Benefits and Barriers of Combined Aerobic and Strength Training on Medical Students’ Psychological Wellbeing

Abstract

Background: While physical activity is associated with improved mental health, many medical students fail to meet recommended exercise guidelines. Understanding how exercise relates to wellness indicators in this population may help guide the development of targeted wellness interventions that promote sustainable health behaviors. Objectives: This study aimed to: (1) assess the prevalence and characteristics of physical activity among medical students; (2) examine associations between exercise behaviors and wellness indicators. Methods: A cross-sectional survey was administered to M.D. students at a U.S. medical school. The survey included validated measures to assess exercise habits, burnout, stress, quality of life, social support, and sleep. Statistical analyses included descriptive statistics, t-tests, Fisher’s exact tests, and multiple linear regression. Results: Among 82 respondents, only 34.2% met both aerobic and strength training CDC guidelines. These students reported significantly lower stress, higher quality of life, and greater friend support compared to peers who met neither guideline. Individual exercise was associated with lower stress, less burnout, and higher quality of life than group exercise, despite the latter being linked to greater social support. Conclusions: In advocating for interventions that support student wellbeing and the development of sustainable health habits, medical schools can help contribute to long-term student wellness.

Keywords

wellness medical students exercise habits burnout stress reduction quality of life

“Addressing time management, energy balance, and mental wellbeing may therefore be key strategies in promoting exercise engagement among medical students.”

Introduction

Medical students face a unique set of psychological and physical challenges stemming from the demanding nature of their training. The academic rigor, competitive environment, and long hours contribute to disproportionately high rates of burnout, depression, stress, and impaired quality of life compared to the general population.^1-3 Studies suggest that up to 50% of medical students experience symptoms of burnout, and approximately 25% report clinical symptoms of depression.¹ These issues not only affect student wellbeing but can persist beyond medical school, increasing the risk of long-term psychiatric disorders and suicidal ideation, with serious implications for the future physician workforce.³

Amid these concerns, regular physical activity and sufficient sleep have emerged as modifiable lifestyle behaviors that significantly improve mental and physical health, reduce symptoms of anxiety and depression, and promote overall wellbeing.^4,5 Despite this, research consistently shows that medical students often experience a decline in both exercise and sleep quality during their training.⁴ Interestingly, while some evidence suggests that medical students may initially be more physically active than the general population, their activity levels tend to decrease with each year of training.^6,7 This paradox highlights a concern regarding the sustainability of wellness behaviors in this population.

There is a growing body of literature suggesting that regular exercise is associated with decreased burnout and improved quality of life among medial trainees.^4,6-11 Among medical students specifically, meeting the Centers for Disease Control and Prevention (CDC) guidelines for aerobic and strength training activities has been linked to reduced rates of burnout and enhanced quality of life.⁷ Furthermore, satisfaction with exercise has been positively correlated with academic performance, social connection, and personal relationships.¹² The mode, intensity, frequency, and duration of exercise also appear to influence these outcomes, with higher-intensity exercise associated with greater self-reported happiness among medical students.^11-13 In addition to these personal benefits, medical students who prioritize their own health behaviors are more likely to serve as effective role models and health advocates for their future patients.^6,7,14,15

Despite these benefits, multiple barriers continue to prevent medical students from maintaining consistent exercise routines. Chief among these are time constraints, academic workload, fatigue, and financial stress.^9,12,16 These obstacles may fluctuate over time, with third-year students—who typically face demanding clinical rotations—reporting the highest levels of perceived difficulty in maintaining physical activity.^12,17 In contrast, fourth-year students often report greater satisfaction with their wellness behaviors, potentially due to more flexible schedules or shifting priorities.¹² Lack of physical activity is not a benign issue; it is associated with increased depressive symptoms and elevated stress.^4,9 For example, one study found that students not meeting health-enhancing physical activity (HEPA) levels had significantly higher stress scores than their more active peers.⁹

While prior research has explored the relationship between physical activity and select dimensions of medical student wellness, few studies have offered a comprehensive, multidimensional analysis that includes factors such as sleep, social support, perceived academic performance, and common barriers to exercise. Additionally, limited data exist on how these variables collectively influence perceived stress and quality of life among medical students.

To address this gap, we conducted a cross-sectional survey among medical students at an LCME accredited allopathic medical school in the United States. The survey assessed demographic characteristics, physical activity patterns (including adherence to CDC guidelines for aerobic and strength training), exercise type, perceived exercise barriers, sleep quantity and sleepiness, perceived stress, social support for exercise, quality of life, and self-reported academic performance. The objectives were to (1) describe the prevalence and characteristics of physical activity, (2) examine associations between exercise and key wellness indicators, and (3) identify the most significant barriers to maintaining regular physical activity.

Findings from this study may inform the development of targeted wellness interventions aimed at fostering sustainable health behaviors in medical students. By focusing on early prevention of burnout and psychosocial distress during training, this research contributes to the foundation for longitudinal strategies in physician wellness. In addition, our results may help guide institutional policies and programs that support medical student wellbeing throughout their training.

Methods

Study Design and Subject Selection

This is an IRB-approved cross-sectional analysis of students across the 4-year M.D. program at an allopathic medical school in the Southeastern U.S. Students were sent an email invitation to complete an online Qualtrics survey in the fall of 2024. Participation in the survey was voluntary, and no incentive for survey completion was offered. Subjects were included with the criteria of being a full-time medical student at the participating university. Individuals with incomplete survey responses were excluded from the data analysis. There are approximately 120 students per year in the associated M.D. program.

Survey Measures

Exercise Habits

To assess adherence with CDC exercise guidelines, we asked students to specify the number of minutes spent per week on moderate-intensity exercise and vigorous-intensity exercise, and the number of times per week they strength-trained each major muscle.¹⁸

We also collected data on specific types of exercise students engage in and whether they predominantly partake in individual or group exercise. Furthermore, we asked students to indicate any barriers they face in being able to engage in exercise.

Burnout

We evaluated burnout using a non-proprietary, single-item tool that was previously shown to be effective in evaluating burnout in healthcare providers.¹⁹ Students were asked to indicate their level of burnout on a scale of 1-5 (1 = “I enjoy my work. I have no symptoms of burnout.” 2 = “Occasionally I am under stress, and I don’t always have as much energy as I once did, but I don’t feel burned out.” 3 = “I am definitely burning out and have one or more symptoms of burnout, such as physical and emotional exhaustion.” 4 = “The symptoms of burnout that I’m experiencing won’t go away. I think about frustration at work a lot;” 5 = “I feel completely burned out and often wonder if I can go on. I am at the point where I may need some changes or may need to seek some sort of help.”). We considered students to have burnout symptoms if they reported a score greater than or equal to 3.¹⁹

Stress

A 10-item Perceived Stress Scale (PSS-10), one of the most widely used psychological instruments for measuring the perception of stress, was used to assess stress levels among medical students over the past month.²⁰ Several similar studies have utilized the PSS-10 to assess stress levels in this population.^1,9,21,22 Each item was scored from 0 (never) to 4 very (often) based on frequency of experiencing a given scenario (e.g., “In the last month, how often have you felt nervous and stressed”?). We categorized student stress levels into 3 categories corresponding to low stress (0-13), moderate stress (14-26), and high stress (27-40) based on total stress scores. The PSS-10 has been shown to be reliable with Cronbach’s alpha as high as 0.91.²³

Quality of Life

A validated 5 item linear analog scale assessment was used to assess students’ quality of life (QOL) over the past week.²⁴ Each item targeted a specific domain, including physical, emotional, spiritual, intellectual, and overall wellbeing. The Likert scale runs from 0 (as bad as it can be) to 10 (as good as it can be) for each question (e.g., “How would you rate your physical wellbeing over the past week?”). A mean QOL score was calculated, with scores of 8 or higher indicating high QOL, and scores less than 8 indicating low QOL, consistent with prior research.⁷ This 5 item QOL was previously found to be reliable with Cronbach’s alpha of 0.88.²⁴

Social Support

Perceived level of social support was measured using a 13-item social support and exercise tool.^25,26 The items pertain to actions of family or friends that provide support for exercise habits. Students rated each item twice, (i.e., once for family, once for friends). For each item, students were asked to rate how often over the past 3 months family or friends offered different forms of social support for exercise. Items were rated from 1 (none) to 5 (very often), with there also being a rating of 8 (does not apply) based on the frequency for each given scenario (e.g., “Discussed exercise with me”). Social support was scored in accordance with current guidelines.²⁷ This tool has been found to be reliable with test-retest reliabilities (range, r = 0.55-0.86) and high internal consistencies (range, Cronbach’s alpha = 0.61-0.91).²⁵

Sleep

Students were asked to report their average amount of sleep per night over the past month (less than or equal to 5 h of sleep, 5 to 7 h of sleep, 7 to 9 h of sleep, or greater than or equal to 9 h of sleep). The Epworth Sleepiness Scale (ESS) was used to measure the level of daytime sleepiness. Students rated their likelihood of falling asleep on a scale of 0 (no chance of dozing) to 3 (high chance of dozing) in 8 daytime situations (e.g., “Sitting and reading”).²⁸ The ESS has been used as a tool to measure subjective sleepiness among medical students.^1,4 Scores were used to categorize students based on levels of sleepiness (<7 unlikely to be sleepy, <9 average level of sleepiness, <15 may be excessively sleepy, <24 excessively sleepy). The questionnaire has shown strong internal consistency as measured by Cronbach’s alpha (0.88).²⁹

Academic Performance

We also asked students to self-report their typical module grades. First-year students did not answer this question as the survey was administered prior to assessment with formal module exams.

The recall periods for each measure were selected based on the time frames validated for each instrument and the expected stability of each construct. Stress was assessed over the past month, consistent with the PSS. Social support was measured over the past 3 months, reflecting the relative stability of perceived support. Burnout and quality of life were assessed over the past week, to capture constructs that vary over shorter timeframes.

Statistical Analysis

Descriptive statistics were first performed and presented to show the demographic characteristics of the study cohort. Univariate analysis was then conducted to compare the difference between meeting and not meeting CDC exercise guidelines on the variables of stress, quality of life, family participation, friend participation, family reward and punishment, sleep score, burnout, and academic performance. In this analysis, two samples t-test for normally distributed continuous variables or rank-sum tests for not normally distributed continuous variables were performed, while Fisher’s exact test was used for all categorical variables. Multiple linear regression analysis was performed to further evaluate the impact of relationship status and having children on stress, quality of life, feelings of social support, sleep, burnout, and academics. All statistical analyses were performed using Stata MP 18. α < 0.05 was considered significant in all tests.

Results

A total of 82 participants completed the survey and were included in the analysis with a response rate of 68.3%. Most of them were M1, M2, or M3 students, accounting for 89.02%. About 99% of the participants were between 18 and 34 years old. Caucasian/white and Asian/pacific islander occupied 83%. Most of the participants (78.05%) were not engaged or married. The majority of respondents (96.34%) did not have children (See Table 1). Of the participants, average stress score, quality of life, family participation, friend participation and sleep score were 14.9 ± 7.9 (moderate stress), 32.1 ± 7.9 (high QOL), 13.3 ± 9.7, 18 ± 9.3, and 7.4 ± 4.4 (average sleepiness) respectively (see Table 2). Their rates of meeting CDC aerobic exercise guidelines, meeting strength exercise guidelines, and meeting both aerobic and strength exercise guidelines simultaneously were 56.1%, 41.5%, and 34.2% separately (see Table 3).

Table 1.

Demographic Characteristics of the Study Population.

Characteristics	Number	Percentage	Cumulation
Year of class
M1	34	41.46	41.46
M2	27	32.93	74.39
M3	12	14.63	89.02
M4	9	10.98	100
Age
18 - 24	47	57.32	57.32
25 - 34	34	41.46	98.78
35 - 44	1	1.22	100
Ethnicity
Asian/Pacific Islander	18	21.95	21.95
Asian/Pacific Islander, other	1	1.22	23.17
Black/African American	3	3.66	26.83
Caucasian/White	50	60.98	87.8
Caucasian/White, Asian/Pacific Islander	2	2.44	90.24
Caucasian/White, Black/African American	1	1.22	91.46
Caucasian/White, Hispanic/Latino	3	3.66	95.12
Hispanic/Latino	3	3.66	98.78
Other (please specify)	1	1.22	100
Relationship status
Engaged	6	7.32	7.32
In a relationship	29	35.37	42.68
Married	12	14.63	57.32
Single	35	42.68	100
Having children
No	79	96.34	96.34
Yes	3	3.66	100

Table 2.

Average Stress Score, Quality of Life Score, Social Support, Sleep Score, Burnout, and Academic Performance of the Study Population.

Item	n	Mean	SD	min	max
Stress score	82	14.854	7.876	1	33
Quality of life score	82	32.134	7.888	15	50
Family participation	82	13.305	9.714	0	45
Friend participation	82	18.012	9.31	0	45
Family reward and punishment	82	2.561	1.758	0	8
Sleep score	82	7.366	4.387	0	20
Burnout	82	2.232	0.615	1	4
Academic performance	52	3.558	0.85	1	5

Table 3.

Prevalence of Meeting CDC Guidelines for Exercise. One Sample Proportion Test was Performed.

Item	Percentage	SE	95% C.I.
Meets aerobic exercise guidelines	56.1	5.48	45.36	66.84
Meets strength exercise guidelines	41.46	5.44	30.8	52.13
Meets both aerobic and strength guidelines	34.15	5.24	23.88	44.41

The univariate analysis showed that compared to those who did not meet both aerobic and strength exercise guidelines simultaneously, participants who met both aerobic and strength exercise guidelines simultaneously had a significantly lower stress score (12.11 [low stress] vs 16.28 [moderate stress], P = 0.022), higher quality of life score (34.86 vs 30.72, P = 0.023), and a higher friend support score (21.29 vs 16.31, P = 0.021, Table 4). However, meeting only the aerobic or only the strength exercise guideline, without meeting both, was not associated with significant differences in stress, quality of life, friend support, sleep score, burnout, or academic performance compared to participants who met neither guideline (Table 4). Exercise form (group or individual exercise) was significantly associated with stress score, quality of life, burnout, and friend participation. Compared to those who partook in individual exercise, those who partook in group exercise experienced significantly higher stress (17.95 vs 13.92, P = 0.05), lower quality of life (27.47 vs 33.54, P = 0.003), higher burnout (2.47 vs 2.16, P = 0.05), but higher friend support (21.79 vs 16.87, P = 0.004, Table 5). Participants engaging in group exercise were significantly less likely to meet CDC strength (P = 0.002) and combined aerobic and strength (P = 0.002) guidelines, while no significant difference was found for aerobic activity alone (P = 0.193, Table 6). Two-way Fisher’s exact test demonstrated that meeting CDC aerobic guidelines was significantly associated with the participants’ relationship status (P = 0.03, Table 7), with those in a relationship more likely to meet the CDC guidelines. Having children did not significantly impact ability to meet CDC exercise guidelines (Table 8). Multiple linear regression analysis further revealed that singles significantly got less family participation support (coef. = -8.4, P = 0.04) and less family reward and punishment (coef. = -1.58, P = 0.043) compared to participants in a relationship (Table 9). Finally, in this survey we found that the top 3 barriers that the participants faced in exercise included lack of time (86.59%), fatigue (69.51%), and lack of motivation (43.9%) (Table 10).

Table 4.

Summary of Univariate Analysis Assessing the Impact of Exercise on Stress, Quality of Life, Feelings of Social Support, Sleep, Burnout, and Academic Performance. Two Sample T-test, or Rank-Sum Test Indicated as “*”, was Performed. Mean (SD).

Item	Not simultaneously meet both CDC guidelines (n = 54)	Simultaneously meet both CDC guidelines (n = 28)	P-value
Stress score	16.28(8.18)	12.11(6.55)	0.022
Quality of life score	30.72(7.78)	34.86(7.5)	0.023
Family participation	14.37(9.22)	11.25(10.47)	0.083*
Friend participation	16.31(8.42)	21.29(10.2)	0.021*
Family reward and punishment	2.61(1.43)	2.46(2.28)	0.443*
Sleep score	7.46(4.75)	7.18(3.66)	0.783
Burnout	2.31(0.58)	2.07(0.66)	0.089
Academic performance	3.58(n = 36, SD = 0.73)	3.5(n = 16, SD = 1.1)	0.748

Item	Not meet any CDC guidelines (n = 30)	Meet CDC aerobic guidelines only (n = 18)	P-value
Stress score	17.63(8.39)	14.89(7.28)	0.256
Quality of life score	28.87(7.44)	32.39(7.73)	0.124
Family participation	15.47(8.36)	13.44(11.06)	0.387*
Friend participation	13.8(4.49)	20.22(11.47)	0.085*
Family reward and punishment	2.97(1.35)	2.06(1.59)	0.034*
Sleep score	7.2(4.97)	7.06(4.41)	0.92
Burnout	2.37(0.49)	2.17(0.51)	0.186
Academic performance	3.57(n = 21, SD = 0.68)	3.5(n = 10, SD = 0.85)	0.905*

Item	Not meet any CDC guidelines (n = 30)	Meet CDC strength guidelines only (n = 6)	P-value
Stress score	17.63(8.39)	13.67(7.28)	0.310
Quality of life score	28.87(7.44)	35(8.02)	0.077
Family participation	15.47(8.36)	11.67(7.74)	0.359*
Friend participation	13.8(4.49)	17.17(11.47)	0.185
Family reward and punishment	2.97(1.35)	2.5(0.84)	0.424
Sleep score	7.2(4.97)	10.0(4.56)	0.211
Burnout	2.37(0.49)	2.5(1.05)	0.626
Academic performance	3.57(n = 21, SD = 0.68)	3.8(n = 5, SD = 0.84)	0.521

Table 5.

Summary of Univariate Analysis Assessing the Impact of Exercise Form (Group vs Individual) on Stress, Quality of Life, Feelings of Social Support, Sleep, Burnout and Academic Performance. Two Sample T-test, or Rank-Sum Test Indicated as “*”, was Performed. Mean (SD).

Item	Partaking group exercise (n = 19)	Partaking individual exercise(n = 63)	P-value
Stress score	17.95(6.64)	13.92(8.03)	0.05
Quality of life score	27.47(6.02)	33.54(7.88)	0.003
Family participation	9.89(6.17)	14.33(10.37)	0.090*
Friend participation	21.79(9.34)	16.87(9.07)	0.004*
Family reward and punishment	2.47(1.5)	2.59(1.84)	0.059*
Sleep score	8.11(4.61)	7.14(4.33)	0.405
Burnout	2.47(0.51)	2.16(0.63)	0.05
Academic performance	3.38(n = 16, SD = 0.81)	3.64(n = 36, SD = 0.87)	0.306

Table 6.

The Association of Exercise Form With Meeting CDC Guidelines, n (%). Fisher’s Exact Test was Performed.

	Group exercise		P-value
	No	Yes	P-value
Meet CDC aerobic guidelines			0.193
No	25(39.68)	11(57.89)
Yes	38(60.32)	8(42.11)
Meet CDC strength guidelines			0.002
No	31(49.21)	17(89.47)
Yes	32(50.79)	2(10.53)
Meet CDC both guidelines			0.002
No	36(57.14)	18(94.74)
Yes	27(42.86)	1(5.26)

Table 7.

Two-Way Contingency Table Showing Association of Relationship Status With Meeting CDC Exercise Guidelines. Fisher’s Exact Test was Performed, n (%).

Relationship status	Not Meet CDC strength guidelines	Meet CDC strength guidelines	P-value
			0.066
Engaged	6(12.5)	0(0)
In a relationship	14(29.17)	15(44.12)
Married	9(18.75)	3(8.82)
Single	19(39.58)	16(47.06)

	Not meet CDC aerobic guidelines	Meet CDC aerobic guidelines	P-value
			0.03
Engaged	6(16.67)	0(0)
In a relationship	10(27.78)	19(41.3)
Married	5(13.89)	7(15.22)
Single	15(41.67)	20(43.48)

	Not meet CDC both guidelines	Meet CDC both guidelines	P-value
			0.241
Engaged	6(11.11)	0(0)
In a relationship	17(31.48)	12(42.86)
Married	9(16.67)	3(10.71)
Single	22(40.74)	13(46.43)

Table 8.

Two-Way Contingency Table Showing Association of Having Children With Meeting CDC Exercise Guidelines. Fisher’s Exact Test was Performed, n (%).

Having children	Not meet CDC strength guidelines	Meet CDC strength guidelines	P-value
			0.252
No	36(100)	43(93.48)
Yes	0(0)	3(6.52)

	Not meet CDC aerobic guidelines	Meet CDC aerobic guidelines	P-value
			1.00
No	46(95.83)	33(97.06)
Yes	2(4.17)	1(2.94)

	Not meet CDC both guidelines	Meet CDC both guidelines	P-value
			1.00
No	52(96.3)	27(96.43)
Yes	2(3.7)	1(3.57)

Table 9.

Summary of Multiple Linear Regression Evaluating the Impact of Relationship Status and Having Children on Stress, Quality of Life, Feelings of Social Support, Sleep, Burnout, and Academic Performance.

	Coefficient	SE	t	P-value
Stress score
Relationship status
Engaged	0
In a relationship	1.17	3.61	0.32	0.747
Married	−0.48	4.11	−0.12	0.908
Single	1.39	3.56	0.39	0.698
Children
No children	0
Having children	2.36	4.95	0.48	0.636
Constant	13.83	3.28	4.21	0
Quality of life
Relationship status
Engaged	0
In a relationship	−0.63	3.62	−0.17	0.863
Married	−0.22	4.12	−0.05	0.957
Single	−1.07	3.57	−0.3	0.765
Children
No children	0
Having children	0.34	4.98	0.07	0.946
Constant	32.83	3.3	9.95	0
Family participation
Relationship status
Engaged	0
In a relationship	−7.57	4.07	−1.86	0.067
Married	2.51	4.64	0.54	0.59
Single	−8.4	4.02	−2.09	0.04
Children
No children	0
Having children	−3.54	5.59	−0.63	0.529
Constant	19.33	3.71	5.21	0
Friend participation
Relationship status
Engaged	0
In a relationship	7.82	4.08	1.91	0.059
Married	1.49	4.65	0.32	0.749
Single	5.87	4.03	1.46	0.149
Children
No children	0
Having children	−3.95	5.6	−0.71	0.483
Constant	12.67	3.72	3.41	0.001
Family reward and punishment
Relationship status
Engaged	0
In a relationship	−1.25	0.78	−1.59	0.115
Married	−0.88	0.89	−0.99	0.326
Single	−1.58	0.77	−2.05	0.043
Children
No children	0
Having children	−0.72	1.07	−0.67	0.506
Constant	3.83	0.71	5.38	0
Sleep score
Relationship status
Engaged	0
In a relationship	1.12	1.95	0.57	0.568
Married	−1.65	2.22	−0.74	0.461
Single	1.63	1.92	0.85	0.399
Children
No children	0
Having children	0.39	2.68	0.14	0.885
Constant	6.5	1.78	3.66	0
Burnout
Relationship status
Engaged	0
In a relationship	−0.09	0.28	−0.33	0.744
Married	−0.22	0.32	−0.7	0.487
Single	−0.07	0.28	−0.26	0.797
Children
No children	0
Having children	−0.16	0.39	−0.42	0.678
Constant	2.33	0.26	9.13	0
Academic performance
Relationship status
Engaged	0
In a relationship	0.5	0.39	1.27	0.209
Married	0.3	0.46	0.65	0.519
Single	0.12	0.39	0.31	0.762
Children
No children	0
Having children	−1.04	0.62	−1.69	0.098
Constant	3.33	0.34	9.8	0

Table 10.

Frequency of Different Barriers to Exercise Faced by Students.

Barrier	Frequency	%
Time constraints	71	86.59
Fatigue	57	69.51
Lack of motivation	36	43.9
Stress or anxiety	31	37.8
Financial	29	35.37
Lack of access	17	20.73
Physical health	8	9.76
Other	6	7.32

Discussion

In our surveyed medical student sample, 56.1% met CDC aerobic guidelines, 41.46% met the strength training guidelines, and 34.15% met both aerobic and strength training guidelines. Similarly, a 2012 study of over 4000 M.D. students across the U.S. found that 62.7% met CDC aerobic guidelines, 38.5% met the strength training guidelines, and 34% met both aerobic and strength training guidelines.⁷ According to the 2020 CDC National Health Interview Survey, 24.2% of U.S. adults met both aerobic and strength training guidelines.³⁰ This suggests our medical student sample is more physically active than similar-aged adults among the general population.

Our findings show that meeting only the aerobic or strength training guidelines did not significantly affect the outcome variables, when compared to students who met neither CDC guidelines. However, meeting both CDC aerobic and strength exercise guidelines was associated with a higher quality of life in our medical student sample. This is consistent with a prior study that found that quality of life was higher among medical students who met CDC recommendations.⁷ We also found that meeting both CDC aerobic and strength exercise guidelines was associated with lower stress levels. This supports prior research showing that self-care activities like physical activity weaken the link between perceived stress and quality of life in medical students.³¹ These results provide further support for the notion that engaging in exercise is essential for medical students’ wellbeing.

Meeting both CDC aerobic and strength exercise guidelines was associated with a higher level of social support provided by friends. This result suggests that the importance of social support in promoting exercise among medical students should not be underestimated. Other studies have found that medical students who engage in group exercise report a higher quality of life.^8,21 Specifically, team-based exercise has been stated to lead to physical activity participation due to a greater sense of accountability.⁸ Thus, encouragement from peers plays a role in fostering consistent exercise habits among students and promoting overall wellbeing.

Interestingly, we found that partaking in individual exercise (compared to group exercise) was associated with lower stress and burnout scores, and higher quality of life in our student sample. However, a greater proportion of students in our study participated in individual exercise (n = 63) compared to group exercise (n = 19). Several previous studies have found a link between exercise and burnout, with research identifying exercise as protective against burnout.⁷ Studies have also identified a dose response effect between exercise and burnout and quality of life with higher intensities and frequency of exercise maximizing this benefit.¹¹ In our sample, students who engaged in group exercise were significantly less likely to meet CDC strength guidelines and combined aerobic and strength guidelines compared with those who exercised individually, while meeting aerobic guidelines alone did not differ between groups. This pattern suggests that many group-based activities may emphasize aerobic components but may not consistently provide sufficient strength training to meet full guideline recommendations. Although group exercisers reported greater friend support, these findings indicate that higher social support does not necessarily translate into meeting the full range of physical activity recommendations. Thus, the more favorable outcomes observed among students who exercised individually may reflect greater adherence to recommended exercise types and intensities, rather than group differences being driven only by sample size.

Thus, it is possible that the benefits seen in the individual exercise group were influenced by the larger sample size or by a higher intensity and frequency of exercise in that group.

While we observed improvements in stress and quality of life, meeting both CDC aerobic and strength training guidelines was not associated with a statistically significant decrease in burnout or levels of sleepiness in our sample. To our knowledge, this is the first study using a non-proprietary, single-item tool to measure burnout in the medical student population. We chose this tool as it was shown to be reliable in measuring burnout in healthcare providers compared to a validated single-item standalone burnout measure from the MBI Emotional Exhaustion subscale.¹⁹ However, other studies have more commonly used variations of the Maslach Burnout Inventory (MBI) to assess burnout in medical students. We acknowledge that the MBI remains the most widely validated instrument for assessing burnout. Future studies using the MBI could provide additional insight into the specific components of burnout—emotional exhaustion, depersonalization, and reduced personal accomplishment—that may not be fully captured by a single-item measure.

The most common barriers to exercise reported among students included lack of time (86.59%), fatigue (69.51%), and lack of motivation (43.9%). Only a minority of students identified physical health (9.8%) or other reasons (7.3%) as limiting factors. These findings suggest that the primary obstacles to physical activity in this student population are largely modifiable and reflect the demanding and emotionally taxing nature of medical school. Addressing time management, energy balance, and mental wellbeing may therefore be key strategies in promoting exercise engagement among medical students. Medical schools, residency training programs, and hospitals may consider having on-site, accessible fitness options and promoting physical activity as a burnout prevention tool so that healthcare students and professionals can use exercise to their mental health benefit.

Our study’s findings provide a more in-depth perspective into the benefits of exercise for medical students. Our findings suggest that exercise benefits both quality of life and can help reduce stress. We’ve also expanded the current base of research by identifying the unique benefits of combined aerobic and strength training and by examining the unique benefits of group vs individual exercise. Ultimately, adequate sleep, lower stress levels, and high levels of social support are factors that are associated with combating burnout and promoting resiliency in the medical student population.¹ Exercise may therefore be of significant value in helping students address the unique set of challenges they face and promote overall medical student wellbeing. Establishing healthy exercise habits not only offers individual benefits to the medical student but also has the potential to influence medical students’ future patients. A physician’s personal exercise habits and attitudes towards prevention directly influence their likelihood of counseling patients on physical activity, highlighting the importance of promoting self-care among medical trainees.

There are several limitations of this study including a relatively simple sample size, especially with lower numbers in years MS-3 and MS-4. We administered the survey at the beginning of the academic year, and the majority of students who completed the survey were first-year medical students. The timing of data collection may not have provided an accurate gauge of more usual levels of burnout experienced among medical students as the academic year progresses. Future research may therefore look to assess levels of burnout at different time points of the academic year, especially at times where burnout is likely to be heightened, such as around medical licensing exams. We also believe obtaining a larger sample size would be useful in examining if burnout varies by class year, or from pre-clinical to clinical students. In sum, our findings add to the compelling body of research highlighting the power of physical activity as a wellness tool to improve various aspects of psychological health and quality of life for the future physician workforce.

Consent to Participate

Per the approved IRB protocol, the explanation of research was provided in the emails to students containing the survey link. Participation in this study was voluntary. Students were free to withdraw their consent and discontinue participation in this study at any time without prejudice or penalty.

Footnotes

Author Contributions

RB led the project and assisted with study conception, survey tool development and administration, interpretation of study findings and writing of the manuscript. DS assisted with study conception, survey tool development, and writing of the manuscript. MV assisted with study conception, data curation and analysis and writing of the manuscript. AB assisted with study conception and reviewed and approved the manuscript. KD oversaw the project progress, provided supervision, and reviewed and approved the manuscript. XZ led the statistical analysis and wrote the results section of manuscript. All authors approved the submitted version of the manuscript.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical Considerations

The study was approved by the University of Central Florida Institutional Review Board and determined to be human subjects research that is exempt from regulation. IRB ID: STUDY00006920

ORCID iDs

Rebekah Brawley

Danielle Springer

Ajay Bharathan

References

Dyrbye

Power

Massie

, et al. Factors associated with resilience to and recovery from burnout: a prospective, multi-institutional study of US medical students. Med Educ. 2010;44(10):1016-1026. doi:10.1111/j.1365-2923.2010.03754.x

Erschens

Eva

Anne

H-W

, et al. Professional burnout among medical students: systematic literature review and meta-analysis. Med Teach. 2019;41(2):172-183. doi:10.1080/0142159X.2018.1457213

Ishak

Nikravesh

Lederer

Perry

Ogunyemi

Bernstein

. Burnout in medical students: a systematic review. Clin Teach. 2013;10(4):242-245. doi:10.1111/tct.12014

Wolf

Rosenstock

. Inadequate sleep and exercise associated with burnout and depression among medical students. Acad Psychiatry. 2017;41(2):174-179. doi:10.1007/s40596-016-0526-y

Bull

Al-Ansari

Biddle

, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. doi:10.1136/bjsports-2020-102955

Stanford

Durkin

Blair

Powell

Poston

Stallworth

. Determining levels of physical activity in attending physicians, resident and fellow physicians and medical students in the USA. Br J Sports Med. 2012;46(5):360-364. doi:10.1136/bjsports-2011-090299

Dyrbye

Satele

Shanafelt

. Healthy exercise habits are associated with lower risk of burnout and higher quality of life among U.S. medical students. Acad Med. 2017;92(7):1006-1011. doi:10.1097/acm.0000000000001540

Weight

Sellon

Lessard-Anderson

Shanafelt

Olsen

Laskowski

. Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program. Mayo Clin Proc. 2013;88(12):1435-1442. doi:10.1016/j.mayocp.2013.09.010

Leuchter

Stuber

McDonald

Croymans

. Relationship between exercise intensity and stress levels among U.S. medical students. Med Educ Online. 2022;27(1):2027651. doi:10.1080/10872981.2022.2027651

10.

Olson

Odo

Duran

Pereira

Mandel

. Burnout and physical activity in Minnesota internal medicine resident physicians. J Grad Med Educ. 2014;6(4):669-674. doi:10.4300/jgme-d-13-00396. Accessed May 22, 2025.

11.

Taylor

Scott

Owen

. Physical activity, burnout and quality of life in medical students: a systematic review. Clin Teach. 2022;19(6):e13525. doi:10.1111/tct.13525

12.

Deisz

Papproth

Ambler

Glick

Eno

. Correlates and barriers of exercise, stress, and wellness in medical students. Med Sci Educ. 2024;34(6):1433-1444. doi:10.1007/s40670-024-02134-5

13.

Fisher

Kaitelidou

Samoutis

. Happiness and physical activity levels of first year medical students studying in Cyprus: a cross-sectional survey. BMC Med Educ. 2019;19(1):475. doi:10.1186/s12909-019-1790-9

14.

Frank

Wright

. Personal and clinical exercise-related attitudes and behaviors of freshmen U.S. medical students. Res Q Exerc Sport. 2004;75(2):112-121. doi:10.1080/02701367.2004.10609142

15.

Recker

Sugimoto

Halvorson

Skelton

. Knowledge and habits of exercise in medical students. Am J Lifestyle Med. 2021;15(3):214-219. doi:10.1177/1559827620963884

16.

Briggs

Riew

Seward

Medicine in Motion Writing Group . Combatting burnout by maximizing medical student participation in exercise events. Am J Lifestyle Med. 2022;16(6):779-784. doi:10.1177/15598276211042821

17.

Bunker

Newsome

Petit

Richardson

Weiss

. Perceptions of exercise during medical school. Acad Psychiatry. 2018;42(1):161-163. doi:10.1007/s40596-017-0722-4

18.

Centers for Disease Control and Prevention . Physical activity for everyone. www.cdc.gov/physicalactivity/everyone/guidelines/adults.html#. Accessed 5 June 2025.

19.

Dolan

Mohr

Lempa

, et al. Using a single item to measure burnout in primary care staff: a psychometric evaluation. J Gen Intern Med. 2015;30(5):582-587. doi:10.1007/s11606-014-3112-6

20.

NH Department of Administrative Services . Perceived stress scale. https://www.das.nh.gov/wellness/docs/percieved_stress_scale.pdf. Accessed 5 June 2025.

21.

Yorks

Frothingham

Schuenke

. Effects of group fitness classes on stress and quality of life of medical students. J Am Osteopath Assoc. 2017;117(11):e17-e25. doi:10.7556/jaoa.2017.140

22.

Lavadera

Millon

Shors

. Map train my brain: meditation combined with aerobic exercise reduces stress and rumination while enhancing quality of life in medical students. J Altern Complement Med. 2020;26(5):418-423. doi:10.1089/acm.2019.0281

23.

Locke

Decker

Sloan

, et al. Validation of single-item linear analog scale assessment of quality of life in neuro-oncology patients. J Pain Symptom Manage. 2007;34(6):628-638. doi:10.1016/j.jpainsymman.2007.01.016

24.

Lee

E-H

. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6(4):121-127. doi:10.1016/j.anr.2012.08.004

25.

Sallis

Grossman

Pinski

Patterson

Nader

. The development of scales to measure social support for diet and exercise behaviors. Prev Med. 1987;16(6):825-836. doi:10.1016/0091-7435(87)90022-3

26.

Sallis

. Social support for exercise survey. https://www.drjimsallis.com/_files/ugd/a56315_88b55acf30eb49f296184d7450798936.pdf. Accessed 5 June 2025.

27.

Sallis

. Social support for diet and exercise behaviors: scoring. https://www.drjimsallis.com/_files/ugd/a56315_c5c11ba674944eb693f4792291bd575d.pdf. Accessed 5 June 2025.

28.

Johns

. A new method for measuring daytime sleepiness: the epworth sleepiness scale. Sleep. 1991;14(6):540-545. doi:10.1093/sleep/14.6.540

29.

Johns

. Reliability and factor analysis of the Epworth sleepiness scale. Sleep. 1992;15(4):376-381. doi:10.1093/sleep/15.4.376

30.

Elgaddal

Kramarow

Reuben

. Physical activity among adults aged 18 and over: united States, 2020. NCHS Data Brief. 2022;443:1-8.

31.

Ayala

Winseman

Johnsen

Mason

HRC

. U.S. medical students who engage in self-care report less stress and higher quality of life. BMC Med Educ. 2018;18(1):189. doi:10.1186/s12909-018-1296-x