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Physical Exercise and Psychological Wellbeing Sapsyc - v36 - n2 - A9
Physical Exercise and Psychological Wellbeing Sapsyc - v36 - n2 - A9
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1 AUTHOR:
Stephen David Edwards
University of Zululand
156 PUBLICATIONS 443 CITATIONS
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Enabled by the positive focus of the World Health Organizations (WHO, 1946)
denition of health as being not only the absence of illness, but also a state of complete physical, mental and social well-being, the public health approach has gained
increasing viability as an alternative, complementary approach to the medical model.
A health and well-being paradigm in which salutogenesis, fortigenesis and positive
psychology have emerged as new perspectives, has begun to answer questions as to
the origins of health, strength and well-being (Antonovsky, 1987, 1993; Edwards,
2001a, 2003a, 2003b; Kuhn, 1962; Oldenburg, 2000; Seligman & Csikszentmihalyi, 2000; Strmpfer, 1995; Wissing & van Eeden, 1998, 2002). This new paradigm
Psychological Society of South Africa. All rights reserved.
ISSN 0081-2463
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Steve Edwards
re-establishes a balanced view of both illness prevention and health promotion. For
example, the salutogenic perspective begins with the commonsense observation that
deviance and illness are the norm, life is an ongoing struggle to survive, and complete
health, strength and well-being is an unrealisable goal (Pretorius, 1998). In general,
well-being can be conceptualised as a positive component of optimal health, and
psychological well-being conceptualised as a positive component of mental health.
Health and well-being interventions typically involve three strategies of disease
and illness treatment, disease and illness prevention, and health and well-being promotion. Following the relative success of modern public health interventions in treating
and preventing disease and illness, especially in developed countries, recent years
have seen the proliferation of health clubs concerned with the promotion of health
and well-being (Corbin & Lindsey, 1997). Such clubs provide opportunities for social
support as well as various forms of physical exercise. For example, in an extensive,
sociologically orientated study with 401 participants, Hayes and Ross (1986) found
that exercise and good physical health improve psychological well-being (as negatively assessed in terms of absence of symptoms of depression and anxiety) through
mediation by internal mechanisms rather than through interactions or evaluations by
others. While this effect was a general nding, it was more apparent in lower and
middle rather than upper income groups.
While mental health generally implies some experience of psychological wellbeing, in the context of the present research psychological well-being refers to a
particular theoretical and empirical construct, measuring the integration of various
psychological components of being well (Edwards, 2002, 2003a, 2003b). This conceptualisation was based on studies by such researchers as Conway and MacLeod (2002);
Corbin and Lindsey (1997); Cowen (2000); Pretorius (1998); Repucci, Woolard, and
Fried (1999); and Wissing and van Eden (1998, 2002), as well as on the following
considerations: rstly, although illness and well-being are typically conceptualised
as existing on a continuum, well-being is best considered as an independent dimension, distinct from illness. From the public health perspective, these dimensions are
best thought of as reecting the operation of two different systems concerned with
prevention and promotion respectively. As distinct from preventing distressing experiences, well-being research and practice are concerned with the promotion of positive
experiences, health, strength, resources, supplies, competencies and skills. Secondly,
conceptualisations of psychological well-being in the literature are very diverse,
which is understandable when one considers that it is a transient condition, which is
multi-factorial in etiology, process and promotion. For example, factors that dene
psychological well-being will differ at different ages and in different circumstances.
Thirdly, psychological well-being has multidimensional personal, transactional and
environmental determinants, which become more complex as the human life cycle
progresses. Environmental factors also include non-psychological factors such as housing, food and employment. Fourthly, it is better to promote psychological well-being
358
than to prevent factors impeding well-being. Fifthly, in as much as there are various
conceptual routes to psychological wellness, there are various methods to measure and
promote it. For example, Wissing and van Eeden (1998); and Conway and MacLeod
(2002) have presented conceptual, empirical, methodological and clinical psychological points of view on the measurement of psychological well-being. Cowen (2000)
has put forward competence, empowerment and resilience as exemplar concepts in
the promotion of psychological well-being. The focus of the present research is on
physical exercise.
Physical exercise may be dened as a subset of physical activities that are planned
and purposeful attempts to improve health and well-being. The use of exercise as a
medium for health promotion is based on international research evidence for the public and mental health benets of physical activity, exercise and tness interventions.
Research has proliferated on the duration, frequency and intensity of various forms
of exercise (Edwards, 2003a, 2003b; Fox, 2000; Hayes & Ross, 1986; Morehouse &
Gross, 1977; Morris & Summers, 1995; Scully, Kremer, Meade, Graham, & Dudgeon,
1998; Weinberg & Gould, 1999). For example, in the United States, the American
College of Sports Medicine recommended exercise programmes based on ndings
that, in general, healthy adults receive cardiovascular benets if they exercise for at
least 20 to 30 minutes, three to ve times a week at 60% to 90% intensity. Yet despite
such health promotion and education, there is evidence that only 15% of American
adults participate in such vigorous exercise activity (Weinberg & Gould, 1999).
Regular, moderate intensity exercise interventions seem particularly valuable in
promoting health and well-being, where the type, intensity and duration of the exercise programmes are tailored to suit the particular exercisers (Berger, 1994, 1996,
2001; Stelter, 1998, 2000, 2001). Studying desirable changes in mood and meaning
in exercise programmes, researchers have emphasised regular non-competitive,
activity involving rhythmic abdominal breathing of 20 to 30 minutes duration in
comfortable, predictable contexts as in Tai Chi, yoga, aerobic exercise and resistance training. Various qualitative and quantitative methods have been used both to
describe the experience and what it means for people, and to measure what changes
result from it (Berger, 1994, 1996, 2001; Edwards, 2001a, 2001b, 2003b; Stelter,
1998, 2000, 2001). Public health interventions attempting to improve quality of life
through increased exercise adherence clearly need to take such personal meanings
into account, as well as the learning principle that people will repeat behaviours that
are intrinsically rewarding.
Many studies have clearly demonstrated the effectiveness of physical exercise
in reducing stress, anxiety and depression (Fox, 2000; Morris & Summers, 1995;
Scully et al., 1998; Weinberg & Gould, 1999). For example, Sinyor, Schwartz,
Peronnet, Brisson, and Seraganian (1983) were able to demonstrate that aerobically trained persons were able to recover faster from experimentally induced
psychosocial stress than untrained persons on physiological, biochemical and
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Steve Edwards
METHOD
Mood
Respondents were required to evaluate their current feelings on a ve-point scale with
regard to six positive and six negative mood states. Negative moods included feeling
anxious, depressed, confused, angry, fatigued and stressed. Positive moods included
feeling energetic, condent, happy, healthy, being in control and strong. The scale is
an adapted version based on the research of Dean, Whelan, and Meyers (1990); and
McNair, Lorr, and Droppleman (1971).
Lifestyle
Respondents were required to afrm or deny seven habits associated with health
(Noakes & Granger 1995). These included regular exercise, regular eating, eating
breakfast, sleeping, smoking, drinking and being over- or underweight. Regular
360
exercise was dened as occurring at least three times a week for at least 30 minutes
a session.
This refers to a 5-item Likert-type scale developed and validated by Diener, Emmons, Larsen, and Griffen (1985). The scale required respondents to make cognitive
judgements, rather than affective responses, as to their global satisfaction with their
quality of life. In their original validation sample of 176 undergraduates, Diener et al.
(1985) obtained a mean score of 23.5 and a standard deviation of 6.43. The testretest
correlation coefcient was 0.82, coefcient alpha was 0.87 and principal axis factor
analysis revealed a single factor, which accounted for 66% of the variance.
Sense of coherence
This well-being component was based on 13 items, which were retained after the
rigorous psychometric evaluation of Antonovskys full 29-item Sense of Coherence
scale by Frenz, Carey, and Jorgensen (1993). These items translated into ve factors
described as comprehensibility, life interest, self-efcacy, interpersonal trust and predictability, with substantial loadings on the core factor labelled sense of coherence
by Frenz et al. (1993). Earlier research by Antonovsky (1987), which validated this
core factor, described sense of coherence in terms of comprehensibility, meaningfulness and manageability subscales, each of which obtained coefcients alpha of 0.8
or higher. Antonovsky (1987) himself dened sense of coherence as:
[A] global orientation that expresses the extent to which one has a pervasive, enduring
though dynamic feeling of condence that (a) the stimuli deriving from ones internal
and external environments in the course of life are structured, predictable and explicable;
(b) the resources are available to one to meet the demands posed by these stimuli; and
(c) these demands are challenges, worthy of investment and engagement (Antonovsky,
1987, p. 19).
Fortitude
The Fortitude scale was developed and standardised in South Africa by Pretorius
(1998) and consists of 20 items, reecting three subscales labelled self-appraisals,
family appraisals and support appraisals with coefcient alphas of 0.74, 0.82 and 0.76
respectively, leading to a full-scale coefcient of 0.85. A principal factor analysis with
varimax rotation resulted in three factors with eigenvalues greater than unity, which
replicated the above-mentioned hypothesised structure of fortitude. The three factors
account for 46% of the variance. The inter-correlations between the subscales were all
moderate, ranging between 0.38.and 0.48, indicating that the three subscales, though
related, were sufciently independent. The correlations between the subscales and
the total scale were relatively high (correlations of 0.72, 0.84, and 0.81 for the self,
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Steve Edwards
family and support subscales respectively), indicating that each subscale contributed
signicantly to the measurement of fortitude.
The Holmes and Rahe (1967) social readjustment scale requires respondents to indicate their current experience of stress in terms of commonly occurring life events.
In creating the scale, Holmes and Rahe (1967) asked 394 respondents to complete a
questionnaire that listed 43 life events drawn from earlier clinical work. Participants
rated the extent to which each event would require readjustment in their lives. For
example in the 43-item scale, the rst rated item, death of a spouse, has a mean value
of 100, marriage has 50 and outstanding personal achievement has 28. In the present
research, a stress management score was also obtained by subtracting the total stress
unit score from an arbitrary ceiling of 100. Persons with more than 100 stress units
would score 0 for stress management.
Psychological well-being
participants dropping out of exercise programmes within the rst six months (Weinberg
& Gould, 1999), as well the irregularity with which exercisers attend health clubs. It
was in fact a difcult and time-consuming task to obtain this follow-up data, and it
was unfortunately not possible at the time to collect data on a comparative number
of drop-outs or irregular exercisers, which would have been ideal as a control group
measure. Future research needs to address this limitation.
A minimum time period of two months was chosen on the basis of previous studies reporting some exercise effects after ve weeks, with the largest effects being
observed after ten to fteen weeks (Roth & Holmes, 1987; Scully et al., 1998). During re-evaluation, participants provided updated information on well-being changes
over the past two to sixth months, as well as type, amount, intensity and duration of
their regular exercise.
The sample consisted of 11 women and 15 men. Their average age was 31.7 years,
with an age range from 16 to 52 years. In terms of home language, there were 7 Afrikaans, 15 English and 4 isiZulu speakers. Participants had been attending health
clubs for an average of ve years and nine months, with a range from two months to
twenty years. Although 7 participants were new health club members, 2 of these new
members also had previous health club exercise experience.
The SPSS statistical programme was used to analyse data. Differences between
means of the various well-being components were analysed with t-tests for paired
samples. A total stress score rather than the derived stress management score was
used for accuracy of measurement. Multiple regression analyses were performed to
evaluate if any psychological well-being changes, as measured by pre-and post-test
differences in total psychological well-being scores, were predicted by any biographical data, particular health club afliation, length of membership, years of exercise
experience, participants estimation of wellness improvement, or the type, amount,
duration and intensity of exercise. In the following results, psychological well-being
components are abbreviated as follows: mood, lifestyle (life), satisfaction with life
(satis), sense of coherence (soc), fortitude (fort), stress, coping (cope) and well-being
percentage (% well-being).
RESULTS
Quantitative ndings
The inter-correlations between the well-being components for the total sample of 216
participants were all positive and low to moderate, ranging between 0.09 and 0.5,
indicating that the seven components, though related, were sufciently independent.
The correlations between the well-being components and the total psychological wellbeing score were all signicant at the 1% level and had the following values: lifestyle,
0.19; fortitude, 0.50; satisfaction with life, 0.53; mood, 0.54; sense of coherence, 0.54;
coping, 0.62; stress management, 0.76.
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Steve Edwards
Regression analysis revealed that all well-being components, with the exception
of lifestyle, were signicant predictors of total psychological well-being, with stress
management being the most signicant predictor, followed by fortitude, sense of
coherence, satisfaction with life, mood and coping respectively. As a predictor, lifestyle
only reached the 6% level of signicance. This non-signicant nding could be due
to a relatively small sample size and the fact that, compared to the other well-being
components, most of the lifestyle items are less specically psychological with their
focus on such factors as diet, sleep, alcohol intake, weight and cigarette smoking
(Edwards 2003a).
Analysis of variance of well-being components of health club members and university students indicated that health club members were signicantly more psychologically well than students, especially due to their healthier lifestyle, decreased stress
and improved coping. Whether they were members of a health club or not, regular
exercisers were signicantly more psychologically well than irregular exercisers,
particularly with regard to mood, lifestyle and coping (Edwards, 2003b). Regular
exercise was dened as meeting the criterion of exercising for an average of thirty
minutes a day at least three times per week.
Table 1 refers to the pre- and post-test means for well-being of the 26 regular exercising health club members over a range of two to six months. From inspection of Table
1 it is clear that there were signicant improvements for the well-being components;
mood, sense of coherence, fortitude, stress, coping and well-being percentage. From
the means for lifestyle and satisfaction with life, it appears that, at pretest, exercisers
were already living very healthily (scoring 6 out of a possible 7) and were already
fairly satised with their lives (scoring 26 out of a possible 35). From an individual
perspective, 24 of the 26 exercisers improved in well-being percentage. The decreased
well-being scores of the other two exercisers reected personal traumas each had
incurred over the post-testing period.
Table 1. Pre- and post-test means and t statistics for well-being components
Mood
Life
Satis
Pretest
33
6.1
25.8
59.9
57.7
99.7
12
61.5
Post-test
36.6
6.3
26.6
65
62.5
60
13.2
71.7
t statistic
2.03*
0.96
Soc
0.99
4.1**
Fort
3.4**
Stress
3.1**
Cope
2.42**
Well-being %
5.4**
Table 2 refers to the multiple regression analysis with health club afliation, length of
membership, age, gender, home language, years of exercise experience, participants
estimation of wellness improvement, and the type, amount, duration and intensity
364
R
.530(a)
R Square
Adjusted R
square
Std. error of
the stimate
.281
-.057
31.38472
ANOVA
Model
1
Sum of Squares
Regression
df
Mean Square
6544.876
818.110
Residual
16745.008
17
985.000
Total
23289.885
25
Sig.
.831
.588(a)
Coefcients
Model
Unstandardised
coefcients
B
Standardised
coefcients
Std. Error
(Constant)
141.007
72.672
Health Club
13.148
14.950
Membership
status
Age
-7.046
Sig.
Beta
1.940
0.069
0.214
0.879
0.391
16.413
-0.104
-0.429
0.673
-1.253
0.809
-0.438
-1.548
0.140
Gender
-8.206
19.212
-0.135
-0.427
0.675
Duration
0.446
0.336
0.401
1.328
0.202
Intensity
-10.107
7.025
-0.439
-1.439
0.168
Exercise
type
Estimate
6.521
6.855
0.308
0.951
0.355
-0.800
0.795
- 0.288
-1.006
0.329
of exercise as predictors and the criterion dependent variable, well-being improvement, as measured by pre- and post-test differences in total psychological well-being
scores
This analysis indicated that well-being improvement was not signicantly predicted
by any of the above independent variables. Thus it could be concluded that the major
factor related to the sustained improvement in well-being, as also evident in Table 1,
was regular exercise of at least two months duration.
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Steve Edwards
Qualitative ndings
The following case vignettes were chosen as representative of the samples views on
exercise and well-being.
Mr A was a 25-year-old Afrikaans-speaking man, who had been exercising regularly for six years, visited the health club four days a week, for about an hour to an
hour and a half, doing mainly aerobic exercises and weight training at 80% intensity.
He described exercise in terms of keeping t and in shape, and well-being in terms of
living a physically and mentally healthy life. He improved in well-being from 53%
to 56%, a 3% increase.
Mrs E, a 52-year-old English-speaking woman, who had been exercising regularly for twenty years, visited the health club every day for about ninety minutes and
mainly exercised aerobically at 70% intensity, as well as doing various other types
of exercises. She described exercise in terms of being healthy, strong and making
proper use of ones body. Well-being meant being able to cope with daily challenges
physical, mental and emotional. She improved in well-being from 70% to 83%, a
13 % increase.
Mrs Z, a 30-year-old isiZulu-speaking woman, who had been exercising regularly
for three months, visited the health club on average four times a week for about thirty
to fourty ve minutes and exercised, mainly aerobics and circuit training, at about
40% intensity. She described exercise as keeping her body moving and well-being as
being physically t. She improved in well-being from 42% to 58%, a 16% increase.
DISCUSSION
self perception (Fox, 1990) in relation to various forms of sport and exercise is currently in progress.
Randol (2002) has suggested the following reasons as to why an activity such as
exercise, which is sometimes physiologically identical to the physiological response
of psychological stress, is helpful as a coping technique: detoxication of stressrelated compounds, outlet for anger and hostility, a form of moving meditation, enhanced feelings of self-esteem and self-efcacy, periodic solitude and introspection,
opportunities for social support, the power of human touch, reduction of muscular
tension, increased endorphin, increased somatic awareness, training for competition,
improvement in sleep and rest, enhanced tness to ght stress and disease. Previous
qualitative research on tness, mental health promotion and the exercise experience
(Edwards, 1999, 2001a, 2001b) also emphasised the above and various other related
factors. Discussions with participants in the present study in health clubs particularly
pointed to two primary factors, which may be described as feel good and social
support factors respectively. These factors are known to be related to mental health
(Weinberg & Gould, 1999).
Psychosocial support acts as a buffer for stressful life events (Sinyor et al., 1983).
This research has been limited to a psychosocial perspective on stress, with special
reference to the perceptions and experiences of life events, and coping with the stress
of such events. Stress itself is an extraordinarily diverse phenomenon with biochemical,
physiological, psychological, social and spiritual concomitants with different effects
on different people at different times and in different contexts (Lazarus, 1993; Selye,
1976). In view of the many unanswered questions about the stress response, with its
extensive physiological and psychological concomitants, Scully et al. (1998) have
argued that the role of exercise is probably best described as preventative rather than
corrective. The present research provides evidence towards the promotive mental
health effects of physical exercise.
The lived body is mediator and anchor in the world (Merleau-Ponty, 1962). In
dialogue with the world, it is a source of pre-reective intentionality, meaning and
goal- directed behaviour (Stelter, 1998, 2000, 2001). Building on positive past experiences that have been bodily re-experienced as anchors is the phenomenological base
for remedial breathing, progressive relaxation, systematic desensitisation, visualisation
and imagery used in exercise psychology (Acharya, 2001; Weinberg & Gould, 1999),
crisis intervention (Gilliland & James, 1997), solution-focused counselling, multicultural counselling and psychotherapy (Ivey, Ivey, & Simek-Morgan 1997). This implies
that researchers and practitioners in the eld need to take great care in exploring and
explicating various meanings of mental health, physical activity and exercise before,
during and after therapeutically focused investigations and interventions.
The ndings do not exclude sources of well-being, health and strength beyond
the physical. They simply provide a further phenomenological perspective on taking care of the human, lived body for such sources of well-being, energy, health and
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Steve Edwards
strength (Edwards, 2001b; Stelter, 1998, 2000, 2001). Earlier research, participant
observation and qualitative interviews with health club participants indicated various
aspects of the exercise experience and many reasons why people exercise (Edwards,
2001a, 2001b, 2002).
Despite the increasing popularity of health clubs by an exercise conscious public, it would be inaccurate to assume that health clubs are typically modern, urban
phenomena, patronised by afuent people in developed countries. I have personally
observed home-made gyms, with various ingeniously crafted apparatuses, such as
weight-lifting equipment made from steel pipes and motor car tyre rims in poor areas
of Senegal. The four health clubs in the present study ranged from a small privately
owned gym, with broken equipment to an international version, complete with professional instruction, state-of-the-art equipment and modern facilities, such as a heated
swimming pool.
The results emphasise the importance and value of models of positive health and
positive psychology such as those of Edwards (2001a); Seeman (1989); Seligman
and Csikszentmihalyi (2000); and Tannahill (2000). Taken together the results also
provide further support for the promotion of public health, through regular exercise in
general and membership of a health club in particular, for those members of society
who are able to afford such membership. Many large companies and institutions have
instituted health clubs on their premises in both developed and developing countries.
In view of ndings as to decreased work absenteeism, and increased productivity and
general wellness (Corbin & Lindsey, 1997; Fox, 2000), this trend is likely to continue.
Health professionals in general and mental health workers in particular could routinely
consider referrals of persons with mental health or stress-related problems to such
health clubs as well as recommending regular exercise.
The ndings extend previous qualitative and quantitative investigations, revealing
universal, essential, diverse and contextual aspects of the exercise experience and its
community effects (Edwards, 2002, 2003a, 2003b). The ndings reect perennial
values, such as the notion of a healthy mind in a healthy body in a healthy community
and society, which have been reported in traditional African, Eastern and Western
forms of health promotion for millennia (Giatsis, 2001; Madu, Baguma, & Pritz,
1998; Ngubane, 1977; Reid, 2001, 2002; Zervas, 2001).
The concept of psychological well-being has much potential value in interventions
for promoting health in general and mental health in particular through its positive
emphasis on survival, health and strength, through managing stress, coping with
crises, and developing resilience, competencies, skills, supplies and resources, such
as health clubs and regular exercise.
CONCLUSION
Previous research established that health club members were more psychologically
well than non-members and that regular exercise, in particular, was associated with
368
psychological well-being (Edwards, 2002, 2003b). The present study extended earlier
research in its ndings that continued regular exercise was associated with further
improvements in psychological well-being. Discussion has emphasised the vital role
that health clubs and regular exercise play as resources for the promotion of mental
health and well-being.
The specic ndings of this research was the relationship between regular physical exercise of at least two months duration in health clubs and various components
of psychological well-being. The signicance of these ndings increases when it is
considered that as a group, the 26 health club members were mostly already seasoned
exercisers. Furthermore, the signicant well-being improvement within the group of
26 exercisers was not predicted by any other variables such as particular health club
afliation, length of membership, age, gender, home language, years of exercise
experience, estimation of well-being improvement and the type, amount, duration or
intensity of exercise.
This research was contextualised within a public health model of mental health
promotion. Physical exercise was conceptualised as a subset of physical activities that
are planned to improve health and well-being, and psychological well-being conceptualised as a positive component of mental health. The research provided empirical
evidence for a relationship that has received experiential and cultural recognition for
millennia. Physical exercise, particularly of the regular, balanced, moderate, enjoyable type, promotes mental health and well-being. Given the limited percentage of the
population engaged in such benecial physical activity, the crucial challenge remains
to nd better and more effective ways to promote such knowledge and behaviour for
the benet of all.
ACKNOWLEDGEMENTS
This research was supported by a South African National Research Foundation Grant
(Gun Number: 2050348) for the project entitled: Methods of health promotion.
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