INTRODUCTION
Social anxiety (SA) is one of the most pervasive mental health issues among college students, often characterized by an intense fear of social situations and a persistent worry about being judged or evaluated negatively by others [1]. his SA or social fear is one of the most common mental disorders worldwide [2], with a high lifetime prevalence [3]. A recent study showed that more than one-third (36%) of younger people aged 16-29 in seven different countries exhibited SA at levels above critical thresholds [4]. A study of Chinese college students found that 23.7% of freshmen had symptoms of SA [5]. The consequences of SA are far-reaching, and numerous studies have shown that chronic SA can impair academic performance [6], interpersonal relationships [7], and even increase suicidal thoughts [8]. Therefore, there is a need to identify SA as early as possible and to explore effective interventions.
The evidence indicates that physical activity (PA) is an efficacious intervention for the promotion of mental health. Furthermore, PA has been demonstrated to provide substantial relief from anxiety symptoms [9], including SA [10]. A study demonstrated that incorporating PA as a primary intervention resulted in a notable reduction in SA levels among college students [11]. PA has been demonstrated to alleviate SA through a range of different physiological and psychological mechanisms. For example, PA may reduce SA levels through alterations in monoamine levels and hypothalamic-pituitary-adrenal axis activity, an increase in neurotrophic growth factors [12], and may also reduce SA levels by reducing anxiety sensitivity [13].
Previous systematic reviews and meta-analyses have investigated the relationship between the components of exercise (e.g., intensity, duration, and frequency) and cognitive improvement in older adults [14]. A study has demonstrated that adjusting the components of exercise can significantly enhance the degree of improvement resulting from the exercise intervention [15]. While the beneficial effects of PA on SA in college students have been demonstrated, and some studies have found that adjusting training volume significantly affects students’ SA levels [16], it is worth noting that the precise exercise prescription (e.g., exercise intensity, frequency, duration) that can be used to obtain the optimal benefits of PA remains an open question.
Based on the findings of previous studies, an exploration of the optimal exercise regimen for alleviating SA is of paramount importance for the prevention and alleviation of SA in college students. The objective of this study was to investigate the relationship between SA and the components of PA among college students. By determining the extent to which different aspects of exercise affect SA levels, mental health professionals and educators can gain valuable insights that can inform the development of effective strategies to support students facing the challenges of SA.
METHODS
Research model
This cross-sectional study used a nonrandom snowball sampling strategy. We posted a web-based questionnaire and asked participants to forward the survey link to invite university students to participate in the study. The purpose of this study was to verify whether exercise factors, such as exercise intensity and duration, have an influence on SA in college students and to further explore which relationships are influenced by specific factors. Most of the subjects had been scanned in the context of previous survey research [17]. Correlational model research involves the measurement of two or more variables between which there is a change to determine the extent of the relationship.
Institutional review board statement
The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Ocean University of China (OUC-HM-2022-011, 05-11-2022).
Study population and research sample
The study population comprised general college students from various departments across six comprehensive universities in Qingdao. Each university has a diverse student body representing different geographic regions of the country, ensuring that the survey data are representative of the broader population. The survey, conducted in two rounds via online questionnaires between April and May 2021, garnered responses from 1,005 participants. Since PA was the critical independent variable and SA levels were the dependent variable, students who did not complete the self-reported measures of PA and SA were excluded from the study. Consequently, 844 participants (84.0%) remained. Among these, 45.3% were women and 54.7% were men. All participants provided informed consent and voluntarily participated in the study.
Data collection tools
In this study, the researchers utilized three instruments: the Personal Basic Information Form to assess individual characteristics, the Physical Activity Rating Scale-3 (PARS-3) to evaluate types of PA, and the Liebowitz Social Anxiety Scale (LSAS) to measure SA levels. Additionally, the study aimed to examine the potential impact of other variables, such as sex, school grade, and whether the participant was an only child, on the relationships between PA and SA.
PARS-3
The PARS-3, revised by Liang and Liu [17] (1994), was adopted to assess the PA of college students [18]. This scale mainly assesses participation in PA during the previous month. It evaluates the general level of PA, which includes three components (such as exercise frequency, exercise intensity, and exercise duration), and each component has five categories. A five-point Likert scale was used to rate PA. Levels 1-5 of exercise duration correspond to 0-4 points (D1=less than 10 minutes, D2=11 to 20 minutes, D3=21 to 30 minutes, D4=31 to 59 minutes, and D5=1 hour or more). The exercise intensity (I1=light-intensity exercise, I2=low-intensity exercise, I3=moderate-intensity continuous exercise, I4=high-intensity exercise, and I5=high-intensity continuous exercise) and frequency (F1=less than once a month, F2=2 to 3 times a month, F3=1 or 2 times a week, F4=3 to 5 times a week, and F5=once a day) were scored from 1 to 5. According to a previous study [19], the total PA score is calculated by the following equation: PA level=exercise intensity×(exercise duration-1)×exercise frequency. Score range is 0-100. The Cronbach’s α of this scale in this study was 0.896, indicating good reliability and validity [20,21]. The scale is designed to assess the amount of PA an individual engages in on a regular basis. A higher score indicates a greater level of exercise, a small amount of exercise is ≤19 points, a moderate amount of exercise is 20 to 42 points, and a large amount of exercise is ≥43 points.
LSAS
In this study, the severity of SA symptoms in university students was measured and scored using the clinician-administered LSAS. Previous studies have shown that the Liebowitz Social Anxiety Scale for Children and Adolescents is a reliable and valid tool for assessing SA disorders [22,23] and has been widely used in studies of pharmacological and cognitive behavioral therapy for social phobia. It consists of 24 items, including four components (e.g., social interaction, public speaking, being observed, and eating and drinking in public) [24]. The fear or anxiety subscale assesses the subjective experience of anxious affect, and the avoidance subscale assesses the high sensitivity of the avoidance response. The total score for SA is the sum of the items measuring fear or anxiety and avoidance symptoms. The range of the total SA score is 0-100, with higher scores indicating greater anxiety. Based on the Social Anxiety Scoring Standard, a SAS≤37 was classified as anxiety-free, a SAS score of 38-50 was classified as mild anxiety, a score of 51-82 points was classified as moderate anxiety, and a score≥83 was classified as severe anxiety. We used the self-reported version of the LSAS, which has good internal consistency (Cronbach’s alpha=0.77) and test-retest reliability (0.82) [25,26].
Statistical analysis
All the statistical analyses were performed using SPSS software version 26.0 (IBM Corp.). Continuous variables are presented as the means±standard deviations, and categorical variables are presented as frequencies (n) and percentages (%). First, descriptive statistics were performed on the demographic variables, including sex, specialty, whether the subject is an only child, and the subject’s place of residence. Secondly, a one-way analysis of variance (ANOVA) was conducted to compare SA scores across five levels of exercise components (duration, intensity, frequency) and three levels of exercise intensity (low, moderate, high). Finally, multiple regression analysis was employed to examine the effects of exercise intensity, duration, and frequency on SA levels. The significance levels were categorized as follows p<0.05.
RESULTS
Descriptive statistics and comparative analysis
The demographic and exercise conditions for the whole sample are presented in Table 1. The percentages of no SA, mild SA, moderate SA, and severe SA were 27.8% (n=235), 46.3% (n=391), 19.3% (n=163), and 6.5% (n=55), respectively. This finding supports previous research suggesting that SA is highly prevalent (72.2%, n=609) among university students.
Overall, regardless of demographic variables or PA level, the percentages and frequency of mild SA were the highest, followed by no SA, moderate SA, and severe SA.
Additionally, in terms of PA levels, nearly 57% of participants indicated that they regularly participated in low-intensity exercise, with moderate and high-intensity exercise accounting for just 23.0% and 20.3%, respectively. According to the data of the study, as the PA level increased, there was also a significant decrease in SA.
One-way ANOVA
To further examine the relationship between PA and SA, a one-way ANOVA was performed to assess SA scores across varying levels of PA. The results, presented in Table 2, revealed significant differences in SA scores among the three levels of PA (F=19.945, η2=0.01). Specifically, the data showed that SA scores were lowest at high levels of exercise and were statistically significantly lower compared to both low and moderate exercise levels. Post hoc analyses revealed that the lowest SA scores were associated with exercise frequency 3, which was comparable to frequency 5 but significantly lower than scores for other frequencies (F=16.31, p<0.05). Additionally, the lowest SA scores were linked to exercise intensity 3, which was significantly lower than scores for other intensities (F= 24.35, p<0.05). Finally, the lowest SA scores were observed at duration 1, which was significantly lower than scores for other durations (F=9.80, p<0.05), as detailed in Table 3.
Multiple regression analysis
Table 4 illustrates the results of the multiple regression between the total SA score and the total PA score. The results indicate that exercise duration (β=-0.151, p=0.001) has a significant negative effect on SA level. Similarly, exercise frequency (β=-0.075, p=0.039) has a statistically significant effect on SA level, with a p-value for frequency less than 0.05. Furthermore, the intensity of exercise (β=-0.021, p=0.608) was found to have a negligible effect on the dependent variable, as indicated by a p-value greater than 0.05. The F-value of 11.965 and the p-value of 0.001 in the significance test indicate that the model is significant. Additionally, the variance inflation factor values of all independent variables in the diagnosis of multicollinearity are less than 10, which indicates that the model does not suffer from serious multicollinearity problems. The regression equation: Total SA score=61.386-0.470×intensity-3.238×duration- 2.152×frequency.
DISCUSSION
The effect of PA on SA has attracted considerable interest in recent years, particularly in the fields of psychology and public health. This interest has led to a growing body of empirical research, including surveys and experimental studies, to explore this relationship. Despite this growing body of research, the mechanisms by which PA affects SA in college students remain largely unexplored. Therefore, using a sample of Chinese college students, this study sought to explore the relationship between PA levels and SA, and to identify more effective exercise levels to alleviate or intervene in SA symptoms.
The main finding of this study was the phenomenon of a significant decrease in the level of SA that accompanied an increase in the level of PA within a certain range. The authors concluded that an increase in the level of PA within a certain range predicted a decrease in the overall level of SA but that this association was not linear. Adjustment revealed a clear trend of decreasing SA levels with increasing baseline exercise, but after a certain level of exercise was reached, the decreasing trend of SA levels gradually slowed with the continued increase in exercise. Furthermore, the preliminary effects of the low-to-moderate exercise group were better in terms of improving the symptoms of SA than those of the high-to-moderate exercise group; the associations between PA and SA were correlated with the amount of exercise and its components.
The role of demographics in the relationship between PA and SA in college students
The present study demonstrated that sex may be a viable and critical demographic indicator influencing social performance in predicting SA. The frequency and percentage of females with mild, moderate, and severe SA were greater than those of males, consistent with previous research [27,28]. In addition, according to our previous research, the proportion of liberal arts students is significantly greater than that of science students; similarly, the proportion of nonoily children is also significantly greater than that of only children [29], which suggests that single children are solid predictive factors for SA. The leading cause for university students’ differences in central and nonoily children was the difference between genders [30]. For example, past studies have suggested that female university students are relatively less receptive to self-acceptance and self-acknowledgment than male university students are influenced by gender roles [31], and an egocentric lifestyle leads to a lack of interpersonal skills. Thus, studies have shown that female students are more prone to SA than male students are on measures that assess SA [32,33].
The role of exercise intensity in the association between the amount of exercise and SA in college students
Exercise intensity refers to how vigorous the PA is [34]. Exercise intensity is one of the most important indices of exercise amount. Herbert et al. [34] and Nouchi et al. [35] found that participation in high-intensity aerobic exercise significantly altered participants’ symptoms of anxiety and effectively alleviated negative emotions such as anxiety and depression. It is noteworthy that the results of the present study diverge from those of previous research in this field. The current study found no significant correlation between exercise intensity and reduced levels of SA, which suggests that exercise intensity may not be a primary determinant of SA. Instead, it may be that the frequency and duration of exercise have a greater impact on SA.
The role of exercise duration in the association between the amount of exercise and SA in college students
Exercise duration is a significant exercise design parameter [36] and refers to the time spent in about, or the accumulated time consumed for a day or a week [37]. Previous findings suggest that prolonged exercise enhances antidepressant effects in endurance exercise participants [38]. This is especially true during long-term whole-body resistance exercises involving a more extended movement of approximately 60 minutes [39]. The present study revealed that the duration of exercise was the most significant predictor of lower total SA scores. Furthermore, when the duration of exercise was found to be effective, exceeding one hour, a notable decline in SA levels was observed among college students.
The role of exercise frequency in the association between the amount of exercise and SA in college students
The term “frequency of exercise” is used to describe the number of times a person engages in PA. Individuals who engage in prolonged periods of PA are less prone to developing psychological disorders such as anxiety and depression [40]. Moreover, regular exercise has been demonstrated to enhance subjective well-being and self-esteem. It is noteworthy that the aforementioned findings are not entirely consistent with those of our own study. The findings of our study indicate that, over time, exercising one to two times per week at a cumulative intensity may prove more effective in reducing SA than engaging in PA almost every day of the week. To achieve optimal relief, the frequency of exercise must be an appropriate number of times per week, with a relatively greater intensity and time load. In light of the aforementioned experimental results, we posit that exercising one or two times per week may represent the optimal frequency for improving SA.
The relationship between PA and SA in college students
Research data indicate that PA levels, defined by exercise, are predictive of reduced SA in college students across various scales. Moreover, PA was negatively correlated with the four dimensions of SA in this population. However, this correlation was not entirely linear, above a certain threshold, the alleviating effect of PA on SA diminished. We hypothesize that a dose-response relationship exists between PA and SA, necessitating further research to determine the optimal amount of exercise required to alleviate SA in college students. Among the three key components of PA—duration, frequency, and intensity—the duration of a single exercise session had the most significant negative predictive effect on SA, followed by exercise frequency. In contrast, exercise intensity had minimal or no significant effect on SA. Therefore, exercise interventions aimed at reducing SA should prioritize controlling the duration and frequency of exercise sessions rather than focusing solely on exercise intensity.
Future PA programs at universities face several challenges, including low student motivation and difficulties in ensuring the overall effectiveness of interventions. To address these issues, increasing the number of group physical activities in physical education courses and encouraging more after-school PA should be considered.
Limitations and relevance for future investigations
The limitations of this study must be acknowledged. The primary limitation is the reliance on self-reported questionnaires, which are susceptible to biases such as memory distortion, personal opinion [41], and social expectations. Consequently, the results should be interpreted with caution, as an explanatory design can only elucidate basic relationships between variables. To better assess causality and track changes in variables over time, future research should consider employing randomized clinical trials to obtain more robust data and clarify the relationship between PA and SA. Additionally, the study could benefit from incorporating advanced statistical techniques, such as mixed-effects modeling, to explore the impact of cohort structure on outcomes. Given the identified nonlinear relationships, future research should also investigate the dose-response relationship between PA and SA in greater detail.
Conclusions
The results of this study indicate that PA significantly predicts reductions in SA levels when considered independently. The most influential factors associated with decreased SA were 1) moderate or higher exercise intensity (within physical tolerance), 2) exercise duration of at least one hour, and 3) exercise frequency of at least 1-2 times per week. The association between exercise duration and frequency and the reduction in SA was notably stronger across various PA components. This suggests that exercise duration and frequency should be carefully managed in PA programs or interventions aimed at reducing SA among college students to achieve a more pronounced effect.
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