncertainty and excessive work demands than because of actual experiences of negative life events ( Table 8).

Physical Activity, Cardiovascular Fitness, Mental Health, and Well-Being

Similar to the online study sample, the laboratory study sample's average time spent sitting was 7.6 h/day. The mean durations for which they engaged in physical activity (i.e., per week) were as follows (total: M = 500.17 min/week, SD = 323.92): activity at work = 57.17 min/week, travel to and from places = 189.20 min/week, and leisure-time activity = 253.80 min/week. Referring to the WHO's recommended levels of physical activity, 9 (30%) of them engaged in < 150 min of moderate-intensity activity, and 2 (6.7%) of them engaged in < 75 min of vigorous-intensity activity.

Their regular physical activity behavior (GPAQ; calculated as MET-minutes per week) was significantly and negatively correlated with coping strategies, social support seeking: r = −0.392, p = 0.032, at T1. Cardiovascular fitness [HRV-HF (n.u.), EO] at T1 was significantly and negatively correlated with self-reported state anxiety, r = −0.509, p < 0.005, and marginally negatively correlated with self-reported depression, r = −0.328, p = 0.077. Significant negative correlations emerged for negative state affect, r = −0.362, p < 0.05, and marginally significant positive correlations emerged for one quality of life domain, namely, social relationships, r = 0.345, p = 0.062.

Effects of Short-Term Aerobic Exercise on Well-Being

At T1, there was no significant difference between the aerobic exercise intervention, motor coordination intervention, and waiting list control group. Within-group comparisons (T1 vs. T2) of T1 and T2 measurements (i.e., depression, anxiety, perceived stress, affect, quality of life, and coping) yielded a few significant findings. The motor coordination intervention group demonstrated a significant decrease in social support seeking from T1 to T2, Z = −2.13, p < 0.05, d = 1.68. The waiting list control group demonstrated a significant decrease for quality of life related environmental factors, Z = −2.08, p = < 0.05, d = 1.92, and a marginal decrease in state positive affect, Z = −1.68, p = 0.092, d = 1.35, between T1 and T2.

Discussion

Mental Health and Well-Being Among University Students

Online and Laboratory Pilot Study

The present results are consistent with the findings of recent health surveys on mental health and well-being. Overall, 36.6% of the participants of the online study, who were recruited from different universities in Germany, reported minimal and mild (31.3%) or moderate (4.58%) to severe (0.65%) depressive symptoms (i.e., as measured by the BDI-II) at T1 (i.e., before the commencement of the interventions). The BDI-II assesses the severity of depressive symptoms during the past 2 weeks. Typically, women have a higher risk of developing major depressive disorder than men do. In the online study ( N = 153), the severity of depressive symptoms did not vary as a function of gender or the academic degrees that the participants were pursuing. Further, there were no significant differences in BDI-II scores between the all-female sample of the laboratory study ( N = 30) and the sample of the online study, which consisted of men and women. In addition, their anxiety scores were comparable to the norms that have been reported for college students and young adults. Nevertheless, at T1, 41.83% of the participants of the initial sample (which included both women and men) scored above the cutoff scores that have previously been reported for state anxiety (e.g., Julian, 2011). Women were overrepresented in the online study sample. This trend is consistent with past observations regarding online studies and research on exercise. Specifically, when compared to men, women have been found to be more willing to participate in online studies (e.g., Smith, 2008), especially those that pertain to exercise, health, and well-being ( Kilpatrick et al., 2005).

With regard to perceived stress, all the students reported experiencing chronic stress due to uncertainty (i.e., financial uncertainty, job uncertainty, uncertainty about other domains of life such as career, family, and friends) and excessive demands (e.g., related to work and social life). These two types of stressors might be major contributors to the consistently high levels of stress that university students experience throughout the entire duration of their academic program. Accordingly, all the participants of the online study reported experiencing several psychosomatic symptoms. With regard to their quality of life, they were more satisfied with their environments and physical health than with their well-being and social relationships. This finding supports the contention that university students are sensitive to and aware of the psychological factors that promote and impair their well-being and mental health.

Further research is needed to determine the generalizability of the present findings to the larger population of university students (e.g., those in other countries). Nevertheless, the present findings are true of those without any history of health problems. Thus, the findings of the present series of pilot studies may also be true of university students without a history of psychiatric, mental, and somatic disorders.

Physical Activity, Mental Health, and Well-Being Among University Students

Among the male and female participants of the online study, none of whom had any history of psychiatric disorders, self-reported engagement in regular physical activity at T1 was significantly and negatively correlated with self-reported depression, trait and state anxiety, psychosomatic symptoms, and body dissatisfaction. Furthermore, physical activity was positively correlated with positive affect and the following quality of life domains: satisfaction with physical health, well-being, and social relationships.

The present findings support the contention that there is a relationship between regular physical activity, mental health, and well-being among university students. Importantly, this relationship was already confirmed using T1 measurements. Therefore, this relationship is independent of the effects of the exercise intervention and any of the control interventions that were used in this study. This suggests that regular physical activity significantly enhances mental health and well-being among university students whose average time spent sitting is approximately 7.5 h per day.

These correlational results cannot be treated as evidence of causal relationships, but the aforementioned correlations suggest that regular physical activity protects university students from mental health problems. Indeed, it was associated with lower levels of depression, anxiety, and psychosomatic stress and better quality of life across the following domains: physical health, well-being, and social relationships. This interpretation concurs with past findings, which suggest that physically active people report lower levels of depression and anxiety and that physical activity, in general, can prevent or alleviate depression, anxiety, and stress symptoms (e.g., Taylor et al., 1985; Paluska and Schwenk, 2000; Penedo and Dahn, 2005). Moreover, short-term exercise interventions may have beneficial effects on the mental health and well-being of university students. The results of the pilot studies, which are discussed in the following sections, partially support this interpretation.

Effects of the Short-Term Aerobic Exercise Intervention on Mental Health and Well-Being

The 6 week low- to moderate-intensity aerobic exercise intervention significantly decreased depressive symptoms among the female and male participants of the online study sample (i.e., between T1 and T2). Among those assigned to the aerobic exercise intervention condition, 73.68% demonstrated improvements in depressive symptoms between T1 and T2. The aerobic exercise group scored at T1 on average two points higher on the BDI-II than the expressive writing group or the waiting list. However, this difference was not statistically significant. From a clinical perspective, the mean scores obtained by the aerobic exercise group participants at T1 were indicative of minimal depressive symptoms. In contrast, the scores obtained by the participants of the other two groups were indicative of a relative absence of depressive symptoms at T1. Therefore, short-term aerobic exercise interventions may be particularly effective in reducing the severity of depressive symptoms among university students who already report depressive symptoms for a constant time at T1. The validity of this speculation should be tested in future studies using larger cohorts of university students.

In addition, the 6 week low- to moderate-intensity aerobic exercise intervention resulted in significant improvements in perceived stress between T1 and T2 (within-subjects comparisons). Notably, perceived stress due to uncertainty increased between T1 and T2 (i.e., effect of time), but this change was less pronounced among the participants assigned to the aerobic exercise intervention group. This supports the contention that engagement in aerobic exercise serves as a buffer against psychological stress among university students (e.g., Kim and McKenzie, 2014; Magalhaes, 2016). This effect was specific to the aerobic exercise intervention. Thus, among university students, aerobic exercise appears to be more efficient in regulating perceived stress than other interventions such as cognitive interventions (e.g., expressive writing). However, the 6 week aerobic exercise intervention did not alleviate the psychosomatic symptoms of perceived stress. Further, those assigned to the exercise intervention group did not demonstrate significant changes in quality of life when compared to the waiting list control and expressive writing intervention groups. The participants assigned to the exercise and expressive writing intervention groups reported that the intervention that they had received (i.e., exercise or expressive writing) alleviated their stress and enhanced their well-being. However, the perceived contributions of their respective interventions to stress regulation and well-being were greater among those assigned to the exercise intervention group than among those assigned to the expressive writing intervention group. Moreover, as mentioned earlier, only the 6 week exercise intervention was effective in decreasing the overall level of perceived stress, especially stress caused by uncertainty.

There were no significant changes in anxiety scores between T1 and T2 (i.e., within-subjects comparisons) in any of the three groups. However, state anxiety scores at T2 were lower among those assigned to the exercise intervention group than among those assigned to the expressive writing intervention or waiting list control group. Recent meta-analytic studies have found that even a single bout of exercise can significantly reduce state anxiety ( Ensari et al., 2015). However, the anxiolytic effects of aerobic exercise become evident only after a minimum of 10 weeks of regular engagement in 21 min aerobic exercise sessions (e.g., Petruzzello et al., 1991).

Past findings on the dose-effect relationship between aerobic exercise and mental health parameters are less consistent. Health-related exercise recommendations (e.g., WHO, ACSM) are disproportionately founded upon their physical health benefits than on their contribution to mental health and well-being. With regard to depression, it is well established that regular exercise (aerobic and anaerobic exercise) has marked antidepressant effects on patients with clinical manifestations of depressive symptoms (for an overview, see Morres et al., 2019). However, little is known about the antidepressant effects of exercise on mild, minimal, and moderate subclinical depressive symptoms. Although a small sample was used in the laboratory study, a comparison of the results of the present series of pilot studies revealed that six but not 2 weeks of regular engagement in low- to moderate-intensity aerobic exercise can significantly alleviate the subclinical depressive symptoms of healthy university students (both men and women) without a history of depression. These effects were evident only after regular engagement in low- to moderate-intensity aerobic exercise for 6 weeks. This observation concurs with recent recommendations, which underscore the need to not only explore the therapeutic effects of low- to moderate-intensity aerobic exercise among clinical populations but also test the effectiveness of aerobic exercise in promoting mental health and well-being. The present series of pilot studies on mental health, well-being, and the effects of physical activity and short-term low- to moderate-intensity aerobic exercise on university students are first steps in this direction.

One of the limitations of the present pilot studies is the use of small samples. However, a pre-post design and a randomized controlled trial and well-controlled online and laboratory study protocols were used. Therefore, this study can serve as a model for future studies. This design allowed to disentangle the quasi-experimental effects of self-reported physical activity from the effects of the short-term aerobic exercise intervention on mental health and well-being. At the same time, it allowed to compare the effects of the short-term aerobic exercise to those of stress-relieving cognitive (i.e., expressive writing) and other types of exercise (i.e., motor coordination) interventions. Expressive writing has been used in cognitive behavioral therapy, in cognitive stress-prevention and self-regulation programs in students and patient samples including multiple or single sessions (e.g., Baikie and Wilhelm, 2005; Lepore, 2006; Herbert et al., 2019). The exercises included in the motor coordination intervention (i.e., balance, agility, and coordination) were selected in accordance with the recommendations of the ACSM ( Garber et al., 2011; American College of Sports Medicine, 2013), which aims to promote the maintenance of motor skills and executive functions across the developmental life span and especially among older adults. The maximal duration and intensity of the motor coordination exercises were lower than those that the ACSM has recommended for motor skills-related exercise training (20-30 min per day). Nevertheless, the participants assigned to the motor coordination intervention group demonstrated significant improvements in motor balance (which was assessed using the balance-board subtest). Thus, aerobic exercise appears to be effective in enhancing the well-being of university students, and other types of exercises (e.g., motor coordination exercises) appear to have unique effects on cognitive and motor performance. In this experimental study, an all-female sample was used to examine the effects of the motor coordination and aerobic exercise interventions. Therefore, future studies should test the present findings using larger samples of university students that include both women and men. Further, future studies should use less conservative inclusion and exclusion criteria. Indeed, in the present series of pilot studies, only participants who completed the interventions were included in the sample.

Cardiovascular Effects

Conclusion and Future Outlook

The present series of pilot studies answer four major questions. None of these questions has been addressed in sufficient detail in previous studies. The present findings regarding the mental health and well-being of university students, which were derived using standardized questionnaires, are alarming because they concur with the results of larger online surveys. In this study, physical activity was significantly related to self-reported depressive symptoms, anxiety, positive affect, and quality of life, irrespective of the gender of the participants and the academic degrees that they were pursuing. These findings underscore the important role that physical activity plays in the well-being of university students. Furthermore, they confirm that regular engagement in low- to moderate-intensity aerobic exercises for 6 weeks is effective in alleviating subclinical depressive symptoms and perceived stress among university students without a history of depression and health concerns. Short-term aerobic exercise interventions may be more effective in promoting the mental health and well-being of students than cognitive interventions are. Therefore, low- to moderate-intensity exercise (e.g., as the one used in the present study) should be incorporated into daily university schedules. Delivering the exercise programs used in this study as online video tutorials may allow university students to practice these exercises in the comfort of their own homes and at a time that is convenient to them. This is also a cost-effective means of reaching less intrinsically motivated students and increasing their likelihood of engagement in regular exercise. With regard to the role of monetary incentives in motivating individuals to participate in studies on mental health and well-being, women have been found to be more likely to participate in online studies, especially those that are related to health. Moreover, high monetary incentives and incentives with low probabilities of payoffs (e.g., lotteries or raffles) have positive effects on study compliance (e.g., Zutlevics, 2016; Vlaev et al., 2019). Different incentives were offered in the two pilot studies (i.e., online study: raffle vs. laboratory study: individual monetary rewards), but they may have had similar effects on potential participants' motivation to participate. In this regard, offering evidence-based exercise programs in classrooms (e.g., by incorporating exercise breaks into weekly lectures and courses and implementing them either directly or through online modules) may be effective in increasing university students' motivation to increase their regular physical activity behaviors, despite their overscheduled work days. Despite constant progress within the field of health management and a wealth of available exercise options, corresponding initiatives to provide structured health management exercise interventions to university students remain sparse (e.g., Brown, 2018). The present findings underscore the need to implement exercise interventions in universities to promote mental health and well-being among university students in the short (i.e., during the course of their academic program) and long term.

Data Availability Statement

The data supporting the conclusions of this article will be made available by the corresponding author, without undue reservation, to any qualified researcher.

Ethics Statement

The experimental protocol, design of the exercise intervention, and its laboratory assessment were reviewed and approved by the local ethics committee of Ulm University. The participants of the online study and the laboratory study provided their written informed consent to participate in the study. Written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article.

Author Contributions

CH drafted and wrote the manuscript and revised it for intellectual content. CH developed, conceptualized and designed the two studies, the experimental designs, the exercise training programs and the RCT for the exercise and cognitive intervention reported in this manuscript (online and laboratory design). CH developed the standardized protocol for HRV measurement at rest. CH supervised and contributed to data collection and data preprocessing (online and laboratory study). CH performed data methods and data interpretation. CH, FM, and VG performed the statistical data analysis of the online study. FM performed the piloting of the n = 10 sample for estimation of max. heart rate. CH and CW performed the statistical data analysis of the laboratory study. Tables and Figures were created by FM, CW and revised by CH. English translations for the exercises in the Tables 1A, B, 5 were provided by FM and CW.

Funding

The study was funded by the budgetary resources of the Department of Applied Emotion and Motivation Psychology, Ulm University, Germany.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thank our student assistants (bachelor and master) for help with data collection and for help with (physiological) data preprocessing.

Footnotes

References

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Regular Physical Activity, Short-Term Exercise, Mental Health, and Well-Being Among University Students: The Results of an Online and a Laboratory Study

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The health benefits of regular physical activity and aerobic exercise are undisputed in the literature. The present series of pilot studies had two major objectives: (a) examine mental health, well-being, and regular physical activity of university students and (b) explore the potential health benefits of short-term aerobic exercise on university students in an online and a laboratory study.

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Regular physical activity is proven to help prevent and manage noncommunicable diseases such as heart diseases stroke, diabetes and several cancer. It also helps prevent hypertension, maintain healthy body weight and can improve mental health, quality of life and well-being. Its our own responsibility to take care of our health and by doing that we must exercise a lot and balance our food diet .

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The Connection Between Mental and Physical Health

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https://www.gamian.eu/time-to-act-on-mental-health/

Mental ill health affects more than 1 in 6 people across the european Union,and a cost of over 600bn mentail illness can affect people of different ages and in a variety of forms including depression.bipolar disorder and schizophrenia-and comes with different cost and consequences that impact individuals,families and carers,the health and social systems,society and the economy.Social and economic.

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Four MEP Alliance for Mental Health co-chairs (Alex Agius Saliba, Radka Maxová, Maria Walsh, and Tomas Zdechovsky) recently published an article in the Parliament Magazine on the need for a comprehensive EU Mental Health Strategy.

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Time to Act on Mental Health - Article | GAMIAN-Europe

# data[].attributes.attachment_link.description
Four MEP Alliance for Mental Health co-chairs (Alex Agius Saliba, Radka Maxová, Maria Walsh, and Tomas Zdechovsky) recently published an article in the Parliament Magazine on the need for a comprehensive EU Mental Health Strategy.

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The benefits of exercise for your physical and mental health

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Even a small amount of exercise can have both curative and preventive health benefits. This article looks at the benefits of exercise for both the mind and body.

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P= I agree that Physical Health is ultimately an individual's responsibility as doing regular physical activities is one of the best options to keep yourself healthy.
E= Regular physical activity is proven to help prevent and manage noncommunicable diseases such as heart disease, stroke, diabetes and several cancers.
E= It prevents diseases because our body is functioning properly as we are healthy. If you do not exercise, your body wouldn't be healthy as you can get sick easily.
L= [Recommended link: The choice is ours. We are the ones deciding whether or not to adopt a healthy lifestyle to maintain our physical fitness.] That is why i agree  physical health in an individual's health is important as it will make you grow healthier.