Reducing Sedentary Behavior and Promoting Physical Activity in Medical Students: Protocol of the PROMESS-Physical Activity Clinical Trial

Reducing Sedentary Behavior and Promoting Physical Activity in Medical Students: Protocol of the PROMESS-Physical Activity Clinical Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Reducing Sedentary Behavior and Promoting Physical Activity in Medical Students: Protocol of the PROMESS-Physical Activity Clinical Trial Sophie Schlatter, Mathilde Mura, Baptiste Morel, Olivier Loisel, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7441836/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The increase in sedentary behavior, coupled with a decrease in physical activity , poses a significant health risk. Medical students, in particular, face higher risks due to demanding academic schedules, prolonged sitting, and limited attention to physical activity. Methods: The PROMESS-Physical Activity clinical trial aims to support future healthcare professionals by enhancing their abilities to reduce their sedentary behavior and promote their physical activity. The support will be provided through a three-session program. Each session will include an individual meeting between a medical student and a PROMESS-Physical activity expert, during which self-care education, advice, and personalized goals will be established. The present protocol is designed to assess the influence of this program on forty-five undergraduate medical students (4th and 5th-year) of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France). Assessments of sedentary behavior and physical activity will be conducted before and during the intervention. At the end of the third session the student’s satisfaction levels regarding the program will be assessed. The primary will be change in sedentary time estimated through self-reported (questionnaires) and objective (accelerometry) measurements during the program. Secondary outcomes will provide a detailed characterization of changes in other sedentary behaviors, physical activity levels, physical fitness and body composition markers. Exploratory outcomes will provide information regarding the satisfaction and will determine the moderators of the program’s efficacy. Data will be analyzed according to the intention-to-treat principle and presented in accordance with the CONSORT Guidelines. Ethical approval has been obtained (IRB: 2023070401). The results from this study will be presented at conferences and in peer-reviewed scientific journals. Discussion: Results will provide valuable insights into the program's efficacy. If its efficacy is proven, PROMESS-Physical Activity could become an integral part of medical education, fostering a healthier future for healthcare professionals. This manuscript follows the SPIRIT guidelines (Additional files 1 & 7). Trial registration: ClinicalTrials.gov: NCT06297304; retrospectively registered Accelerometry Body composition markers Curriculum Medical Students Peer coaching Physical fitness Physical activity Sedentary behavior Self-monitoring Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The transition from high school to university is characterized by major lifestyle changes that may hinder the adoption of healthy behaviors. Accordingly, previous researches have shown that starting university is associated with unhealthy eating, alcohol and drug use, and poor sleep habits [ 1 – 4 ]. In addition, major changes are observed in sedentary behavior that refers to any waking activities with very low energy expenditure (mostly involving sitting, reclining, or lying down ; ≤1.5 metabolic equivalents), and in physical activity that refers to any bodily movement produced by skeletal muscles that results in energy expenditure beyond resting levels [ 5 – 7 ]. The shift from high school to university life often results in a marked increase in sedentary behavior, coupled with a reduction in physical activity levels [ 8 – 12 ]. Castro (2020) show that university students spend more than 7 hours per day doing sedentary activities. In addition, they often struggle to maintain regular physical activity due to lack of time, lack of motivation, and lack of accessible places [ 13 , 14 ]. The organization of the academic calendar, along with the characteristics of the university environment, also play a role in reducing engagement in moderate-to-vigorous physical activity (MVPA) [ 10 , 12 , 15 ]. Consequently, physical fitness levels of university students are generally low [ 16 ]. The demanding nature of certain academic programs, particularly those with prolonged and intensive workloads such as medical curricula, places some university students at increased risk for adopting unhealthy behaviors [ 8 , 12 , 17 , 18 ]. Barret (2024) reported that medical students spend over 10 hours a day engaged in sedentary behavior, exceeding largely the thresholds associated with an increased risk of all-cause mortality [ 8 , 18 , 19 ]. In addition, medical students often struggle to maintain regular physical activity due to constraints of time and energy, as well as feelings of guilt of spending time doing something else than studying [ 13 ]. These behaviors heighten the risk of health deterioration, as mounting evidence indicates that excessive sedentary behavior and insufficient physical activity can profoundly impact physical (e.g., cardiovascular disease, hypertension, obesity, musculoskeletal disorders) and mental health (e.g., anxiety, burnout, depression) [ 19 – 22 ]. Individuals who spent most of their time sitting have a higher risk of all-cause mortality (HR = 1.16; 95% CI:1.11–1.20) [ 20 ] (8 hours vs 4 hours ; HR = 1.52; 95% CI: 1.13–2.03) [ 19 ]. Moreover, inactive individuals face higher risk of premature death compared to the most active ones (HR = 0.27; 95% CI:0.23–0.32) [ 21 ] and are more prone to mental health issues [ 22 ]. Similar deleterious effects can be expected for medical students [ 23 – 28 ]. In this population, higher sedentary time has been associated with depression and anxiety [29, 30 but see 15]. While lower level of physical activity has been associated with higher levels of stress, burnout, anxiety and with lower levels of quality of life and self-confidence [ 18 ][ 15 , 31 – 33 ]. More precisely, lower levels of MVPA was linked to a higher symptoms of depression, burnout, anxiety and lower happiness in medical students [ 15 , 34 , 35 ]. To prevent the onset and persistence of these disorders, interventions aimed at reducing sedentary behavior and promoting physical activity should be implemented early in the medical curriculum. To our knowledge, no previous studies have attempted to address the sedentary behavior of medical students and only few studies have implemented physical activity programs [ 33 , 36 – 41 ]. Among them, Yorks and collaborators investigated the effect of participating in a weekly group fitness class and evidenced that individuals involved in the group experienced less stress and had an enhanced quality of life compared to individuals who exercised alone or did not engage in regular physical activity [ 39 ]. Weight and collaborators also offered medical residents the opportunity to participate in a 12-week physical activity program [ 33 ]. Following the program, students reported an increase in their levels of physical activity and an improvement in their quality of life. However, these programs suffered from a weak adhesion and/or engagement that may stem from a lack of alignment between the explored interventions and the specific needs of medical students. To address the needs and constraints of medical students, programs can be collaboratively developed with them and the faculty staff. This process can help to develop attractive and effective physical activity interventions, as it has been previously and successfully realized with other students [ 42 ]. Programs should assist students in implementing habit changes, such as reducing periods of prolonged sedentary behavior, increasing daily step counts [ 43 – 45 ] and/or encouraging physical activity practice [ 33 , 39 ]. To increase intention to change, programs should include planning the lifestyle modifications, setting goals, and delivering feedback, encouragement and personalized advice - including insights on individuals’ own behaviors and characteristics [ 13 ]. As an initial step in this direction, our team involved medical students and faculty staff in the development process of a program entitled Preventive Remediation for Optimal MEdical StudentS (PROMESS)-Physical Activity [ 13 ]. The PROMESS-Physical Activity program aims to provide solutions to medical students to reduce their sedentary behavior and increase their levels of physical activity during their curriculum. The program includes multiple one-on-one sessions, in which an expert will provide self-care educational content and individual diagnostics related to sedentary behavior, physical activity and physical fitness. These sessions will also serve as a space for students to share their personal challenges, thereby helping them to better identify their needs. Personalized advice and goal-setting will stem from these discussions. Aims The aim of this clinical trial will be to determine the influence of the PROMESS-Physical Activity program on medical students’ sedentary behavior and physical activity levels. The primary outcome will be the change in sedentary time measured through reported (Recent Physical Activity Questionnaire, Global Physical Activity Questionnaire) and objective (accelerometry) measurements. The secondary outcomes will include a detailed characterization of changes in other sedentary behaviors, physical fitness, physical activity levels, and body composition markers, assessed through questionnaires, accelerometry, and bioimpedance analysis. Exploratory outcomes will provide information regarding the student’s level of satisfaction and will determine the moderators of the program’s efficacy. It is expected that sedentary behavior will decrease, while physical activity levels will increase throughout the program. These changes may further contribute to improvements in physical fitness and body composition. Methods/Design 1. Design and setting This study is part of a larger randomized controlled trial assessing the effects of a multi-modal health intervention called the PROMESS project [ 13 , 46 , 47 ]. The project will be presented to all 4th and 5th years undergraduate students of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France) through a lecture, and an informative email will be sent to their university addresses. Volunteer students will be able to register for the project by replying to the email and the first 70 volunteers will be recruited (without monetary compensation). No exclusion criteria will be applied. For the entire PROMESS project, the 70 undergraduate medical students recruited will be randomized into two groups (1:2 ratio): a control group (n = 25) and an interventional group (n = 45) stratified by gender and study years. The present clinical trial (PROMESS-Physical Activity) will specifically focus on the interventional group, in which 45 students will undergo a preventive program focused on sedentary behavior reduction and physical activity promotion (Fig. 1 ). 2. Ethic statement The research project was approved by the Dean of the faculty (GR), the Lyon University Health Department and a sample of local medical students. All procedures will be performed in adherence to the Helsinki declaration [ 48 ]. Ethical approval from the Institutional Review Board of the Claude Bernard University Lyon 1 (CUMG, France) has been obtained (IRB 2023070401) and the study has been registered in ClinicalTrials.gov (NCT06297304). Modifications to the protocol that may impact the conduct of the study will require a formal amendment. The participants' anonymity and confidentiality will be ensured and maintained according to laws and regulations. The principal investigator (SS) will provide oral and written information and participants will provide a written consent prior to enrollment following a sufficient reflection time (Additional file 2). 3. Characterization of the population at baseline Before the intervention, students enrolled will complete a brief demographic survey, providing information regarding their year of study, age, gender, height, weight, smoking status and any medication use. Baseline sedentary behavior and physical activity levels will be evaluated using validated self-reported questionnaires and objective accelerometry measurements. Combining the results of subjective and objective measurements can provide a more complete assessment of these health behavior patterns in medical students [ 49 ]. Physical fitness will be assessed through standardized physical tests, while body composition markers will be measured using bioimpedance analysis, as detailed below: Questionnaires Recent Physical Activity Questionnaire. The RPAQ is an 8-item questionnaire that estimates the individual sedentary behavior over the past four weeks during work, study, transport, home, and leisure. Scores are expressed in hours per day for week and weekend days. A sedentary time inferior to 3 hours per day is considered as low, between 3 and 7 hours as moderate, and superior to 7 hours as high, as defined by French National Observatory for Physical Activity and Sedentary Behavior (ONAPS). In addition, an estimation of the number of floors climbed per day is asked. The French version adapted by the ONAPS will be used [ 50 ]. Global Physical Activity Questionnaire. The GPAQ is a 16-item questionnaire designed to access sedentary behavior (1-item, hour:min per day) and physical activity levels over a typical week (15-items) [ 51 ]. The 15-items evaluate the frequency, duration and intensity of physical activity in three domains: work, transport and leisure. The intensity is expressed in metabolic equivalents of Task (MET); 1 MET corresponds to the energy expended while sitting quietly (approximately 1 kcal/kg/hour). Moderate physical activity is assigned a value of 4 and vigorous physical activity of 8 MET. The total score of physical activity is expressed in MET-min/week. Based on this score, physical activity levels are classified as low ( 3000 MET-min/week) [ 51 , 52 ]. The French version of the GPAQ will be used (reliability; ICC = 0.37–0.94, Kappa = 0.50–0.62, validity; r = 0.41–0.86) [ 52 ]. Accelerometry records The baseline levels of sedentary behavior and physical activity will be monitored for 21 consecutive days using a triaxial accelerometer worn at the non-dominant wrist (GENEActiv, ActivInsights, Kimbolton, UK). The raw tridimensional acceleration will be sampled at 60 Hz with a sensitivity range of ± 8g (g is the Earth’s gravity acceleration = 9.81 m.s − 2 ). Students will be encouraged to wear the device as consistently as possible while maintaining their usual lifestyle habits with the option to remove it when showering, if wearing it could cause injury, or for professional reasons in specific clinical settings. Individuals’ records will be included in the subsequent analyses if they contain data for at least seven days. The GENEActiv device is a reliable and valid tool to measure adult sedentary and physical activity behaviors in real-life conditions (ICC = 0.68–0.88; Kappa = 0.53) [ 53 , 54 ]. GENEActiv data will be downloaded using GENEActiv PC software (version 4.0.12) and saved in raw format as binary files. Those raw data will be analyzed according to GENEActiv algorithms and open-source methodR-package GGIR [ 55 ]. The analysis of physical activity intensity will be performed using the Euclidean Norm Minus One (ENMO) signal, expressed in milligravity units, with the following thresholds; sedentary behaviors values 2020 mg. The markers used with a brief description are given below. Total sedentary time (minutes per day). The mean of time spent engaging into a sedentary behavior per day. Sedentary bouts (number). The number of prolonged sedentary periods lasting at least 30, 60, and 120 minutes per day - classified as prolonged, extended, and extreme sedentary bouts, respectively [ 5 , 56 ]. Light Physical Activity (minutes per day). The mean duration spent in LPA per day. Moderate-to-Vigorous Physical Activity (minutes per day). The mean duration spent in MVPA per day. Steps (number). The total number of steps per day. The critical Dynamic Body Acceleration (DBAc; in g). A two-parameter critical intensity model [ 57 ] will be fitted to the Dynamic Body Acceleration records (from 3 to 30 minutes) using a quantile regression to obtain the asymptote being DBAc. This parameter can be used as a severe intensity domain boundary to discriminate between steady- and non-steady-state metabolic rate activities in daily living (Rozier-Delgado et al. 2025). This method improves the actual intensity classification based on absolute cut-offs that fails to represent the time spent in intensity domains with individual physiological meanings. It also represents a major threshold in exercise physiology: the higher it is, the greater the individual's aerobic fitness. Body composition markers After measuring weight using an electronic scale (Scale 100, Decathlon, France) and the height, the body mass index (BMI) will be calculated as the weight divided by the square of the height. The students’ body composition – including fat-free mass, skeletal muscle mass, fat mass, bone mineral content and fat-free mass hydration – will be evaluated using bioimpedance analysis measurement (Biody Xpert ZM 3; Aminogram SAS, La Ciotat, France), according to the manufacturer recommendations. More precisely, students will be seated and holding the device in their hand, with their thumb and fingers placed on the integrated electrodes of the device. Then, they will put two other integrated electrodes on their ankle, just below the malleolus to start the measurement. During the measurement, they will be asked to remain still with a straight back. Resistance, reactance, impedance and phase angle will be obtained at 54 frequencies ranging from 1 kHz to 1000 kHz to evaluate body composition. Additionally, evolution of phase angle at 50 kHz and impedance ratio Z200/Z5, i.e. the ratio between the impedances obtained at 200 kHz (Z200) and at 5 kHz (Z5), will be studied considering their relationship with health status and systemic inflammation [ 58 ]. A. Physical fitness A battery of physical tests will be performed under the supervision of a physical activity instructor, verbal encouragement will be provided to ensure optimal performance [ 59 ]. The objective of these tests is to provide students with feedback on their level of physical fitness, in order to facilitate the discussion during the PROMESS-Physical Activity sessions. Maximal Strength Lower limb muscle strength will be assessed using a maximal isometric knee extensors torque test. The student will be seated with his/her hip and knee joints at 90° and his/her arms crossed over their chest. The right upper thigh will be immobilized to the chair to minimize extraneous movement, while the ankle will be attached to a force gauge (DFS II, Chatillon Force Measurement, AMETEK STC, USA) [ 60 , 61 ]. First, the student will perform a warm-up with a 3-second intended extension at 10%, 30%, and 70% of their perceived maximal intensity. Second, two maximal isometric voluntary contractions will be performed during which the student will be instructed to try to extend his/her knee as hard as possible for a 5-s duration [ 60 , 61 ]. The contractions will be separated by a 1-min recovery to prevent muscle fatigue [ 62 ]. The highest value will be used to determine the student's the maximal isometric strength (in N). Maximal Power The student will adopt the starting squat position and hold it for 3-sec before realizing a vertical jump, with a 90° knee angle and hands placed at the hip’s sides. Two or three warm-up jumps will be completed to ensure familiarization and the absence of countermovement. Upon receiving the start signal, the student will perform two jumps, aiming to reach the maximum height, with a 1-min recovery between each. Jump heights will be recorded using the Optojump system (Microgate Srl, Bolzano, Italy, [ 63 ]). The highest jump value will be used to estimate the peak power, calculated using the following equation: peak power (W) = 60.7 × (jump height [cm]) + 45.3 × (body mass [kg]) – 2055 [ 64 ]. Endurance Cardiorespiratory fitness. The shuttle run test (SRT) is a common undirect method to estimate individual cardiorespiratory fitness. In its original version, participants run back and forth between two lines set 20 meters apart, with the running speed gradually increasing; the highest speed (i.e., SRT speed) reached is then used to estimate maximal oxygen uptake (VO 2 max) [ 65 , 66 ]. A modified version, called the 10m-SRT, will be used with lines placed 10 meters apart; the running pace will start at 6.5 km/h and increase by 0.5 km/h every minute, guided by an audio signal (Pack Sportbeeper Pro, CE, France) (Additional file 3). The estimated VO 2 max (mL/kg/min) will be determined according to the following equation: VO 2 max = 8.0574 * 10m-SRT speed – 32.64 (Additional file 3). Heart rate recovery. The heart rate will be monitored during and after the SRT (Polar A200 device connected to a Polar H7 chest strap sensor). The heart rate will be recorded immediately, as well as one and three minutes after stopping. Heart Rate Recovery (HRR, in beats per minute) will be calculated by subtracting the heart rate measured at one minute (HRR1) and three minutes (HRR3) after exercise from the heart rate at the time of stopping (HRS). 4. Intervention The PROMESS-Physical Activity program has been developed with inputs from medical students and health professionals [ 13 ]. It will consist of three sessions, spaced 14 to 21 days apart. Each session will involve an individual meeting between a student and a PROMESS-Physical Activity expert. These sessions will be conducted in three distinct periods, with fifteen different students randomly assigned to one of the periods (Fig. 1 ). A. Expert training Meetings will be conducted by graduate medical students, considered as experienced peers regarding their advancement in the medical curriculum [ 13 ]. Prior to engaging in the sessions with students, those experienced peers will undergo a thorough training to be considered as experts. This training will involve several key steps, including reading a set of articles outlined in Additional file 4, observing each session at least once to obtain practical insights, and conducting themselves each session at least once, guided by an expert in sport sciences (AM, MM, SS; PhD in sports science). These training steps will be repeated if necessary. This comprehensive training process, which might last approximately 4 days, is designed to ensure that peers will be adequately prepared and proficient to effectively deliver the PROMESS-Physical Activity program. B. Overall session organization Each session will consist of an individual meeting between an undergraduate medical student and a PROMESS-Physical Activity expert (Fig. 2 ). To improve the reproducibility of the program, experts will follow a detailed step-by-step procedure for each session. All sessions will follow a consistent structure. The session will start with a short introduction talk, in which the expert will briefly explain the main steps. Following this, body composition markers will be assessed and the student will be asked to complete questionnaires. The expert will then provide pedagogical content about sedentary behavior, physical activity, and physical fitness, explaining thresholds and their relationships to health. During the meeting, the student will be provided the possibility to discuss his/her habits, allowing both the student and the expert to identify student’s needs. Specific advices and goals will be set based on this discussion, partly based on a predefined list of specific guidance (Additional file 5) created during a prior co-construction workshop [ 13 ]. Between sessions, students will receive two self-monitoring tools: a pedometer (FitBit Alta HR activity tracker, CA, USA) and a diary (Fig. 3 ) to enhance habit awareness. To further support students in achieving their goals, they will be offered the opportunity to participate in weekly group fitness sessions. C. Questionnaires At the beginning of each session, the student will answer the following Visual Analog Scales (VAS), and complete the GPAQ and RPAQ questionnaires. Each VAS will prompt the student to move a cursor to indicate his/her response on a 100-mm scale [ 39 , 67 ]. The cursor will start at the 0 position for each question. VAS - sedentary behavior. The level of perceived sedentary behavior will be assessed by asking: “Over the past two weeks, how would you characterize your level of sedentary behavior?” ranging from 0 (extremely sedentary) to 100 (not sedentary at all). VAS - physical activity . The level of perceived physical activity will be assessed by asking “Over the past two weeks, how would you characterize your level of physical activity?” ranging from 0 (completely inactive) to 100 (extremely active). VAS - physical fitness . The level of perceived physical fitness will be assessed by asking “Over the past two weeks, how would you characterize your level of physical fitness?” ranging from 0 (worst shape ever) to 100 (best shape ever). D. Session description Session 1 (S1). The first session will last approximately 60 minutes (Fig. 2 ). This session will begin with a brief presentation of the expert's background as well as with an explanation regarding the confidentiality of the exchanges. Then the following steps will be followed: Body composition markers . The body composition markers will be assessed as described above. Sedentary behavior and physical activity . The student will answer the aforementioned VAS, RPAQ and GPAQ. Pedagogical content . This content, composed of two main sections, will be supported by printed materials. The first section provides definitions of physical activity [ 7 ]. To encourage interaction and assess baseline knowledge, the expert will first ask students to define physical activity and then will explain the main different type of physical activity: work, transport, domestic activities, and leisure (i.e., physical exercise and sport). The expert will give deeper information on physical exercise by defining aerobic, strength, and flexibility and explaining the concept of physical activity intensity [ 68 ]. Students will be asked about their knowledge of physical activity recommendations before receiving guidance from the expert (i.e., 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise per week or any combination of both) [ 68 ]. Students will also receive personalized feedback on their baseline physical activity levels (from GPAQ) and their average daily stair climbing (from RPAQ), to encourage individual self-awareness. The second part provides information on sedentary behavior [ 5 , 6 ]. The expert will present the sedentary thresholds and will stress on the deleterious impact of sedentary behavior on health [ 20 , 21 , 69 ]. Students will also receive feedback on their baseline sedentary behaviors (RPAQ scores). Providing and discussing each student's data will help identify their specific needs and allow the expert to dispense tailored advice. Diary . A diary will be given to the student, with instructions to fill it out until the next session (Fig. 3 ). Each day, the student will report their time spent in sedentary behavior and if he/she has broken sedentary periods (e.g. rising up, doing some steps). They will report their physical activity, briefly describing the type of activity, its duration, and rating the perceived effort on a scale from 1 (very easy) to 5 (exhausting). The diary will enable students to engage in a self-monitoring process, enhancing their awareness and providing an opportunity to reflect on their behaviors. The expert and the student will fill the current day together to provide an example, and objectives will be pre-scheduled in the diary (e.g., participating in the fitness class). Advice . During the entire session, advice concerning sedentary behavior reduction and physical activity promotion will be provided. Advice will be based on the predetermined list (Additional file 5) [ 13 ]. Pedometer. To increase habit awareness and encourage the student to increase their level of physical activity, they will wear a pedometer that displays the number of daily steps (FitBit Alta HR activity tracker, CA, USA), until the next session. Wearing pedometers has been shown to improve physical activity levels, reduce BMI, and enhance cardiovascular fitness [ 43 , 70 ]. Students will need to record their daily step counts in their diaries, allowing for a continuous 'self-monitoring' process (Fig. 3 ). Becoming aware of their daily steps might help them achieve the current guideline of 10,000 steps per day [ 71 ]. Fitness classes. Throughout the PROMESS-Physical Activity program, the student will have the opportunity to participate in a one-hour fitness class per week [ 13 ]. These group sessions, led by certified instructors, will begin with full-body warm-up exercises, followed by either a ‘High-Intensity Interval Training’ session or an ‘Every Minute on the Minute’ workout. Each session will conclude with a cool-down phase. The sessions will focus on strength training, cardiorespiratory endurance, mobility, and balance, and will be adapted to offer varying levels of difficulty for each exercise (Additional file 6). As described for baseline, the students will have to wear an accelerometer between S1 and session 2 (Fig. 2 ). Individual goals . At the end of the session, the expert will answer all the questions that may arise and will settle the student’s goal for the next session. Both the student and the expert will write the goals and sign an agreement, which should promote the student’s commitment and motivation [ 13 ]. At the end of each session, the expert will report the following information on several 5-point Likert scales [ 13 , 46 , 47 ]: Likert - Expert comfort. The expert will have to report his/her level of comfort regarding his/her relationship with the student during the session (1: not comfortable at all, 2: slightly comfortable, 3: fairly comfortable, 4: comfortable, 5: very comfortable). Likert - Expert satisfaction. The expert will have to report his/her level of satisfaction regarding his/her animation of the session (1: not satisfied at all, 2: slightly satisfied, 3: fairly satisfied, 4: satisfied, 5: very satisfied). Likert - Advice given . Concerning predefined advice, expert will report if he/she: 1) did not mention this during the meeting; 2) mentioned this but did not directly advise it; 3) mentioned this and recommended it; 4) had set this in the goals; 5) performed a positive reinforcement. He/she will also reported any advice given during the session that is not on the predefined list. Session 2 (S2). The second session will last approximately 60 minutes (Fig. 2 ), the following steps will be followed: Body composition markers. Using the same procedure as described above. Sedentary behavior and physical activity. Using the same procedure as described above. Feedback on diary . The diary filled out between S1 and S2 will be discussed. The expert will ask the student regarding the types of physical activity engaged, as well as their frequency, duration and intensity. The discussion will also cover the number of steps taken and how to increase it. Additionally, the expert will support the student in reflecting on their sedentary behavior by identifying periods of prolonged inactivity, analyzing the frequency and nature of sedentary breaks, and exploring strategies to reduce sedentary habits. Feedback on S1 goals. A discussion will help to identify the obstacles to achieve each previously established goal. Pedagogical content . This content is composed of three main sections provides information on students' baseline characteristics (Fig. 4 ). The first part provides information on sedentary behavior assessed through accelerometry (hours:min per day) along with the thresholds. The second part provides information on physical activity levels measured through accelerometry (number of daily steps, LPA and MVPA). The third part provides information on physical fitness markers (strength, power and endurance scores), along with a short description of each tests. Students' fitness scores will be discussed in regards to norms and/or recommendations (MIVC strength [ 72 ]; peak power [ 73 ]; VO 2 max [ 74 ]). Comparing students' fitness levels relative to established benchmarks will facilitate the identification of specific areas for improvement and favor dispensation of personalized advice. In addition, the expert provides information about student’s body composition markers at baseline (fat-free mass, fat mass and fat-free mass hydration). The values for each parameter will be examined in relation to normative standards and illustrated through a visual interface provided by the Biody Manager software (2024 © Biody Manager by Aminogram, Version 3.3.1, La Ciotat, France). As performed in S1, advice will be provided throughout the entire session. The student will receive a new diary, a pedometer and an accelerometer. The expert will address all questions, individual goals will be established and signed. Similar to S1, at the end of the session, the expert will report his/her level of comfort, satisfaction, rate the predefined advice, and report all the goals established during this session. In addition, the expert will estimate: Student’s goal achievements . The expert will estimate whether the student has achieved the goals previously set (session 1 goals) on a 4-point Likert scale (i.e., 0: not achieved at all, 1: slightly achieved, 2: fairly well achieved, 3: well achieved). Session 3 (S3). The third session will last approximately 45 minutes, the following steps will be followed: Body markers. Using the same procedure as described above. Sedentary behavior and physical activity. Using the same procedure as described above. Feedback on diary . The sedentary behavior and physical activity diary filled out between S2 and S3 will be discussed as described above. Feedback on S2 goals. Feedback on session 2 goals will be provided as described above. Feedback on the achievement. In order to offer the student a comprehensive overview of his/her achievements across the program, the expert will provide an individualized printed visual summary that will comprise: 1) the evolution of sedentary time (hours:min per day) assessed through the RPAQ (baseline, S1, S2, S3) and accelerometry (baseline, between S1 and S2); 2) his/her evolution of physical activity assessed through the GPAQ (MVPA at baseline, S1, S2, S3) and accelerometry (numbers of daily steps, LPA and MVPA at baseline and between S1 and S2); 3) his/her goals set during the program. Progression will be discussed based on the goals in order to help the student to identify what was effective for him/her. In addition, the student’s will be encouraged to proactively determine and report his/her long-term goals on his/her own to enhance autonomy and long-term commitment. As performed in S1 and S2, advice will be provided throughout the entire session and the expert will address all questions. Just before ending the session, the level of student satisfaction regarding the PROMESS-Physical Activity program will be assessed through the following 100-mm VAS. Composite score - Student's satisfaction. The student’s satisfaction will be measured using a composite score, calculated as the average of a specific and a general scores. The specific score (sedentary behavior, physical activity, physical fitness) will be calculated as the average of the scores obtained at the three VAS ranging from 0 (absolutely not) to 100 (completely): “Do you think the intervention has helped you to decrease your sedentary behavior?”, “Do you think the intervention has helped you to increase your physical activity level?” and “Do you think the intervention has helped you to increase your physical fitness level?”. The general score (relevance and sustainability) will be calculated as the average of the scores obtained at the two VAS ranging from 0 (absolutely not) to 100 (completely): “Do you think the proposed goals were suitable for your daily life?” and “Do you think you can sustain the changes in habits achieved?” [ 46 , 47 ]. For all scores of student’s satisfactions, a score lower than 30 will be considered highly negative, from 30 to 45 negative, from 45 to 55 neutral, from 55 to 70 positive, and equal or above 70 highly positive [ 46 , 47 ]. At the end, the expert will report his/her level of comfort, satisfaction, rate the predefined advice, report all the goals settled, and estimate whether the student has achieved the goals settled in S2. He/she will report his/her overall level of satisfaction regarding the student's progress during the PROMESS-Physical Activity program ("Are you satisfied with the student's progress during the whole intervention?") on a Likert scale ranging from 1 (not satisfied at all) to 5 (very satisfied) [ 46 , 47 ]. Availability of the PROMESS-Physical Activity material All materials necessary to perform the PROMESS-Physical Activity program are available from the authors upon reasonable request (SS, AM, [email protected] and/or personal mails). 5. Data management and monitoring The principal investigator (SS) will ensure that the protocol and ethical guidelines for data collection and analysis will be followed. She will be responsible for maintaining the anonymity of the included students (participants will be assigned a unique identification code). In addition, the students will receive a letter with information that clarifies how their data will be used regarding the General Data Protection Regulation, including the contact details of the university’s data protection officer, as well as the contact of the principal investigator. Students will be informed that if they wish to withdraw, they have to contact SS who will conduct a dropout analysis. All source documents, including written consent and printed materials, will be stored in a secure locker at the RESHAPE Laboratory (INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France) for a five-year period after the last publication of results. Raw data, processed data, and analysis scripts will be stored on a password-protected computer at the RESHAPE laboratory, accessible only to registered investigators (SS, AM). The database preparation and statistical analysis will be conducted anonymously. Since the study involves minimal risk to participants, a Data Monitoring Committee was considered as unnecessary; moreover, the project’s approbation by an institutional review board (IRB: 2023070401) affirming adequate monitoring. 6. Data analysis Data analysis will take place once all data have been collected. No interim analyses and stopping guidelines to terminate the study are planned. Data analyzed. Variables will be expressed as means with standard deviations and ranges, medians with interquartile ranges, or counts and percentages. Data will be analyzed according to the intention-to-treat principle and presented in agreement with international consolidated standards of reporting trials guidelines. A p-value < 0.05 will be considered statistically significant. All models’ assumptions will be checked. For linear regressions, the β coefficients with their 95% confidence interval and the adjusted coefficients R² will be provided. All statistical analysis will be performed using the most recent version of the R software [ 75 ]. Outcomes. The primary outcome will be the change of the sedentary time evaluated by the RPAQ (scores obtained at S1, S2, S3), the GPAQ (scores obtained at S1, S2, S3) and accelerometry (scores obtained at baseline, S1-S2, S2-S3). The secondary outcomes will be the change of other variables assessing sedentary behavior, physical fitness, physical activity levels, or body composition as specified in the Additional file 7. A priori-sample size. The intended sample size was calculated for the primary outcome (evolution of the sedentary time). Based on an expected medium effect size for repeated measures (f = 0.20, α = 5%, power = 0.80%, 3 measurements) the calculation resulted in a total sample size of 42 participants (G*Power v3.1.9.6). To prevent probable attrition and/or data losses, 10% additional volunteers will be recruited resulting in a 45 total sample size. Statistical analysis plan Descriptive variables. Characteristics of students at baseline will be described using descriptive statistics. Primary and secondary outcomes . Linear mixed models (with a random effect for participants and experts) will be performed to explore the impact of the PROMESS-Physical Activity program on the primary and secondary outcomes. For secondary outcomes, p-values will be reported both unadjusted and adjusted to account for multiple testing. Exploratory outcomes. Moderators of efficacy. The program’s efficacy will be determined by a delta score on the sedentary time evaluated by accelerometry (S2-S3 score minus baseline score). A negative delta score will indicate reduced sedentary behavior, a neutral score no change, and a positive score an increase in sedentary behavior during the program. As such, a lower delta score will represent higher efficacy. The model will explore whether the delta score was influenced by the students’ characteristics at inclusion, such as gender, age and study year. This model will also explore the influence of periods (periods 1, 2, and 3) and experts. Composite score – Student satisfaction. The mean composite satisfaction score should be equal to or greater than 70 to conclude that the students will be highly satisfied (using a one-sample t -test or Wilcoxon signed-rank test). Similarly, the four scores of satisfactions will be independently explored in order to have a greater insight into the program’s acceptability. Moderators of satisfaction. The model will explore the influence of student characteristics at inclusion, such as gender, age, study year and baseline scores of sedentary time on the composite satisfaction score. This model will also explore the potential influence of the periods and the experts. 7. Dissemination and open science strategies This study adopts citizen science, by co-constructing the research with medical students and health professionals [ 13 ]. The protocol has been pre-registered for transparency and reduce biases. Anonymous data and analysis scripts will be shared for reproducibility, and all materials will be available upon reasonable request for easy replication. Results will be published in open-access journals, presented at scientific congresses, in medical thesis dissertations, and shared with educational committees. 8. Preliminary survey To determine the interest of medical students in the PROMESS program, a survey was administered in June 2023 to all the 535 fourth-year undergraduate medical students of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France). Students answered several questions, including: "How interested are you in following an intervention aiming to improve physical activity: Very interested, interested, moderately interested, not interested, or very not interested?". Fourteen percent of students were not interested at all, and 15% were not interested. Conversely, more than 71% were interested (27% moderately interested, 29% interested, and 15% very interested). These results reinforce the need for the PROMESS-Physical Activity program. Discussion As the decline in medical students’ quality of life becomes increasingly evident throughout their curriculum, it is essential to implement early interventions focusing on various aspects of health prevention (e.g., sleep management, or stress regulation program [ 13 ] [ 46 , 47 ]). The PROMESS-Physical Activity program is designed to help medical students reduce sedentary behavior and maintain adequate levels of physical activity. As such, the results of this upcoming study will offer valuable insights into the program’s efficacy in achieving these goals. Additionally, the study will provide a detailed analysis of the program’s impact on various aspects of sedentary behavior, physical activity and physical fitness, using both self-reported questionnaires and objective accelerometry data. It will also evaluate the student satisfaction and identify potential moderators influencing the program’s efficacy. Collectively, these findings will offer critical insights into whether the PROMESS-Physical Activity program can serve as a sustainable solution for promoting health among medical students. Research implications This study may have several implications for both students and faculties. The direct expectations for students are to decrease their sedentary behavior while maintaining an active behavior however, the program’s impact may also go beyond the study’s aim. Reducing sedentary behavior and increasing physical activity, may improve the student’s quality of life as well as physical and mental health [ 20 , 26 , 29 – 31 , 76 , 77 ]. More specifically, providing advice on active breaks aimed at interrupting prolonged sitting - and replacing it with LPA - may not only reduce total sedentary time, but also positively influence musculoskeletal health, cognitive abilities, mood, and fatigue [ 44 , 78 – 82 ]. Similarly, it may be anticipated that an higher-level MVPA can positively impact student’s mental health [ 77 ]. Indeed, physical activity plays a crucial role in emotional regulation [ 18 , 83 ]. A recent study found that medical students with higher levels of physical activity reported greater well-being right before an academic exam [ 18 ], it may be expected that this positive state of mind is associated with better coping during the exam. Similarly, improved physical activity levels and physical fitness, might contribute to improve academic performance [ 84 – 86 ]. Thus, the PROMESS-Physical activity program could directly enhance academic performance [ 86 ], as well as indirectly, through the improvement of physical fitness and mental health [ 87 , 88 ]. Finally, despite recent efforts to enhance physical activity education in medical curriculum, studies showed that students still feel unprepared to apply their knowledge in a clinical setting and remain unaware of physical activity guidelines [ 89 ]. The PROMESS-Physical Activity program could positively affect students' confidence and knowledge, enabling them to better support their future patients. Additionally, the findings may promote social acceptance of breaking up sitting time and encourage institutions to invest in solutions such as sit-stand desks [ 90 ]. Anticipated limitations and issues This study has anticipated limitations. First, since only 4th and 5th-year undergraduate medical students will be included, the generalization of the following findings to other medical or non-medical students may be limited. We could consider that, depending on the academic schedule or the time of year, such as during internships, sedentary time could decrease and LPA time could increase, or vice versa during exam periods [ 9 , 12 ]. This issue should be mitigated by implementing the PROMESS-Physical Activity program in three distinct periods. Secondly, self-reports of physical activity and sedentary behavior may be subjective to biases, particularly with a tendency to underestimate sedentary time and overestimate physical activity [ 91 ]. Thus, the present combined approach - using both subjective and objective measures - remains necessary. Conclusion The PROMESS-Physical Activity program aims to provide solutions to medical students to reduce their sedentary behavior and increase their levels of physical activity during their curriculum. The results seek to provide valuable insights into the program’s efficacy. If its efficacy is proven, PROMESS- Physical Activity may become an integral and sustainable part of medical education to foster a healthier future for healthcare professionals. Declarations Ethics approval and consent to participate All participants will consent to participate in the study in agreement with the ethical approval of the present study (Institutional Review Board IRB 2023-07-04-01), and all the procedures will be performed in adherence to the Helsinki Declaration. Participants will receive oral and written information and provide written consent before enrollment in the study following sufficient reflection time. SPIRIT recommendations This manuscript follows the SPIRIT recommendation (Additional file 8). Availability of data and materials All materials necessary to perform the PROMESS-Physical Activity program are available from the authors upon reasonable request. The datasets used and analyzed during the following study will be available from the corresponding author upon reasonable request. Consent for publication All authors gave their consent to publish the present article. Competing interests Etienne Gouraud is a research scientist employed by Aminogram SAS, the manufacturer of the bioimpedance device used in this study. The other authors declare that they have no competing interests. Funding This work is financially supported by the contribution of student and campus life of the Claude Bernard University Lyon 1 (Grant number 22CVEC_SAN), This funder has no role in the study design; data collection, analysis, and interpretation; report writing; and the decision to submit the article for publication. Additional funding provided through a grant awarded to BM (ANR-22-CE14-0073). Authors' contributions SS – Conceptualization; Investigation; Methodology; Resources; Project administration; Supervision; Writing- original draft; Writing - review & editing; Contact information for trial. MM – Conceptualization; Investigation; Methodology; Resources; Writing- original draft; Writing - review & editing BM – Conceptualization; Methodology; Resources; Writing - review & editing OL – Conceptualization; Investigation; Methodology; Writing - review & editing MA – Conceptualization; Investigation; Methodology; Writing - review & editing EG – Conceptualization; Methodology; Writing - review & editing AH – Conceptualization; Resources; Writing - review & editing CH – Conceptualization; Methodology; Resources; Writing - review & editing VP – Conceptualization; Methodology; Resources; Supervision; Writing - review & editing GR – Conceptualization; Methodology; Resources; Project administration; Supervision; Writing - review & editing AM – Conceptualization; Investigation; Methodology; Resources; Project administration; Supervision; Writing- original draft; Writing - review & editing Authors' information SS – is a postdoctoral researcher, Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, France; Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France. ORCID: MM – is a postdoctoral fellow, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg. ORCID: https://orcid.org/0000-0003-3010-1788 BM – is an associate professor, Inter-University Laboratory of Human Movement Biology, Université Savoie Mont Blanc, Chambéry, FRANCE. ORCID: https://orcid.org/0000-0002-2872-6423 OL – is a graduate medical student, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France. MA – is a graduate medical student, Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France. EG – is a research scientist employed by Aminogram SAS. ORCID: https://orcid.org/0000-0003-1377-5318 AH – is a medical doctor and the director of the University Health service of Claude Bernard University Lyon 1. CH – is a professor, Laboratoire Interuniversitaire de Biologie de la Motricité, UR7424, Université de Lyon, Villeurbanne, France. ORCID: https://orcid.org/0000-0002-9845-2456 VP – is a professor, Laboratoire Interuniversitaire de Biologie de la Motricité, UR7424, Université de Lyon, Villeurbanne, France. ORCID: https://orcid.org/0000-0003-2057-061X GR – is professor and dean, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France, Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, TRAJECTOIRES, F-69500 Bron, France. ORCID: https://orcid.org/0000-0003-2751-1217 AM – is an associate professor, Movement - Interactions - Performance (MIP, UR 4334), Nantes Université, Nantes, France; and was a postdoctoral researcher at the time of the study, Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, France; Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France. ORCID: https://orcid.org/0009-0006-0876-5325 Acknowledgments We express our gratitude to the members of the University Health Service (Université Claude Bernard Lyon 1) for their participation in the discussions and their insights into the needs of medical students, as well as their understanding of the local university system. We also thank Aya Mekki for her assistance with the preliminary survey. Additionally, we would also like to thank Vincent Bretin and Léo Cadet for their support in the development of the Fitness classes. We would like to thank Mathilde Clabaut and the STAPS department for lending us equipment, without which this project would not have been possible. Their logistical support was greatly appreciated. Lastly, we are grateful to the students and institutional members who believed in our project and helped secure funding (CVEC Université Claude Bernard Lyon 1). References Winpenny EM, Smith M, Penney T, Foubister C, Guagliano JM, Love R, et al. 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The Tridirectional Relationship among Physical Activity, Stress, and Academic Performance in University Students: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18:739. Al-Drees A, Abdulghani H, Irshad M, Baqays AA, Al-Zhrani AA, Alshammari SA, et al. Physical activity and academic achievement among the medical students: A cross-sectional study. Med Teach. 2016;38:S66–72. Alnofaiey YH, Atallah HM, Alrawqi MK, Alghamdi H, Almalki MG, Almaleky JS, et al. Correlation of Physical Activity to Mental Health State and Grade Point Average Among Medical Students in Saudi Arabia: A Cross-Sectional Study. Cureus. 2023;15:e40253. Adedokun CA, Curles WG, DeMaio EL, Asif IM. Analysis of American Medical Students’ Knowledge of Physical Activity Recommendations. Primer Leawood Kan. 2021;5:31. McLachlan ML, Schupack KM, Curry EN, Konwinski BL, Younge TS, Gonzalez CA. Sit-Stand Desks and Physical Self-care Behaviors in a Family Medicine Residency. PRiMER. 2022;6. Nelson MC, Taylor K, Vella CA. Comparison of Self-Reported and Objectively Measured Sedentary Behavior and Physical Activity in Undergraduate Students. Meas Phys Educ Exerc Sci. 2019;23:237–48. Additional Declarations Competing interest reported. Etienne Gouraud is a research scientist employed by Aminogram SAS. The other authors declare that they have no competing interests. Supplementary Files Additionalfile520250812.docx Additionalfile720250812.docx Additionalfile120250812.docx Additionalfile620250812.docx Additionalfile420250812.docx Additionalfile220250812.docx Additionalfile320250812.docx Additionalfile220250812.docx Additionalfile320250812.docx Additionalfile820250812.doc Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7441836","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":509646027,"identity":"74020d40-f012-4ed7-9b4a-5a7347bf38c9","order_by":0,"name":"Sophie 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1","display":"","copyAsset":false,"role":"figure","size":165616,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy Design.\u003c/strong\u003e Seventy undergraduate medical students will be enrolled. First, students will realize baseline measurements. Then, they will be randomized into the control or the interventional group. This clinical trial will specifically focus on the interventional group (n=45). Each student in this group will be randomly assigned to one of the three periods (Period 1, Period 2, or Period 3) to follow a sedentary behavior reduction and physical activity promotion program (i.e., PROMESS-Physical Activity). This program will consist of three sessions, spaced 14 to 21 days apart. The primary outcome will be the evolution of sedentary time assessed through questionnaires (RPAQ, GPAQ) and accelerometry. Secondary outcomes will include other sedentary behaviors, physical fitness, physical activity levels and body composition markers assessed through questionnaires (RPAQ, GPAQ), VAS, accelerometry and bioimpedance analysis. Exploratory outcomes will include the student’s level of satisfaction and the moderators of the program’s efficacy. Abbreviations: GPAQ Global Physical Activity Questionnaire; RPAQ Recent Physical Activity Questionnaire; VAS Visual Analog Scales.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/3691f77b01124c06242c37c7.png"},{"id":95156626,"identity":"704563e4-793a-4d2f-91f3-480809166782","added_by":"auto","created_at":"2025-11-05 01:44:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":136191,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePROMESS-Physical Activity program.\u003c/strong\u003e Prior to the intervention, the sedentary behavior and physical activity levels, body composition markers, and physical fitness will be determined to establish baseline scores. The PROMESS-Physical Activity program will comprise three sessions, spaced 14 to 21 days apart. Each sessions is an individual meeting between a PROMESS-Physical Activity expert and a student. The aim of these sessions is to identify needs regarding sedentary behavior and physical activity in order to set individual goals to reduce sedentary behavior and increase physical activity. Between each session, the students will wear a pedometer and an accelerometer. They also will report their behaviors related to sedentary behavior and physical activity in a diary. Abbreviations: S1, Session 1; S2, Session 2. GPAQ Global Physical Activity Questionnaire; RPAQ Recent Physical Activity Questionnaire.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/f46bec827f8f96bbba221692.png"},{"id":95225922,"identity":"4b581dab-367a-49fc-8525-43a49f8e3d97","added_by":"auto","created_at":"2025-11-05 16:25:46","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":160876,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePROMESS-Physical Activity diary.\u003c/strong\u003e Between the sessions, students will fill out this diary. They will report their physical activity practices (green part) by specifying the type, duration and perceived effort, as well as their number of daily steps. Additionally, they will track their sedentary behavior periods (red part) and indicate whether they take breaks from sedentary activities (green upward arrow) on a daily basis.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/1b9834d1a21efa1793855a23.jpg"},{"id":95226498,"identity":"fdcea566-f01e-4077-923b-9cefd0042181","added_by":"auto","created_at":"2025-11-05 16:31:16","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":127468,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExample of the pedagogical content of the PROMESS-Physical Activity program.\u003c/strong\u003e This figure illustrates an example of the PROMESS-Activity support provided during Session 2. It is structured as a three-part cycle: (1) Sedentary Behavior, (2) Physical Activity, and (3) Physical Fitness. Each part integrates results from baseline questionnaires, accelerometer recordings, or physical fitness tests. Providing and discussing student's scores will help identify their specific needs and allow the expert to determine tailored advice.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/6a056482cbfa710b7252b89e.jpg"},{"id":103049465,"identity":"91964e6e-5708-4207-83b8-8fbdd98cab78","added_by":"auto","created_at":"2026-02-20 07:41:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1719461,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/00be57c5-e4dc-4665-9bf3-780ee9aa0af8.pdf"},{"id":95156622,"identity":"3b5369ab-5da8-47a8-a90c-0ba78c51030b","added_by":"auto","created_at":"2025-11-05 01:44:50","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":37577,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile520250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/93f685b7b263f29b96df73c4.docx"},{"id":95225976,"identity":"884e1d19-328e-4b59-89db-23538e20f0c0","added_by":"auto","created_at":"2025-11-05 16:25:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14125,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile720250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/adb52dceb38414edae7e9b01.docx"},{"id":95225871,"identity":"0d277ec2-5436-4423-b6dd-296d914835a6","added_by":"auto","created_at":"2025-11-05 16:25:40","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19130,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile120250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/7c06486ea9fa34e82f852c54.docx"},{"id":95225367,"identity":"094cddb3-bb29-48f4-b9bc-4fdaa01cc3bd","added_by":"auto","created_at":"2025-11-05 16:24:55","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":23637,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile620250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/6782a53fce01eabc06ab3b43.docx"},{"id":95156636,"identity":"d9a26981-a4d7-41d5-8235-55437988dbe3","added_by":"auto","created_at":"2025-11-05 01:44:51","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":32634,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile420250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/ab5c048582a8977bee501df8.docx"},{"id":95226668,"identity":"9cc1fa3f-f0f2-4788-be52-e53db76529b1","added_by":"auto","created_at":"2025-11-05 16:31:36","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":64973,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile220250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/84de2ec61441736bfc4c28c8.docx"},{"id":95156640,"identity":"63ce9ea9-6b49-4aae-8f9e-ed265804fcf5","added_by":"auto","created_at":"2025-11-05 01:44:51","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":57828,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile320250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/c5732f0cea9e325d68019511.docx"},{"id":95156634,"identity":"7db37dbe-eebe-45fe-a87f-a3df545914c4","added_by":"auto","created_at":"2025-11-05 01:44:51","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":64973,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile220250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/b722d2129e966f7fd6f2abe2.docx"},{"id":95156647,"identity":"cd368b71-dad2-43c6-a06f-7930b2a2bd24","added_by":"auto","created_at":"2025-11-05 01:44:51","extension":"docx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":57828,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile320250812.docx","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/ea549d7f5f097e48a528f330.docx"},{"id":95156653,"identity":"01539978-7c53-41ab-9700-a03f8b233557","added_by":"auto","created_at":"2025-11-05 01:44:51","extension":"doc","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":80384,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile820250812.doc","url":"https://assets-eu.researchsquare.com/files/rs-7441836/v1/1b44fac34205e9f568dd0c48.doc"}],"financialInterests":"Competing interest reported. Etienne Gouraud is a research scientist employed by Aminogram SAS. The other authors declare that they have no competing interests.","formattedTitle":"Reducing Sedentary Behavior and Promoting Physical Activity in Medical Students: Protocol of the PROMESS-Physical Activity Clinical Trial","fulltext":[{"header":"Background","content":"\u003cp\u003eThe transition from high school to university is characterized by major lifestyle changes that may hinder the adoption of healthy behaviors. Accordingly, previous researches have shown that starting university is associated with unhealthy eating, alcohol and drug use, and poor sleep habits [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In addition, major changes are observed in sedentary behavior that refers to any waking activities with very low energy expenditure (mostly involving sitting, reclining, or lying down ; \u0026le;1.5 metabolic equivalents), and in physical activity that refers to any bodily movement produced by skeletal muscles that results in energy expenditure beyond resting levels [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe shift from high school to university life often results in a marked increase in sedentary behavior, coupled with a reduction in physical activity levels [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Castro (2020) show that university students spend more than 7 hours per day doing sedentary activities. In addition, they often struggle to maintain regular physical activity due to lack of time, lack of motivation, and lack of accessible places [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The organization of the academic calendar, along with the characteristics of the university environment, also play a role in reducing engagement in moderate-to-vigorous physical activity (MVPA) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Consequently, physical fitness levels of university students are generally low [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe demanding nature of certain academic programs, particularly those with prolonged and intensive workloads such as medical curricula, places some university students at increased risk for adopting unhealthy behaviors [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Barret (2024) reported that medical students spend over 10 hours a day engaged in sedentary behavior, exceeding largely the thresholds associated with an increased risk of all-cause mortality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, medical students often struggle to maintain regular physical activity due to constraints of time and energy, as well as feelings of guilt of spending time doing something else than studying [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese behaviors heighten the risk of health deterioration, as mounting evidence indicates that excessive sedentary behavior and insufficient physical activity can profoundly impact physical (e.g., cardiovascular disease, hypertension, obesity, musculoskeletal disorders) and mental health (e.g., anxiety, burnout, depression) [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Individuals who spent most of their time sitting have a higher risk of all-cause mortality (HR\u0026thinsp;=\u0026thinsp;1.16; 95% CI:1.11\u0026ndash;1.20) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] (8 hours \u003cem\u003evs\u003c/em\u003e 4 hours ; HR\u0026thinsp;=\u0026thinsp;1.52; 95% CI: 1.13\u0026ndash;2.03) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Moreover, inactive individuals face higher risk of premature death compared to the most active ones (HR\u0026thinsp;=\u0026thinsp;0.27; 95% CI:0.23\u0026ndash;0.32) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and are more prone to mental health issues [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similar deleterious effects can be expected for medical students [\u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In this population, higher sedentary time has been associated with depression and anxiety [29, 30 but see 15]. While lower level of physical activity has been associated with higher levels of stress, burnout, anxiety and with lower levels of quality of life and self-confidence [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e][\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. More precisely, lower levels of MVPA was linked to a higher symptoms of depression, burnout, anxiety and lower happiness in medical students [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo prevent the onset and persistence of these disorders, interventions aimed at reducing sedentary behavior and promoting physical activity should be implemented early in the medical curriculum. To our knowledge, no previous studies have attempted to address the sedentary behavior of medical students and only few studies have implemented physical activity programs [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37 CR38 CR39 CR40\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Among them, Yorks and collaborators investigated the effect of participating in a weekly group fitness class and evidenced that individuals involved in the group experienced less stress and had an enhanced quality of life compared to individuals who exercised alone or did not engage in regular physical activity [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Weight and collaborators also offered medical residents the opportunity to participate in a 12-week physical activity program [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Following the program, students reported an increase in their levels of physical activity and an improvement in their quality of life. However, these programs suffered from a weak adhesion and/or engagement that may stem from a lack of alignment between the explored interventions and the specific needs of medical students.\u003c/p\u003e\u003cp\u003eTo address the needs and constraints of medical students, programs can be collaboratively developed with them and the faculty staff. This process can help to develop attractive and effective physical activity interventions, as it has been previously and successfully realized with other students [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Programs should assist students in implementing habit changes, such as reducing periods of prolonged sedentary behavior, increasing daily step counts [\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] and/or encouraging physical activity practice [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. To increase intention to change, programs should include planning the lifestyle modifications, setting goals, and delivering feedback, encouragement and personalized advice - including insights on individuals\u0026rsquo; own behaviors and characteristics [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs an initial step in this direction, our team involved medical students and faculty staff in the development process of a program entitled Preventive Remediation for Optimal MEdical StudentS (PROMESS)-Physical Activity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The PROMESS-Physical Activity program aims to provide solutions to medical students to reduce their sedentary behavior and increase their levels of physical activity during their curriculum. The program includes multiple one-on-one sessions, in which an expert will provide self-care educational content and individual diagnostics related to sedentary behavior, physical activity and physical fitness. These sessions will also serve as a space for students to share their personal challenges, thereby helping them to better identify their needs. Personalized advice and goal-setting will stem from these discussions.\u003c/p\u003e\n\u003ch3\u003eAims\u003c/h3\u003e\n\u003cp\u003eThe aim of this clinical trial will be to determine the influence of the PROMESS-Physical Activity program on medical students’ sedentary behavior and physical activity levels. The primary outcome will be the change in sedentary time measured through reported (Recent Physical Activity Questionnaire, Global Physical Activity Questionnaire) and objective (accelerometry) measurements. The secondary outcomes will include a detailed characterization of changes in other sedentary behaviors, physical fitness, physical activity levels, and body composition markers, assessed through questionnaires, accelerometry, and bioimpedance analysis. Exploratory outcomes will provide information regarding the student’s level of satisfaction and will determine the moderators of the program’s efficacy. It is expected that sedentary behavior will decrease, while physical activity levels will increase throughout the program. These changes may further contribute to improvements in physical fitness and body composition.\u003c/p\u003e"},{"header":"Methods/Design","content":"\u003ch2\u003e1. Design and setting\u003c/h2\u003e\n\u003cp\u003eThis study is part of a larger randomized controlled trial assessing the effects of a multi-modal health intervention called the PROMESS project [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e]. The project will be presented to all 4th and 5th years undergraduate students of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France) through a lecture, and an informative email will be sent to their university addresses. Volunteer students will be able to register for the project by replying to the email and the first 70 volunteers will be recruited (without monetary compensation). No exclusion criteria will be applied. For the entire PROMESS project, the 70 undergraduate medical students recruited will be randomized into two groups (1:2 ratio): a control group (n\u0026thinsp;=\u0026thinsp;25) and an interventional group (n\u0026thinsp;=\u0026thinsp;45) stratified by gender and study years.\u003c/p\u003e\n\u003cp\u003eThe present clinical trial (PROMESS-Physical Activity) will specifically focus on the interventional group, in which 45 students will undergo a preventive program focused on sedentary behavior reduction and physical activity promotion (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch2\u003e2. Ethic statement\u003c/h2\u003e\n\u003cp\u003eThe research project was approved by the Dean of the faculty (GR), the Lyon University Health Department and a sample of local medical students. All procedures will be performed in adherence to the Helsinki declaration [\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e]. Ethical approval from the Institutional Review Board of the Claude Bernard University Lyon 1 (CUMG, France) has been obtained (IRB 2023070401) and the study has been registered in ClinicalTrials.gov (NCT06297304). Modifications to the protocol that may impact the conduct of the study will require a formal amendment. The participants' anonymity and confidentiality will be ensured and maintained according to laws and regulations. The principal investigator (SS) will provide oral and written information and participants will provide a written consent prior to enrollment following a sufficient reflection time (Additional file 2).\u003c/p\u003e\n\u003ch2\u003e3.\u0026nbsp;Characterization of the population at baseline\u003c/h2\u003e\n\u003cp\u003eBefore the intervention, students enrolled will complete a brief demographic survey, providing information regarding their year of study, age, gender, height, weight, smoking status and any medication use. Baseline sedentary behavior and physical activity levels will be evaluated using validated self-reported questionnaires and objective accelerometry measurements. Combining the results of subjective and objective measurements can provide a more complete assessment of these health behavior patterns in medical students [\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e]. Physical fitness will be assessed through standardized physical tests, while body composition markers will be measured using bioimpedance analysis, as detailed below:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaires\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eRecent Physical Activity Questionnaire.\u003c/span\u003e The RPAQ is an 8-item questionnaire that estimates the individual sedentary behavior over the past four weeks during work, study, transport, home, and leisure. Scores are expressed in hours per day for week and weekend days. A sedentary time inferior to 3 hours per day is considered as low, between 3 and 7 hours as moderate, and superior to 7 hours as high, as defined by French National Observatory for Physical Activity and Sedentary Behavior (ONAPS). In addition, an estimation of the number of floors climbed per day is asked. The French version adapted by the ONAPS will be used [\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eGlobal Physical Activity Questionnaire.\u003c/span\u003e The GPAQ is a 16-item questionnaire designed to access sedentary behavior (1-item, hour:min per day) and physical activity levels over a typical week (15-items) [\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e]. The 15-items evaluate the frequency, duration and intensity of physical activity in three domains: work, transport and leisure. The intensity is expressed in metabolic equivalents of Task (MET); 1 MET corresponds to the energy expended while sitting quietly (approximately 1 kcal/kg/hour). Moderate physical activity is assigned a value of 4 and vigorous physical activity of 8 MET. The total score of physical activity is expressed in MET-min/week. Based on this score, physical activity levels are classified as low (\u0026lt;\u0026thinsp;600), medium (between 600 and 3000), or high (\u0026gt;\u0026thinsp;3000 MET-min/week) [\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e]. The French version of the GPAQ will be used (reliability; ICC\u0026thinsp;=\u0026thinsp;0.37\u0026ndash;0.94, Kappa\u0026thinsp;=\u0026thinsp;0.50\u0026ndash;0.62, validity; r\u0026thinsp;=\u0026thinsp;0.41\u0026ndash;0.86) [\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eAccelerometry records\u003c/h3\u003e\n\u003cp\u003eThe baseline levels of sedentary behavior and physical activity will be monitored for 21 consecutive days using a triaxial accelerometer worn at the non-dominant wrist (GENEActiv, ActivInsights, Kimbolton, UK). The raw tridimensional acceleration will be sampled at 60 Hz with a sensitivity range of \u0026plusmn;\u0026thinsp;8g (g is the Earth\u0026rsquo;s gravity acceleration\u0026thinsp;=\u0026thinsp;9.81 m.s\u003csup\u003e\u0026minus;\u0026thinsp;2\u003c/sup\u003e). Students will be encouraged to wear the device as consistently as possible while maintaining their usual lifestyle habits with the option to remove it when showering, if wearing it could cause injury, or for professional reasons in specific clinical settings. Individuals\u0026rsquo; records will be included in the subsequent analyses if they contain data for at least seven days.\u003c/p\u003e\n\u003cp\u003eThe GENEActiv device is a reliable and valid tool to measure adult sedentary and physical activity behaviors in real-life conditions (ICC\u0026thinsp;=\u0026thinsp;0.68\u0026ndash;0.88; Kappa\u0026thinsp;=\u0026thinsp;0.53) [\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e]. GENEActiv data will be downloaded using GENEActiv PC software (version 4.0.12) and saved in raw format as binary files. Those raw data will be analyzed according to GENEActiv algorithms and open-source methodR-package GGIR [\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e]. The analysis of physical activity intensity will be performed using the Euclidean Norm Minus One (ENMO) signal, expressed in milligravity units, with the following thresholds; sedentary behaviors values\u0026thinsp;\u0026lt;\u0026thinsp;100 mg; light physical activity (LPA) values between 100 and 2020 mg; and moderate-to vigorous physical activity (MVPA) values\u0026thinsp;\u0026gt;\u0026thinsp;2020 mg. The markers used with a brief description are given below.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eTotal sedentary time\u003c/span\u003e (minutes per day). The mean of time spent engaging into a sedentary behavior per day.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eSedentary bouts\u003c/span\u003e (number). The number of prolonged sedentary periods lasting at least 30, 60, and 120 minutes per day - classified as prolonged, extended, and extreme sedentary bouts, respectively [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eLight Physical Activity\u003c/span\u003e (minutes per day). The mean duration spent in LPA per day.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eModerate-to-Vigorous Physical Activity\u003c/span\u003e (minutes per day). The mean duration spent in MVPA per day.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eSteps\u003c/span\u003e (number). The total number of steps per day.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eThe critical Dynamic Body Acceleration\u003c/span\u003e (DBAc; in g). A two-parameter critical intensity model [\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e] will be fitted to the Dynamic Body Acceleration records (from 3 to 30 minutes) using a quantile regression to obtain the asymptote being DBAc. This parameter can be used as a severe intensity domain boundary to discriminate between steady- and non-steady-state metabolic rate activities in daily living (Rozier-Delgado et al. 2025). This method improves the actual intensity classification based on absolute cut-offs that fails to represent the time spent in intensity domains with individual physiological meanings. It also represents a major threshold in exercise physiology: the higher it is, the greater the individual's aerobic fitness.\u003c/p\u003e\n\u003ch3\u003eBody composition markers\u003c/h3\u003e\n\u003cp\u003eAfter measuring weight using an electronic scale (Scale 100, Decathlon, France) and the height, the body mass index (BMI) will be calculated as the weight divided by the square of the height. The students\u0026rsquo; body composition \u0026ndash; including fat-free mass, skeletal muscle mass, fat mass, bone mineral content and fat-free mass hydration \u0026ndash; will be evaluated using bioimpedance analysis measurement (Biody Xpert\u003csup\u003eZM\u003c/sup\u003e 3; Aminogram SAS, La Ciotat, France), according to the manufacturer recommendations. More precisely, students will be seated and holding the device in their hand, with their thumb and fingers placed on the integrated electrodes of the device. Then, they will put two other integrated electrodes on their ankle, just below the malleolus to start the measurement. During the measurement, they will be asked to remain still with a straight back. Resistance, reactance, impedance and phase angle will be obtained at 54 frequencies ranging from 1 kHz to 1000 kHz to evaluate body composition. Additionally, evolution of phase angle at 50 kHz and impedance ratio Z200/Z5, i.e. the ratio between the impedances obtained at 200 kHz (Z200) and at 5 kHz (Z5), will be studied considering their relationship with health status and systemic inflammation [\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eA. Physical fitness\u003c/h3\u003e\n\u003cp\u003eA battery of physical tests will be performed under the supervision of a physical activity instructor, verbal encouragement will be provided to ensure optimal performance [\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e]. The objective of these tests is to provide students with feedback on their level of physical fitness, in order to facilitate the discussion during the PROMESS-Physical Activity sessions.\u003c/p\u003e\n\u003ch3\u003eMaximal Strength\u003c/h3\u003e\n\u003cp\u003eLower limb muscle strength will be assessed using a maximal isometric knee extensors torque test. The student will be seated with his/her hip and knee joints at 90\u0026deg; and his/her arms crossed over their chest. The right upper thigh will be immobilized to the chair to minimize extraneous movement, while the ankle will be attached to a force gauge (DFS II, Chatillon Force Measurement, AMETEK STC, USA) [\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e]. First, the student will perform a warm-up with a 3-second intended extension at 10%, 30%, and 70% of their perceived maximal intensity. Second, two maximal isometric voluntary contractions will be performed during which the student will be instructed to try to extend his/her knee as hard as possible for a 5-s duration [\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e]. The contractions will be separated by a 1-min recovery to prevent muscle fatigue [\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e]. The highest value will be used to determine the student's the maximal isometric strength (in N).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eMaximal Power\u003c/h2\u003e\n\u003cp\u003eThe student will adopt the starting squat position and hold it for 3-sec before realizing a vertical jump, with a 90\u0026deg; knee angle and hands placed at the hip\u0026rsquo;s sides. Two or three warm-up jumps will be completed to ensure familiarization and the absence of countermovement. Upon receiving the start signal, the student will perform two jumps, aiming to reach the maximum height, with a 1-min recovery between each. Jump heights will be recorded using the Optojump system (Microgate Srl, Bolzano, Italy, [\u003cspan class=\"CitationRef\"\u003e63\u003c/span\u003e]). The highest jump value will be used to estimate the peak power, calculated using the following equation: peak power (W)\u0026thinsp;=\u0026thinsp;60.7 \u0026times; (jump height [cm])\u0026thinsp;+\u0026thinsp;45.3 \u0026times; (body mass [kg]) \u0026ndash; 2055 [\u003cspan class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eEndurance\u003c/h3\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eCardiorespiratory fitness.\u003c/span\u003e The shuttle run test (SRT) is a common undirect method to estimate individual cardiorespiratory fitness. In its original version, participants run back and forth between two lines set 20 meters apart, with the running speed gradually increasing; the highest speed (i.e., SRT speed) reached is then used to estimate maximal oxygen uptake (VO\u003csub\u003e2\u003c/sub\u003emax) [\u003cspan class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e66\u003c/span\u003e]. A modified version, called the 10m-SRT, will be used with lines placed 10 meters apart; the running pace will start at 6.5 km/h and increase by 0.5 km/h every minute, guided by an audio signal (Pack Sportbeeper Pro, CE, France) (Additional file 3). The estimated VO\u003csub\u003e2\u003c/sub\u003emax (mL/kg/min) will be determined according to the following equation: VO\u003csub\u003e2\u003c/sub\u003emax\u0026thinsp;=\u0026thinsp;8.0574 * 10m-SRT speed \u0026ndash; 32.64 (Additional file 3).\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eHeart rate recovery.\u003c/span\u003e The heart rate will be monitored during and after the SRT (Polar A200 device connected to a Polar H7 chest strap sensor). The heart rate will be recorded immediately, as well as one and three minutes after stopping. Heart Rate Recovery (HRR, in beats per minute) will be calculated by subtracting the heart rate measured at one minute (HRR1) and three minutes (HRR3) after exercise from the heart rate at the time of stopping (HRS).\u003c/p\u003e\n\u003ch2\u003e4. Intervention\u003c/h2\u003e\n\u003cp\u003eThe PROMESS-Physical Activity program has been developed with inputs from medical students and health professionals [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. It will consist of three sessions, spaced 14 to 21 days apart. Each session will involve an individual meeting between a student and a PROMESS-Physical Activity expert. These sessions will be conducted in three distinct periods, with fifteen different students randomly assigned to one of the periods (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eA. Expert training\u003c/h3\u003e\n\u003cp\u003eMeetings will be conducted by graduate medical students, considered as experienced peers regarding their advancement in the medical curriculum [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. Prior to engaging in the sessions with students, those experienced peers will undergo a thorough training to be considered as experts. This training will involve several key steps, including reading a set of articles outlined in Additional file 4, observing each session at least once to obtain practical insights, and conducting themselves each session at least once, guided by an expert in sport sciences (AM, MM, SS; PhD in sports science). These training steps will be repeated if necessary. This comprehensive training process, which might last approximately 4 days, is designed to ensure that peers will be adequately prepared and proficient to effectively deliver the PROMESS-Physical Activity program.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eB. Overall session organization\u003c/h2\u003e\n\u003cp\u003eEach session will consist of an individual meeting between an undergraduate medical student and a PROMESS-Physical Activity expert (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). To improve the reproducibility of the program, experts will follow a detailed step-by-step procedure for each session.\u003c/p\u003e\n\u003cp\u003eAll sessions will follow a consistent structure. The session will start with a short introduction talk, in which the expert will briefly explain the main steps. Following this, body composition markers will be assessed and the student will be asked to complete questionnaires. The expert will then provide pedagogical content about sedentary behavior, physical activity, and physical fitness, explaining thresholds and their relationships to health. During the meeting, the student will be provided the possibility to discuss his/her habits, allowing both the student and the expert to identify student\u0026rsquo;s needs. Specific advices and goals will be set based on this discussion, partly based on a predefined list of specific guidance (Additional file 5) created during a prior co-construction workshop [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eBetween sessions, students will receive two self-monitoring tools: a pedometer (FitBit Alta HR activity tracker, CA, USA) and a diary (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) to enhance habit awareness. To further support students in achieving their goals, they will be offered the opportunity to participate in weekly group fitness sessions.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eC. Questionnaires\u003c/h2\u003e\n\u003cp\u003eAt the beginning of each session, the student will answer the following Visual Analog Scales (VAS), and complete the GPAQ and RPAQ questionnaires. Each VAS will prompt the student to move a cursor to indicate his/her response on a 100-mm scale [\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e67\u003c/span\u003e]. The cursor will start at the 0 position for each question.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eVAS - sedentary behavior.\u003c/span\u003e The level of perceived sedentary behavior will be assessed by asking: \u0026ldquo;Over the past two weeks, how would you characterize your level of sedentary behavior?\u0026rdquo; ranging from 0 (extremely sedentary) to 100 (not sedentary at all).\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eVAS - physical activity\u003c/span\u003e. The level of perceived physical activity will be assessed by asking \u0026ldquo;Over the past two weeks, how would you characterize your level of physical activity?\u0026rdquo; ranging from 0 (completely inactive) to 100 (extremely active).\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eVAS - physical fitness\u003c/span\u003e. The level of perceived physical fitness will be assessed by asking \u0026ldquo;Over the past two weeks, how would you characterize your level of physical fitness?\u0026rdquo; ranging from 0 (worst shape ever) to 100 (best shape ever).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eD. Session description\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eSession 1 (S1).\u003c/strong\u003e The first session will last approximately 60 minutes (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). This session will begin with a brief presentation of the expert's background as well as with an explanation regarding the confidentiality of the exchanges. Then the following steps will be followed:\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eBody composition markers\u003c/span\u003e. The body composition markers will be assessed as described above.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eSedentary behavior and physical activity\u003c/span\u003e. The student will answer the aforementioned VAS, RPAQ and GPAQ.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003ePedagogical content\u003c/span\u003e. This content, composed of two main sections, will be supported by printed materials. The first section provides definitions of physical activity [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. To encourage interaction and assess baseline knowledge, the expert will first ask students to define physical activity and then will explain the main different type of physical activity: work, transport, domestic activities, and leisure (i.e., physical exercise and sport). The expert will give deeper information on physical exercise by defining aerobic, strength, and flexibility and explaining the concept of physical activity intensity [\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e]. Students will be asked about their knowledge of physical activity recommendations before receiving guidance from the expert (i.e., 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise per week or any combination of both) [\u003cspan class=\"CitationRef\"\u003e68\u003c/span\u003e]. Students will also receive personalized feedback on their baseline physical activity levels (from GPAQ) and their average daily stair climbing (from RPAQ), to encourage individual self-awareness. The second part provides information on sedentary behavior [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. The expert will present the sedentary thresholds and will stress on the deleterious impact of sedentary behavior on health [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e69\u003c/span\u003e]. Students will also receive feedback on their baseline sedentary behaviors (RPAQ scores). Providing and discussing each student's data will help identify their specific needs and allow the expert to dispense tailored advice.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eDiary\u003c/span\u003e. A diary will be given to the student, with instructions to fill it out until the next session (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Each day, the student will report their time spent in sedentary behavior and if he/she has broken sedentary periods (e.g. rising up, doing some steps). They will report their physical activity, briefly describing the type of activity, its duration, and rating the perceived effort on a scale from 1 (very easy) to 5 (exhausting). The diary will enable students to engage in a self-monitoring process, enhancing their awareness and providing an opportunity to reflect on their behaviors. The expert and the student will fill the current day together to provide an example, and objectives will be pre-scheduled in the diary (e.g., participating in the fitness class).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eAdvice\u003c/span\u003e. During the entire session, advice concerning sedentary behavior reduction and physical activity promotion will be provided. Advice will be based on the predetermined list (Additional file 5) [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003ePedometer.\u003c/span\u003e To increase habit awareness and encourage the student to increase their level of physical activity, they will wear a pedometer that displays the number of daily steps (FitBit Alta HR activity tracker, CA, USA), until the next session. Wearing pedometers has been shown to improve physical activity levels, reduce BMI, and enhance cardiovascular fitness [\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e70\u003c/span\u003e]. Students will need to record their daily step counts in their diaries, allowing for a continuous 'self-monitoring' process (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Becoming aware of their daily steps might help them achieve the current guideline of 10,000 steps per day [\u003cspan class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eFitness classes.\u003c/span\u003e Throughout the PROMESS-Physical Activity program, the student will have the opportunity to participate in a one-hour fitness class per week [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. These group sessions, led by certified instructors, will begin with full-body warm-up exercises, followed by either a \u0026lsquo;High-Intensity Interval Training\u0026rsquo; session or an \u0026lsquo;Every Minute on the Minute\u0026rsquo; workout. Each session will conclude with a cool-down phase. The sessions will focus on strength training, cardiorespiratory endurance, mobility, and balance, and will be adapted to offer varying levels of difficulty for each exercise (Additional file 6).\u003c/p\u003e\n\u003cp\u003eAs described for baseline, the students will have to wear an accelerometer between S1 and session 2 (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eIndividual goals\u003c/span\u003e. At the end of the session, the expert will answer all the questions that may arise and will settle the student\u0026rsquo;s goal for the next session. Both the student and the expert will write the goals and sign an agreement, which should promote the student\u0026rsquo;s commitment and motivation [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAt the end of each session, the expert will report the following information on several 5-point Likert scales [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e]:\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eLikert - Expert comfort.\u003c/span\u003e The expert will have to report his/her level of comfort regarding his/her relationship with the student during the session (1: not comfortable at all, 2: slightly comfortable, 3: fairly comfortable, 4: comfortable, 5: very comfortable).\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eLikert - Expert satisfaction.\u003c/span\u003e The expert will have to report his/her level of satisfaction regarding his/her animation of the session (1: not satisfied at all, 2: slightly satisfied, 3: fairly satisfied, 4: satisfied, 5: very satisfied).\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eLikert - Advice given\u003c/span\u003e. Concerning predefined advice, expert will report if he/she: 1) did not mention this during the meeting; 2) mentioned this but did not directly advise it; 3) mentioned this and recommended it; 4) had set this in the goals; 5) performed a positive reinforcement. He/she will also reported any advice given during the session that is not on the predefined list.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSession 2 (S2).\u003c/strong\u003e The second session will last approximately 60 minutes (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e), the following steps will be followed:\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eBody composition markers.\u003c/span\u003e Using the same procedure as described above.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eSedentary behavior and physical activity.\u003c/span\u003e Using the same procedure as described above.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eFeedback on diary\u003c/span\u003e. The diary filled out between S1 and S2 will be discussed. The expert will ask the student regarding the types of physical activity engaged, as well as their frequency, duration and intensity. The discussion will also cover the number of steps taken and how to increase it. Additionally, the expert will support the student in reflecting on their sedentary behavior by identifying periods of prolonged inactivity, analyzing the frequency and nature of sedentary breaks, and exploring strategies to reduce sedentary habits.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eFeedback on S1 goals.\u003c/span\u003e A discussion will help to identify the obstacles to achieve each previously established goal.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003ePedagogical content\u003c/span\u003e. This content is composed of three main sections provides information on students' baseline characteristics (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). The first part provides information on sedentary behavior assessed through accelerometry (hours:min per day) along with the thresholds. The second part provides information on physical activity levels measured through accelerometry (number of daily steps, LPA and MVPA). The third part provides information on physical fitness markers (strength, power and endurance scores), along with a short description of each tests. Students' fitness scores will be discussed in regards to norms and/or recommendations (MIVC strength [\u003cspan class=\"CitationRef\"\u003e72\u003c/span\u003e]; peak power [\u003cspan class=\"CitationRef\"\u003e73\u003c/span\u003e]; VO\u003csub\u003e2\u003c/sub\u003emax [\u003cspan class=\"CitationRef\"\u003e74\u003c/span\u003e]). Comparing students' fitness levels relative to established benchmarks will facilitate the identification of specific areas for improvement and favor dispensation of personalized advice.\u003c/p\u003e\n\u003cp\u003eIn addition, the expert provides information about student\u0026rsquo;s body composition markers at baseline (fat-free mass, fat mass and fat-free mass hydration). The values for each parameter will be examined in relation to normative standards and illustrated through a visual interface provided by the Biody Manager software (2024 \u0026copy; Biody Manager by Aminogram, Version 3.3.1, La Ciotat, France).\u003c/p\u003e\n\u003cp\u003eAs performed in S1, advice will be provided throughout the entire session. The student will receive a new diary, a pedometer and an accelerometer. The expert will address all questions, individual goals will be established and signed.\u003c/p\u003e\n\u003cp\u003eSimilar to S1, at the end of the session, the expert will report his/her level of comfort, satisfaction, rate the predefined advice, and report all the goals established during this session. In addition, the expert will estimate:\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eStudent\u0026rsquo;s goal achievements\u003c/span\u003e. The expert will estimate whether the student has achieved the goals previously set (session 1 goals) on a 4-point Likert scale (i.e., 0: not achieved at all, 1: slightly achieved, 2: fairly well achieved, 3: well achieved).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSession 3 (S3).\u003c/strong\u003e The third session will last approximately 45 minutes, the following steps will be followed:\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eBody markers.\u003c/span\u003e Using the same procedure as described above.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eSedentary behavior and physical activity.\u003c/span\u003e Using the same procedure as described above.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eFeedback on diary\u003c/span\u003e. The sedentary behavior and physical activity diary filled out between S2 and S3 will be discussed as described above.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eFeedback on S2 goals.\u003c/span\u003e Feedback on session 2 goals will be provided as described above.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eFeedback on the achievement.\u003c/span\u003e In order to offer the student a comprehensive overview of his/her achievements across the program, the expert will provide an individualized printed visual summary that will comprise:\u003c/p\u003e\n\u003cp\u003e1) the evolution of sedentary time (hours:min per day) assessed through the RPAQ (baseline, S1, S2, S3) and accelerometry (baseline, between S1 and S2);\u003c/p\u003e\n\u003cp\u003e2) his/her evolution of physical activity assessed through the GPAQ (MVPA at baseline, S1, S2, S3) and accelerometry (numbers of daily steps, LPA and MVPA at baseline and between S1 and S2);\u003c/p\u003e\n\u003cp\u003e3) his/her goals set during the program. Progression will be discussed based on the goals in order to help the student to identify what was effective for him/her. In addition, the student\u0026rsquo;s will be encouraged to proactively determine and report his/her long-term goals on his/her own to enhance autonomy and long-term commitment.\u003c/p\u003e\n\u003cp\u003eAs performed in S1 and S2, advice will be provided throughout the entire session and the expert will address all questions.\u003c/p\u003e\n\u003cp\u003eJust before ending the session, the level of student satisfaction regarding the PROMESS-Physical Activity program will be assessed through the following 100-mm VAS.\u003c/p\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eComposite score - Student's satisfaction.\u003c/span\u003e The student\u0026rsquo;s satisfaction will be measured using a composite score, calculated as the average of a specific and a general scores. The specific score (sedentary behavior, physical activity, physical fitness) will be calculated as the average of the scores obtained at the three VAS ranging from 0 (absolutely not) to 100 (completely): \u0026ldquo;Do you think the intervention has helped you to decrease your sedentary behavior?\u0026rdquo;, \u0026ldquo;Do you think the intervention has helped you to increase your physical activity level?\u0026rdquo; and \u0026ldquo;Do you think the intervention has helped you to increase your physical fitness level?\u0026rdquo;. The general score (relevance and sustainability) will be calculated as the average of the scores obtained at the two VAS ranging from 0 (absolutely not) to 100 (completely): \u0026ldquo;Do you think the proposed goals were suitable for your daily life?\u0026rdquo; and \u0026ldquo;Do you think you can sustain the changes in habits achieved?\u0026rdquo; [\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eFor all scores of student\u0026rsquo;s satisfactions, a score lower than 30 will be considered highly negative, from 30 to 45 negative, from 45 to 55 neutral, from 55 to 70 positive, and equal or above 70 highly positive [\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAt the end, the expert will report his/her level of comfort, satisfaction, rate the predefined advice, report all the goals settled, and estimate whether the student has achieved the goals settled in S2. He/she will report his/her overall level of satisfaction regarding the student's progress during the PROMESS-Physical Activity program (\"Are you satisfied with the student's progress during the whole intervention?\") on a Likert scale ranging from 1 (not satisfied at all) to 5 (very satisfied) [\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eAvailability of the PROMESS-Physical Activity material\u003c/h2\u003e\n\u003cp\u003eAll materials necessary to perform the PROMESS-Physical Activity program are available from the authors upon reasonable request (SS, AM, [email protected] and/or personal mails).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Data management and monitoring\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe principal investigator (SS) will ensure that the protocol and ethical guidelines for data collection and analysis will be followed. She will be responsible for maintaining the anonymity of the included students (participants will be assigned a unique identification code). In addition, the students will receive a letter with information that clarifies how their data will be used regarding the General Data Protection Regulation, including the contact details of the university\u0026rsquo;s data protection officer, as well as the contact of the principal investigator. Students will be informed that if they wish to withdraw, they have to contact SS who will conduct a dropout analysis. All source documents, including written consent and printed materials, will be stored in a secure locker at the RESHAPE Laboratory (INSERM U1290, Universit\u0026eacute; Claude Bernard Lyon 1, Lyon, France) for a five-year period after the last publication of results. Raw data, processed data, and analysis scripts will be stored on a password-protected computer at the RESHAPE laboratory, accessible only to registered investigators (SS, AM). The database preparation and statistical analysis will be conducted anonymously. Since the study involves minimal risk to participants, a Data Monitoring Committee was considered as unnecessary; moreover, the project\u0026rsquo;s approbation by an institutional review board (IRB: 2023070401) affirming adequate monitoring.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6. Data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis will take place once all data have been collected. No interim analyses and stopping guidelines to terminate the study are planned.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analyzed.\u003c/strong\u003e Variables will be expressed as means with standard deviations and ranges, medians with interquartile ranges, or counts and percentages. Data will be analyzed according to the intention-to-treat principle and presented in agreement with international consolidated standards of reporting trials guidelines. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 will be considered statistically significant. All models\u0026rsquo; assumptions will be checked. For linear regressions, the \u0026beta; coefficients with their 95% confidence interval and the adjusted coefficients R\u0026sup2; will be provided. All statistical analysis will be performed using the most recent version of the R software [\u003cspan class=\"CitationRef\"\u003e75\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes.\u003c/strong\u003e The primary outcome will be the change of the sedentary time evaluated by the RPAQ (scores obtained at S1, S2, S3), the GPAQ (scores obtained at S1, S2, S3) and accelerometry (scores obtained at baseline, S1-S2, S2-S3). The secondary outcomes will be the change of other variables assessing sedentary behavior, physical fitness, physical activity levels, or body composition as specified in the Additional file 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA priori-sample size.\u003c/strong\u003e The intended sample size was calculated for the primary outcome (evolution of the sedentary time). Based on an expected medium effect size for repeated measures (f\u0026thinsp;=\u0026thinsp;0.20, \u0026alpha;\u0026thinsp;=\u0026thinsp;5%, power\u0026thinsp;=\u0026thinsp;0.80%, 3 measurements) the calculation resulted in a total sample size of 42 participants (G*Power v3.1.9.6). To prevent probable attrition and/or data losses, 10% additional volunteers will be recruited resulting in a 45 total sample size.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical analysis plan\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eDescriptive variables.\u003c/strong\u003e Characteristics of students at baseline will be described using descriptive statistics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary and secondary outcomes\u003c/strong\u003e. Linear mixed models (with a random effect for participants and experts) will be performed to explore the impact of the PROMESS-Physical Activity program on the primary and secondary outcomes. For secondary outcomes, p-values will be reported both unadjusted and adjusted to account for multiple testing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExploratory outcomes.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModerators of efficacy.\u003c/strong\u003e The program\u0026rsquo;s efficacy will be determined by a delta score on the sedentary time evaluated by accelerometry (S2-S3 score \u003cem\u003eminus\u003c/em\u003e baseline score). A negative delta score will indicate reduced sedentary behavior, a neutral score no change, and a positive score an increase in sedentary behavior during the program. As such, a lower delta score will represent higher efficacy. The model will explore whether the delta score was influenced by the students\u0026rsquo; characteristics at inclusion, such as gender, age and study year. This model will also explore the influence of periods (periods 1, 2, and 3) and experts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComposite score \u0026ndash; Student satisfaction.\u003c/strong\u003e The mean composite satisfaction score should be equal to or greater than 70 to conclude that the students will be highly satisfied (using a one-sample \u003cem\u003et\u003c/em\u003e-test or Wilcoxon signed-rank test). Similarly, the four scores of satisfactions will be independently explored in order to have a greater insight into the program\u0026rsquo;s acceptability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModerators of satisfaction.\u003c/strong\u003e The model will explore the influence of student characteristics at inclusion, such as gender, age, study year and baseline scores of sedentary time on the composite satisfaction score. This model will also explore the potential influence of the periods and the experts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7. Dissemination and open science strategies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adopts citizen science, by co-constructing the research with medical students and health professionals [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. The protocol has been pre-registered for transparency and reduce biases. Anonymous data and analysis scripts will be shared for reproducibility, and all materials will be available upon reasonable request for easy replication. Results will be published in open-access journals, presented at scientific congresses, in medical thesis dissertations, and shared with educational committees.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8. Preliminary survey\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the interest of medical students in the PROMESS program, a survey was administered in June 2023 to all the 535 fourth-year undergraduate medical students of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France). Students answered several questions, including: \"How interested are you in following an intervention aiming to improve physical activity: Very interested, interested, moderately interested, not interested, or very not interested?\". Fourteen percent of students were not interested at all, and 15% were not interested. Conversely, more than 71% were interested (27% moderately interested, 29% interested, and 15% very interested). These results reinforce the need for the PROMESS-Physical Activity program.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs the decline in medical students\u0026rsquo; quality of life becomes increasingly evident throughout their curriculum, it is essential to implement early interventions focusing on various aspects of health prevention (e.g., sleep management, or stress regulation program [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]). The PROMESS-Physical Activity program is designed to help medical students reduce sedentary behavior and maintain adequate levels of physical activity. As such, the results of this upcoming study will offer valuable insights into the program\u0026rsquo;s efficacy in achieving these goals. Additionally, the study will provide a detailed analysis of the program\u0026rsquo;s impact on various aspects of sedentary behavior, physical activity and physical fitness, using both self-reported questionnaires and objective accelerometry data. It will also evaluate the student satisfaction and identify potential moderators influencing the program\u0026rsquo;s efficacy. Collectively, these findings will offer critical insights into whether the PROMESS-Physical Activity program can serve as a sustainable solution for promoting health among medical students.\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eResearch implications\u003c/h2\u003e\u003cp\u003eThis study may have several implications for both students and faculties. The direct expectations for students are to decrease their sedentary behavior while maintaining an active behavior however, the program\u0026rsquo;s impact may also go beyond the study\u0026rsquo;s aim. Reducing sedentary behavior and increasing physical activity, may improve the student\u0026rsquo;s quality of life as well as physical and mental health [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. More specifically, providing advice on active breaks aimed at interrupting prolonged sitting - and replacing it with LPA - may not only reduce total sedentary time, but also positively influence musculoskeletal health, cognitive abilities, mood, and fatigue [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan additionalcitationids=\"CR79 CR80 CR81\" citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]. Similarly, it may be anticipated that an higher-level MVPA can positively impact student\u0026rsquo;s mental health [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. Indeed, physical activity plays a crucial role in emotional regulation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e]. A recent study found that medical students with higher levels of physical activity reported greater well-being right before an academic exam [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], it may be expected that this positive state of mind is associated with better coping during the exam. Similarly, improved physical activity levels and physical fitness, might contribute to improve academic performance [\u003cspan additionalcitationids=\"CR85\" citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e]. Thus, the PROMESS-Physical activity program could directly enhance academic performance [\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e], as well as indirectly, through the improvement of physical fitness and mental health [\u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFinally, despite recent efforts to enhance physical activity education in medical curriculum, studies showed that students still feel unprepared to apply their knowledge in a clinical setting and remain unaware of physical activity guidelines [\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e]. The PROMESS-Physical Activity program could positively affect students' confidence and knowledge, enabling them to better support their future patients. Additionally, the findings may promote social acceptance of breaking up sitting time and encourage institutions to invest in solutions such as sit-stand desks [\u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eAnticipated limitations and issues\u003c/h2\u003e\u003cp\u003eThis study has anticipated limitations. First, since only 4th and 5th-year undergraduate medical students will be included, the generalization of the following findings to other medical or non-medical students may be limited. We could consider that, depending on the academic schedule or the time of year, such as during internships, sedentary time could decrease and LPA time could increase, or \u003cem\u003evice versa\u003c/em\u003e during exam periods [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This issue should be mitigated by implementing the PROMESS-Physical Activity program in three distinct periods. Secondly, self-reports of physical activity and sedentary behavior may be subjective to biases, particularly with a tendency to underestimate sedentary time and overestimate physical activity [\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e]. Thus, the present combined approach - using both subjective and objective measures - remains necessary.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe PROMESS-Physical Activity program aims to provide solutions to medical students to reduce their sedentary behavior and increase their levels of physical activity during their curriculum. The results seek to provide valuable insights into the program\u0026rsquo;s efficacy. If its efficacy is proven, PROMESS- Physical Activity may become an integral and sustainable part of medical education to foster a healthier future for healthcare professionals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants will consent to participate in the study in agreement with the ethical approval of the present study (Institutional Review Board IRB 2023-07-04-01), and all the procedures will be performed in adherence to the Helsinki Declaration. Participants will receive oral and written information and provide written consent before enrollment in the study following sufficient reflection time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPIRIT recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript follows the SPIRIT recommendation (Additional file 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll materials necessary to perform the PROMESS-Physical Activity program are available from the authors upon reasonable request. The datasets used and analyzed during the following study will be available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors gave their consent to publish the present article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEtienne Gouraud is a research scientist employed by Aminogram SAS, the manufacturer of the bioimpedance device used in this study. The other authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is financially supported by the contribution of student and campus life of the Claude Bernard University Lyon 1 (Grant number 22CVEC_SAN), This funder has no role in the study design; data collection, analysis, and interpretation; report writing; and the decision to submit the article for publication. Additional funding provided through a grant awarded to BM (ANR-22-CE14-0073).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSS – Conceptualization; Investigation; Methodology; Resources; Project administration; Supervision; Writing- original draft; Writing - review \u0026amp; editing; Contact information for trial.\u003c/p\u003e\n\u003cp\u003eMM – Conceptualization; Investigation; Methodology; Resources; Writing- original draft; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eBM – Conceptualization; Methodology; Resources; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eOL – Conceptualization; Investigation; Methodology; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eMA – Conceptualization; Investigation; Methodology; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eEG – Conceptualization; Methodology; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eAH – Conceptualization; Resources; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eCH – Conceptualization; Methodology; Resources; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eVP – Conceptualization; Methodology; Resources; Supervision; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eGR – Conceptualization; Methodology; Resources; Project administration; Supervision; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003eAM – Conceptualization; Investigation; Methodology; Resources; Project administration; Supervision; Writing- original draft; Writing - review \u0026amp; editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSS – is a postdoctoral researcher, Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, France; Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France. ORCID: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMM – is a postdoctoral fellow, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg. ORCID: https://orcid.org/0000-0003-3010-1788\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBM – is an associate professor, Inter-University Laboratory of Human Movement Biology, Université Savoie Mont Blanc, Chambéry, FRANCE. ORCID: https://orcid.org/0000-0002-2872-6423\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOL – is a graduate medical student, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.\u003c/p\u003e\n\u003cp\u003eMA – is a graduate medical student, Faculté de Médecine Lyon Sud, Université Claude Bernard Lyon 1, Lyon, France.\u003c/p\u003e\n\u003cp\u003eEG – is a research scientist employed by Aminogram SAS. ORCID: https://orcid.org/0000-0003-1377-5318\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAH – is a medical doctor and the director of the University Health service of Claude Bernard University Lyon 1.\u003c/p\u003e\n\u003cp\u003eCH – is a professor, Laboratoire Interuniversitaire de Biologie de la Motricité, UR7424, Université de Lyon, Villeurbanne, France. ORCID: https://orcid.org/0000-0002-9845-2456\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVP – is a professor, Laboratoire Interuniversitaire de Biologie de la Motricité, UR7424, Université de Lyon, Villeurbanne, France. ORCID: https://orcid.org/0000-0003-2057-061X\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGR – is professor and dean, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France, Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, TRAJECTOIRES, F-69500 Bron, France. ORCID: https://orcid.org/0000-0003-2751-1217\u003c/p\u003e\n\u003cp\u003eAM – is an associate professor, Movement - Interactions - Performance (MIP, UR 4334), Nantes Université, Nantes, France; and was a postdoctoral researcher at the time of the study, Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, France; Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France. ORCID: https://orcid.org/0009-0006-0876-5325\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our gratitude to the members of the University Health Service (Université Claude Bernard Lyon 1) for their participation in the discussions and their insights into the needs of medical students, as well as their understanding of the local university system. We also thank Aya Mekki for her assistance with the preliminary survey. Additionally, we would also like to thank Vincent Bretin and Léo Cadet for their support in the development of the Fitness classes. We would like to thank Mathilde Clabaut and the STAPS department for lending us equipment, without which this project would not have been possible. Their logistical support was greatly appreciated. Lastly, we are grateful to the students and institutional members who believed in our project and helped secure funding (CVEC Université Claude Bernard Lyon 1).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWinpenny EM, Smith M, Penney T, Foubister C, Guagliano JM, Love R, et al. Changes in physical activity, diet, and body weight across the education and employment transitions of early adulthood: A systematic review and meta-analysis. Obes Rev Off J Int Assoc Study Obes. 2020;21:e12962.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWengreen HJ, Moncur C. 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The Short Term Musculoskeletal and Cognitive Effects of Prolonged Sitting During Office Computer Work. Int J Environ Res Public Health. 2018;15:1678.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFalck RS, Davis JC, Liu-Ambrose T. What is the association between sedentary behaviour and cognitive function? A systematic review. Br J Sports Med. 2017;51:800\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWennberg P, Boraxbekk C-J, Wheeler M, Howard B, Dempsey PC, Lambert G, et al. Acute effects of breaking up prolonged sitting on fatigue and cognition: a pilot study. BMJ Open. 2016;6:e009630.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHachenberger J, Teuber Z, Li Y-M, Abkai L, Wild E, Lemola S. Investigating associations between physical activity, stress experience, and affective wellbeing during an examination period using experience sampling and accelerometry. Sci Rep. 2023;13:8808.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCastelli DM, Hillman CH, Buck SM, Erwin HE. Physical fitness and academic achievement in third- and fifth-grade students. J Sport Exerc Psychol. 2007;29:239\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStephens MB, Dong T, Durning SJ. Physical Fitness and Academic Performance: A Pilot Investigation in USU Medical Students. Mil Med. 2015;180 suppl4:77\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWunsch K, Fiedler J, Bachert P, Woll A. The Tridirectional Relationship among Physical Activity, Stress, and Academic Performance in University Students: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18:739.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Drees A, Abdulghani H, Irshad M, Baqays AA, Al-Zhrani AA, Alshammari SA, et al. Physical activity and academic achievement among the medical students: A cross-sectional study. Med Teach. 2016;38:S66\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlnofaiey YH, Atallah HM, Alrawqi MK, Alghamdi H, Almalki MG, Almaleky JS, et al. Correlation of Physical Activity to Mental Health State and Grade Point Average Among Medical Students in Saudi Arabia: A Cross-Sectional Study. Cureus. 2023;15:e40253.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdedokun CA, Curles WG, DeMaio EL, Asif IM. Analysis of American Medical Students\u0026rsquo; Knowledge of Physical Activity Recommendations. Primer Leawood Kan. 2021;5:31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcLachlan ML, Schupack KM, Curry EN, Konwinski BL, Younge TS, Gonzalez CA. Sit-Stand Desks and Physical Self-care Behaviors in a Family Medicine Residency. PRiMER. 2022;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNelson MC, Taylor K, Vella CA. Comparison of Self-Reported and Objectively Measured Sedentary Behavior and Physical Activity in Undergraduate Students. Meas Phys Educ Exerc Sci. 2019;23:237\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Accelerometry, Body composition markers, Curriculum, Medical Students, Peer coaching, Physical fitness, Physical activity, Sedentary behavior, Self-monitoring","lastPublishedDoi":"10.21203/rs.3.rs-7441836/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7441836/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe increase in sedentary behavior, coupled with a decrease in physical activity\u003cstrong\u003e, \u003c/strong\u003eposes a significant health risk. Medical students, in particular, face higher risks due to demanding academic schedules, prolonged sitting, and limited attention to physical activity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The PROMESS-Physical Activity clinical trial aims to support future healthcare professionals by enhancing their abilities to reduce their sedentary behavior and promote their physical activity. The support will be provided through a three-session program. Each session will include an individual meeting between a medical student and a PROMESS-Physical activity expert, during which self-care education, advice, and personalized goals will be established. \u0026nbsp;The present protocol is designed to assess the influence of this program on forty-five undergraduate medical students (4th and 5th-year) of the Lyon-Est Faculty of Medicine (Claude Bernard University Lyon 1, France). Assessments of sedentary behavior and physical activity will be conducted before and during the intervention. At the end of the third session the student’s satisfaction levels regarding the program will be assessed.\u003c/p\u003e\n\u003cp\u003eThe primary will be change in sedentary time estimated through self-reported (questionnaires) and objective (accelerometry) measurements during the program. Secondary outcomes will provide a detailed characterization of changes in other sedentary behaviors, physical activity levels, physical fitness and body composition markers. Exploratory outcomes will provide information regarding the satisfaction and will determine the moderators of the program’s efficacy.\u003c/p\u003e\n\u003cp\u003eData will be analyzed according to the intention-to-treat principle and presented in accordance with the CONSORT Guidelines. Ethical approval has been obtained (IRB: 2023070401). The results from this study will be presented at conferences and in peer-reviewed scientific journals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e Results will provide valuable insights into the program's efficacy. If its efficacy is proven, PROMESS-Physical Activity could become an integral part of medical education, fostering a healthier future for healthcare professionals. This manuscript follows the SPIRIT guidelines (Additional files 1 \u0026amp; 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003eClinicalTrials.gov: NCT06297304; retrospectively registered\u003c/p\u003e","manuscriptTitle":"Reducing Sedentary Behavior and Promoting Physical Activity in Medical Students: Protocol of the PROMESS-Physical Activity Clinical Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-05 01:44:46","doi":"10.21203/rs.3.rs-7441836/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7e2f3f41-d451-49bf-839c-9d1e1543d0e6","owner":[],"postedDate":"November 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T08:26:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-05 01:44:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7441836","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7441836","identity":"rs-7441836","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}