Association between physical activity and mental wellbeing amongst adults in the urban area of the Wardha District – A study protocol

Background

The World Health Organization defines health as a state of complete physical, mental, and social wellbeing rather than just the absence of disease or impairment. There is a lot of zeal for promoting mental health, eliminating prejudice, and ensuring that mental and physical health are held to the same standards. Yet, it is not always easy to understand what “mental health” means in these contexts or if a single, unified definition ties them all together.^1,2

In recent years, young people’s mental health has become increasingly focused, especially due to its importance in helping them successfully transition into adulthood. Statistics from high-income countries show that mental health among adults is worsening, reflected in more mental disorders being diagnosed and treated compared to a few decades ago.³ Given that sedentary behavior has been linked to serious health risks like cardiovascular disease, type 2 diabetes, high blood pressure, and colon and prostate cancer, it is imperative to support interventions that encourage physical activity and discourage sedentary behavior. Most people’s physical activity was reduced during the COVID-19 pandemic, specifically those with chronic health conditions like diabetes, heart disease and cancer suffered a lot. Public health professionals must develop strategies to support people in continuing to exercise at their normal levels.^4–6

It has been confirmed that a significant connection exists between participating in physical activity and experiencing an enhanced mental and physical health state. Research has demonstrated that the biological changes that occur due to exercise can positively impact mental wellbeing. Physical exercise is thought to be among the most potent stimulators of neurogenesis, with a range of peripheral factors activated by physical activity. Serotonin, β-endorphin, and adiponectin are particularly known to increase hippocampal proliferation, which could have a pragmatic impact on one’s mood.⁷ Mental wellbeing is when an individual can reach their full potential, handle daily stresses, be productive, and positively impact their surroundings.^7,8

In recent years, the prevalence of stress among adults has been on the rise, prompting the need for more research on how physical activity can help reduce this stress. Studies indicate that a decrease in physical activity may lead to worsened mental health, potentially resulting in greater levels of anxiety and depression.⁵ The literature on physical activity has seen an upward trend in the last decade, reaching a peak in 2021. Recent research has shown an increased focus on the potential connection between physical activity and mental wellbeing in adults, regardless of whether or not they have a mental illness. Research has also displayed that physical activity has numerous positive impacts on people who suffer from mental health issues. Still, it has yet to be sufficiently studied for its effects on those with no mental illness.⁹

Rationale

The association between physical activity and mental health in adults must be carefully considered because this is the age group when the majority of mental illnesses manifest and when physical activity levels decline. This study aims to investigate this connection. This study will determine the mental health symptoms and happiness index amongst adults residing in the Wardha urban area as well as the relationship between physical activity and mental health. More research needs to be done on the relationship between these two in India, so this study is planned to fill that gap.

Aim

To determine the association between physical activity and mental wellbeing of adults in the urban area of Wardha district.

Objectives

Study design

The present study will be a cross-sectional study.

Study place/setting

The online questionnaire will be available to all adults in the urban area of the Wardha district who have access to the internet.

Study participants/population

People aged between 18 and 40 years in the urban area of Wardha district will be asked to fill out an online questionnaire. The participants will be invited to be part of the study via social media platforms (Facebook, WhatsApp). The online link of the questionnaire will be made available to them. There won’t be any paper version of the survey. Furthermore, it will only be available in English.

The inclusion criteria for being part of this study are that individuals must be between 18 and 40 years of age, have a good command of the English language, and be currently residing in India. No other criteria were stated for being excluded from the study.

Sample size

The number of participants (“N”), Z-score for the intended confidence interval (Z), the standard deviation (“s”), and the preferred error margin (E) are all taken into account when determining the sample size for the study.

The “s” was collected from a prior study involving 548 older persons¹⁴ because this research was unprecedented and was looking at the relationship between physical activity and mental health.

In the mentioned study,¹⁴ the mean ± SD of the overall mental wellbeing mean scores was 28.54 ± 3.83. Taking into account a “Z” of 1.96 (which translates to an error rate of 0.05%), the standard deviation (3.83), and the intended margin of error (E = 1), the estimated sample size was calculated to be N = (1.96)² (3.83)²/ (1)² = 138 participants. Considering the potential for 20% of the data to be missing or have errors in data entry, the revised sample size was 173 adults.

Sampling method

People taking part in the online survey will be chosen using a convenience sampling method.

Variables

For this study, variables associated with demographic information, levels of physical activity, and psychological characteristics will be examined.

This survey aims to collect information on demographic factors and physical activity habits. Participants will be asked about their age, gender, marital status, household’s yearly income, employment status, smoking and alcohol status. To assess physical activity levels, the modified short form of the IPAQ will measure the duration and frequency of physical activity in the previous week, including time spent in vigorous, moderate, walking, and sitting activities.

The short form of the Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), the Pemberton Happiness Index (PHI), and the PHQ-9 will be used in the study to assess mental health and psychological factors. According to the SWEMWBS, mental health will be divided into four categories: probable depression (scores 7–17), possible depression (scores 18–20), average mental health (scores 21–27), and high mental health (scores 28–35). The PHI scale will use a yes/no response to evaluate subjective wellbeing. The PHQ-9 uses a 4-point Likert scale response format to measure mental health symptoms like insomnia, fatigue, dietary changes, difficulties with concentration, suicidal thoughts, and restlessness (Table 1 describes the key study parameters, their variables and data source and collection method).

Study/data tools

The tool referred to will be an online questionnaire with a consent form. The questionnaire will be created using a Google Forms. This questionnaire will have two parts: the first part relates to the individual’s demographic profile. In contrast, the second part will be the short-form of the IPAQ version 2.0. The tool’s objective is to assess adults’ levels of physical activity. Individuals must fill out the appropriate form with their consent before participating. With established concurrent and criterion validity in different languages and test-retest reliability of 0.80 or higher, the IPAQ has been validated among people aged 15 to 69.¹¹ The WEMWBS and the PHI will measure mental wellbeing.^4,8,12 In Asian populations from China and Pakistan, the WEMWBS has undergone internal consistency, test-retest validity, and construct validity tests.¹³ Although India is culturally distinct from China and Pakistan, many sociocultural components that affect mental health are shared across the three countries. The WEMWBS has been used in Indian communities in the past.¹³ Mental health symptoms will be assessed using PHQ-9.¹⁰

Data collection procedure

The online questionnaire will be shared. The study will be conducted electronically, on the participant’s own devices/phones, and will take approximately 10 min. The participants will fill out the online survey. Each survey will ensure anonymity and will consist of a page for consent and information about the study’s objectives. Those undertaking the survey using their devices/phones will have to tick the consent checkbox at the beginning.

Possible confounders

Numerous variables, such as age, gender, ethnicity, socioeconomic status, baseline symptoms of mental health disorders, sleep frequency, smoking, and alcohol consumption, may need to be considered when analyzing mental health symptoms. These variables will be analyzed and evaluated using the demographic profile and PHQ-9.

Bias

Due to the lack of an available sampling frame and the use of convenience sampling, the sample is likely to be unrepresentative of the population being studied, resulting in an inability to make generalizations. Furthermore, the survey could be subject to biases such as respondents providing answers they feel are socially acceptable rather than honest, an inability to accurately assess themselves, confusion around the interpretation of questions, the restriction of rating scales, and the responses being influenced by previous answers. Additionally, the people who complete the questionnaire may not be representative of the population being studied.

Ethical considerations

Ethical approval for this study (DMIHER (DU)/IEC/2023/633) was provided by the ethical committee of Datta Meghe Institute of Higher Education and Research (DMIHER) Sawangi (deemed to be University) on 11/Feb/2023.

The confidentiality of the participants will be respected and safeguarded throughout the research process, and their information will only be accessible to the researchers.

Data analysis plan

The responses from the online questionnaire will be exported to a Microsoft Excel version 2305 file. Subsequently, this data will be encoded, entered, and processed through SPSS version 22 (RRID:SCR_002865). The data will be tabulated and visualized through tables and graphs. Chi-squared tests will be employed for categorical data, while the ANOVA test will be used to compare the mean of more than two groups of numerical data.⁷

Expected outcomes/results

Among adults, there will be a direct correlation between the degree of physical activity and mental wellbeing, signifying that higher levels of physical activity could lead to more significant mental health benefits.

Implications of the study

This study seeks to appraise the participant’s current health status, analyze the factors influencing their mental health, and provide advice on improving their overall wellbeing. Additionally, the data collected can be used for future research. Through this study, it is possible to gain insight into the obstacles to mental health and ways to overcome them. Furthermore, it is essential to prioritize mental health in adults.

Limitations

The design and implementation of the study may be hampered by methodological shortcomings, such as a lack of precision when measuring physical activity. Additionally, those who lack the necessary resources, such as a mobile phone, internet access, and proficiency in English, may not be able to participate in the study.

Study status

IEC approval has been received and the data collection tool for the study has been prepared.