This study aimed to examine physical activity levels, sleep quality, and musculoskeletal discomfort in university students during the academic and exam periods.
Approach or Design
A cross-sectional comparative design was used.
Setting
The study was conducted at a University.
Participants
A total of 227 (n = 199 female) undergraduate students participated.
Method
Data were collected face-to-face using the Cornell Musculoskeletal Discomfort Questionnaire, Pittsburgh Sleep Quality Index (PSQI), and International Physical Activity Questionnaire-Short Form (IPAQ-SF) during both periods. Daily sitting durations and preferred study postures were also recorded. Data were analyzed using paired t-tests, with significance set at P < 0.05.
Results
During the exam period, musculoskeletal discomfort was highest in the back, lower back, and neck regions. PSQI scores showed worse subjective sleep quality, longer sleep latency, shorter duration, and increased disturbances during exams (P < 0.05). IPAQ-SF results indicated reduced physical activity and significantly increased daily sitting time in the exam period (P < 0.05).
Conclusion
University students experience more musculoskeletal discomfort, poorer sleep quality, and decreased physical activity during exams. These findings highlight the need for preventive strategies during high-stress academic periods.
MemonARGuptaCCCrowtherMEFergusonSATuckwellGAVincentGE. Sleep and physical activity in university students: a systematic review and meta-analysis. Sleep Med Rev. 2021;58:101482. doi:10.1016/j.smrv.2021.101482
2.
Ferreira SilvaRMMendonçaCRAzevedoVDRaoof MemonARNollPRESNollMJ. Barriers to high school and university students’ physical activity: a systematic review. PLoS One. 2022;17(4):e0265913. doi:10.1371/journal.pone.0265913
3.
KljajevićVStankovićMĐorđevićD, et al.Physical activity and physical fitness among university students—A systematic review. Int J Environ Res Publ Health. 2021;19(1):158. doi:10.3390/ijerph19010158
4.
HerbertCJ. Enhancing mental health, well-being and active lifestyles of university students by means of physical activity and exercise research programs. Front Public Health. 2022;10:849093. doi:10.3389/fpubh.2022.849093
5.
JiangWLuoJGuanH. Gender difference in the relationship of physical activity and subjective happiness among Chinese university students. Front Psychol. 2021;12:800515. doi:10.3389/fpsyg.2021.800515
6.
HariyantoAAMaSMustarYSPramonoBAPuteraSHP, eds. Physical activity and its relation to academic performance among university studentsUnima International Conference on Social Sciences and Humanities (UNICSSH 2022). Atlantis Press; 2023.
7.
PilcherJJMorrisDMBryantSAMerrittPAFeiglHB. Decreasing sedentary behavior: effects on academic performance, meta-cognition, and sleep. Front Neurosci. 2017;11:219. doi:10.3389/fnins.2017.00219
8.
Dewald-KaufmannJFOortFJMeijerAM. The effects of sleep extension on sleep and cognitive performance in adolescents with chronic sleep reduction: an experimental study. Sleep Med. 2013;14(6):510-517. doi:10.1016/j.sleep.2013.01.012
9.
AlvaroPKRobertsRMHarrisJK. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep. 2013;36(7):1059-1068. doi:10.5665/sleep.2810
10.
CampbellRSoenensBBeyersWVansteenkisteM. University students’ sleep during an exam period: the role of basic psychological needs and stress. Motiv Emot. 2018;42(5):671-681. doi:10.1007/s11031-018-9699-x
11.
BouloukakiITsiligianniIGStathakisG, et al.Sleep quality and fatigue during exam periods in university students: prevalence and associated factors. Healthcare. 2023;11(2):300. doi:10.3390/healthcare11020300
12.
LinKBroadbentE. Understanding embodied effects of posture: a qualitative study. Psychol Health. 2023;38(2):447-460. doi:10.1080/08870446.2022.2052690
13.
Flores-CruzG. Effects on interpretation bias, mood, and physical tension during Mobile device usage: an examination of slumped, upright, and lying Down postures. The Pegasus Review: UCF Undergraduate Research Journal. 2021;12(2):5.: Iss.
14.
PirutaJKułakW. Physiotherapy in text neck syndrome: a scoping review of current evidence and future directions. J Clin Med. 2025;14(4):1386. doi:10.3390/jcm14041386
15.
AlacaNAcarAÖÖztürkS. Low back pain and sitting time, posture and behavior in office workers: a scoping review. J Back Musculoskelet Rehabil. 2024;Advance online publication. doi:10.3233/BMR-230068
16.
VujcicIStojilovicNDubljaninELadjevicNLadjevicISipetic-GrujicicJ. Low back pain among medical students in Belgrade (Serbia): a cross-sectional study. Pain Res Manag. 2018;2018:8317906. doi:10.1155/2018/8317906
17.
ParkSMKimHJJeongH, et al.Longer sitting time and low physical activity are closely associated with chronic low back pain in population over 50 years of age: a cross-sectional study using the sixth Korea National Health and Nutrition Examination Survey. Spine J. 2018;18(1):2051-2058. doi:10.1186/s12889-018-5929-3
18.
YangSBoudier-RevéretMYiYGHongKYChangMC. Treatment of chronic neck pain in patients with forward head posture: a systematic narrative review. Healthcare. 2023;11(6):887. doi:10.3390/healthcare11060887
19.
HuangTLarsenKTRied-LarsenMMøllerNCAndersenLB. The effects of physical activity and exercise on brain-derived neurotrophic factor in healthy humans: a review. Scand J Med Sci Sports. 2014;24(1):1-10. doi:10.1111/sms.12069
20.
BükülmezE. İlköğretim 8. sınıf öğrencilerinde sınav kaygısı ve ders çalışma yaklaşımları arasındaki ilişkisi [relationship between exam anxiety and study approaches among 8th grade students]. In: Sosyal Bilimler Enstitüsü; 2015. Master’s thesis.
21.
SaglamMArikanHSavciS, et al.International Physical Activity Questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;45(1):278-284. doi:10.2466/06.08.PMS.111.4.278-284
22.
WohlgenanntISimonsAStieglitzS. Virtual reality. Business & Information Systems Engineering. 2020;62(5):455-461. doi:10.1007/s12599-020-00650-2
23.
ErdinçÖHotKÖzkayaM. Turkish version of the cornell musculoskeletal discomfort questionnaire: cross-cultural adaptation and validation. Work. 2011;39(3):251-260. doi:10.3233/WOR-2011-1161
24.
AkçaEYıldırımM. Pittsburgh Uyku Kalitesi İndeksinin geçerliği ve güvenirliği [Validity and reliability of the Pittsburgh Sleep Quality Index]. Türk Psikiyatri Derg. 1996;7(2):107-115.
25.
KhanDRizwanKRiazMUShahidMAinNUAjmalM. Role of physical activity among medical students; an observational study. The Health Journal of Pakistan. 2022;2(3):245-251. nts; An Observational Study: Physical Activity in Medical Students. 2022;2(3):245-51. doi:10.55735/hjprs.v2i3.64
26.
van SluijsEMFEkelundUCrochemore-SilvaI, et al.Physical activity behaviours in adolescence: current evidence and opportunities for intervention. Lancet. 2021;398(10298):429-442. doi:10.1016/S0140-6736(21)01242-7
27.
ZhouSLiLZhaoYCaoYPengBZhengL. Physical activity under stress: a perspective of HAPA and individual differences. Int J Environ Res Publ Health. 2021;18(22):12144. doi:10.3390/ijerph182212144
28.
PechtlSMKimLPJacobsenKH. Physical inactivity and sedentariness: languorous behavior among adolescents in 80 countries. J Adolesc Health. 2022;70(6):950-960. doi:10.1016/j.jadohealth.2022.01.005
29.
AbdulghaniHMAlKanhalAAMahmoudESPonnamperumaGGAlfarisE. Stress and its effects on medical students: a cross-sectional study at a college of medicine in Saudi Arabia. J Health Popul Nutr. 2011;29(5):516-522. doi:10.3329/jhpn.v29i5.8907
30.
Stults-KolehmainenMASinhaR. The effects of stress on physical activity and exercise. Sports Med. 2014;44(1):81-121. doi:10.1007/s40279-013-0090-5
31.
JiCYangJLinLChenS. Physical exercise ameliorates anxiety, depression and sleep quality in college students: experimental evidence from exercise intensity and frequency. Behav Sci. 2022;12(3):61. doi:10.3390/brainsci12030061
32.
AlnawwarMAAlraddadiMIAlgethmiRASalemGASalemMAAlharbiAA. The effect of physical activity on sleep quality and sleep disorder: a systematic review. Cureus. 2023;15(8):e43236. doi:10.7759/cureus.43236
33.
OzcanBAcimisN. Sleep quality in Pamukkale University students and its relationship with smartphone addiction. Pakistan J Med Sci. 2021;37(1):206-213. doi:10.5505/pjms.2020.54451
34.
WangFBíróÉ. Determinants of sleep quality in college students: a literature review. Explore. 2021;17(2):170-177. doi:10.5964/ejop.2417
35.
SchmicklerJMBlaschkeSRobbinsRMessF. Determinants of sleep quality: a cross-sectional study in university students. Int J Environ Res Publ Health. 2023;20(3):2019. doi:10.3390/ijerph20032019
36.
ChevalBMaltagliatiSSieberSCullatiSSanderDBoisgontierMP. Physical inactivity amplifies the negative association between sleep quality and depressive symptoms. Prev Med. 2022;164:107233. doi:10.1016/j.psychres.2022.107233
37.
ZhangLZhaoSZhaoSZhengHKeYYangW. Sedentary behavior and its association with psychological well-being and sleep quality in adolescents: evidence from a propensity score analysis. Sleep Med Rev. 2025;59:281-298. doi:10.1016/j.smrv.2024.101671
38.
LengRGuoAQianGMaoS. Influence of sedentary behavior on sleep quality in postmenopausal women in high-altitude regions of China: a cross-sectional study. Front Neurol. 2025;15:1476010. doi:10.3389/fnut.2024.1476010
39.
AlshahraniSMAlzuabiHAAlkalthemDHAlhadidiGHAlrajhiGM. Sleep patterns and quality during summer and academic year among female university students. Saudi Med J. 2024;29(4):252-261. doi:10.17712/nsj.2024.4.20240024
40.
TunayVBTedaviF. Yetişkinlerde fiziksel aktivite. Türkiye Klinikleri, Fiziksel Tıp ve Rehabilitasyon. 2008;18(3):77-86.
41.
SachdevaAAthavaleAGuptaSTiwariP. A study on neck pain and low back pain among the undergraduate students of a medical college in Bhopal, India. J Clin Diagn Res. 2022;16(6):YC01-YC05. doi:10.7860/JCDR/2022/53456.16379
42.
MahdaviSBRiahiRVahdatpourBKelishadiR. Association between sedentary behavior and low back pain: a systematic review and meta-analysis. Health Promot Perspect. 2021;11(4):393-402. doi:10.34172/hpp.2021.48
43.
DzakpasuFQCarverABrakenridgeCJ, et al.Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis. Int J Environ Res Publ Health. 2021;18(1):56. doi:10.3390/ijerph18010056
44.
PachecoMPCarvalhoPJCavalheiroLSousaFM. Prevalence of postural changes and musculoskeletal disorders in young adults. Int J Environ Res Publ Health. 2023;20(24):7191. doi:10.3390/ijerph20247191
45.
BouloukakiITsiligianniIStathakisG, et al.Sleep quality and fatigue during exam periods in university students: prevalence and associated factors. Healthcare. 2023;11(17):2389. doi:10.3390/healthcare11172389
46.
OverstreetDSStrathLJJordanM, et al.A brief overview: sex differences in prevalent chronic musculoskeletal conditions. Int J Environ Res Publ Health. 2023;20(5):4521. doi:10.3390/ijerph20054521
47.
AkkamAAHuzaymiDDQahlA, et al.Prevalence and contributing factors of neck and low back pain among university students during examination periods: a survey based study at Jazan University. Saudi J Sports Med. 2024;24(2):76-81. doi:10.4103/sjsm.sjsm_10_24
48.
AlshehriMMAlqhtaniAMGharawiSH, et al.Prevalence of lower back pain and its associations with lifestyle behaviors among college students in Saudi Arabia. BMC Muscoskelet Disord. 2023;24(1):646. doi:10.1186/s12891-023-06683-5
49.
Madrid-ValeroJJMartínez-SelvaJMRibeiro do CoutoBSánchez-RomeraJFOrdoñanaJR. Age and gender effects on the prevalence of poor sleep quality in the adult population. Gac Sanit. 2017;31(1):18-22. doi:10.1016/j.gaceta.2016.05.013
