Relationship between self-rated health, sense of coherence and physical activity in a survey of secondary school students

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As a sense of coherence can help in the choice of preventive behaviours, this study also examined the relationship between students’ sense of coherence and physical activity. Methods A quantitative cross-sectional study was conducted among adolescents aged 15–19 years attending a full-time secondary school in Western Transdanubia, Hungary. The paper-based questionnaire included self-reported questions on physical activity in addition to socio-demographic variables, while the standardised instrument measured dimensions of subjective health (Health Thermometer - EuroQol scale, EQ VAS, Health Survey Short Form SF-36 Questionnaire) and Sense of Coherence (SOC 13). The 448 evaluable responses were analysed using SPSS Statistics 22 software with the Kolmogorov-Smirnov test, Mann-Whitney test, Kruskal-Wallis test, t-test and ANOVA test (p < 0.05). Results 67.79% of the respondents were female, and the majority of the sample (69.87%) lived in a full family. The amount of physical activity was adequate for 22.2% of respondents and nearly adequate for 29%, while 64.1% of the sample were in the adequate category for the quality of physical activity. Regular physical activity had a positive effect on self-reported health perception (p < 0.05). The mean scores for mental health, vitality and general health perception were significantly higher among students who were adequately or nearly adequately physically active (p < 0.05). A positive correlation was found between sense of coherence and frequency of physical activity (p 0.05). Discussion The overall results for physical activity in the study sample are not optimal. By increasing the sense of coherence – providing models, increasing knowledge, creating a supportive environment for physical activity – it is possible to enhance the choice to engage in regular physical activity, and make the right choices for the individual in different life situations, thus increasing the health-promoting effect of physical activity on self-reported health. Health sciences/Health care Health sciences/Health care/Quality of life physical activity the sense of coherence secondary school students vitality and mental health preventive behaviours Figures Figure 1 Figure 2 Figure 3 Introduction According to WHO estimates, there are between 4 and 5 million preventable deaths worldwide each year ( 1 ). Regular physical activity is an important part of healthy lifestyle and can play a key role in maintaining and improving the health of the population. Physical activity is key to the primary prevention and management of chronic non-communicable diseases (NCDs) (including mental health conditions, cardiovascular disease, type 2 diabetes mellitus, obesity, musculoskeletal conditions and cancer). Physical activity also has a positive effect on mental health, reducing symptoms of depression and anxiety, improving thinking skills, preventing deterioration in brain function and reducing the risk of developing dementia and Alzheimer’s disease [2]. Regular physical activity of adequate quality and quantity has both preventive and curative benefits, with physical, psychological, social, environmental and protective effects [2, 3]. The global epidemic of physical inactivity is associated with a range of chronic diseases and premature mortality, which represents a significant economic burden in addition to the disease burden. Physical inactivity is also associated with direct health costs, including time lost from work [4]. The physiological and psychological benefits of physical activity are well documented, but the majority of adolescents are still not engaging in sufficient time and intensity of physical activity. According to WHO recommendations, children and adolescents should engage in at least 60 minutes of moderate-intensity (preferably aerobic) physical activity per day and three times per week of vigorous-intensity and muscle-strengthening physical activity ( 5 ). Estimates suggest that more than 80% of adolescents fail to meet these standards ( 6 ). According to the pooled results of the 2018 HBSC survey, less than one in five adolescents meets WHO recommendations for physical activity, with only 19% of adolescents doing 60 minutes of moderate-intensity physical activity per day. Since 2014, the proportion of regular physical activity has decreased in about a third of the countries surveyed, particularly among boys, but the proportion of boys is still higher, with almost half of boys (49%) and a third of girls (35%) doing vigorous physical activity four or more times a week. The gender gap with increasing age is also present for moderate (aerobic) and vigorous intensity exercise ( 7 ). Following a systematic review of the literature (n = 43) from 1969 to 2018, Pinto et al. found an increase in the prevalence of physical activity among adolescents in some studies (n = 16), but an almost equal decrease in physical activity in others (n = 15) ( 8 ). Research in children and adolescents also confirms the preventive role of physical activity in obesity prevention, musculoskeletal, cardiometabolic, social and emotional health, and results have also shown a significant correlation between regular physical activity and improved health-related quality of life ( 9 , 10 , 11 ). Adolescents who do not engage in the amount and intensity of physical activity recommended by the WHO are more likely to experience problems with their mental health and well-being ( 12 , 13 , 14 ). A literature review by Biddle et al. (2019) also showed an association between physical activity and mental health in young people, and a causal relationship was also found for cognitive functioning ( 15 ). In a study by Jussila et al. (2023) (n = 32,829) of Finnish 8th and 9th graders (M = 15.4 years), 30 minutes of leisure-time physical activity per week was associated with a 17% lower likelihood of chronic stress symptoms ( 16 ). Regular physical activity can increase self-esteem, life satisfaction and social well-being, improve sleep quality and reduce risk factors for depression ( 17 , 18 ). According to Antonovsky’s model of salutogenesis, health is much more than low levels of risk factors. Antonovsky believes that the origin of health is a stress-oriented concept that focuses on resources, leading to a greater sense of coherence that maintains and improves health and helps to choose preventive behaviours. Health depends on an individual’s ability to cope with external forces, circumstances, threatening environmental influences, stressors and to maintain a balanced sense of subjective health ( 19 , 20 , 21 ). Sense of coherence (and its extent) is a key determinant and explanatory factor of health status, which is closely related to health and the positive self-perception of health. The aim of the present research was to assess the physical activity of secondary school students and to understand its effect on subjective general health, vitality and mental health. As a sense of coherence can help in the choice of preventive behaviours, this study also examined the relationship between students’ sense of coherence and physical activity. Materials and methods The aim of this literature review was to gather evidence-based information to answer the formulated research questions. Relevant evidence-based primary research studies and systematic literature reviews focusing on secondary school students were reviewed. PubMed, Scopus and Google Scholar were searched for studies less than 10 years old, with the following keywords: ‘adolescents and physical activity’, ‘adolescents and mental health’, ‘adolescents and stress/coping’, ‘adolescents and sense of coherence’. Type, location and time of the research This quantitative, cross-sectional research was conducted in public educational institutions in Vas and Zala Counties in Western Transdanubia, Hungary, in full-time secondary schools. The first version of the questionnaire was piloted in one secondary school class (n = 28) and the instrument was finalised on the basis of the experience gained there. The current study was conducted after obtaining written informed consent from the headmasters of the school districts and the selected secondary schools Sampling was carried out using simple convenience sampling within the target population. Sampling The inclusion criterion for the sample was students aged 15–19 attending a full-time four-year secondary school, and the exclusion criterion was students studying as private students. In our research instrument, we have adopted items from the questionnaires of representative national and international surveys, so our results are comparable with these data and it was not necessary to create a sub-sample or control group for the purposes of this research. The primary sampling units were randomly selected classes (using the systematic random method), rather than individual students. Measuring instrument used The paper-based questionnaire included self-edited questions, along with socio-demographic variables and standardised scales. The physical activity-related questions in the questionnaire were taken from the instrument used in the HBSC research. The weekly occurrence of physical activity, as one of the most important health-promoting behaviours, was measured based on the WHO recommendation for children and adolescents to engage in at least 60 minutes of moderate-intensity physical activity per day ( 22 ). To measure subjective health perceptions, the EQ-VAS health thermometer and the Health Survey Short Form SF-36 Questionnaire were used in this study. On a Visual Analogue Scale (VAS), respondents were asked to mark their current health status on a line from perfect health (100 points) to worst health (0 points), a so-called health thermometer, and to indicate their relationship to the endpoints of the scale ( 23 , 24 ). The 36-Item Short Form Survey (SF-36) is widely used for monitoring the health status of the population, evaluating the results of health care treatments, estimating the burden of disease, and monitoring the results of clinical practices, as well as in medical and other research where changes in health status are measured ( 25 , 26 ). The questionnaire is a measure of subjective perception of health status and assesses respondents’ opinions about their own health. The instrument measures the general health of individuals in the population aged 14 years and over by asking 36 questions. The SF-36 is a multi-item scale measuring eight health concepts: 1) physical functioning (limitations in physical activities because of health problem); 2) social functioning (limitations in social activities because of physical or emotional problems); 3) physical role (limitations in usual role activities because of physical health problems); 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) emotional role (limitations in usual role activities because of emotional problems); 7) vitality (energy and fatigue); 8) general health perceptions and, in addition, by summing the eight dimensions, a single health outcome. The survey of the eight categories outlines which areas are problematic and provides a profile of the respondent’s health. A higher score indicates better health ( 25 , 27 , 28 ). The measurement tool used in this research included the following items from the SF 36 questionnaire: general health perception, vitality and mental health ( 28 ). General health perceptions were measured by five questions, vitality and mental health by transformed scale scores calculated from the combined scores of 4–4 questions, thus ranging from 0 to 100. A shortened standardised questionnaire of 13 questions was used to measure the sense of coherence. Respondents were asked to indicate their level of agreement with the statements on a 7-point Likert scale. Based on the total number of responses to the 13 items, the possible score for sense of coherence ranged from 0 to 91. The 13-item sense of coherence scale for adults is also applicable to children aged 12 years and older ( 29 ). Sample The expected sample size was defined as 500 participants. In this study, 12 parents returned the passive consent form in 18 classes from 5 secondary schools. During the computer data cleaning process, 13 questionnaires were removed from the sample because more than 50% of the questions were not answered or were obviously nonsense. Finally, the responses of 448 students were analysed. Applied statistical tests, software For the analysis we used SPSS Statistics 22 software. Normality was tested using the Kolmogorov-Smirnov test and then, to determine differences between groups, a t-test and ANOVA were used for parametric variables, while the Mann-Whitney and Kruskal-Wallis tests were used for non-parametric variables (p < 0.05). Ethical compliance The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of the School Ethics Committee of Doctoral Program on Educational Sciences at the University of Pécs. The research was conducted ethically, the results are reported honestly, the submitted work is original and not (self-) plagiarized, and authorship reflects the individuals’ contributions. The measurement instruments were completed anonymously and the filled in forms did not contain any information that could identify the students. Once the data were processed, they were published only in aggregated form, with no information about individual classes or schools. Results Description of the socio-demographic/biographical characteristics of the sample: In the survey of 10th, 11th and 12th grade secondary school students in Western Transdanubia, the mean age of the respondents was 16.87 years (SD: 0.82), two-thirds were female, more than half lived in a town and two-fifths lived in the same municipality as the school. The majority of the sample (69.87%) lived in a full family. 28.79% (129) of the families had one child and 22.1% (99) had three or more children. (Table I.) Table I. Sample characteristics Variables Mean Range Age (n = 448) 16.87 ± 0.82 years 15 − 19 years absolute frequency relative frequency (%) Sex (n = 447) male 144 32.21% female 303 67.79% Place of residence (n = 445) county seat 140 31.46% town 123 27.46% settlement/village 182 40.9% Family type (n = 448) full family 313 69.87% restructured family 49 10.94% single-parent family 82 18.4% parentless family 4 0.89% Number of siblings (n = 448) no siblings 129 28.79% one sibling 220 49.11% two siblings 84 18.75% three or more siblings 15 3.35% Examining the relationship between physical activity and subjective perceptions of health 60 minutes of exercise per day was considered to be an adequate amount of physical activity. Categorisation was based on the Health Behaviour in School-aged Children (HBSC) study classification (‘adequate’ if 60 minutes of physical activity were done every day of the week, ‘nearly adequate’ if at least 5–6 days per week, ‘little’ if 3–4 days per week, and ‘very little’ if 2 days or less per week). 22.2% of the young people who responded were classified as doing an adequate amount of physical activity, 29.02%-29.02% as doing nearly adequate or little physical activity, and 19.76% as doing very little physical activity. In terms of the quality of physical activity (intensity and duration), at least 3 hours per week of physical activity that resulted in sweating was considered adequate, which characterised 64.1% of the sample, but 9.6% of the sample did not engage in any vigorous physical activity at all. The health status of the respondents was measured using the EQ-VAS health thermometer. The mean value of the actual health perception was 79.16 on a scale of 100 (SD: 16.5, max: 100, min: 10). The students’ health status was also assessed using the standardised health assessment instrument SF-36. In this sample, the mean for general health perception was M: 74.94 (SD: 17.31), for mental health M: 68.33 (SD: 19.06) and for vitality 50.47 (SD: 20.59). Based on the quality of physical activity, the study sample was divided into two groups (adequate, inadequate) and the relationship between physical activity and subjective health perception was measured. The difference in the mean self-rated health scores of the groups was tested using a t-test. The mean scores for general health perception were not significantly different (t(446) -0.676 p = 0.52) for qualitatively adequate (M = 75.68) and inadequate physical activity (M = 74.52). Mean values for the other subjective health indicators examined in the groups were also nearly identical for mental health (t(445) 0.149 p = 0.882), vitality (t(446) 1.677 p = 0.094). (Fig. 1 ) Examining the relationship between quantitative indicators of physical activity and health perceptions In this study, changes in physical activity were also examined in relation to students’ current health perceptions as measured by the Visual Analogue Scale. A Kruskal-Wallis test was used to test the effect of physical activity on self-rated health, based on the Kolmogorov-Smirnov test of normality of the data obtained from the EQ visual analogue scale. Based on the analysis, a significant difference in the variation of physical activity quantity was demonstrated for self-reported health perception (H(3,416)24.34 p < 0.001) (Fig. 2 ), which was not demonstrated for the qualitative indicator of physical activity (U = 22936.0 z=-0.067 p = 0.947). As the amount of physical activity increased, the mean scores for the other domains of subjective health perception also increased, most significantly for vitality (adequate physical activity M = 55.46; nearly adequate M = 54.62; little M = 46.11; very little M = 45.84). When examining vitality, a significant difference (M = 9.62 points) was found between the two extreme groups in terms of frequency of physical activity for the ‘adequate’ and ‘very little’ categories (F(3,417)7.371 p < 0.001). Based on the results, the young people who reported the most positive general health (M = 79) and mental health (M = 73.93) were those who engaged in adequate physical activity (at least 60 minutes of physical activity per day, every week). Results show that with increasing frequency of weekly physical activity, mean scores for general health (F(3,417)3,146 p = 0.025) and mental health (F(3,417)5,88 p = 0.001) also increased significantly. (Fig. 2 .) Examining the relationship between physical activity and a sense of coherence The analysis also examined the relationship between physical activity as a preventive behaviour and the sense of coherence. It was hypothesised that the frequency and intensity of leisure-time physical activity would be influenced by the individual’s sense of coherence. The exact value of the sense of coherence —the point at which the measured data can be considered a risk factor—cannot be determined. At an individual level, the sense of coherence can only be determined at a particular point in time. In this survey, the mean score for sense of coherence was 54.38 (SD: 11.35, max: 90, min: 13) based on the responses of secondary school students aged 15–19. To determine the correlation between the sense of coherence and the frequency of physical activity, the Kruskal-Wallis test was used after the normality test, and the results showed that the value of the sense of coherence was significantly different according to the amount of physical activity of the students (H(3,416)9,821 p = 0.02). However, after calculations with the Mann-Whitney test, the sense of coherence did not significantly differentiate the quality indicator of students’ physical activity (U = 22819.5 z=-0.107 p = 0.195) (Fig. 3 ). When interpreting the results, the limitations of the research must also be taken into account. Although the schools included in the study are homogeneous in terms of school type, they cannot be considered representative, and further studies in other types of schools and on a representative sample are needed to make the results generalisable. In addition, the respondents are not completely unrelated to each other, as school classes participated in the survey. It should also be noted that the quantity and quality of physical activity and the perception of health status were based on self-reports by the students. Discussion Looking at the amount of physical activity in the current study, one in two students engaged in an adequate or nearly adequate amount of physical activity, 5–7 times per week, but two in ten students had very little weekly physical activity. The quality of physical activity was only adequate for two out of three students. Overall, the presented quantitative and qualitative indicators of leisure-time physical activity are suboptimal, which is consistent with international and national research findings among adolescents ( 7 , 8 ). Sedentary lifestyle is a global problem in developed countries, posing a challenge in terms of health promotion, health preservation and economic aspects. In terms of the health status of the responding students, the overall health perception is considered adequate compared to previous research. The mean normal values for vitality and mental health of the healthy Hungarian population under 18 years of age published by Czimbalmos et al. in 1999 were 79 and 79, which is much lower for the current study population. ( 30 ) However, evidence from the 2018 international HBSC survey shows a significant downward trend in mental health scores for school-aged youth compared to data from 2002, 2006, 2010 and 2014 ( 7 ). The amount of physical activity was positively correlated with measured self-rated health indicators, which has been confirmed by previous research as well ( 12 , 13 , 14 , 15 ). Engaging in regular physical activity can be a protective factor. The results confirm the importance of physical activity as a health-promoting health behaviour for self-reported health perceptions. In order to maintain and improve somatic-mental health and well-being, strategies to increase the frequency and intensity of regular physical activity among adolescents and young people should be implemented to promote exercise, which would also lead to a reduction in healthcare-related expenditures (32, 33). Regular physical activity is associated with better subjective health, which can also prevent the development of certain diseases. Regular physical activity, performed correctly, becomes part of everyday life from childhood, with positive effects on health in adulthood. According to the results of this research, the sense of coherence plays a role in the changes in the regularity of physical activity, and a linear stochastic relationship between the variables was demonstrated, which was also proved by a study (n = 277) among adolescents in Kaposvár, Hungary, where a greater sense of coherence was measured among youths who played sports every day of the week outside of physical education classes. The foundations for long-term health can be established in childhood and it is therefore very important to reduce and stop negative health behaviours and to strengthen and increase positive ones. According to the salutogenetic model, developing a sense of coherence through general resources (family, providing a role model, increasing knowledge, and creating a supportive environment for physical activity) is of utmost importance. The regularity of leisure-time physical activity can also be increased through school resources. In the teenage years, the role of peer relationships is particularly important in developing a healthy lifestyle. A greater sense of coherence helps to cope with problems and make the right choices and decisions in different life situations, thus contributing to preventive behaviours and reducing risk behaviours, thus increasing the health-promoting effects of physical activity on self-reported health status. Declarations Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Author Contribution IK and GHF contributed to the conception and design of the study. All authors contributed to the article and approved the submitted version. Data Availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. References WHO. Guidelines on physical activity and sedentary behaviour. 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Cite Share Download PDF Status: Published Journal Publication published 22 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 29 Jan, 2025 Reviews received at journal 27 Jan, 2025 Reviewers agreed at journal 22 Jan, 2025 Reviews received at journal 02 Dec, 2024 Reviewers agreed at journal 30 Nov, 2024 Reviewers invited by journal 18 Nov, 2024 Editor assigned by journal 18 Nov, 2024 Editor invited by journal 14 Nov, 2024 Submission checks completed at journal 13 Nov, 2024 First submitted to journal 29 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5353185","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":385211492,"identity":"a94d7cc3-de7e-4bd3-a35d-07f1fa6d0b63","order_by":0,"name":"Ilona Karácsony","email":"","orcid":"","institution":"University of Pécs","correspondingAuthor":false,"prefix":"","firstName":"Ilona","middleName":"","lastName":"Karácsony","suffix":""},{"id":385211493,"identity":"8485717e-8c5d-4ad4-89be-778de0a73c20","order_by":1,"name":"Gabriella Hideg-Fehér","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABGUlEQVRIie3PMUvDQBTA8SeBuLza9QZJvsKFDCoEHf0arwTSxUrdOsRyIGQSskboh/AjXAhclrg7FlyDdOxUzSVWFBK7OtyfcLyQ/HgJgMn0L0MAgvNTPchmdgDs7gH/mzDcEx9sTegAgS+ir4k4RNzrF7VZLxiOxSiX9eJ+mroJWXfbAM4Y9RKvug0zqhgyeUL5qipnT4ktrYwiuMgGiLjxYZIw/SO8GCVq9qyOhYVUAH8dIGndkB1DtyU7Nb3qyMcgcZneIhjyloiYuN18GJIcJJy9h0CKoVcgz1dKepmKqMiiEHm17t+SzoqjbRw4Tvnob+p46Y4flPc2Dy4dXg5skfvJas/i+8Te9/UW8ft++YObTCaTqesTjI9ckjlf/ZYAAAAASUVORK5CYII=","orcid":"","institution":"University of Pécs","correspondingAuthor":true,"prefix":"","firstName":"Gabriella","middleName":"","lastName":"Hideg-Fehér","suffix":""}],"badges":[],"createdAt":"2024-10-29 09:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5353185/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5353185/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-12686-0","type":"published","date":"2025-07-22T15:57:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70626206,"identity":"59f4cb97-38e3-4a2f-88d9-334b699673af","added_by":"auto","created_at":"2024-12-05 04:45:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":6109,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMean self-rated health scores based on qualitative indicator of physical activity, n=445\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5353185/v1/011cbaa27251db09cf9d60e8.png"},{"id":70626207,"identity":"27a34abb-59ae-4564-8fae-e18d9512d9d9","added_by":"auto","created_at":"2024-12-05 04:45:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14647,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMean self-rated health scores based on quantitative indicator of physical activity, n=416\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5353185/v1/0afaf5f1395d5d47520cd8ba.png"},{"id":70626900,"identity":"eb963bf7-0e76-4d92-b293-cb66aa73a971","added_by":"auto","created_at":"2024-12-05 04:53:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":14188,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eRelationship between sense of coherence and frequency of physical activity (n=416)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5353185/v1/f43f18468ed14db976b8386b.png"},{"id":87756656,"identity":"10ccc4ad-b1a1-4422-9a51-82090fda5754","added_by":"auto","created_at":"2025-07-28 16:06:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":723182,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5353185/v1/0cdf81ff-f864-4fbc-b136-329664a326ef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between self-rated health, sense of coherence and physical activity in a survey of secondary school students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to WHO estimates, there are between 4 and 5\u0026nbsp;million preventable deaths worldwide each year (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Regular physical activity is an important part of healthy lifestyle and can play a key role in maintaining and improving the health of the population. Physical activity is key to the primary prevention and management of chronic non-communicable diseases (NCDs) (including mental health conditions, cardiovascular disease, type 2 diabetes mellitus, obesity, musculoskeletal conditions and cancer). Physical activity also has a positive effect on mental health, reducing symptoms of depression and anxiety, improving thinking skills, preventing deterioration in brain function and reducing the risk of developing dementia and Alzheimer\u0026rsquo;s disease [2]. Regular physical activity of adequate quality and quantity has both preventive and curative benefits, with physical, psychological, social, environmental and protective effects [2, 3]. The global epidemic of physical inactivity is associated with a range of chronic diseases and premature mortality, which represents a significant economic burden in addition to the disease burden. Physical inactivity is also associated with direct health costs, including time lost from work [4].\u003c/p\u003e \u003cp\u003eThe physiological and psychological benefits of physical activity are well documented, but the majority of adolescents are still not engaging in sufficient time and intensity of physical activity. According to WHO recommendations, children and adolescents should engage in at least 60 minutes of moderate-intensity (preferably aerobic) physical activity per day and three times per week of vigorous-intensity and muscle-strengthening physical activity (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Estimates suggest that more than 80% of adolescents fail to meet these standards (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). According to the pooled results of the 2018 HBSC survey, less than one in five adolescents meets WHO recommendations for physical activity, with only 19% of adolescents doing 60 minutes of moderate-intensity physical activity per day. Since 2014, the proportion of regular physical activity has decreased in about a third of the countries surveyed, particularly among boys, but the proportion of boys is still higher, with almost half of boys (49%) and a third of girls (35%) doing vigorous physical activity four or more times a week. The gender gap with increasing age is also present for moderate (aerobic) and vigorous intensity exercise (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Following a systematic review of the literature (n\u0026thinsp;=\u0026thinsp;43) from 1969 to 2018, Pinto et al. found an increase in the prevalence of physical activity among adolescents in some studies (n\u0026thinsp;=\u0026thinsp;16), but an almost equal decrease in physical activity in others (n\u0026thinsp;=\u0026thinsp;15) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Research in children and adolescents also confirms the preventive role of physical activity in obesity prevention, musculoskeletal, cardiometabolic, social and emotional health, and results have also shown a significant correlation between regular physical activity and improved health-related quality of life (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Adolescents who do not engage in the amount and intensity of physical activity recommended by the WHO are more likely to experience problems with their mental health and well-being (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). A literature review by Biddle et al. (2019) also showed an association between physical activity and mental health in young people, and a causal relationship was also found for cognitive functioning (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In a study by Jussila et al. (2023) (n\u0026thinsp;=\u0026thinsp;32,829) of Finnish 8th and 9th graders (M\u0026thinsp;=\u0026thinsp;15.4 years), 30 minutes of leisure-time physical activity per week was associated with a 17% lower likelihood of chronic stress symptoms (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Regular physical activity can increase self-esteem, life satisfaction and social well-being, improve sleep quality and reduce risk factors for depression (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to Antonovsky\u0026rsquo;s model of salutogenesis, health is much more than low levels of risk factors. Antonovsky believes that the origin of health is a stress-oriented concept that focuses on resources, leading to a greater sense of coherence that maintains and improves health and helps to choose preventive behaviours. Health depends on an individual\u0026rsquo;s ability to cope with external forces, circumstances, threatening environmental influences, stressors and to maintain a balanced sense of subjective health (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Sense of coherence (and its extent) is a key determinant and explanatory factor of health status, which is closely related to health and the positive self-perception of health.\u003c/p\u003e \u003cp\u003eThe aim of the present research was to assess the physical activity of secondary school students and to understand its effect on subjective general health, vitality and mental health. As a sense of coherence can help in the choice of preventive behaviours, this study also examined the relationship between students\u0026rsquo; sense of coherence and physical activity.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe aim of this literature review was to gather evidence-based information to answer the formulated research questions. Relevant evidence-based primary research studies and systematic literature reviews focusing on secondary school students were reviewed. PubMed, Scopus and Google Scholar were searched for studies less than 10 years old, with the following keywords: \u0026lsquo;adolescents and physical activity\u0026rsquo;, \u0026lsquo;adolescents and mental health\u0026rsquo;, \u0026lsquo;adolescents and stress/coping\u0026rsquo;, \u0026lsquo;adolescents and sense of coherence\u0026rsquo;.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eType, location and time of the research\u003c/h2\u003e \u003cp\u003eThis quantitative, cross-sectional research was conducted in public educational institutions in Vas and Zala Counties in Western Transdanubia, Hungary, in full-time secondary schools. The first version of the questionnaire was piloted in one secondary school class (n\u0026thinsp;=\u0026thinsp;28) and the instrument was finalised on the basis of the experience gained there. The current study was conducted after obtaining written informed consent from the headmasters of the school districts and the selected secondary schools Sampling was carried out using simple convenience sampling within the target population.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling\u003c/h3\u003e\n\u003cp\u003eThe inclusion criterion for the sample was students aged 15\u0026ndash;19 attending a full-time four-year secondary school, and the exclusion criterion was students studying as private students. In our research instrument, we have adopted items from the questionnaires of representative national and international surveys, so our results are comparable with these data and it was not necessary to create a sub-sample or control group for the purposes of this research. The primary sampling units were randomly selected classes (using the systematic random method), rather than individual students.\u003c/p\u003e\n\u003ch3\u003eMeasuring instrument used\u003c/h3\u003e\n\u003cp\u003eThe paper-based questionnaire included self-edited questions, along with socio-demographic variables and standardised scales. The physical activity-related questions in the questionnaire were taken from the instrument used in the HBSC research. The weekly occurrence of physical activity, as one of the most important health-promoting behaviours, was measured based on the WHO recommendation for children and adolescents to engage in at least 60 minutes of moderate-intensity physical activity per day (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo measure subjective health perceptions, the EQ-VAS health thermometer and the Health Survey Short Form SF-36 Questionnaire were used in this study. On a Visual Analogue Scale (VAS), respondents were asked to mark their current health status on a line from perfect health (100 points) to worst health (0 points), a so-called health thermometer, and to indicate their relationship to the endpoints of the scale (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 36-Item Short Form Survey (SF-36) is widely used for monitoring the health status of the population, evaluating the results of health care treatments, estimating the burden of disease, and monitoring the results of clinical practices, as well as in medical and other research where changes in health status are measured (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The questionnaire is a measure of subjective perception of health status and assesses respondents\u0026rsquo; opinions about their own health. The instrument measures the general health of individuals in the population aged 14 years and over by asking 36 questions. The SF-36 is a multi-item scale measuring eight health concepts: 1) physical functioning (limitations in physical activities because of health problem); 2) social functioning (limitations in social activities because of physical or emotional problems); 3) physical role (limitations in usual role activities because of physical health problems); 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) emotional role (limitations in usual role activities because of emotional problems); 7) vitality (energy and fatigue); 8) general health perceptions and, in addition, by summing the eight dimensions, a single health outcome. The survey of the eight categories outlines which areas are problematic and provides a profile of the respondent\u0026rsquo;s health. A higher score indicates better health (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe measurement tool used in this research included the following items from the SF 36 questionnaire: general health perception, vitality and mental health (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). General health perceptions were measured by five questions, vitality and mental health by transformed scale scores calculated from the combined scores of 4\u0026ndash;4 questions, thus ranging from 0 to 100. A shortened standardised questionnaire of 13 questions was used to measure the sense of coherence. Respondents were asked to indicate their level of agreement with the statements on a 7-point Likert scale. Based on the total number of responses to the 13 items, the possible score for sense of coherence ranged from 0 to 91. The 13-item sense of coherence scale for adults is also applicable to children aged 12 years and older (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eSample\u003c/h3\u003e\n\u003cp\u003eThe expected sample size was defined as 500 participants. In this study, 12 parents returned the passive consent form in 18 classes from 5 secondary schools. During the computer data cleaning process, 13 questionnaires were removed from the sample because more than 50% of the questions were not answered or were obviously nonsense. Finally, the responses of 448 students were analysed.\u003c/p\u003e\n\u003ch3\u003eApplied statistical tests, software\u003c/h3\u003e\n\u003cp\u003eFor the analysis we used SPSS Statistics 22 software. Normality was tested using the Kolmogorov-Smirnov test and then, to determine differences between groups, a t-test and ANOVA were used for parametric variables, while the Mann-Whitney and Kruskal-Wallis tests were used for non-parametric variables (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical compliance\u003c/h2\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of the School Ethics Committee of Doctoral Program on Educational Sciences at the University of P\u0026eacute;cs. The research was conducted ethically, the results are reported honestly, the submitted work is original and not (self-) plagiarized, and authorship reflects the individuals\u0026rsquo; contributions.\u003c/p\u003e \u003cp\u003eThe measurement instruments were completed anonymously and the filled in forms did not contain any information that could identify the students. Once the data were processed, they were published only in aggregated form, with no information about individual classes or schools.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDescription of the socio-demographic/biographical characteristics of the sample:\u003c/h2\u003e \u003cp\u003eIn the survey of 10th, 11th and 12th grade secondary school students in Western Transdanubia, the mean age of the respondents was 16.87 years (SD: 0.82), two-thirds were female, more than half lived in a town and two-fifths lived in the same municipality as the school. The majority of the sample (69.87%) lived in a full family. 28.79% (129) of the families had one child and 22.1% (99) had three or more children. (Table I.)\u003c/p\u003e\u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eTable I.\u003c/b\u003e \u003cem\u003eSample characteristics\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (n\u0026thinsp;=\u0026thinsp;448)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e16.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e15 \u0026minus;\u0026thinsp;19 years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eabsolute frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003erelative frequency (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (n\u0026thinsp;=\u0026thinsp;447)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.21%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of residence (n\u0026thinsp;=\u0026thinsp;445)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecounty seat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.46%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.46%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esettlement/village\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily type (n\u0026thinsp;=\u0026thinsp;448)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efull family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.87%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erestructured family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.94%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esingle-parent family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparentless family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of siblings (n\u0026thinsp;=\u0026thinsp;448)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno siblings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eone sibling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etwo siblings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.75%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethree or more siblings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eExamining the relationship between physical activity and subjective perceptions of health\u003c/h2\u003e \u003cp\u003e60 minutes of exercise per day was considered to be an adequate amount of physical activity. Categorisation was based on the Health Behaviour in School-aged Children (HBSC) study classification (\u0026lsquo;adequate\u0026rsquo; if 60 minutes of physical activity were done every day of the week, \u0026lsquo;nearly adequate\u0026rsquo; if at least 5\u0026ndash;6 days per week, \u0026lsquo;little\u0026rsquo; if 3\u0026ndash;4 days per week, and \u0026lsquo;very little\u0026rsquo; if 2 days or less per week). 22.2% of the young people who responded were classified as doing an adequate amount of physical activity, 29.02%-29.02% as doing nearly adequate or little physical activity, and 19.76% as doing very little physical activity. In terms of the quality of physical activity (intensity and duration), at least 3 hours per week of physical activity that resulted in sweating was considered adequate, which characterised 64.1% of the sample, but 9.6% of the sample did not engage in any vigorous physical activity at all.\u003c/p\u003e \u003cp\u003eThe health status of the respondents was measured using the EQ-VAS health thermometer. The mean value of the actual health perception was 79.16 on a scale of 100 (SD: 16.5, max: 100, min: 10). The students\u0026rsquo; health status was also assessed using the standardised health assessment instrument SF-36. In this sample, the mean for general health perception was M: 74.94 (SD: 17.31), for mental health M: 68.33 (SD: 19.06) and for vitality 50.47 (SD: 20.59).\u003c/p\u003e \u003cp\u003eBased on the quality of physical activity, the study sample was divided into two groups (adequate, inadequate) and the relationship between physical activity and subjective health perception was measured. The difference in the mean self-rated health scores of the groups was tested using a t-test. The mean scores for general health perception were not significantly different (t(446) -0.676 p\u0026thinsp;=\u0026thinsp;0.52) for qualitatively adequate (M\u0026thinsp;=\u0026thinsp;75.68) and inadequate physical activity (M\u0026thinsp;=\u0026thinsp;74.52). Mean values for the other subjective health indicators examined in the groups were also nearly identical for mental health (t(445) 0.149 p\u0026thinsp;=\u0026thinsp;0.882), vitality (t(446) 1.677 p\u0026thinsp;=\u0026thinsp;0.094). (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eExamining the relationship between quantitative indicators of physical activity and health perceptions\u003c/h2\u003e \u003cp\u003eIn this study, changes in physical activity were also examined in relation to students\u0026rsquo; current health perceptions as measured by the Visual Analogue Scale. A Kruskal-Wallis test was used to test the effect of physical activity on self-rated health, based on the Kolmogorov-Smirnov test of normality of the data obtained from the EQ visual analogue scale. Based on the analysis, a significant difference in the variation of physical activity quantity was demonstrated for self-reported health perception (H(3,416)24.34 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), which was not demonstrated for the qualitative indicator of physical activity (U\u0026thinsp;=\u0026thinsp;22936.0 z=-0.067 p\u0026thinsp;=\u0026thinsp;0.947). As the amount of physical activity increased, the mean scores for the other domains of subjective health perception also increased, most significantly for vitality (adequate physical activity M\u0026thinsp;=\u0026thinsp;55.46; nearly adequate M\u0026thinsp;=\u0026thinsp;54.62; little M\u0026thinsp;=\u0026thinsp;46.11; very little M\u0026thinsp;=\u0026thinsp;45.84). When examining vitality, a significant difference (M\u0026thinsp;=\u0026thinsp;9.62 points) was found between the two extreme groups in terms of frequency of physical activity for the \u0026lsquo;adequate\u0026rsquo; and \u0026lsquo;very little\u0026rsquo; categories (F(3,417)7.371 p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Based on the results, the young people who reported the most positive general health (M\u0026thinsp;=\u0026thinsp;79) and mental health (M\u0026thinsp;=\u0026thinsp;73.93) were those who engaged in adequate physical activity (at least 60 minutes of physical activity per day, every week). Results show that with increasing frequency of weekly physical activity, mean scores for general health (F(3,417)3,146 p\u0026thinsp;=\u0026thinsp;0.025) and mental health (F(3,417)5,88 p\u0026thinsp;=\u0026thinsp;0.001) also increased significantly. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eExamining the relationship between physical activity and a sense of coherence\u003c/h2\u003e \u003cp\u003eThe analysis also examined the relationship between physical activity as a preventive behaviour and the sense of coherence. It was hypothesised that the frequency and intensity of leisure-time physical activity would be influenced by the individual\u0026rsquo;s sense of coherence. The exact value of the sense of coherence \u0026mdash;the point at which the measured data can be considered a risk factor\u0026mdash;cannot be determined. At an individual level, the sense of coherence can only be determined at a particular point in time.\u003c/p\u003e \u003cp\u003eIn this survey, the mean score for sense of coherence was 54.38 (SD: 11.35, max: 90, min: 13) based on the responses of secondary school students aged 15\u0026ndash;19. To determine the correlation between the sense of coherence and the frequency of physical activity, the Kruskal-Wallis test was used after the normality test, and the results showed that the value of the sense of coherence was significantly different according to the amount of physical activity of the students (H(3,416)9,821 p\u0026thinsp;=\u0026thinsp;0.02). However, after calculations with the Mann-Whitney test, the sense of coherence did not significantly differentiate the quality indicator of students\u0026rsquo; physical activity (U\u0026thinsp;=\u0026thinsp;22819.5 z=-0.107 p\u0026thinsp;=\u0026thinsp;0.195) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWhen interpreting the results, the limitations of the research must also be taken into account. Although the schools included in the study are homogeneous in terms of school type, they cannot be considered representative, and further studies in other types of schools and on a representative sample are needed to make the results generalisable. In addition, the respondents are not completely unrelated to each other, as school classes participated in the survey. It should also be noted that the quantity and quality of physical activity and the perception of health status were based on self-reports by the students.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eLooking at the amount of physical activity in the current study, one in two students engaged in an adequate or nearly adequate amount of physical activity, 5\u0026ndash;7 times per week, but two in ten students had very little weekly physical activity. The quality of physical activity was only adequate for two out of three students. Overall, the presented quantitative and qualitative indicators of leisure-time physical activity are suboptimal, which is consistent with international and national research findings among adolescents (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Sedentary lifestyle is a global problem in developed countries, posing a challenge in terms of health promotion, health preservation and economic aspects. In terms of the health status of the responding students, the overall health perception is considered adequate compared to previous research.\u003c/p\u003e \u003cp\u003eThe mean normal values for vitality and mental health of the healthy Hungarian population under 18 years of age published by Czimbalmos et al. in 1999 were 79 and 79, which is much lower for the current study population. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) However, evidence from the 2018 international HBSC survey shows a significant downward trend in mental health scores for school-aged youth compared to data from 2002, 2006, 2010 and 2014 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe amount of physical activity was positively correlated with measured self-rated health indicators, which has been confirmed by previous research as well (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Engaging in regular physical activity can be a protective factor. The results confirm the importance of physical activity as a health-promoting health behaviour for self-reported health perceptions. In order to maintain and improve somatic-mental health and well-being, strategies to increase the frequency and intensity of regular physical activity among adolescents and young people should be implemented to promote exercise, which would also lead to a reduction in healthcare-related expenditures (32, 33). Regular physical activity is associated with better subjective health, which can also prevent the development of certain diseases. Regular physical activity, performed correctly, becomes part of everyday life from childhood, with positive effects on health in adulthood.\u003c/p\u003e \u003cp\u003eAccording to the results of this research, the sense of coherence plays a role in the changes in the regularity of physical activity, and a linear stochastic relationship between the variables was demonstrated, which was also proved by a study (n\u0026thinsp;=\u0026thinsp;277) among adolescents in Kaposv\u0026aacute;r, Hungary, where a greater sense of coherence was measured among youths who played sports every day of the week outside of physical education classes. The foundations for long-term health can be established in childhood and it is therefore very important to reduce and stop negative health behaviours and to strengthen and increase positive ones. According to the salutogenetic model, developing a sense of coherence through general resources (family, providing a role model, increasing knowledge, and creating a supportive environment for physical activity) is of utmost importance. The regularity of leisure-time physical activity can also be increased through school resources. In the teenage years, the role of peer relationships is particularly important in developing a healthy lifestyle.\u003c/p\u003e \u003cp\u003eA greater sense of coherence helps to cope with problems and make the right choices and decisions in different life situations, thus contributing to preventive behaviours and reducing risk behaviours, thus increasing the health-promoting effects of physical activity on self-reported health status.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of interest\u003c/h2\u003e \u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eIK and GHF contributed to the conception and design of the study. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. \u003cem\u003eGuidelines on physical activity and sedentary behaviour. Geneva\u003c/em\u003e (World Health Organization, 2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReiner, M., Niermann, C., Jekauc, D. \u0026amp; Woll, A. Long-term health benefits of physical activity - a systematic review of longitudinal studies. \u003cem\u003eBMC Public. 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Act\u003c/em\u003e. \u003cb\u003e18\u003c/b\u003e, 100315. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi.org/10.1016/j.mhpa.2019.100315\u003c/span\u003e\u003cspan address=\"10.1016/j.mhpa.2019.100315\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"physical activity, the sense of coherence, secondary school students, vitality and mental health, preventive behaviours","lastPublishedDoi":"10.21203/rs.3.rs-5353185/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5353185/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eThe aim of the present research was to assess the physical activity of secondary school students and to understand its effect on subjective general health, vitality and mental health. As a sense of coherence can help in the choice of preventive behaviours, this study also examined the relationship between students\u0026rsquo; sense of coherence and physical activity.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quantitative cross-sectional study was conducted among adolescents aged 15\u0026ndash;19 years attending a full-time secondary school in Western Transdanubia, Hungary. The paper-based questionnaire included self-reported questions on physical activity in addition to socio-demographic variables, while the standardised instrument measured dimensions of subjective health (Health Thermometer - EuroQol scale, EQ VAS, Health Survey Short Form SF-36 Questionnaire) and Sense of Coherence (SOC 13). The 448 evaluable responses were analysed using SPSS Statistics 22 software with the Kolmogorov-Smirnov test, Mann-Whitney test, Kruskal-Wallis test, t-test and ANOVA test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e67.79% of the respondents were female, and the majority of the sample (69.87%) lived in a full family. The amount of physical activity was adequate for 22.2% of respondents and nearly adequate for 29%, while 64.1% of the sample were in the adequate category for the quality of physical activity. Regular physical activity had a positive effect on self-reported health perception (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean scores for mental health, vitality and general health perception were significantly higher among students who were adequately or nearly adequately physically active (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). A positive correlation was found between sense of coherence and frequency of physical activity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The means of the self-reported health indicators and the sense of coherence were almost identical between the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eThe overall results for physical activity in the study sample are not optimal. By increasing the sense of coherence \u0026ndash; providing models, increasing knowledge, creating a supportive environment for physical activity \u0026ndash; it is possible to enhance the choice to engage in regular physical activity, and make the right choices for the individual in different life situations, thus increasing the health-promoting effect of physical activity on self-reported health.\u003c/p\u003e","manuscriptTitle":"Relationship between self-rated health, sense of coherence and physical activity in a survey of secondary school students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-05 04:45:29","doi":"10.21203/rs.3.rs-5353185/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-29T07:33:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-27T06:34:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188528184728047751037107569759627366273","date":"2025-01-22T11:19:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-02T14:19:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123613735639095682951026165808356015801","date":"2024-11-30T11:38:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-18T14:49:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-18T14:48:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-11-14T10:48:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-13T05:29:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-10-29T09:42:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"602f70b4-9fc0-4768-b0c7-4d4bb1fe358d","owner":[],"postedDate":"December 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":41034313,"name":"Health sciences/Health care"},{"id":41034314,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2025-07-28T15:59:35+00:00","versionOfRecord":{"articleIdentity":"rs-5353185","link":"https://doi.org/10.1038/s41598-025-12686-0","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-22 15:57:05","publishedOnDateReadable":"July 22nd, 2025"},"versionCreatedAt":"2024-12-05 04:45:29","video":"","vorDoi":"10.1038/s41598-025-12686-0","vorDoiUrl":"https://doi.org/10.1038/s41598-025-12686-0","workflowStages":[]},"version":"v1","identity":"rs-5353185","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5353185","identity":"rs-5353185","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}