RELATION BETWEEN PHYSICAL TRAINING AND STRESS, JOB

SATISFACTION, PRODUCTIVITY AT WORK AND QUALITY OF

LIFE

By
Alain Touma

Project presented to the Physical Education Department for obtaining a Master in Sports
Management

Faculty of Arts and Sciences

University of Balamand

November 2019

Copyright © 2019, Alain Touma

All Rights Reserved
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University of Balamand

Faculty of Arts and Social Sciences

This is to certify that I have examined this copy of a Master’s project by

Alain Touma

and have found that it is complete and satisfactory in all the respects,
and that any and all revisions required by the final
examining jury have been made.

JURY MEMBERS:

Approved: ____________________
Full name, Ph.D.
President of the jury

Approved: ____________________
Full name, Ph.D.
Jury Member

Approved: ____________________
Full name, Ph.D.
Supervisor

Date of thesis defense: December 6, 2019

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ACKNOWLEDGEMENTS

Foremost, I would like to express my sincere gratitude to my advisor Dr. Christophe

Jacob for the continuous support, heartfelt patience, great motivation, immense knowledge
and invaluable guidance he has been providing me with. I am gratefully indebted for his
tremendous contribution in this thesis.
In addition, I would like to express my very profound gratitude to my family whose
unflinching insistence has resulted in this achievement. My uncommon thankfulness goes to
my friends and my trainees for providing me with unfailing support and continuous
encouragement throughout my years of study and the process of researching and writing this
thesis. This accomplishment would not have been possible without them. Thank you.
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ABSTRACT

Research aim: This research has been intended to study and evaluate the relationship between
the level of physical training, stress, job satisfaction and the quality of life.

It has been endeavored to read different articles and international journals displayed by
various specialists and researchers regarding the impact of physical training on stress level,
quality of life and job satisfaction.

The methodology has been prepared with sources of data and sampling techniques. It selected
120 participants and received 92.5 percent response rate, measurement items of each factor
being fixed with valid source, quantitative & qualitative methods for data collection such as
questionnaire and open questions. All data collected are found reliable.

Findings from data analysis are that people who train at a frequency of around 0 to 2
times per week have a moderate working hours per week, while people who train at a
frequency ranged from 5 to 7 times per week have a higher load of working hours.
Nevertheless, people who train more than 7 times per week have lower working hours. The
scale of fitness reached by people who train 0 to 2 times per week is low which is normal
comparing with people who enjoy more training hours per week.
Concerning the stress level, the findings reveal that the average of stress does not really
differ from a specific training hour category to another, since it is almost the same level of
stress. This also applies to the job satisfaction level that is almost stable in all categories of
training hours. However, additional hours of training per week are reflected in an increase of
the general quality of life.
Discussions on findings of data analysis and outcomes of the literature review are made
and conclusions are drawn that physical activity does not have direct impacts on job
satisfaction, as some of the non-satisfied employees may train regularly. It has no impact on
stress level either.
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TABLE OF CONTENTS

ACKNOWLEDGEMENTS iii
ABSTRACT iv
TABLE OF CONTENTS v
LIST OF ABBREVIATIONS vii
LIST OF TABLES viii
LIST OF FIGURES ix
CHAPTER 1: INTRODUCTION 1
CHAPTER 2: LITERATURE 5
2.1 Stress, Depression and Health 5
2.2 Stress Related to Work 8

2.3 Physical Activity (PA), Exercises 10

2.4 Physical Activity (PA), Exercises and Stress 13

2.4.1 Physical Activity Can Cause Stress 17

2.4.1.1 Muscle dysmorphia (MD) 19
2.4.1.2 Anorexia nervosa 23
2.4.1.3 Anorexia athletica 25
28
2.5 Physical Activity (PA), Exercises and Health
2.6 Physical Activity and Work 29
2.6.1 No relation between Physical Activity and Work 31
2.7 Gender, Stress and Physical Activity 32
CHAPTER 3: MATERIALS AND METHODS 34
3.1 The Subjects 34
3.2 The Survey and the Questionnaires 34
3.3 Study Design 34
CHAPTER 4: RESULTS 35
4.1 Results for the whole Population 35
4.2 Results for the Women 39
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4.3 Results for the Men 42

CHAPTER 5: DISCUSSION 46
CONCLUSION AND PERSPECTIVES 49
LIST OF REFERENCES 50

APPENDIX A : Demographic Data 58

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LIST OF ABBREVIATIONS

ADAA Anxiety and Depression Association of America

AIS American Institute of Stress
APA American Psychological Association
BID Body Image Dissatisfaction
BMI Body Mass Index
Co-League Companies League
HPA Hypothalamic-Pituitary-Adrenal
HRQoL Health Related Quality of Life
MD Muscle Dysmorphia
MMA Mixed Material Arts
OCD Obsessive Compulsive Disorder
PA Physical Activity
US United State
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LIST OF TABLES

Table 4.1 General characteristics of the population 36

Table 4.2 Stress levels, job satisfaction and quality of life of the population 38
Table 4.3 General characteristics of the women 40
Table 4.4 Stress levels, job satisfaction and quality of life of the women 41
Table 4.5 General characteristics of the men 42
Table 4.6 Stress levels, job satisfaction and quality of life of the men 44
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LIST OF FIGURES

Figure 1.1 Body illustration for the types of muscles dysmorphia. 23

Figure 1.2 The Figure Rating Scale (FRS). 25
Figure 4.1 Gender respondents by percentage. 44
Figure 4.2 Training times per week for women and men. 44
Figure 4.3 The relation between stress level and training times per week. 45
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CHAPTER 1

INTRODUCTION

Stress is a universal and normal happening that touches every person at various moment

in their lifetimes. It is the body's response mechanism to physical threats (such being afraid of

something or having phobia) or emotional tensions (such as being protective over the family,

friends and colleagues). Stress can be felt from environmental, physical, emotional, or mental

factors. A Few of the highly frequent causes of stress are:

Survival Stress: it is when people are afraid of someone or something, so to be able to

cope with the dangerous situation, the body responds by natural energy or what is known as

the survival stress.

Internal Stress: This is internal pressure and it is outstanding among the most

imperative sorts of fear to understand and manage. Inward pressure is once the person pushes

themselves to their limits. This frequently occurs when people worry over things they can't

control or place themselves in stressful situations. A few people become controlled by this

type of rushed, stressful aspect of life that results in being under pressure; sometimes they

become addicted to that form of stress and even more look for stressful events and feel

worried about things that aren't unpleasant.

Environmental Stress: This form of stress is a consequence to contextual factors

surrounding people and a source of pressure, such as commotion, pollution, and load from

work or family. Recognizing these ecological fears and thinking how to manage and to stay

away from them will help to defeat the feeling of anxiety.

Fatigue and Overwork: This sort of stress is cumulative fatigue that develops over time,

years and can negatively affect the body. It may be brought by working excessively hard at

one’s job, school, or home. Don’t know how to deal with time, energy and stress affect the
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way of the person’s life and take big part of time for resting and relaxing. This can be one of

the hardest sorts of worry to stay away from on the grounds that most individuals feel this is

out of their control.

In some situations, stress can be beneficial, but on other occasions, it can have a

negative impact on the individual’s mental and/or physical wellbeing. Stress manifests itself

biologically through the release of certain chemicals into the blood, mainly cortisol,

adrenaline (also called epinephrine) and noradrenaline. The positive effect of these chemicals

is reflected by the additional strength and energy endowed to a person under a stressful

situation caused by any kind of physical danger, a response known as the fight or flight

response. The negative effect of stress, on the other hand, is when it is caused by emotional

strain or continuous challenges without relief between stressors, resulting in draining the

individual from their physical strength and energy, reaching emotional distress in severe

situations.

Detecting the source of stress is the first step in dealing with it. It is recommended that

people take appropriate steps to recognize when they are under stress, what is causing their

stress, and how to practically deal with stressful periods in their lives in ways that can

improve both their mental and physical health. The focus of this study is stress among the

Lebanese population. Nowadays, Lebanese citizens are witnessing high levels of stress which

is diffusing among people faster than ever. Basic life securities are serious factors of stress in

Lebanon, like work insecurities, continuous heavy road traffic, high unemployment rates, low

basic wages, expensive basic living conditions, unstable political environment, high rate of

morbid diseases, etc… Not to mention also that causes of stress and coping measures differ

between genders, and this will be detailed in the literature review.

Life isn’t stress free, be it in Lebanon or elsewhere. However, the key to a somehow

calm living is finding the right way of dealing with stress and managing its causes. Several
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actions can be taken, some of which are beneficial, like doing sports, listening to music,

enjoying food, owning a pet, be surrounded by friends, traveling, or meditating, and some

others can turn out to be harmful if abused such as smoking and drinking alcohol excessively.

In this study, we will explore the effect of exercising on stress, to find whether the

former is a reliever of the latter or not, and consequently, whether exercising has a positive

effect on productivity at work or not. This study will investigate the relationship between

exercising on one hand, and stress, job satisfaction and quality of life on the other hand.

Working in the fitness industry exposes the trainer to the daily life of his or her trainees,

the majority of whom, in my case, are active adults in the work life. This daily contact with

people and the trust relationship that is built throughout the training period between the

trainer and the trainee allows the former to detect a strong link between sports and stress. In

fact, it is a multifaceted relation: 1) sports can relieve stress, 2) sports can cause stress, 3)

stress can positively affect performance, and 4) stress can negatively affect performance.

1) Sports can relieve stress for several reasons: it is a healthy distraction and it releases

hormones such as serotonin and dopamine that positively affect the mood (Hamedinia and

Hosseini-Kakhak, 2017).

2) Sports can cause stress: if it becomes a challenging activity (a difficult workout, preparing

for a competition...) it can become a stressor (Meeusen, Waston, Hasegawa, Roelands, &

Piacentini, 2007).

3) Stress can positively affect performance: if exercising is seen as a distraction and stress

reliever by the trainee, his daily stress would be a motivation during the sports activity.

4) Stress can negatively affect performance: if the stress reaches a point where it has caused

energy drain and low muscular strength caused by an exhausted nervous system, not only

will it affect one’s physical performance during sports activities, but it would also

demotivate him or her to train and decrease their ability to focus during exercising.
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All types of trainings can either create stress or reduce stress depending on the

individual’s expectations or requirements from the training. The intensity, duration,

frequency and volume of the workouts change depending on the expected result and the

individual’s objectives. On many occasions, people would over train in order to reach the

body image they wish. They would stay long hours at the gym, or alternate between indoor

activities (weight training, aerobic training, pilates…), outdoor activities (walking, running,

cycling…) and team sports (basketball, football, handball…) on the same day, without the

knowledge of their trainer, if they have engaged one. They would work out on daily basis, not

allowing their body to recover sufficiently, causing muscular pain and joint injuries. In

addition, in cases of people suffering from mental challenges such as muscular dysmorphia or

anorexia nervosa, the workouts are the result of the mental stress they put on their body

shapes, and they become a cause of physical distress due to the overtraining stage they

usually reach.

Limited findings show that there is a correlation between exercise and stress.

According, to a recent ADAA survey (Anxiety and Depression Association of America,

2008), (Physical Activity Reduces Stress, 2008) 14 percent of individuals that train frequently

can cope and deal with stress. In addition, few researches show a relation between stress and

job satisfaction, which affects productivity at work. Referring to a survey done by the AIS

(American Institute of Stress) (Workplace Stress, 2006) 46 percent of people in the United

States consider that the workload is the main cause of stress survey.

In this study, we will attempt to answer the following questions scientifically, and

based on a field survey:

1) Is there a relation between physical training and stress and the job satisfaction?

2) Is there a relation between physical training and productivity at work and quality of life?
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CHAPTER 2

LITERATURE REVIEW

2.1 Stress, Depression and Health

In the 20th and 21st centuries, the stress level of people has been witnessing increasing

levels due to the major changes that occurred in the different aspects of the human life. The

industrial revolution was the pivotal point: the increase in mass production caused a shift and

a boost in wealth, resulting in the creation of a middle class. Now, it was possible for hard

work and good ideas to make the poor rich. Competition grew, markets grew, and greed grew

exponentially. Humanity has been since then in a never-ending race for more. During the

same period, women in industrialized countries fought for and obtained their rights for

education and work, and today, these have become top priorities in a woman’s life, leading to

increased stressful situations especially when a woman has children. The past 150 years

witnessed the fastest evolution in humanity in all fields of technology, science, economics

and politics, making life harder and more stressful.

The term stress nowadays is being linked to any domain, profession, disease and

chronic disease. Humans use the term stress in their everyday life although the internal and

external factors causing it may differ from one person to another.

As such, there has not been one particular explanation for stress. McEwen (2007)

considers that “Stress is a word used to describe experiences that are challenging emotionally

and physiologically”, while Walter B. Cannon, more recently, utilizes it for the aggregate of

outer elements disturbing homeostasis of a living creature (Persson and Zakrisson 2016).

Work-related pressure is the most generally expected unending life stress and that is directly

linked to coronary artery diseases (Rozanski, Blumenthal, & Kaplan 1999). 'Stress' can be
 6

used in a biological setting to describe the non-specific or unknown reaction of the body to

any request set upon it (Russell, 1999). Russell (1999) thinks that “a brief examination of any

daily newspaper will reveal that stress has become a universal explanation for human

behavior, failure and disease by doctors, politicians, the business world, athletes and ordinary

people. Every modern library and bookstore contains large numbers of books offering advice

on how to deal with the Stress of life.” Any event faces the humans in their life which haven’t

a specific cause, people relate to stress to solve or decrease the effect on them.

Long-lived stress causes serious damage to people’s lives, ranging from depression, to

health problems to chronic and morbid diseases. Depression is the psychological

manifestation of stress and is defined as the over activity of the hypothalamic-pituitary-

adrenal (HPA) axis that is similar to the hormone secretion of neuroendocrine reply to stress

(Anderson, 2008). Medicare in the United States spending by the Americans on depression

medicine and aid has grown from $1.3 billion in 1992 to $2.1 billion in 2000 and was

expected to expand to $2.5 billion in 2004 (Physical Activity Fundamental to Preventing

Disease, 2002). At this same growth rate, it is estimated that this amount today has reached

$4 billion (Jackson, Knight & Rafferty 2010) say that unhealthy behaviors may have

defensive mental health are the effect of those who live in chronically stressful surroundings.

However, such unhealthy behaviors when combined with negative environmental

circumstances eventually contribute to morbidity and mortality but with different racial

parties and social groups. According to Anderson (2008), arm pain, lower back pain, shoulder

pain and neck pain are due to stress-related depression.

Stress also affects physical health causing heart attacks, cardiovascular diseases,

diabetes and other problems like asthma, eczema and psoriasis, reflux and stomachache, hair

loss and brittle nails, to mention a few. My work experience and daily contact with adults

under stress are a proof of the negative effect of stress on health. For instance, one of my
 7

trainees has skin problems resulting from depression. Another one has Crohn’s disease

caused by stress and anxiety. A third developed adult asthma after an acute period of work-

related stress.

Asthma pathogenesis and its exacerbation have been independently associated with

stress and contaminations (Trueba and Ritz, 2013). Stress can contribute to cardiovascular

diseases, involving coronary heart disease on the long-term development and severe

activating of cardiac events (Steptoe and Kivimäki, 2012).

Lack of exercises, bad diet, drinking alcohol and smoking are associated with a harmful

behavior while a person is under stress (Stults-Kolehmainen and Sinha, 2014). The

association between mental distress (like depression and anxiety) and physical inactivity

especially when manifested in long periods of staying seated are burdensome to wellbeing

and quality of life (Rebar, Duncan, Short, & Vandelanotte, 2014). Scientists, using data from

the California Work and Health Survey that took place between 1998 to 1999, attempted to

estimate if there is a link between asthma and physical inactivity with perceived depression

and stress on the personal and work level stressors. Maybe physical inactivity and asthma

enhance the effects of stressors, and that exercise may ameliorate these conditions by

diminishing stressor effects (Hurwitz, 2003). In another research, the study was about

“Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress,

and depression among Dutch adolescents” concluded that musculoskeletal pain is not

associated with the use of computer and the physical activity among adolescents but with the

stress and depression (Diepenmaat, Van der Wal, De Vet, & Hirasing, 2006). Stress,

depression and fatigue may affect an individual’s performance in sports or in any type of

physical activity. Even Though physical performance can be affected by psychological

fatigue or burn out on intellectual and skilled performance is well known and it was been

carefully examined. A long term demanding intellectual activity will result a

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psychobiological state called mental fatigue (Marcora, Staiano, & Manning, 2009).

As stated by Findlay (2019), a decrease in the level of stress would definitely improve

the quality of a person’s life, not only by increasing his or her happiness, but by also

decreasing their risk of chronic psychological and physical diseases like depression and

hypertension. Chronic diseases result in a bad quality of life, and this is why health-related

quality of life (HRQoL) was developed as a perfect indicator to show a person’s health status

and quality of living (Rebar, Duncan, Short, & Vandelanotte, 2014).

2.2 Stress Related to Work

There is nowadays a magnitude of the effects of job stress, and this is the rationale

behind the stress becoming a research topic. In addition, if a person has several diseases like

hypertension and heart problems while that person faces high levels of stress in the job may

have a negative outcome on the emotional state as well.

In general, job stress is directly related and a source for job satisfaction, yet the two

terms are separated (Stanton, Bachiochi, Robie, Perez, & Smith, 2002). An opposite

association among job stress and job satisfaction among various populations has been

described always in the literature.

The nature and the progress of the relation between job stress and job satisfaction is

blurry than the direction of the relation.

Employees at work they cannot avoid the pressure at the workplace due to the difficulty

of the environment at work. Sometimes work pressure may be great for the employees, they

keep them attentive and alert, motivated, learn and listen that differ from resources and

personal characteristics. However, when that pressure listed above develops to an extreme

level it will lead to unmanageable stress. And that work stress can harm the employees' health

and the business performance.

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A poor work organization and a weak work design lead to work-related stress. Lack of

control over the workers, the bad way managers work, and a weak system of any company

causes nonexistence care and support among the colleagues and supervisors.

Numerous studies in the U.S show that American adults illustrate that the major source

of stress is job stress and it has increased more and more over the past few decades. Increased

heart attack rates, hypertensions and other disorders have been connected to high levels of job

stress not as evaluated by the perception of having little control over the health side (Stress

Effects 50 Common Signs and Symptoms of Stress, n.d.).

In the organizations, the term absenteeism which is how much a person has been absent

over the year without a good reason is related to job satisfaction in any job. Absenteeism is

related to stress or illnesses that affect the work itself, and consequently the productivity of

the company. According to a review in more than 300 companies 800,000 workers are in a

sick leave because of the stress boosted. Every day due to stress around 1 million workers are

absent. The European Agency for Safety and Health at Work (Workplace Stress, 2006) stated

that absenteeism at work is associated to stress and the last minute no show also attached to

job stress which cost annually a loss of 550 million working days. A bad consequence arises

in the companies and touches the key employees, which lead to a domino effect that transmit

down to other employees and may affect scheduled procedures and operations.

Moreover, there is a special relation maintained between stress, anxiety and job

satisfaction in numerous researches. Moore (2010) suggested that lower productivity,

absenteeism, weak and poor work performance, higher turnover and mishap or problems at

work are the result of extreme level of stress, and a work-related stress will result directly in a

decreased job satisfaction. The bad relation or interactions among peers and supervisors

created by job burn-out and nervous atmosphere are the result of stress at work. According to

the APA excellence (American Psychological Association Center of Organizational

 10

Excellence) (Work Stress, n.d.) in the U.S. 65 percent of the employees mentioning work as

an important basis of stress and that more than $300 billion costs the U.S. industry a year due

to job stress because of low productivity, bad turnover, absenteeism, legal, medical, and

insurance costs.

The daily life stress and the work-related stress are the main pioneer for depression and

anxiety, which afflicts each year 17.6 million of the Americans population and costs the U.S.

businesses around $24 billion yearly in lost or lack of productivity and employee absenteeism

and illness (Hurwitz, 2003). When workers are psychologically and mentally tired from all of

the anxieties, uncertainties, and pressure carried on by the internal and external stressful

lifestyle or environment, the employees are simply more unable to concentrate and even

distracted and prone to make errors, harmful or even catastrophic mistakes at the job. Also it

is stated that many organizations face or have incapability to differentiate their work-related

stress from non-work-related stress, even more stress can be caused by what the employee is

waiting from the work itself in all situations and circumstances and what really the work

situation is about. Likewise, the effect of these indications on associations is critical as they

lead to antagonistic vibe in the work environment, low assurance, relational clash, expanded

advantage costs, diminished profitability and expanded non-attendance. The mental effect of

work environment stress incorporates depression, persistent anxiety, doubt, and anger

(Colligan and Higgins, 2006). Family problems, insecurity about the future, insomnia and

financial difficulties lead and cause stress and affect the work performance. Employees

encountering constant work pressure have been appeared to affect their health by creating

unbalanced blood pressure, augmented cholesterol levels, substance abuse, diabetes, muscle

tension, hypertension, ulcers, migraines, headaches, and clinical depression (Colligan and

Higgins 2006).
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2.3 Physical Activity (PA), Exercises

Any body movement needs a group of muscles to work and involve energy more than

resting and that movement improves health in general is called Physical activity. Here are

some of the examples of physical activity like walking, gymnast, running, weightlifting,

dancing, swimming, yoga and gardening. Health- related physical activity can be tested and

measured fewer than five different components which consist of body composition by

analyzing the body weight, fat, muscles and water percentages. Cardiovascular fitness by

measuring the heart rates after a small cardio exercise called the step test. Flexibility test is

about how much the person can reach past his toes in sitting position with fully extended

legs. Muscular endurance and strength can be measured by how much the person perform

push up and sit up for one minute. Although there is a correlation between physical activity

and fitness, however physical fitness is mainly determined by physical activity patterns

(Blair, Cheng, & Holder, 2001). Physical activities help and boost the cardiorespiratory

system, yet genetic play a huge role in the contributions to fitness (Blair, Cheng, & Holder,

2001). Physical activity and physical fitness are two types of physical demand, by enhancing

the volume of the activity in any person life will automatically improve the fitness level of

the person himself; although genetic has a control over the adaptation for fitness level.

(Haskell et al., 2007). However, health and wellness can be improved by physical activity and

fitness none of them is more important than the other (Blair, Cheng, & Holder, 2001).

Someone is physically fit and being fit is a good quality of a person in good health and

can be efficient and effective in everyday tasks. Fitness is a term used for a person who can

perform several activities and function under different situations and adapt to them. A huge

change occurs in the fitness industries and new friendly equipment line to serve better the

human fitness and the beauty of the bodies. Physical fitness has advantage over physical

activity because it is more specific and demand more special technique and training than just
 12

aerobic and anaerobic abilities like endurance and strength. Fitness programs includes

techniques for balance, agility, speed, power, coordination… more than just the components

of physical activity.

Exercise regularly can had advantage on the long-term and immediate benefits. Being

positive, having a good mood, good appearance, enhancing energy, boosting strength and

developing flexibility all are results of a good physical fitness. Both physical activity and

physical fitness after training regularly showed a decrease in the morbidity and mortality

level. Exercise is a physical activity which is planned, structured, and repetitive which has a

goal or objective to maintaining or developing the physical fitness.

Fitness includes general and specific trainings. Fitness is defined as the ability of the

person to do or perform any daily life activities without extreme fatigue (Sharifzadeh, 2013).

Caspersen, Powell, and Christenson (1985) explained that when any human body move and

use the skeletal muscles system that create energy which is called energy expenditure.

Kilocalorie (Kcal) is the unit for measuring the energy expenditure. The energy expenditure

can be found in any daily life activity under several types from sports to job-related activity,

households, conditioning, cooking, walking… Physical fitness is a set of characteristics that

are skill related movements with specific tests and measurement that allow the person to

evaluate his fitness level accordingly.

To advance and keep up great wellbeing and physical autonomy, grown-ups will profit

by performing set of exercises that help to develop and improve muscular strength and

endurance for at least two days every week. It is prescribed that the person exercise for two

days at least and perform 8 to 10 exercises on nonconsecutive days every week for the main

muscle groups. To expand quality improvement, a resistance training (weight, elastics) must

to be utilized 8 to 12 repetitions for each set of exercise bringing about failure and tiredness

in the muscle itself. Muscle-reinforcing exercises incorporate a dynamic program that include
 13

weight training, resistance training, body weight workout, jumps and stair climbing that use

the major muscle groups (Haskell et al., 2007). Haskell et al. (2007) claims that every adult

aged 18 to 65 year must move in a moderate intensity for a minimum of 30-minutes for an

average of five days a week with any aerobic exercise like walking, swimming and 20-

minutes, three days a week with a high intensity training to endorse and sustain health.

A good program includes a mixture of both trainings moderate and vigorous-intensity

training that can be achieved to meet this recommendation. For example, a person can

organize his time by dividing the week Monday, Wednesday and Friday for walking about 30

minute which is a moderate intensity; and Tuesday, Thursday and Saturday for a 20-minute

jogging for a tough intensity. A 30-minute walk with a moderate intensity which is in the

aerobic phase with a normal breathing, where the heart rate is above normal around 130 beat

per minute. Vigorous-intensity activity mainly it is in the anaerobic phase like in the 20-

minute jogging, which induces an increase in the heart rate above 140 beat per minute and

with a rapid breathing.

Moreover, strength or weight training is very essential for every adult and must perform

it for a minimum of two days each week for maintaining and increasing muscular endurance

and strength. Due to the connection between wellbeing, health and physical movement,

training avoids any diseases or danger in the health of any person. People want more fitness

and training to improve their personal fitness and are more aware of the fact that being fit

may result of decreasing their danger for chronic diseases, inabilities or inhibit undesirable

weight gain may profit by surpassing the base suggested measures of physical activity.

"Exercise is the single best thing you can do for your brain in terms of mood, memory,

and learning," says Ratey (2008) (Harvard Medical School psychiatrist), author of the book,

Spark: The Revolutionary New Science of Exercise and the Brain. "Even 10 minutes of

activity changes your brain" (Ratey, 2008).

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2.4 Physical Activity (PA), Exercises and Stress

Stress in a person’s life is an unavoidable part of his daily routine. In the U.S.

corresponding to the most recent ADAA survey on stress and anxiety disorders seven out of

ten adults declare they suffer stress and anxiety daily, and most tell it affects at least fairly

with their lives (Physical Activity Reduces Stress, 2008). When the APA (American

Psychological Association) studied people in 2018, (Stress in America: The State of Our

Nation, 2017) they found that in 2018 more people related physical and emotional signs due

to stress than they did in 2017, and almost half described that their stress has improved in the

past year.

People should know how to deal and cope with stress because it’s impossible to

eliminate it from person’s life and nearly all people generally do. About 14 percent of people

train or exercise regularly so they can deal more with the stress accordingly to ADAA online

poll (Physical Activity Reduces Stress, 2008).

According to Lazarus and Cohen, (1977) there can be three levels of stress

management. The first level is how can the person take control and advantage over a stressful

situation by using formal methods like time management, persistence and take decision to

overcome it. The informal method like take a break or vacation from work which can reduce

the daily stress. That level is called the external environment.

The second level is about changing the view or perception of the person facing stress.

As (Selye, 1976) said, "It’s not what happens to a man that counts, it’s how he takes it."

Everyone has confronting stress in his life, but the perception of the person defines whether

the stress reaction is triggered or not.

At the third level adjusting the stress response is the main deal that helps coping
 15

stressful situations. This level gives the person the last chance of action or intervention.

Managing the following consequent response directly diminishes the aftereffects of the stress

reaction. Thinking twice in a stressful situation may avoid a harmful action, like fighting,

screaming, shouting and arguing.

At levels two and three, this is where exercise could contribute logically. Exercise plays

a huge part of changing the point of view of the problem and could be preventive, which help

in the stress reaction by decreasing or sometimes stop it completely. Lazarus and Cohen

(1977) put it into context: "coping behavior precedes emotion and helps regulate its form and

intensity." The term 'fight or flight' in any stressful position is a natural and biological

reaction followed instinctively by resting and relaxation, so exercise is shifting the stress

reply itself. At this stage, exercise take advantage of the somatopsychic effect which is the

correlation of the mind-body and that also changes the perception of the reaction. Exercise

therefore matches (Lazarus and Cohen) 1977, “ameliorative palliative procedure”. Exercise is

a natural therapy for the body and mind.

For Davidson, Goleman, & Schwartz (1976) among others have described that exercise

is a paradox and self-contradiction. So, they called exercise as a stimulant, consequently how

at the same time can be a method of relaxation? How can a method or technique that mainly

has a positive result have a different outcome? However, everyone understands and knows

that exercise has a positive impact and reduces stress! People recognize that moving their ass

off has a good, positive, high, and better physical and moral feeling after exercising. Byrd

(1963) stated in San Francisco 92% of 438 physicians recommended at least one of the four

following physical activities in that order: walking, swimming, golf and bowling. Seemingly,

that the correlation of the mind and body improves by the result of good physical health and

wellbeing of the person who train and exercise regularly. National Heart, Lung and Blood

Institute (1981) prepared a booklet includes several statements said by the people who
 16

exercise properly and feel better after, from these statements: "helps in coping with stress",

"helps counter anxiety and depression," "helps you to relax and feel less tense" and

"improves the ability to fall asleep quickly and sleep well". For Morgan (1982) many

designed programs for the correlation of physical activity and stress reduction were not able

to find a way. Several cross-sectional studies explained only the physiological evidence

among active and sedentary groups who exercise or train. But the main point is to find a

relation between the psychological and physiological aspect in stress decline. Although,

psychological differences occur between active people not every person who exercises has a

perfect and good life without stress and anxiety. Nevertheless, Morgan (1982) says that even

with a poor relation among psychological and physiological demand there is an important

backing that exercise play a role in stress reduction. Two researchers out of this chaos

(DeVries, 1968) and (Morgan, 1982) have been engaged in a series of significant

investigations.

People who train have fewer rates of depression and anxiety, though working out help

positively and in good way the changes in mental health and capability to manage stressful

encounters (Stults-Kolehmainen and Sinha, 2014). Exercising is one of the main solutions for

dealing with stress. When someone stress about something mainly it affects the brain along

with the entire nervous system and impact the whole-body organs and systems. So, when

working the body and feel better, so does the mind. Exercising or working out at any level

that generate hormone called endorphin which secrete chemicals in the brain and play a

natural role in pain relief and enhance the quality of the sleep which will result in a better

mood and reduces stress. Doctors and physicians constantly recommend and encourage

people to stay fit and active because there are several benefits of physical activity some are

developing physical condition and fighting disease. Moreover, a better mental health and

fitness have been related to exercise and it is thought to be important for decreasing stress.
 17

Findings in exercises and stress show a positive relation that it is very successful at

reducing exhaustion, improving alertness and focus, and at boosting the overall mental

cognitive skills. Stress and anxiety drained the energy and the ability to concentrate of any

person at any atmosphere, so exercising may be a great solution. Treating minor to moderate

depression by exercises can be effective and useful as anti-depressants. The relation between

physical activity and mood, stress, anxiety and wellbeing were studied in many researches,

and all the researchers found and assure that being active, healthy and exercise regularly have

a positive impact on depression, anxiety and mood (Strohle, 2008). In big companies

managers found a brilliant method which is training and exercising for helping, reducing

employee pressure and anxiety levels (Moore, 2010). Exercising increases the person’s

positive thoughts, energy levels, good quality of sleep, distract them from fears and make

them move far away of the depressing ideas that can have impact on anxiety and depression.

Scientists have found that training under an aerobic exercises or system demonstrated a

decline in high tension, bad mood, bad quality of sleep and improve self-esteem. Work Out

daily for five minutes of aerobic or cardiovascular exercise can stimulate anti-anxiety effects

(Physical Activity Reduces Stress, 2008). Studies and strategies designed to produce and

prove that good behavior, exercise and physical activity have great impact on excluding stress

in real-world settings. For enhancing quality of life, sleep and decreasing stress and

depression; being fit, active and exercise are an efficient techniques. Physical activity and

exercises have been proven to stimulate positive mental health in people life and the ability to

cope and eliminate stressful moments. Additionally, training program and sports show to

improve a person status by decreasing depression (Stults-Kolehmainen and Sinha, 2014). A

right volume of exercises will help to decrease the stress level in any human body (Findlay,

2019). Even more stretching or flexing the muscles of the neck, shoulders, back, arms…

reduces the chance of being tight and fatigue for the person himself. Exercises reduce stress
 18

and affect the quality of life of the individuals by improving the capability to deal with stress

and ameliorate the physical performance, strength and aerobic fitness (Atlantis, Chow, Kirby,

& Singh, 2004). A great amount of physical activity results in better sleeping, good mental

health and enjoying going out with friends.

2.4.1 Physical Activity Can Cause Stress

Physical activity, training and exercising can create a stressful impact on the body and

overtraining can put pressure on the trainee himself. For Gardner (2005) intense training and

difficult exercises are in fact a stressor them self. The bad concept of overtraining in a

training session is when the body did not have the time to recover from the session and the

person exercise too much like twice a day or every day for several hours. Strenuous exercise

above the maximum oxygen uptake increases cortisol levels (Minetto et al., 2006). Cortisol is

the most abundant of the glucocorticoid hormones secreted by the adrenal glands and the

most destructive. Increased cortisol levels have been associated with stress, and cortisol has

been identified as the main hormone secreted in response to chronic intense stress. A result of

training hard the body may collapse under several forms’ anorexia nervosa, anorexia

athletica, muscles dysmorphia, bigorexia… which lead to unhealthy life, depression, anxiety

and suicide.

Like the psychological stress experienced depression, misunderstanding, anger, anxiety and

irritability, the physiological aspect show same status while is overstressed from training.

When someone is emotionally stressed and physically overloaded the body secretes the same

stress hormones and exhausts the entire body.

In fact, some of people see or experienced the good mood and happiness after working

out. Repeated studies and real life cases with individuals and animals have revealed that

training and working out regularly can decrease depression, bad mood, anxiety and stress;
 19

while increase good mood, happiness and keep people joyful.

But sometimes exercising may be hell and type of torturing for some because they dislike

exercising, or training to fulfill the order and happiness of others like doctor prescription or

family order from wife, parents, neighbors…

The case, which is rare and unusual when people train under pressure, pushed and forced to

exercise does not have a positive impact over emotions. That question over the years has been

of a significant interest and attention for the scientists to study.

The ‘Overtraining Syndrome’ has been studied by researchers and shown that people

who train a lot prone to have similar symptoms like clinical depressive people, the happy

hormones like serotonin doesn’t work properly in both cases. Psychologically too, the

reaction of the over trained people and the clinically depressed were seen to have insomnia,

bad temper, cheerless and demotivated.

In Germany the Technical University of Munich (Nixdorf, Frank, & Beckmann, 2016)

found that there is 20 percent more chance in young players and athletes, who train frequently

and do not have enough time to recover from training, stress and injury will suffer from

depression.

Moreover, too much and excessive training are related to eating disorders, body image

dissatisfaction and slimness even among people who do not have eating disorders. Also,

excessive exercise affects performance or quality of life even though mental health specialist

does not find out any problem in the eating disorder.

For those who suffer from anorexia, bulimia or any eating disorders and train a lot to

fulfill their demand in not gaining weight relates to symptoms of eating disorder like poorer

quality of life and depression and they can’t handle the consequences. Extreme training and

overtraining may encounter health troubles including dehydration, stress fractures, and

overuse of the skeletal muscles system from muscles, tendons, ligaments, joints and that lead
 20

to a higher percentage of injuries. Furthermore, not only excessive training and sports are the

only causes, there are several physical and mental issue that lead to eating disorders. A

psychanalyst or psychologist has a great role to help people who exercise a lot and

experienced indicator in eating disorder.

2.4.1.1 Muscles dysmorphia (MD)

Muscles Dysmorphia known under several names: “muscle dysmorphia”, “reverse

anorexia”, “bigorexia”, “machismo nervosa”, “vigorexia”. A new disorder called muscles

dysmorphia (MD) shown usually in men who train as bodybuilders and have huge muscle

mass, have unreasonable confidence that they are of very small musculature (Choi, Pope, &

Olivardia, 2002). Muscles Dysmorphia (MD) is a body dysmorphic disorder in which the

trainee is dissatisfied with their body size and shape (Hernández-Martínez, Gonzalez-Marti,

& Jordan, 2017).

It is characterized by: (Naseem, n.d.)

● Spending a lot of time in sports centers training to improve muscle mass.

● Obsession along with freaking if the person is unable to work out everyday

● Training non-stop even if exhausted or injured.

● Usage of misappropriate protein supplements and pills or extreme diet plan.

● The person uses steroids and cycle abuse with another ingredient misuse.

● Camouflage the body when pain occurs.

● Uncontrollable and always evaluating his body to other physiques.

● Noteworthy suffering and mood changes.

● Avoid relationships, work, friends and put training the priority.

Here are some of the causes regarding Muscle Dysmorphia, those are four different types:
 21

1) Socio-environmental aspects (social media influencers, sport events, parents)

2) Sensitive issues (negative affect, stress, depression)

3) Psychological factors (bad body image, feeling down, being perfect, low self-

esteem).

4) Physiological factors (being under weight, muscularity, like big muscles)

Ogden and Mundray (1996) studied and discovered that media play a great role in

prompting body image in bad and good way in both genders. The media influencers, fitness

beauty events, and sports participation media have an important part to play in establishing

and aggravating body dissatisfaction image (Ogden and Mundray, 1996).

Mass media under many forms’ present males with perfect bodies and emphasize on the

muscularity and that anyone has muscularity is often symbolized by force, power and success

(Grossbard, Lee, Neighbors, & Larimer, 2009). In the last decades researches have

demonstrated the real perfect image of male has to be well-built and powerful. Additionally,

action toys, action movies and broadcast have play role in the image of males in size,

muscularity, and force (Pope, Olivardia, Gruber, & Borowiecki, 1999). Moreover, Leit, Gray,

& Pope (2002) consider that Playgirl models present recently have come to be more muscular

and stronger. Also, the body dissatisfaction image was increased after that beautiful image of

the Playgirl center, and every man want to be in good shape, muscular and powerful (Leit,

Pope, & Gray, 2001; Lorenzen, Grieve, & Thomas, 2004; Baird, 2005).

Studies show that men face more and more difficulty then female toward body

dissatisfaction because male experience body displeasure when they worry about weight and

muscularity (Bergstrom and Neighbors, 2006). When men use products where mainly are

illegal like anabolic steroids, protein pills and diets because they need to look good and

improve their virility and robustness (McCabe and Ricciardelli, 2004). Another possibility is

the excessive and extreme training like weightlifting where men might take part to increase
 22

their muscle mass. As confirmed earlier, that spend so many times in the gyms in order to

grow and improve muscularity is an indicator of Muscle Dysmorphia. Thompson and Stice

(2001) have found that accepting and making a belief it may cause probability of developing

or maintaining the bad idea of eating and body disorder. Thompson and Stice (2001) define

that belief as “the extent to which an individual cognitively buys into societal norms of size

and appearance, to the point of modifying one’s behavior in an attempt to approximate these

standards” (p.181). The social and traditional standard that every man wish to imitate is the

body shape called mesomorph (Grieve, 2007). All men will have the same body they wished

about it if they agree with the society belief of the perfect men body, like nowadays female

with their beauty operations.

The path might be harmful and sometimes with unhealthy behaviors to gain a beautiful

and perfect male body. Grieve (2007) assumes that once men belief in the ideal body shape

that will create and increase the Muscle Dysmorphia percentage and result in body image

dissatisfaction with low self-confidence. In addition, if any individual face low self-esteem

that make the belief of great shape be more visible to others, and the bad body image will

increase as that belief become stronger.

Low self-confidence is an important element in Grieve’s (2007) theoretical model that

can cause the progress of Muscle Dysmorphia. And if that low self-confidence is based on the

look and appearance of the person then it will lead to overtraining or spending more time in

any activity linked to image or appearance like strength training in order to raise again the

self-esteem (Crocker, 2002). Additionally, scientists have found those self-esteem and body

attitudes are related and there is a positive relation. Assessments of the body and self-become

progress and positive relation, help reinforce self-esteem in both men and women (Grieve,

2007); (Mintz and Betz, 1986). For this reason, the development of Muscle Dysmorphia

would be directly linked in some instances to low self-esteem.

 23

Many adolescents spend huge time in gyms, doing multiple numbers of exercises, pay a

lot of money on food and supplements, abnormal eating disorder and even going for a

shortcut with steroids and substance abuse. Adolescents, especially males, are facing body

image dissatisfaction and/or distress (BID), and their behavioral patterns tend to be unclear

and underdiagnosed (Burlew and Shurts, 2013). Muscle dysmorphia is common between

bodybuilders; it would lead to mental problems, mainly low self-esteem, low confidence,

body dissatisfaction and social factors (Jones, 2016). The person avoids any social activity or

place because of his muscularity concerns, if so, dressing loose outfits and verifying the

physique in the mirror are essential tools. Like the Muscle Dysmorphia concept there is the

"reverse anorexia" disorder, where people seemed themselves small, tiny and fragile, but they

were large and with a huge muscle mass. Also, reverse anorexic people rejected the

appearance at the beach, even wore many layers of clothes even in summertime and the high

temperature, and they excluded themselves from any invitation because they be afraid of the

judging of others (Pope, Katz, & Hudson, 1993).

Figure 1.1: Body illustration for the types of muscle dysmorphia (Schneider, Agthe, Yanagida, Voracek, &

Hennig-Fast, 2017).
 24

2.4.1.2 Anorexia nervosa

Anorexia nervosa disease is an eating disorder described by an extreme weight loss,

troubles in maintaining proper and balanced body composition and it will lead to body image

disorder. Limitation in the food intake, calories consumption and counting every calorie that

characterized people with anorexia nervosa. Here are some of the unhealthy methods used by

the person with anorexia nervosa for instance, training a lot and in an aggressive way,

vomiting after meals, usage of some drug pills for water retention and eats large quantities in

a short period of time once a day (Yager and Andersen, 2005).

Historians and psychologists have discovered and proofed that anorexia indicators were

presented long time ago for hundreds or thousands of years, and anorexia disorder can affect

all ages, races, genders, religions, ethnicities, societies …

Although anorexia disorder is mainly presented in the adolescence phase of life, but

children’s and adults nowadays are diagnosed with anorexia nervosa. And no need that the

person must be skinny or underweight to struggle in that disorder. Furthermore, some surveys

have noticed that big, heavy people can also suffer from that disorder and being detected due

to their intellectual bias in fat and obesity. People facing the anorexia nervosa syndrome stay

away from eating, they have extreme and limited diet with very small quantities of food.

Even if they are severely underweight and skinny, they might see themselves as overweight,

and they take their weigh every day or after every meal. A study done by Bjornsson et al.

(2013) found that the age between 16 and 17 was linked to severe symptoms such as eating

disorders, anxiety disorder, attempted suicide, harmful substance usage, and social phobia.

Two subtypes show underneath the big title anorexia nervosa: a restrictive food intake

disorder type and binge-purge cycle (Bulimia Nervosa Disorder) type.

Restrictive food intake disorder: People select the types of foods and don’t meet the
 25

appropriate quantities and energy from food needed in the everyday consumption.

Binge-Purge cycle: it is same as the restrictive food intake disorder but with a little

difference which is eating big quantities in a short period of time and then purge or get rid of

them in a unhealthy way (such as vomiting, use of laxatives and diuretics, etc.)

Eating disorder and excessive exercise are related to each other in a badly way, and

mainly affect the quality of life and daily functions of the person who suffer from any eating

disorder. Training in an extremely way is one of the main characteristics of eating disorder,

and particularly in the anorexia nervosa where the amount of food is restricted and don’t meet

the proper energy burned for the perfect functioning of the body. High intensity training for

any patient in anorexia nervosa disorder it may aggravate the symptoms, but they explain that

the volume and the intensity of the workouts become incontrollable as the disorder growths.

Many people using the expressions activity disorders and eating disorders to protect their

feelings, emotions and sustain the self-esteem. Persons that suffer from both eating disorders

and activity disorders have many similar characteristics, and both groups are aware of the

input of controlling their physique over the diet and training and not the output. In addition,

these people are dedicated and put their mind over problems, respect themselves with self-

discipline and they have the capability to continue and fight.

Women must maintain a normal body weight; it can be referred for normal people of a

BMI among 18.5 kg/m2 and 25 kg/m2. The figure 1.2 shows the differences in BMI and their

interpretation for female body and which can be applied for men also. For the female it is

very important not to attempt the underweight phase where the anorexia nervosa can be

shown and lose their premenstrual syndrome with a low percentage of fat in their body.
 26

Figure 1.2: The Figure Rating Scale (FRS), (Cardinal, Kaciiroti, & Lumberg, 2012).

2.4.1.3 Anorexia athletica

High intensity raining and excessive exercise at athletes and professional in sports can

lead to unhealthy outcomes in physical and emotional levels. Those unhealthy outcomes can

come under the disorders cited before like the body image disorder and mainly in the eating

disorder, but here the syndrome is called “Anorexia Athletica”. The disorders at this level

have several names like exercise addiction, uncontrollable athleticism and exercise

dependence. However, some leaders in sports industry believe that not all excessive training

has to be linked to eating disorder, sometimes athletes suffer from the sport or exercise itself.

And that behavior causes high self-esteem, being control freak all around their lives and over

their physique and appearance. Certain women who suffer from activity disorder and train a

lot reveal that these methods help them manage their low self-esteem. Also, for some that

feeling after training like drugs they feel “high” and become addicted for it. The Obsessive-

Compulsive Disorder (OCD) might be one of the causes for excessive exercising.
 27

Some athletes lose weight intentionally to drop weight category in competitions as a

positive useful technique over their opponents; but this technique may turn in a harmful one

by the obsession of losing weight and therefore affect their healthy lifestyle for instance the

eating disorder (Sudi et al., 2004). The athletes decrease their body weight and especially the

fat percentage to gain speed in races or to enter in low weight category like in MMA fights.

Summer body may cause pressure and stress for the trainee himself because for some it is too

difficult to reshape again before summer and beach time.

Anorexia athletica mostly has to do with athletic performance. Although for some

professionals in the health and mental filed the anorexia athletica is not seen as an eating

disorder but the doctors use it to define some of the symptoms that show signs in the irregular

eating forms.

These are classical signs of anorexia athletica or hypergymnasia (Raghavan, 2007):

1- Calculating calories and weight:

Obsession with food, calories and body weight is a classic indication of someone

suffering from anorexia athletica. When counting calories, planning your next meal and

compulsively keeping track of your body weight becomes your main concern, you could be

revealing signs of anorexia athletica.

2- Being displeased with physical appearance:

People suffering from anorexia athletica are often displeased with their physical

appearances. They aim for a slimmer or thinner body and obsessively work towards

achieving it through their diet and exercise. Revealing symptoms like checking weight and

being upset if it doesn’t match the expectations is a classic indication.

3- Stressing too much on body weight:

Anorexia athletica causes the sufferers to place too much stress on their body weight, so

much that their self-worth is directly tied to it. Decreased body weight means higher self-
 28

esteem for the sufferers.

4- Fearing weight gain:

Since so much of their self-worth is tied to their body weight, for someone who suffers

from the problem, there couldn’t be a bigger frightening than gaining weight. Gaining weight

or even feeling fat is something that sufferers are frightened of.

5- Using multiple approaches to maintain low body weight:

Along with limiting calorific intake and controlling food choices or food groups to drop

the excess weight, sufferers also indulge in extreme and vigorous exercise routines. Some

may even misuse diuretics and laxatives to achieve their target weight. Inducing vomiting to

expel food is also not uncommon.

6- Feeling guilty about breaking diet rules:

Suffers often stick to a strict diet routine, omitting certain “bad” foods or food groups

altogether. They exhibit a lot of culpability for disobeying these self-set rules.

7- Having no underlying medical conditions:

Suffers often have no medical conditions that call for limiting food intake or excess

exercise. They indulge in these restrictions simply to keep their weight under control.

8- Revealing amenorrhea:

Female athletes who reveal anorexia athletica often have irregular menstrual cycles and

amenorrhea or absence of periods. Their emphasis on limited eating and excessive exercising

causes low energy levels, which can disorder the hypothalamic pituitary axis, causing

amenorrhea.

2.5 Physical Activity (PA), Exercises and Health

Exercising regularly may help adults who have pain, disease or chronic disease.

Physical activity and exercising help improving the metabolism where the body burns
 29

calories while resting and doing nothing, for instance weight training which help to build

muscles boost the metabolic rate. While training to body needs oxygen to function properly

so the oxygen increases in the blood stream and ameliorate the cardiovascular and the

muscular system. While training and building a good muscle mass in the body that lead to

fewer injuries due to the strength of the joint itself (muscles, ligaments and tendons). Regular

workout and physical activity are associated to enhance health and to lower the risks of

chronic disease in adults (Guidelines for School and Community Programs to Promote

Lifelong Physical Activity among Young People, 2009). Guidelines for school and

community programs to promote lifelong physical activity among young people (2009)

claims that in the United States of America active and fit people are less probable to develop

chronic diseases than inactive people, chronic diseases are linked to sickness and mortality

for example hypertension, colon cancer, heart attack and diabetes non-insulin dependent.

Also, all causes related to mortality are inferior among active people than inactive and

sedentary people. Several illnesses of the modern life like diabetes, depression,

cardiovascular disease, obesity caused by a sedentary life style; while some studies have

shown that restrained exercises can be more helpful for cardiovascular, metabolic systems

and the brain (McEwen, 2007).

Hurwitz (2003) assumed that people affected by asthma and people who are physical

inactive might enlarge tension in a stressful situation; suggesting that continuous asthma can

lead to depression and more stress in life and proofed that physical activity can enhance

asthmatic people by reducing stress level. Training an asthmatic person will ameliorate his

condition and all the cardiovascular system and mainly the lungs.

Aerobic and anaerobic exercises strengthen the heart conditions and improve the blood

circulation and increase the oxygen level in the blood. Also, exercising regularly and eating

healthy can drop the blood pressure and triglyceride levels. So eat healthy, avoid fats,
 30

consume food rich in fibers, be active and fit can help so much to decrease the heart attack

risk, diminishes bad cholesterol (HDL) and coronary artery disease. Brown and Roberts

(2011) said that the worldwide obesity epidemic, and to the overall burden of disease are the

effect of deficiency in physical activity. Furthermore, any moderate physical activity can

lower sugar level in the blood and assist the hormonal response of the insulin to get better and

this positive response can avoid the person to reach diabetes type 2 and prevent metabolic

syndrome. And if the person already has any of these chronic diseases, physical activity helps

him to manage his lifestyle to keep him on the right track.

2.6 Physical Activity and Work

In research done by (Rooth, 2011) about hiring experiment he found that “mentioning

being involved in any leisure sport at the job applications have a two percentage higher

probability of receiving a callback for interview, which is equivalent to the return to 1.5

additional years of work experience.” Depending on the job itself some jobs are more

physical than others, which demand from the employees to be physically strong and fit to be

able to carry some heavy materials. In the bureaucratical job the employees have to be

physically strong and have a minimum of healthy lifestyle to be able to work with less pain in

the neck, back and arm which lead to better performance in the job. Moore (2010), state that

an improvement in job satisfaction is showed by circuit weight training. Train or practicing

any kind of sports might show to the managers that the workers are motivated, enjoy good

health and can probably perform better in their jobs (Rooth, 2011).

In the application for any job the employer should mention a special space for those

who train or doing any leisure activity (Hobby). Rooth (2001) mentioned that many job

applications contain no details about any activity as team or individual sports, while other

show interest in any sports or activity from amateur level to competitive level. In
 31

employments that need power and force physical demand is essential, the notice of recreation

sports in the application support the candidate to be solid and expand the chance of getting a

return call for a meeting by five percent, this five percent is the difference between the

candidates that practice any sport and those who not (Rooth, 2011). Nowadays many

companies show interest in sports by sponsoring athletes or marathons or by creating Co-

League (Companies League) between the companies and banks, and mainly team sports

where the companies can integrate many employees at the same time which can help them in

team building. While other companies make good deals with gyms centers by offering a

specific discount to the employees who wants to train in those gyms, or by offering gym

memberships paid by the company itself and the employees can benefit from it. If an

individual is physically fit, he will almost certainly handle more physically requesting

activities, for example, bearing easily more weight, keep the same tempo at work for longer

hours without taking the same number of breaks (Sharifzadeh, 2013). Physical activity and

fitness programs designed to motivate and involve workers in sport may be an important

method to increase physical activity for time poor working people (Brown and Roberts,

2011). A better mental state, physical well-being and more job satisfaction showed in

employee who exercised (Moore, 2010).

Hurwitz (2003) claimed that workers who are inactive physically might face stress and

depression and indicating that physical activity might be very helpful in the way the person

react in preventing stress, anxiety, sadness, and absenteeism. That hypothesis strengthens the

relation between exercise and stress in work. Individuals who improved health and being

fitter work with higher intensities for longer days and less or fewer sick days (Rooth, 2011).

Fewer sick days mains lower percentage in absenteeism rate which affect the productivity

percentage in the end of every year, every company wish to lower the absenteeism rate which

increases and ameliorate the productivity that lead to increase profit. Also have a better health
 32

related quality of life in companies where the employees are more active and spend less time

sitting (Rebar, Duncan, Short, & Vandelanotte, 2014).

The deindustrialization of advanced financial system and move to progressively

inactive business and affect the chances of employees to take part in physical action (Brown

& Roberts, 2011). This can have a negative effect on efficiency and laborer wellbeing and

potentially manipulating the economic development. Increasing the level of physical activity

in companies might have a direct correlation to productivity and wages (Rooth, 2011).

2.6.1 No relation between Physical Activity and Work

In other hand, exercise and stress related to work shows no correlation in several

researches. A survey done by both Kirkcaldy & Cooper (1993) revealed that directors and

employees who regularly exercise and are physically fit were not expressively stress free in

their work and behavior compared to these who stress and do not exercise before. Many jobs

are not physically demanding like lifting heavy materials and cannot affect the performance

of any employee to complete their tasks. Bureaucratic jobs are more likely related to sittings

and have fewer physical movements in the office or salesman all day in their cars.

Sharifzadeh (2013) said that no considerable associations among BMI level and productivity

at work, following the statistical numbers showed in the survey applied being fit or not

doesn’t affect the productivity level.

Nowadays, several companies around the world shifted from humans’ resources to

machines and robotics to increase their profit and limit or avoid loses. For instance,

computers, laser machines and the future of work is robotics produces more in a short period

of time than humans and that a perfect direction to increase productivity and profit in

companies. The machines are accomplishing the tasks faster and big quantities, so companies

have fewer wages to pay for employees which help the companies to improve their
 33

productivity level (Sharifzadeh, 2013).

2.7 Gender, Stress and Physical Activity

Mentally and physically stress responses are distinct in both gender men and women.

Both gender share significant similarity in sources of stress, for example, cash matters,

employer stability, wellbeing, and relationship issues (Women and Stress, 2019). Even the

difference can be shown in the martial status and mainly for women. Men and women try to

cope stress in very different ways. Women reported that they stress more often than men (28

percent vs. 20 percent) (Gender and Stress, 2010). In the societies where female has the right

to work, they feel stress more than men and specially married women because they have to

take care of the children, join family commitments despite the job obligations (Women and

Stress, 2019). Men stated that work is the main source of stress (76 percent compared with 65

percent of women), but money is the cause of stress for women (79 percent compared with 73

percent of men) and to the economic situation (68 percent compared with 61 percent of men)

(Gender and Stress, 2010).

Even though the gender reported approximately the same average of stress, women can

express and show that stress level is on arise more than men expressing. As cited before that

married women are more expected to stress than single women and it is mentioned in this

survey that in the last month married women experienced for instance: sensation to cry (54

percent vs. 33 percent), tendency to be annoyed and angry (52 percent vs. 38 percent), feel

headaches (48 percent vs. 33 percent) and experiencing fatigue (47 percent vs. 35 percent)

(Gender and Stress, 2010). Some of the women help and listen to other in any subject at all

level and try to help and care about the situation, so they feel sad sometime not to reach their

desire and pleasure level for themselves. And that need to much energy to be able to take care

of other needs as contradictor of maintaining their own demands. For fewer women who
 34

work and suffer from stress and anxiety, they might not notice their basics and needs

(Women and Stress, 2019).

Too many ways to deal with the stress also differ among genders, for men playing any

kind of sports is important method for stress relief (16 percent vs. 4 percent) and the big part

is listening to music (52 percent vs. 47 percent) (Gender and Stress, 2010). Men say that

exercise prevents them from sickness (29 percent vs. 18 percent), something they can

perform in a great way (19 percent vs. 11 percent) and it is a way to distract themselves (34

percent vs. 23 percent).

For the women eating is the perfect way to manage stress more than men (31 percent

vs. 21 percent), likewise eating fast food, unhealthy food and chocolate (49 percent of women

vs. 30 percent of men). Also, women go for shopping and travel outside their countries in

order to cope with stress.

 35

CHAPTER 3

MATERIALS AND METHODS

3.1 The Subjects

The sample size for this study consisted of bosses, employees, residents, trainees,

students, parents… (n = 111) from various companies, chalets, gym at Siwar Center located

in Zouk. The participants were randomly selected and consist of males and females aged

between 18 and 55 + years old.

3.2 The Survey and Questionnaires

The surveys were handed to the subjects on the main gate of the compound, where

they filled all the four questionnaire, Appendix A (open questions), Stress survey, Job

Satisfaction survey and the Quality of life survey.

3.3 Study Design

This study utilized a quantitative research design using survey data. A survey using a

correlational design in which I explored the relationship between three main variables

(exercise, stress level and job satisfaction). I explored, described and saw the causality effect

between these variables and compared the results after the statistical responses.
 36

CHAPTER 4

RESULTS

4.1 Results for the whole Population

Table 4.1 shows the general characteristics of the entire population. 111 men and

women answer correctly to the all the questionnaires, they were 34 inactive and 77 actives

with an average weight of 71.98kg for a height of 170.88 cm. The inactive subjects exhibited

the lowest scale of fitness (3.45) and the group training the most (5-7 times per week)

exhibited the highest level of fitness (6.84).

 37

Table 4.1: General characteristics of the population

Number of Training Weight per Height per Working Lifetime Number Scale of

subjects sessions per Kg cm hours per working Fitness

of children
week week hours

111 71.98 170.88 37.89 11.75 0.86 5.1

15.83 10.32 17.98 8.29 2.24

73.08 169.94 37.84 14.73 1 3.45

34 0-2
16.79 10.47 18.16 10.22 0.96 2.08

72.57 170.37 37.8 11.73 0.74 4.74

27 3-4
16.01 8.69 16.86 7.60 0.90 1.95

66.27 169.16 40.31 10.62 0.29 6.36

31 5-7
12.54 10.76 15.54 6.93 0.69 1.8

78.47 176.10 34.42 8.29 0.21 6.84

19 7+
 38

16.69 10.58 22.88 5.82 0.53 1.21

Values are means ± standard deviations

 39

Stress level, job satisfaction score and quality of life are shown in the Table 4.2. For

the general population, the inactive group always exhibited the lower values for quality of

life. Job satisfaction was very close between the groups and stress scores seem to have no

relation with the number of training sessions per week.

 40

Table 4.2: Stress levels, job satisfaction and quality of life of the population

Training PSS PSS Job QoL 1 QoL 2 QoL 3 QoL 4 QoL

sessions Short Satisfaction general

per week

21.14 8.90 9.77 68.35 53.50 61.59 68.61 64.97

6.05 2.07 2.67 17.17 11.02 12.66 18.68 16.29

19.64 9.14 9.96 61.02 50.42 57.23 65.68 59.28

0-2
5.83 2.23 3.04 15.92 9.86 14.07 18.43 17.10

21.09 8.62 9.87 68.51 54.89 61.88 69.13 68.51

3-4
6.90 1.98 2.41 16.39 8.97 12.80 16.95 16.84

22.20 8.36 9.05 70.96 54.49 63.97 68.81 64.71

5-7
5.98 1.75 2.80 18.92 12.54 10.40 17.47 16.01

7+ 22.16 9.73 9.71 76.97 55.45 65.13 72.80 70.55

 41

5.04 2.32 2.09 12.68 12.61 1196 23.37 11.61

Values are means ± standard deviations

 42

4.2 Results for the Women

Table 4.3 shows the general characteristics of the women population. In this group 17

were inactive and 45 were physically active. As for the general population, inactive women

exhibited the lowest scale of fitness (2.82) and the group training the most (5-7 times per

week) exhibited the highest level of fitness (7.42).

 43

Table 4.3: General characteristics of the women

Number Training Weight per Height per Working Lifetime Number Scale of

of Kg cm hours per working Fitness

hours per of
week hours
subjects week children

62 62.14 167.85 34.13 10.51 0.56 4.85

9.63 6.09 17.31 6.89 0.84 2.32

17 62.00 162.29 30.58 10.06 0.88 2.82

0-2
9.94 7.17 16.40 5.96 0.85 1.74

17 65.73 165.82 38.43 11.28 0.76 4.64

3-4
11.47 5.75 16.75 7.72 0.97 1.99

21 59.74 163.09 36.85 10.52 0.19 5.8

5-7
7.82 5.35 16.03 7.06 0.60 1.96

7 61.28 165.14 23.14 9.83 0.42 7.42

7+
 44

11.11 5.87 22.58 8.25 0.78 0.78

Values are means ± standard deviations

Table 4.4: Stress levels, job satisfaction and quality of life of the women

Training PSS PSS Job Satisfaction QoL 1 QoL 2 QoL 3 QoL 4 QoL

Short general
hours per

week

20.97 8.83 9.81 67.94 54.03 60.75 69.35 66.88

5.85 1.74 2.81 17.47 11.54 12.65 19.25 17.04

19.00 9.17 10.41 63.23 50 55.14 67.64 61.39

0-2
3.57 1.84 3.33 16.22 11.22 14.62 20.59 19.13

20.41 9.00 9.8 70.58 56.51 62.74 69.11 67.83

3-4
7.29 1.87 2.51 18.19 8.20 12.01 17.12 17.90

21.96 8.20 9.11 68.45 53.40 61.90 67.06 67.26

5-7
5.4 1.50 2.69 19.61 13.33 10.05 17.17 15.32
 45

24.14 8.51 9.46 65.71 52.90 58.57 67.04 64.64

7+
6.89 1.22 3.07 19.62 14.18 15.72 21.18 19.21

Values are means ± standard deviations

4.3 Results for the Men

Table 4.5: General Characteristics of the men

Number of Training Weight per Height per Working Lifetime Number Scale of

hours per Kg cm hours per working Fitness

subjects of children
week week hours

49 84.42 179.77 42.91 13.17 0.64 5.41

13.17 7.25 17.81 9.54 0.91 2.10

17 84.17 177.58 40.06 19.4 1.12 4.08

0-2
14.89 7.11 16.92 11.58 1.08 2.20

10 86.20 178.1 36.66 12.44 0.70 4.90

3-4
17.52 7.35 18.03 7.82 0.82 1.96
 46

10 80.20 181.9 48.00 10.80 0.5 6.90

5-7
8.41 7.48 11.74 7.08 0.84 1.19

12 88.5 182.50 39.83 7.45 0.08 6.50

7+
9.54 6.59 22.18 4.29 0.28 1.31

Values are means ± standard deviations

 47

Table 4.6: Stress levels, job satisfaction and quality of life of the men

PSS PSS Job Satisfaction QoL 1 QoL 2 QoL 3 QoL 4 QoL

Short general

21.35 9.00 9.72 68.87 52.84 62.67 67.68 62.56

6.34 2.44 2.52 16.94 10.41 12.75 18.05 15.11

22.29 9.11 9.46 58.82 50.84 59.31 63.72 57.16

7.51 2.61 2.69 15.78 8.61 13.62 16.38 15.09

22.29 8.00 10.00 65.00 52.14 60.41 69.16 69.68

6.38 1.82 2.39 12.90 9.98 14.59 17.59 15.73

22.7 8.70 10.2 76.25 58.78 68.33 72.50 59.37

7.36 2.21 3.01 17.12 10.96 10.24 18.44 16.92

21.00 9.91 9.40 80.20 52.97 64.58 68.05 66.92

3.43 2.71 2.11 12.45 12.81 11.16 21.27 10.36

Values are means ± standard deviations

 48

Gender

44%

56%

Male Female

Figure 4.1: Gender respondents by percentage .

Training Times per Week

7+ 19 7 12

5-7 31 21 10

3-4 27 17 10

0-2 34 17 17

0 10 20 30 40 50 60 70 80

Figure 4.2: Training times per week for women and men.
 49

22.5
22.2 22.16
22

21.5
21.09
21
Stree Level

20.5

20
19.64
19.5

19

18.5

18
0-2 3-4 5-7 7+
Training Times / week

Figure 4.3: The relation between stress level and training times per week .
 50

CHAPTER 5

DISCUSSION

The findings show that people who train at a frequency of around 0 to 2 times per week

have a moderate load of working hours per week (37.84 hours), while people who train at a

frequency ranged from 5 to 7 times per week have a higher load of working hours (40.31

hours). Nevertheless, people who train more than 7 times per week which means sometimes

twice a day are working less (34.42 hours).

The scale of fitness reached by people who train 0 to 2 times per week is 3.45 increases

to 6.84 when it comes to people who enjoy more than 7 hours of training per week. The

normal deduction of the above is that the more people train, the more they are satisfied with

their fitness level which means none or very few people may suffer from muscle dysmorphia

in our study.

On another note, and concerning the stress level, the findings reveal that the average of

stress does not really differ from a specific training hour category to another, since it is

almost the same, revolving around 21.52 in average. It seems that even though working more

hours during the week may be more stressful, it is compensate by more training hours in our

population.

Concerning the job satisfaction, it also seems that the groups are comparable as we

observed a steady value of the job satisfaction that is about 9.64 for all the groups. However,

additional hours of training per week seem to improve the general quality of life from 59.28%

to 70.55% (respectively for people training 0-2 hours and 7+ hours per week).

Those results, if we only look at the extremes (0-2 hours and 7+), can also be

interpreted as follow: when almost the same level of stress is revealed by people who train 0-
 51

2 or 7+ times, this leads me to conclude that the stress level of the daily life responsibilities

and duties doesn’t decrease with training or exercise. Remarkably, those who train 0-2 or 7+

times, do also have the same rate of job satisfaction, which shows that very low training has

the same impact on job satisfaction as a lot of training. Only, those who train and exercise

more than 3 to 4 times per week have a better quality of life level. This is sad, as it can be

interpreted that starting more than 3-4 times per week, training may represent an additional

stress. Indeed, the 7+ hours per week is the less stress by working hours as they are the ones

working the less but are still very stressed (maybe due to their body image dissatisfaction).

For the 7+ training may be suspected to be the main source of stress even though open

questionnaires and/or interview should confirm this hypothesis.

Besides, there could possibly be another reason why such results have been obtained,

and it is definitely related to the surveyed sample of people who answered the questionnaire

and who may have misunderstood some parts. It is also important to note that most of the

people in Lebanon think that the more they train the more the benefits regarding physical and

mental health so that it may have interfered with some answers about those 2 topics. In fact,

some people may think they are in good conditions as they train a lot which is not always the

case.

Also, the causes of stress in Lebanon differ from other countries because the person

have several tasks to work on and be covered from his side and not taking his rights from the

government, like health, education, financial security, environmental care… For that many

reasons the Lebanese people may train and stress because they have several different sources

of stress beside their personal life.

At the end of this project showing that training more may not be the solution to deal with

daily stress. However, in my working experience in my own gym, I can notice that people
 52

who work out after a long day in their offices benefit from the 1 hour gym session and leave

the gym in a very good mood with a smile. It is hard to say if their smile would be bigger if

they just spend this hour playing with their kids but it can definitively make them more able

to go back home in a good mood.

On the other hand, people who want to train just to be perfect as much as a picture on any

social media platform put more stress on them and live on that dream which is unreal. In fact,

most of the influencers people wants to copy use several unhealthy techniques to obtain their

perfect shape. Doing this project opened my eyes regarding muscles dysmorphia and the

importance some people give to their image and more specifically the symptoms and the

consequences. This is going to help me a lot detecting these kinds of people in order to better

take care of them. In this case hiking can be a good remedy as it combines nature and light

cardio training without any concern about performance and goal. It can really relieve stress

relief in people because there is no competition with anyone; they just enjoy the connection

with the Mother Nature with no distraction.

 53

CONCLUSION AND PERSPECTIVES

In conclusion, this study is the first attempt at establishing a relationship between

exercises and stress, job satisfaction, and quality of life while utilizing direct and indirect

methods in Lebanon. The following conclusions are based on the results of this study and are

believed to be significant to the study of fitness on one hand and stress, job satisfaction and

quality of life related outcomes on another hand. This study has provided evidence that

people with increased fitness levels may experience better quality of life but not necessarily

decreased stress and increased job satisfaction.

Finally, it is worth mentioning that we should have engaged a bigger number of participants

in the questionnaire. At the same time, the study should have reviewed absenteeism in real

numbers. It is yet hoped that this study will provide the readers with insight as to the

importance of training since, though the questionnaire numbers show no relation between

training and stress when coaches experience in real life can reported everyday how relieved

and comforted are the trainees when they leave the gym or at the moment they are doing

physical activity.

Moreover, more links should be built between the fitness body and the companies in

order to work together to improve satisfaction at work, physical health and reduce

absenteeism.
 54

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APPENDIX A: Demographic Data

1. Current age (years): ___ 18-25

___ 25-40

___ 40-55

___ 55 +

2. Weight: ______kg

3. Height: ______ cm

4. Gender: _______Male _______Female

5. Working hours per week: ______

6. Total duration of working life (years): _______

7. Marital status: _______ Married _______ Single ______ Divorced

8. Number of children _______ 0 1 2 3 4 5 6

9. Do you do sports, if yes what kind do you do? _____________

10. If yes how many times do you train per week? 0-2 / 3-4 / 5-7 / 7+

11. If the answer of question 9 is No, what stops you from training? _______

- Time / Motivation / Injury / Nutrition / Stress … others _______

12. Where do you see yourself on a scale of fitness from (0 10).

0 10
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Perceived Stress Scale

The questions in this scale ask you about your feelings and thoughts during the last month. In

each case, you will be asked to indicate by circling how often you felt or thought a certain

way.

0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often

1. In the last month, how often have you been upset because of something that happened

unexpectedly? 0 1 2 3 4

2. In the last month, how often have you felt that you were unable to control the important

things in your life? 0 1 2 3 4

3. In the last month, how often have you felt nervous and “stressed”? 0 1 2 3 4

4. In the last month, how often have you felt confident about your ability to handle your

personal problems? 0 1 2 3 4

5. In the last month, how often have you felt that things were going your way?

01234

6. In the last month, how often have you found that you could not cope with all the things that

you had to do? 0 1 2 3 4

7. In the last month, how often have you been able to control irritations in your life? 0 1 2 3 4

8. In the last month, how often have you felt that you were on top of things?

01234

9. In the last month, how often have you been angered because of things that were outside of

your control? 0 1 2 3 4

10. In the last month, how often have you felt difficulties were piling up so high that you

could not overcome them? 0 1 2 3 4

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Job satisfaction questionnaire

This measure differentiates between various types of satisfaction:

With the work itself, with pay, with promotions, with the supervisor, and with co-workers.

7654321

Work: Exciting - /- - - / - - - / - - - / - - - / - - - / - - - / Boring

Unpleasant - /- - - / - - - / - - - / - - - / - - - / - - - / Pleasant

Challenging - /- - - / - - - / - - - / - - - / - - - / - - - / Unchallenging

Satisfying - /- - - / - - - / - - - / - - - / - - - / - - - / Unsatisfying

Pay: Rewarding - /- - - / - - - / - - - / - - - / - - - / - - - / Unrewarding

Large - /- - - / - - - / - - - / - - - / - - - / - - - / Small

Wrong - /- - - / - - - / - - - / - - - / - - - / - - - / Right

Positive - /- - - / - - - / - - - / - - - / - - - / - - - / Negative

Promotions Unjust - /- - - / - - - / - - - / - - - / - - - / - - - / Just

Reliable - /- - - / - - - / - - - / - - - / - - - / - - - / Unreliable

Positive - /- - - / - - - / - - - / - - - / - - - / - - - / Negative

Reasonable - /- - - / - - - / - - - / - - - / - - - / - - - / Unreasonable

Supervisor: Near - /- - - / - - - / - - - / - - - / - - - / - - - / Distant

Sincere - /- - - / - - - / - - - / - - - / - - - / - - - / Insincere

Unfriendly - /- - - / - - - / - - - / - - - / - - - / - - - / Friendly

Qualified - /- - - / - - - / - - - / - - - / - - - / - - - / Unqualified
 65

Co-workers: Careful - /- - - / - - - / - - - / - - - / - - - / - - - / Careless

Loyal - /- - - / - - - / - - - / - - - / - - - / - - - / Disloyal

Pleasant - /- - - / - - - / - - - / - - - / - - - / - - - / Unpleasant

Boring - /- - - / - - - / - - - / - - - / - - - / - - - / Interesting
 66

Quality of life questionnaire

The Following questions ask how you feel about your quality of life, health, or other areas of

your life. Please choose the answer that appears most appropriate. If you are unsure about

which response to give to question, the first response you think of is often the best one.

Please keep in mind your standards, hopes, pleasures and concerns. We ask that you think

about your life in the last four weeks.

Neither poor
Very poor Poor Good Very good
nor good

1. How would you rate your

1 2 3 4 5
quality of life?

Neither
Very Very
Dissatisfied satisfied nor Satisfied
dissatisfied satisfied
dissatisfied

2. How satisfied are you with

1 2 3 4 5
your health?

The following questions ask about how much you have experienced certain things in the last

four weeks.

A moderate Very An extreme

Not at all A little
amount much amount

3. To what extent do you feel 5 4 3 2 1

that physical pain prevents

you from doing what you

 67

need to do?

4. How much do you need any

medical treatment to 5 4 3 2 1

function in your daily life?

5. How much do you enjoy

1 2 3 4 5
life?

6. To what extent do you feel

1 2 3 4 5
your life to be meaningful?

A moderate Very
Not at all A little Extremely
amount much

7. How well are you able to

1 2 3 4 5
concentrate?

8. How safe do you feel in

1 2 3 4 5
your daily life

9. How healthy is your

1 2 3 4 5
physical environment?

The following questions ask about how completely you experience or were able to do certain

things in the last four weeks.

Not at all A little Moderately Mostly Completely

10. Do you have enough energy

1 2 3 4 5
for everyday life?

11. Are you able to accept your

1 2 3 4 5
bodily appearance?

12. Have you enough money to 1 2 3 4 5

 68

meet your needs?

13. How available to you is the

information that you need in 1 2 3 4 5

your day-to-day life?

14. To what extent do you have

the opportunity for leisure 1 2 3 4 5

activities?

Neither poor
Very poor Poor Good Very good
nor good

15. How well are you able to

1 2 3 4 5
get around?

Very Neither
Very
dissatisfie Dissatisfied satisfied nor Satisfied
satisfied
d dissatisfied

16. How satisfied are you with

1 2 3 4 5
your sleep?

17. How satisfied are you with

your ability to perform your 1 2 3 4 5

daily living activities?

18. How satisfied are you with

1 2 3 4 5
your capacity for work?

19. How satisfied are you with

1 2 3 4 5
yourself?

20. How satisfied are you with 1 2 3 4 5

 69

your personal relationships?

21. How satisfied are you with

1 2 3 4 5
your sex life?

22. How satisfied are you with

the support you get from 1 2 3 4 5

your friends?

23. How satisfied are you with

the conditions of your 1 2 3 4 5

living place?

24. How satisfied are you with

your access to health 1 2 3 4 5

services?

25. How satisfied are you with

1 2 3 4 5
your transport?

The following question refers to how often you have felt or experienced certain things in the

last four weeks.

Never Seldom Quite often Very often Always

26. How often do you have

negative feelings such as

5 4 3 2 1
blue mood, despair, anxiety,

depression?