Exercise as a Coping Strategy for Stress a Review

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Exercise as a Stress Coping Mechanism in a Pharmacy Pupil Population

American Journal of Pharmaceutical Educational activity April 2017, 81 (3) 50; DOI: https://doi.org/ten.5688/ajpe81350

Abstract

Objective. To assess the coping mechanisms used by chemist's students and their human relationship to perceived stress.

Methods. Data were gathered utilizing the Perceived Stress Calibration (PSS10) and Brief COPE with the boosted coping mechanisms of exercise and utilise of prescribed medications.

Results. A survey that was sent to 368 students had an 81% response rate. Perceived stress was significantly higher than standard populations, but consistent with other chemist's pupil populations. The most oft reported coping mechanisms were the adaptive strategies of agile coping, credence and planning. Maladaptive strategies of behavioral detachment, venting and cocky-arraign were significantly associated with higher perceived stress scores and the new addition of an do coping machinery significantly associated with lower perceived stress scores. Use of prescribed medications was not significantly associated with perceived stress levels.

Conclusion. Inclusion of exercise as a coping mechanism may be beneficial in like populations.

Keywords

stress
exercise
student
PSS10
Cursory COPE

INTRODUCTION

Health intendance profession curriculums have long been associated with high levels of student stress.ⁱ Shapiro and colleagues found 600 articles discussing the importance of stress in medical educational activity between 1966 and 1999.^two These levels of stress may exist concerning because stress has been associated with depression, anxiety and increased illness.^3-5 Fifty-fifty more integral for a wellness intendance student population is that stress may be associated with dumb determination-making skills,⁶ lower academic performance,^three,7,8 and a reduction in empathy that may impact a educatee's ability to develop relationships with their patients.⁹

Specifically in pharmacy education, in that location have been several studies that examined stress and other related factors in students. Stress has been measured past several different instruments including the 10 question Perceived Stress Calibration (PSS10),^ten-13 14 question Perceived Stress Calibration (PSS14),^14-xviii Stress in Academic Life Scale (SALS),¹⁹ Student Life Stress Inventory (SLSI),²⁰ Derogatis Stress Contour²¹ and other question sets.^22-24 Several studies accept measured health-related quality of life (HRQOL),^{xi,thirteen,xx,23,25} finding that mental HRQOL was significantly lower in pharmacy students than their demographic equivalents. It has also been found that lower mental HRQOL scores were associated with increased stress (on various stress scales),^{11,13,20,23,25} lower perceived academic success,²³ and increased use of maladaptive coping skills.¹¹

Equally of import is how an individual reacts to stress. Struthers and colleagues found that the negative effect between stress and academic performance could be mediated depending on the blazon of coping strategy employed.⁸ Coping strategies may be considered adaptive or maladaptive, with maladaptive coping strategies being associated with less favorable outcomes.²⁶ We explored the association between enrollment in a full-time chemist's shop schoolhouse curriculum and stress as measured by the PSS10 cess instrument. We also evaluated which coping mechanisms were used by chemist's students to assistance manage their perceived stress using the Brief COPE. Boosted coping mechanisms were included because they may be pertinent to this specific population.

METHODS

A web survey was sent in April 2015 to all (368) currently enrolled students at the Feik School of Chemist's, Academy of the Incarnate Word. Participation was voluntary. We utilized the SurveyMonkey software (San Mateo, CA), an online electronic survey instrument which allows respondents to answer confidentially at their convenience. A faculty member announced the survey at each course and non-respondents were sent a reminder afterward three days. We received Institutional Review Board blessing prior to sending out the survey.

Perceived stress was measured using the previously validated 10 particular Perceived Stress Scale (PSS10),^27-29 which in some populations has been shown to have increased reliability over alternative detail scales.^30,31 Validity of the calibration has been demonstrated past both biological changes such as higher cortisol levels and behavioral changes such as poor health practices.²⁷ Respondents answered 10 questions on how unpredictable, uncontrollable and overloaded they found their lives during the final month. Items were scored on a 0 to four Likert scale. 4 of the 10 questions were worded in a positive manner and therefore were reverse scored in order to obtain the correct overall perceived stress score. The perceived stress scales have been successfully used in other pharmacy student populations,^{ten,14,15,17,18,25} including the 10 particular version.^10-12 The authors of the scale specifically stated that it is not intended to be a diagnostic tool, so in that location are no "high stress" or "low stress" cutoffs. We can, however, compare to other populations. A mean score of 15.8 was constitute in a national survey of 2000 adults from the general population, administered in 2009.²⁷

To assess coping mechanisms in our student population, we utilized the Cursory COPE.³² This scale asked two questions for each coping dimension measured. Respondents chose from i=I haven't been doing this at all to 4=I've been doing this a lot. The Brief COPE has been used successfully in the by for chemist's educatee populations.^11,18 This scale typically measures fourteen different dimensions merely depending on the population being studied, dimensions may exist omitted, replaced or more may exist added to the scale.³²

Afterwards observing the coping mechanisms measured within the Cursory COPE, nosotros assembled a panel of kinesthesia and staff from the pharmacy school to discuss other coping mechanisms they believed might be pertinent. After a series of discussions and reviews of coping literature, 2 additional dimensions were hypothesized to accept potential significance and were added. Exercise has been cited equally a coping strategy for stress,^33,34 including in pharmacy student populations.^xiii,35 Also, while the Cursory COPE asks respondents about alcohol and other drugs, information technology does non specifically ask almost prescribed medications. A study by Frick and colleagues found that 11.6% of a pharmacy student population responded that they used prescription antianxiety medications or sleep aids for stress relief.³⁵ The dimensions were represented past the two exercise questions and ii prescription medication questions (Appendix 1). These questions were written in a way that was consequent with the Brief COPE.

Additional questions on the survey included a qualitative question that asked respondents what they accept establish to be an effective way to cope with stress. Assay was performed using SPSS version 22 (Armonk, NY).³⁶

RESULTS

The survey response rate (Table 1) for all enrolled students was 81%, with specific class cohorts ranging from 64% to 95%.

Table 1.

Survey Response Charge per unit

Utilizing the PSS10 (Cronbach's alpha .87), the mean perceived stress score for the educatee population was eighteen.2, with a standard deviation of six.viii (Table ii). Utilizing a one-way analysis of variance (ANOVA), perceived stress scores were found to differ significantly by class cohort (p=.001). Specifically, tertiary twelvemonth students (P3) were more likely to report higher levels of stress than first twelvemonth (P1) or fourth yr (P4) students. Besides P1 students were likely to report less perceived stress than 2d year (P2) students (Tukey examination with a 95% confidence interval).

Table 2.

Perceived Stress Score by Academic Year

Tabular array three displays the ways and standard deviations for the 16 coping mechanisms by class that were measured with the most oftentimes reported at the summit (agile coping) and the to the lowest degree oft reported coping mechanism at the bottom (use of prescribed medications). The created questions for exercise and prescribed medications were plant to take a Cronbach's alpha of .95 and .081 respectively. The traditional coping strategies in the Brief COPE take been split into adaptive and maladaptive strategies.^32,37 The adaptive strategies from the traditional calibration are marked with an asterisk.

Table 3.

Reported Coping Mechanisms Mean and Standard Difference by Academic Twelvemonth

Reported use of coping strategies was generally consistent beyond course. The only exceptions were the coping machinery of self-blame (ANOVA p=.016), which was reported slightly more than oft in P2 students than in P4 students (Tukey p=.011) and self-distraction (ANOVA p=.01), which was reported more than oftentimes in P1 students than P4 students (Tukey p=.011).

Utilizing linear regression, all sixteen coping mechanisms were evaluated against the students' perceived stress score (Tabular array 4). Three of the traditional maladaptive coping mechanisms (behavioral disengagement, venting and self-blame) were institute to be significant (p<.05) in that students who reported using these maladaptive coping mechanisms as well reported higher perceived stress. The added exercise coping mechanism was also found to be significant (p<.01), where students who reported using practise as a coping mechanism reported lower perceived stress. The dimension of prescribed medications had the lowest hateful usage charge per unit of any of the coping strategies. While not significantly correlated with perceived stress levels, 15% of respondents did indicate some use of this coping mechanism.

Table iv.

Standardized Beta Coefficients (R^two=.33)

Regardless of other factors like sources of stress, a third of the variation in the perceived stress score was accounted for by utilized coping mechanisms (R^two=.36).

At the finish of the survey, respondents were asked an open concluded question of "What have you found to exist an effective way to cope with stress." Of the 298 students, 213 (72%) responded. Perceived effective coping mechanisms varied widely with some respondents mentioning several different coping mechanisms inside their responses. Prevalent themes included physical exercise (87), socializing/talking to others (46), prayer (24), music/TV/movies (nineteen), and slumber (17).

DISCUSSION

The college levels of perceived stress and the variance based on class accomplice are non unexpected. Several previous studies take been published with similar findings where pharmacy student populations have higher levels of perceived stress in years where the curriculum may be considered more rigorous.^11,eighteen

Coping skills accept also been examined in chemist's pupil populations using the Cursory COPE.^eleven,xviii Our population reported utilizing the adaptive coping strategies more than often than the maladaptive coping strategies. Consistent with our findings, Hirsch and colleagues measured beyond the 3 pre-clinical years of the pharmacy curriculum and found no difference in the use of maladaptive and adaptive coping strategies based on class and that students in all classes reported using adaptive coping strategies at twice the rate of maladaptive strategies.¹¹ Mayer and Baugh also found that students reported using adaptive coping mechanisms more maladaptive.¹⁸ This may exist positive considering using adaptive strategies may consequence in more favorable outcomes than using maladaptive strategies.³⁸ What had not previously been examined is the role of exercise as a coping machinery in this population.

Apply of do as coping machinery was extremely prevalent, with 75% of respondents stating that they were increasing exercise to some degree. Exercise has often been correlated with decreased stress; however, the studies have varied by population and sources of stress.^33,34

Every bit stated in Table 4, a statistically significant correlation was constitute between perceived stress and reported utilise of exercise as coping mechanism in our population. Some other study of chemist's shop students by Geslani and Gaebelein establish that nearly half of the population used practise as a coping mechanism.¹³ This association between stress and physical practice has been shown in both laboratory and real-life situations,^33,34 and multiple studies take institute that physical activeness correlated with lower levels of cocky-reported perceived stress.^39,40 Specific to our student population, there have been a few studies that found a human relationship between physical exercise and stress of academic-related activities.^41,42

However, nosotros need to be cautious to consider the direction of the potential causality in the correlation. Could information technology be that the students that perceived less stress believed they had more than time to be physically active? Some studies have even found a decreased duration of physical activeness when perceived stress was increased.⁴¹

So, is the perceived stress reducing the level of physical activity or is the physical activity decreasing the perceived stress? The literature review in 2009 establish that stress moderation furnishings were consistently found in different samples and methodologies.⁴³ For our population, a qualitative question from the survey may assist usa. Respondents in our survey were asked a gratis text question "What have yous establish to be an effective style to cope with stress?" By far the virtually prevalent respond was along the lines of unlike forms of physical practice (running, biking, working out), which occurred in the text of 87 different respondents. This indicates that students believe that physical exercise is an constructive way to reduce or forbid stress and may make an argument for exercise having applied significance in reducing stress as well as beingness statistically significant.

LIMITATIONS

Perceived stress has been shown to exist college in female populations and to decrease with age.²⁷ Our sample was younger and contained more females than the national sample we utilized as a benchmark. Still, perceived stress in this population was still higher than the national female or youngest cohort. In improver, many of the questions inside the survey are quite personal and respondents might be either reluctant to admit to negatively associated activities due to social desirability biases or concerns about potential ramifications. For case, ane of the questions specifically asks about substance corruption. This population's institution has a policy of targeted drug screening which could effect in expulsion, thus increasing reluctance to acknowledge substance corruption even on a confidential survey.

It is unclear if the higher rates of perceived stress are more associated with an private'south personality rather than the curriculum they are currently undergoing. Tracking the same individuals as they move through the entire four-yr curriculum may help with this limitation.

While the overall response rate was high, it was noticeably lower for P3 and P4 students. Since the survey was voluntary, students with the highest caste of stress may have felt that they had the least corporeality of time to spend on other activities, like taking a survey. However, the non-respondents may instead have had depression stress and felt that the survey did non pertain to them, or they may accept been influenced past some unknown factor unrelated to stress.

CONCLUSION

The creators of the Brief COPE have stated the need to accommodate the scale to the specific population. We believe that inclusion of practice as coping machinery is advisable for this population. Nosotros also believe that students who regularly participate in concrete exercise should be encouraged to proceed this practice equally it may assist with perceived stress while in a rigorous academic program.

ACKNOWLEDGMENTS

The writer would similar to acknowledge the Feik School of Pharmacy stress cess committee (Dr. Mosley, Dr. Copeland and Ms. Seeger) for their insight; Dr. Linn and Ms. Zertuche for their methodological assist; and Dr. Maize and Ms. Etter for facilitating and administering the survey.