Journal of Exercise Physiologyonline

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1 1 Journal of Exercise Physiologyonline October 2013 Volume 16 Number 5 Editor-in-Chief Official Research Journal of Tommy the American Boone, PhD, Society MBA of Review Exercise Board Physiologists Todd Astorino, PhD Julien Baker, ISSN PhD Steve Brock, PhD Lance Dalleck, PhD Eric Goulet, PhD Robert Gotshall, PhD Alexander Hutchison, PhD M. Knight-Maloney, PhD Len Kravitz, PhD James Laskin, PhD Yit Aun Lim, PhD Lonnie Lowery, PhD Derek Marks, PhD Cristine Mermier, PhD Robert Robergs, PhD Chantal Vella, PhD Dale Wagner, PhD Frank Wyatt, PhD Ben Zhou, PhD Official Research Journal of the American Society of Exercise Physiologists ISSN JEPonline Fitness and Health in College Students: Changes across 15 Years of Assessment Annie C. Wetter, Thomas J. Wetter, Kelly J. Schoonaert School of Health Promotion and Human Development, University of Wisconsin-Stevens Point, Stevens Point, Wisconsin, USA ABSTRACT Wetter AC, Wetter TJ, Schoonaert KJ. Fitness and Health in College Students: Changes across 15 Years of Assessment. JEPonline 2013;16(5):1-9. The purpose of this study was to examine the fitness profiles (aerobic fitness, bicep strength, flexibility, blood pressure, body weight, and body mass) of college-age adults across a 15-yr period. Physical fitness assessments in over 1800 students 18 to 19 yrs of age were analyzed from three cohorts: , , and Mean values for physical fitness and health indicators declined significantly from to , especially in women. Significant differences and non-significant trends occurred over the 15-yr period across most measures: males gained 4.5 kg in body weight (P<0.05) and 3.3% body fat (P<0.05) and declined in aerobic fitness, strength, and flexibility (all P<0.05); women gained 5.4 kg in body weight, 3.2% body fat (P<0.05), 6.7 and 1.4 mmhg in diastolic and systolic blood pressure, respectively, both P<0.05) and declined in aerobic fitness strength (P<0.05) and flexibility (P<0.05). The percentage of males classified as overweight or obese increased from 24% and 7.4% in to 27.4% and 10.6% in , respectively. Among the women, overweight and obesity increased from 30.2% to 30.7% and 10.4% to 14.0%, respectively. The findings indicate increased risk of chronic diseases in young college-aged adults. Increasing prevalence of obesity and overweight combined with trends toward decreasing fitness levels in every category suggest the need for additional health promotion efforts on college campuses. Key Words: College Students, BMI, Aerobic Capacity, Flexibility

2 2 INTRODUCTION Although evidence supports a role for genetic influences on obesity risk (5), a large body of research suggests that behavioral and environmental factors strongly influence weight gain (2,10). This is a major problem worldwide because obesity is a serious public health issue. Understandably, major life transitions challenge individuals with changes in multiple behavioral and environmental factors that impact lifestyle decision-making. The college years in particular represent a major life transition for adolescents as they enter into adulthood and begin establishing their independent lifestyle. This transitional period is typically associated with increased risk for excessive weight gain (8,18), given that the prevalence of obesity doubles in young adults from their 20s to their 30s (9). Based on selfreported height and weight, 33 to 35% of U.S. college students are overweight or obese (1,15). Increasing numbers of young adults are attending college. From college enrollments increased by 11%, and from it increased to 37% (26). Although non-traditional student (age 25 or older) enrollment has risen faster than for students aged 25 or less (42% vs. 34%, respectively), college enrollment among adults under the age of 25 is expected to rise another 11% by Thus, college campuses represent an important setting to address the elevated obesity risk during this life stage, especially there is a recognized lack of clinical attention devoted to weight gain during college and the dearth of research evidence on effective obesity prevention programs tailored to young adults (12,13). With increased attention to this issue, it is anticipated that there will be a better understanding of obesity-related risk and healthy lifestyle habits among college students. One aspect of obesity risk that is not well studied among young adults is physical activity (12), especially the role of regular exercise in the prevention of chronic diseases. Although results have been mixed, many studies indicate that physical activity is inversely and inactivity/sedentary behavior is directly associated with weight or fatness in adolescence (4,17). Self-reported assessment of physical activity among young adults indicates that over 50% of the U.S. college students do not participate in moderate or vigorous physical activity (1). In fact, it is clear that physical activity declines sharply from high school to the first year of college (3) and, then, it continues to decline thereafter (24). While these self-reported activity patterns are disconcerting, more worrisome is evidence that suggests the actual physical activity levels are far lower than the self-reported levels. A recent comparison of self-reported and objective assessments of physical activity among adults found that self-reported levels of moderate and vigorous activity were 4 and 7 times higher than those measured by accelerometer (25). Among the youth aged 12 to 19 yrs, the findings were similar with inactive participants over-reporting activity to a greater extent (14). Recent research (27,28) suggests that physical fitness may influence the risk of obesity related morbidities independent of physical activity even as early as adolescence (20). Whether one can use fitness as a surrogate for physical activity remains unclear. Yet, the evidence suggests that assessing fitness in young adults is valuable. Such measurements should be easy to acquire, especially with college students who are a captive audience where facilities and coursework dedicated to physical activity and fitness are generally available. Despite this thinking, it is uncommon to find physical fitness data on college students. In 1985, the American Alliance for Health, Physical Education, Recreation and Dance published physical fitness norms for college students. Since then few studies have examined fitness in large populations of college students (21,22). Objective evidence on the state of college student health and fitness is needed to guide healthcare decisions regarding the importance of including fitness and wellness coursework in the college curriculum. Thus, the purpose of this study was to examine the

3 relationship between the objective measures of physical fitness, body weight, and fatness in a large cohort of college students over a 2-decade period. 3 METHODS Subjects Data were collected over a 15-yr period as part of the LongWell study that included the assessment of health and wellness in college students at a medium-size Mid-western university. During this time period, all students were required to earn 2 wellness credits in non-physical activity courses. Various wellness courses were available, but most students satisfied the requirement by taking HPW 102 The Healthy American, a large (n=300 per section) introductory course. Required coursework included a variety of self-reported assessments across seven dimensions of wellness (e.g., Testwell survey) and biometric variables of physical fitness. The students were cleared by a university health services clinician prior to undertaking any fitness protocols. They were required to complete all assignments, including biometric testing, but were not required to participate in the study. Students were offered the opportunity to contribute their de-identified data to the study, and they signed an informed consent agreement prior to data collection. The study was approved by the university s Institutional Review Board. In the current report, cross-sectional data were from years (n=891), (n=505), and (n=442), which covered a 15-yr period at a 10 and, then 5-yr intervals. Although the study is ongoing and the data have been collected every year within this range, this report consists of measures in a select age (18 to 19 yrs old) and a time point (spring semester) in the and cohorts in order to compare to previously published data in this population from (23). The data were stratified by gender and analyzed for differences by t-test after checking for normality Procedures For the fitness assessment, the students completed an online health risk assessment that was supervised by the University Health Services. Referral to a primary care physician occurred if any risk to the subjects was indicated. Once cleared through the risk assessment under the supervision of a physician, the students signed up for a 30-min fitness appointment. They reported to the exercise physiology laboratory staffed by trained technicians who were upper class Health Promotion students. In the laboratory, the students completed a questionnaire to acquire demographic data including age, gender, ethnicity, and informed consent to participate in the LongWell study. After sitting quietly for at least 5 min, resting blood pressure and heart rate were recorded. During the assessments, blood pressure was measured using an automated cuff. In the case of unusually high values, measures were repeated. Height was measured without shoes using a stadiometer. Weight was measured by an electronic scale. Body composition was measured using computerized skinfold calipers (Microfit FAS-2 Assessment System; Microfit, Inc. Fresno, CA). The skinfold sites for males were chest, abdomen, and thigh, and for females it was triceps, supraillium, and thigh. All skinfold measures were repeated two to three times of which an average of the two closest measures was recorded. BMI was calculated for each subject using the standard formula of dividing weight by height squared (kg m -2 ). The participants were classified based on BMI as underweight, normal weight, overweight, or obese using the Centers for Disease Control and Prevention (CDC) definitions for adults. Aerobic fitness was assessed using a Monark cycle ergometer interfaced to a computer that monitored the heart rate signal detected by a heart rate monitor around the subject s chest. A modified Astrand-Rhyming protocol was used and Microfit software predicted the subject s VO 2 max after cycling at a minimum of

4 two workloads within a moderate intensity level. Pedal rate was monitored and maintained at 50 rpm via computer feedback. Isometric biceps strength was assessed using a cable attached to the electronic scale with the arms at an approximate 90 angle. Back and hamstring flexibility was assessed using an electronic sit-and-reach device. This device is similar to a yardstick placed at a height of 2 in above the floor and between the subject s legs. The heels were placed at 40 cm. Each student received a copy of the results along with an interpretation of the values and, if warranted, suggestions for improvement. Statistical Analyses Statistical analyses were performed using SPSS statistics 21.0 (IBM, Armonk, NY, USA). Data were stratified by gender and analyzed for differences across time points. Because individual data were not available for the previously published data set, one-way ANOVA from summary data was done using an online calculator ( Post hoc analyses were run using another online calculator ( that used a Bonferroni correction to adjust for multiple comparisons. Systolic and diastolic blood pressure from were not included in analyses because a different method was used during the second two time points. Height for the earliest time point was also not included in analyses because a significant digit was missing. For height, blood pressures, biceps strength, and flexibility differences were analyzed using a t-test. Chisquare analysis was used to assess differences in BMI and body fat categories. Categorical data were limited to the and cohorts for which raw data were accessible. Relationships among BMI, body fat, and aerobic fitness were determined by Pearson correlation. Significance was set at P< RESULTS The data represent primarily freshman students in their second semester of college (901 males; 937 females). The summary statistics for male and female students are presented in Tables 1 and 2, respectively. Average body weight was significantly higher at the latter two time points with an increase of 4.4 and 5.4 kg in males and females as compared to the first time point. This represents a 10 to 12-lb increase in body weight over 15 yrs. BMI and body fat percentage was similarly increased. Aerobic fitness decreased in both genders and has continued to fall over the last 5 yrs in females. Systolic and diastolic blood pressures increased and relative biceps strength fell from to for both genders. Flexibility decreased in males and showed a trend towards a decrease in females over the last two time points. Table 1. Male Subject Fitness and Health Measures. Measures (n=463) (n=222) (n=216) Height (m) 1.8 ± ± ± 0.07 Weight (kg) 77.1 ± ± 14.6 A 81.5 ± 15.6 A BMI (kg m -2 ) 23.6 ± ± 4.3 A 25.2 ± 4.4 A Body Fat (%) 11.4 ± ± 6.3 A 14.7 ± 7.1 A Resting HR (beats min -1 ) 72.3 ± ± ± 11.4 Systolic BP (mmhg) ± ± ± 12.0 B Diastolic BP (mmhg) 72.8 ± ± ± 9.8 B Aerobic fitness (ml kg -1 min -1 ) 47.3 ± ± 8.8 A 39.1 ± 10.0 A Biceps strength/body weight Not reported 0.57 ± ± 0.12 B Back/hamstring flexibility (cm) Not reported 40.7 ± ± 10.2 B Data are Mean ± SD. A P<0.05 compared to B P<0.05 compared to Abbreviations: BP; blood pressure.

5 5 Table 2. Female Subject Fitness and Health Measures. Measures (n=428) (n=283) (n=226) Height (m) 1.7 ± ± ± 0.07 Weight (kg) 62.8 ± ± 12.2 A 68.2 ± 13.6 A BMI (kg m -2 ) 22.6 ± ± 4.0 A 24.6 ± 4.8 A Body Fat (%) 23.3 ± ± ± 6.8 AB Resting HR (beats min -1 ) 76.1 ± ± 9.3 A 77.4 ± 12.1 B Systolic BP (mmhg) ± ± ± 8.8 B DBP (mmhg) 67.8 ± ± ± 8.2 B Aerobic fitness (ml kg -1 min -1 ) 40.9 ± ± 9.2 A 35.8 ± 8.6A B Biceps strength/body weight Not reported 0.39 ± ± 0.09 B Back/hamstring flexibility (cm) Not reported 45.1 ± ± 10.8 Data are Mean ± SD. A P<0.05 compared to B P<0.05 compared to Abbreviations: BP; blood pressure. Table 3 presents the percentage of students in each BMI classification. Although the fraction of both male and female students who were classified as underweight decreased and those classified as either overweight or obese increased over the last two assessment periods, Chi square analysis of changes in BMI categories within each gender across time points was not significant (Males: X 2 = 5.213, P=0.157; Females: X 2 = 4.700, P=0.195). When obesity status was determined by percent body fat ( 25% for men, 35% for women), Chi square analysis found a significant increase in females (X 2 = , P<0.001) in the obese category in years compared to (13% and 2.1%, respectively), but no significant shift was seen among males (5.5% in and 9% in ; X 2 = 2.781, P=0.095). Table 3. BMI Classifications for Cohorts and BMI category Males Males Females Females Underweight 3.5% 1.8% 1.4% 0.5% Normal 65.0% 60.2% 58.1% 54.9% Overweight 24.0% 27.4% 30.2% 30.7% Obese 7.4% 10.6% 10.4% 14.0% Table 4. Bivariate Pearson Correlation to Estimated VO 2 max. Males Males Females Females BMI %body fat All correlations are significant at P< DISCUSSION Our study reports objectively measured health and physical fitness variables across a 15-yr period in college males and females. The trends in the data indicate increasing body weight and fat and a

6 worsening of aerobic fitness, muscular strength, and flexibility in both genders. While some college students are exceedingly fit and most are healthier compared to the average American adult population, these trends are worrisome as more young adults are falling into health and fitness categories that indicate a greater risk of chronic health problems as they age. The 2012 American College Health Assessment reference data report found 34.3% of college students were overweight or obese by self-reported BMI (1). Our objective measures show that in , 38% of the male and 45% of the female students were overweight or obese. However, when percent body fat was used to determine obesity status, only 9% of the men (>25% fat) and 13% of women (>35% fat) were obese in the cohort. Even though the proportion of students classified as obese using percent body fat was lower than when using BMI, the trend is a concern. In only 5.5% of men and 2.1% of women had body fat levels within the range considered to increase health risk. Furthermore, the subjects were incoming college students (18 to 19 yrs old), and recent data by Gropper et al. (11) indicate that college males and females gain weight and body fat throughout their college years. The findings indicate that college freshmen are 10 lbs (males) to 12 lbs (females) heavier in than they were in While this change might represent an increase in lean muscle mass and greater strength, the data suggest otherwise. The percentage body fat measures indicate most of the weight change was due to an increase in fat (7 lbs in men; 8 lbs in women). The strength of the biceps expressed relative to body weight decreased significantly in both genders. Of all the measures in this study, aerobic fitness has decreased the most over these 15 yrs. While aerobic fitness in men stabilized over the past 5 yrs, female fitness continued to decline. This trend towards lower fitness levels among young people is consistent with other findings. Pribis et al. (21) reported a significant decline in fitness of college students between 1996 and Ekblom et al. (7) found that aerobic fitness in Swedish young people (16 yrs of age) declined across a 20-yr period, which was similar to what we found in our study. While it would be interesting to compare the aerobic fitness of our sample to normative data, published ACSM data was determined using a treadmill protocol which gives values approximately 10% higher than cycle ergometer determined values. If we were to use a 10% factor to adjust the aerobic fitness values of our latest time point, the average male and female student value would be 43.0 ml kg -1 min -1 and 39.4 ml kg -1 min -1, respectively. This would place the averages between the 40 and 50th percentile for males and at the 60th percentile for females using the ACSM data for 20 to 29 yr olds. Thus, it is not the actual value that is the cause for concern. It is the trend for the continuing decrease in fitness among young adults that raises concern. Evidence of declining fitness and increasing body fatness suggests college students are not engaged in healthy habits that include attention to fitness. Future health care cost control and national productivity may hang in the balance. Sacheck et al. (22) found multiple metabolic risk factors present in young (mean age of 19 yrs) college students. In addition, their analysis revealed that in these young adults, both increased body fatness and decreased physical fitness were associated with an increase in metabolic risk. Physically fit students were more likely to have optimal blood glucose and lipid levels independent of their percent body fat. Another report (6) found the prevalence of metabolic syndrome among a sample (n=207) of college students (18 to 24 yrs of age) was 6.8% and nearly half of the sample had at least 1 risk factor for metabolic syndrome. These researchers (6) and others (12,16,18-19,21) have called for more research in young adults to establish clinical guidelines and effective programs for health promotion specifically for this age group. 6

7 7 CONCLUSIONS To date, efforts to foster and support physical activity and healthy body weight status have been ineffective in this age group. While college students are generally healthier than older adults, if these trends continue into later adulthood, then, further losses in physical functioning and increases in body weight and fat will increase the risk of chronic disease and in turn increase health care costs and decrease the quality of life in America. Thus, it is imperative to better understand how to best support the establishment of healthy lifestyle habits during the transition from adolescence to adulthood. College campuses are uniquely positioned to take the lead in fostering healthy lifestyles in an increasing number of young adults. ACKNOWLEDGMENTS The authors would like to acknowledge the continued contributions of Walter Wright of the National Wellness Institute, Stevens Point, WI. Address for correspondence: Annie C. Wetter, PhD, School of Health Promotion and Human Development, University of Wisconsin-Stevens Point, Stevens Point, WI Telephone: (715) ; REFERENCES 1. American College Health Association. National College Health Assessment II: Reference Group Executive Summary Spring Hanover, MD. American College Health Association; Anderson P. Reducing overweight and obesity: Closing the gap between primary care and public health. Fam Pract. 2008;25 Suppl 1:i10-i Bray SR, Born HA. Transition to university and vigorous physical activity: Implications for health and psychological well-being during transition to university life. J Am Coll Health. 2004; 52: Catenacci VA, Wyatt HR. The role of physical activity in producing and maintaining weight loss. Nat Clin Pract Endocrinol Metab. 2007;3(7): Choquet H, Meyre D. Genetics of obesity: What have we learned? Curr Genomics. 2011;12 (3): Dalleck LC, Kjelland EM. The prevalence of metabolic syndrome and metabolic syndrome risk factors in college-aged students. Am J Health Promot. 2012;27(1): Ekblom OB, Ekblom-Bak EAM, Ekblom BT. Cross-sectional trends in cardiovascular fitness in Swedish 16-year-olds between 1987 and Acta Pediatrica. 2011;100: Gordon-Larsen P, The NS, Adair LS. Longitudinal trends in obesity in the United States from adolescence to the third decade of life. Obesity. 2010;18(9):

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