The Relationship Between Physical Activity, Exercise-Related Health Beliefs, Barriers to Exercise and Postural Habits in University Students

The Relationship Between Physical Activity, Exercise-Related Health Beliefs, Barriers to Exercise and Postural Habits in University Students | 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 Research Article The Relationship Between Physical Activity, Exercise-Related Health Beliefs, Barriers to Exercise and Postural Habits in University Students Muhammet ÖZALP This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7687781/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background This study examines whether exercise-related health beliefs, perceived barriers to exercise, and habitual postural behaviors differ across physical activity levels in university students. Understanding these differences can identify behavioral and ergonomic targets for promoting musculoskeletal health and sustaining physical activity. Methods This cross-sectional study included 244 university students from a vocational school in Turkey. Participants were recruited via voluntary in-class announcements. Validated self-report instruments were employed for data collection. Physical activity was measured with the International Physical Activity Questionnaire–Short Form -Short Form, exercise barriers with the Physical Activity Barriers Scale, exercise-related health beliefs with the Health Belief Model Scale for Exercise, and postural status with the Postural Habits and Awareness Scale. Results The 244 participants demonstrated similar distributions of age, gender, body mass index, and height across the different physical activity groups. However, significant differences emerged in personal barriers, total exercise barriers, and persistence and total scores of the Health Belief Model Scale, with students in the high activity group reporting fewer barriers and stronger persistence and belief scores compared to low and moderate groups (p 0.05). Conclusion The study found that more active students held stronger convictions about the benefits of exercise and perceived fewer obstacles to being active. However, postural awareness and habits did not vary significantly with activity level. Physical activity exercise barriers health beliefs posture Introduction University students are at a pivotal stage for establishing lifelong health behaviors; however, research consistently indicates that many fail to meet recommended physical activity (PA) levels and are adopting increasingly sedentary lifestyles ( 1 – 3 ). Evidence from a large survey underscores this issue, finding that although less than 10% of students were considered physically active, a plurality exceeding 40% were classified as extremely sedentary, spending most of their day seated for over six hours ( 1 ). The well-documented benefits of regular PA for university students encompass improved physical health, a reduced risk of chronic diseases, enhanced mental well-being, and superior academic performance( 4 – 6 ). However, student engagement in PA is mediated by a range of factors. Positive health beliefs—such as the perception that exercise improves appearance or reduces stress—can motivate participation, whereas negative perceptions and low self-efficacy often act as deterrents ( 4 , 7 ). Social support, especially from peers and family, also significantly influences the adoption and maintenance of PA habits ( 7 , 8 ). The barriers to PA engagement in the university population are complex and varied. Predominant among these are perceived time constraints from heavy academic workloads, insufficient motivation, inadequate access to recreational facilities, and the absence of social support for exercise( 1 , 9 – 11 ). Evidence from a systematic review indicates that barriers to PA—categorized as psychological (e.g., low motivation), environmental (e.g., lack of accessible facilities), and socioeconomic (e.g., limited financial resources) are common among heterogeneous student populations ( 9 ). Postural habits and PA are closely interrelated. The high prevalence of sedentary activities (e.g., prolonged screen time and studying) correlates with increased risks of musculoskeletal pain and poorer sleep quality( 1 , 2 , 12 ). Students with higher levels of Postural Habits and Awareness Scale (PHAS) typically exhibit healthier postural habits and report a lower incidence of musculoskeletal complaints( 2 , 12 ). Understanding the interplay between PA levels, health beliefs, postural habits, and barriers is essential for developing effective interventions. Research consistently shows that addressing both psychological (e.g., self-efficacy, motivation) and environmental (e.g., facility access, social support) factors is key to promoting active lifestyles and reducing sedentary behavior among university students ( 1 , 4 , 7 – 9 ). This context underscores the importance of investigating these relationships to inform health promotion strategies tailored to the unique needs and challenges of university populations. Materials and methods This research is a descriptive and cross-sectional study conducted among students at Vocational School. The total student population at the school was 550. The required sample size was calculated as 227 using the formula: n= [Nt2pq]/[d2(N-1) + t2 pq], where N = 550, p = 0.5, q = 0.5, d = 0.05 and t = 1.96. A convenience sampling approach was used, where students who met inclusion criteria and were present during classroom announcements were invited to voluntarily participate in the study. A total of 251 students initially agreed, but 7 were excluded based on the exclusion criteria, resulting in a final sample of 244. All university students between the ages of 18 and 25 who volunteered and signed an informed consent form were included in the study. Individuals with a health condition that prevented physical activity, professional athletes, and those who filled out the survey incompletely or invalidly were excluded Ethics This research followed ethical guidelines outlined in the Declaration of Helsinki. The study protocol received approval from Nevşehir Hacı Bektaş Veli University the Scientific Research and Publication Ethics Committee. (Decision #2025.11.306, dated July 30, 2025). All participants provided written informed consent before taking part in the study. Data collection Data were collected through face to face or telephone interviews under the researcher's supervision. Before participating in the study, the purpose and procedures were explained to the participants in detail, and their written or verbal consent was obtained. The interviews were conducted over two weeks at Kozakli Vocational School. Each survey session lasted approximately 10 minutes. International Physical Activity Questionnaire-Short Form (IPAQ-Short Form) It was developed by by Craig et al. in 2003 ( 13 ). The validity and reliability of this instrument for a Turkish population were subsequently established by Sağlam in 2010 ( 14 ). The questionnaire assesses an individual's physical activity over the preceding seven-day period. To quantify activity levels, the Metabolic Equivalent of Task (MET) method was employed. Adhering to the official IPAQ scoring protocol, a total weekly MET-minute score was computed. This was achieved by multiplying the reported frequency (in days per week) and duration (in minutes per day) for each activity category—walking, moderate, and vigorous—by their respective MET values (3.3, 4.0, and 8.0). The sum of these weighted values across all intensity levels yielded the final MET-minutes/week score. Physical Activity Barriers Scale (PABS) The Physical Activity Barriers Scale (PABS) was employed to evaluate participants' perceived barriers to physical activity. Originally developed as a 24-item instrument by Ibrahim et al. (2013) in Malaysia ( 15 ). Turkish adaptation and validation were performed by Yurtçiçek et al. (2018) ( 16 ). Confirmatory analyses upheld a three-factor structure comprising 22 items distributed across the following subscales: personal barriers (14 items), social environment barriers (3 items), and physical environment barriers (5 items). This self-report measure utilizes a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree) and contains no reverse-scored items. Higher total and subscale scores reflect a greater perceived level of barriers. For the Turkish version, the internal consistency reliability, as measured by Cronbach's alpha, was reported as 0.91 for the total scale, 0.88 for the personal barriers subscale, 0.79 for the social environment barriers subscale, and 0.83 for the physical environment barriers subscale. Health Belief Model Scale for Exercise (HBMSE) The Health Belief Model Scale for Exercise (HBMSE), developed by Caz and Paktaş (2023), was used in this study to assess participants' health beliefs regarding exercise ( 17 ). This multidimensional scale comprehensively evaluates core beliefs about the importance of exercise for health, perceptions of its potential benefits, and beliefs concerning personal control over exercise behavior. The reliability of the scale was established through both test-retest and internal consistency analyses. These analyses revealed excellent reliability, with a stability coefficient of 0.852 and a Cronbach's alpha internal consistency coefficient of 0.943. The HBMS comprises three main sub-dimensions: Health Promotion: This sub-dimension measures the belief in exercise's ability to improve and maintain general health. It assesses perceptions of exercise's effectiveness in reducing the risk of chronic disease, improving physical function, increasing energy levels, and enhancing overall quality of life. Cognitive Health: This subscale evaluates beliefs about the effects of exercise on cognitive functions (e.g., memory, attention, and focus) and mood. It encompasses perceived benefits such as reducing stress and anxiety, alleviating symptoms of depression, increasing mental clarity, and improving overall mood. Persistence: This subscale assesses individuals' self-efficacy, motivation, and intention to maintain exercise behavior long-term. It measures the belief in one's ability to adhere to an exercise program, persevere through challenges, and integrate exercise into daily life. Postural Habits and Awareness Scale (PHAS) The Postural Habits and Awareness Scale (PHAS) is a validated instrument created by Bayar et al. (2023) to evaluate healthy adults' self-perceived postural habits and awareness. This 19-item tool employs a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The maximum score for posture habits is 35, and the maximum score for postural awareness is 60, for a total of 95. A high score indicates good posture and awareness. Postural habits items include statements about the individual's preferred posture in daily activities such as standing, sitting, lying, shopping, and carrying certain items. Postural awareness items, on the other hand, include statements regarding subjective conscious awareness of body posture. The scale demonstrates good reliability, with a Cronbach's alpha of 0.73 ( 18 ). Statistical analysis Data analysis was performed using Turcosa Cloud statistical software (Turcosa Ltd. Co., Turkey). The distribution of continuous variables was assessed using histograms, Q-Q plots, and the Shapiro-Wilk test. Since the variables did not show normal distribution, descriptive statistics were presented as median and interquartile range (IQR: 25th–75th percentile). Categorical variables were reported as frequency and percentage. To examine differences in exercise health belief and postural awareness subdimensions across physical activity levels, the Kruskal-Wallis test was used. For variables with significant overall differences, pairwise comparisons were conducted using Dunn’s test with Holm correction. The association between gender and physical activity level was evaluated using the chi-square test. A p-value less than 0.05 was considered statistically significant. Results The analysis included 244 university students (88.9% female, 21.1% maşe: mean age 19 years), categorized into low (36.8%), moderate (39.7%), and high (23.3%) physical activity groups. The groups were demographically similar, with no significant differences in age, weight, height, BMI, or gender distribution (p > 0.05) (Table 1 ). Table 1 Participant Characteristics by Physical Activity Level Variable Total (n = 244) Low PA (n = 90) Moderate PA (n = 97) High PA (n = 57) p-value¹ Age (years) 19( 18 – 20 ) 19( 18 – 20 ) 19( 18 – 20 ) 19(18.5–20.5) 0.479 Weight (kg) 57(50–65) 58(50–65) 56(50–65) 56(52.5–65) 0.780 Height (cm) 163(160–168) 162(159-166.2) 164(160-169.5) 165(160–169) 0.123 Bmi 21.06(19.2–23.4) 21.09(19.3–23.9) 21.04(18.9–23.3) 20.9(19.5–23.3) 0.884 Gender 0.244 Female 217 (88.9%) 84(93.3%) 84(86.5%) 49(85.9%) Male 27 (11.06%) 6(6.6%) 13(13.4%) 8(14.03%) Physical Activity Level Low 90 (36.8%) Moderate 97(39.7%) High 57(23.3%) ¹ p-values calculated using Kruskal-Wallis test for continuous variables and Chi-square test for categorical variables. Significant differences emerged in personal and total barrier scores across activity groups (p < 0.001). Post-hoc analysis showed that highly active students reported notably fewer personal and overall barriers than their less active and moderately active peers (p 0.05) (Table 2 ). Table 2 Comparison of Total and Sub-Dimension Scores of the Physical Activity Barriers Scale Across Physical Activity Levels (Kruskal-Wallis and Dunn-Holm Tests) Physical Activity Barriers Scale Physical Activity Level Mean (IQR:%25–%75) χ² p Significant Pairwise Differences (Dunn) Personal barriers Low (n = 90) 35(28.7–41.2) 23.81 < 0.001 Low - High (p < 0.001) Moderate -High (p < 0.001) Low - Moderate(p = 0.489) Moderate (n = 97) 34(41 − 14) High (n = 57) 28(34 − 14) Social environment barriers Low (n = 90) 8( 6 – 9 ) 0.64 0.726 Not Performed Moderate (n = 97) 7( 6 – 10 ) High (n = 57) 7( 6 – 9 ) Physical environment barriers Low (n = 90) 15( 10 – 18 ) 0.14 0.929 Not Performed Moderate (n = 97) 14( 11 – 17 ) High (n = 57) 15( 10 – 18 ) Total Low (n = 90) 58(47-66.2) 14.38 < 0.001 Low - High (p < 0.001) Moderate -High (p = 0.003) Low - Moderate(p = 0.538) Moderate (n = 97) 57(46.5–66) High (n = 57) 49(40.5–57.5) Significant differences in persistence scores were observed across the physical activity groups (p = 0.003). Post-hoc tests revealed that the high PA group reported significantly higher persistence than both the low and moderate PA groups (p < 0.01). Furthermore, the high PA group also demonstrated significantly higher total scores compared to the low PA group (p = 0.033; pairwise p = 0.043). In contrast, scores for the health promotion and cognitive health sub-dimensions were comparable across all groups (Table 3 ). Table 3 Comparison of Total and Sub-Dimension Scores of the Health Belief Model Scale for Exercise According to Physical Activity Levels (Kruskal-Wallis and Dunn-Holm Tests) Health Belief Model Scale for Exercise Physical Activity Level Mean (IQR:%25–%75) χ² p Significant Pairwise Differences (Dunn) Health Promotion Low (n = 90) 50(41- 54.2) 4.67 0.096 Not Performed Moderate (n = 97) 49(42–54) High (n = 57) 52(45.5–56) Cognitive Health Low (n = 90) 36(31.7–40) 0.97 0.615 Not Performed Moderate (n = 97) 36(33–39) High (n = 57) 36(34.5–36.5) Persistence Low (n = 90) 15( 10 – 18 ) 11.63 0.003 Low - High (p = 0.004) Moderate -High (p = 0.007) Low - Moderate(p = 0.726) Moderate (n = 97) 14( 11 – 17 ) High (n = 57) 15( 10 – 18 ) Total Low (n = 90) 101(91–114) 6.80 0.033 Low - High (p = 0.043) Moderate -High (p = 0.052) Low - Moderate(p = 0.773) Moderate (n = 97) 104(93-113.5) High (n = 57) 108(97.5–121) As shown in Table 4 , no significant differences were observed between PA groups for any postural measure, including habits (p = 0.184), awareness p = 0.068), or total scores (p = 0.393) (Table 4 ). Table 4 Comparison of Total and Sub-Dimension Scores of the Postural Habits and Awareness Scale According to Physical Activity Levels (Kruskal-Wallis) Postural Habits and Awareness Scale Physical Activity Level Mean (IQR:%25–%75) χ² p Postural habits Low (n = 90) 22( 20 – 25 ) 3.38 0.184 Moderate (n = 97) 23( 21 – 25 ) High (n = 57) 24( 21 – 26 ) Postural awareness Low (n = 90) 41.5(37.7–46) 5.36 0.068 Moderate (n = 97) 42(37–46) High (n = 57) 39(34.5–34.5) Total Low (n = 90) 65(58–70) 1.87 0.393 Moderate (n = 97) 65(59–70) High (n = 57) 62(57–69) Discussion The study demonstrated that university students with high levels of PA had significantly lower personal and total barrier scores compared to their low and moderately active counterparts. These findings are largely consistent with the existing literature and underscore the determinant role of individual barriers in the participation of university students in PA. Numerous studies indicate that students with low levels of PA perceive a greater number of barriers, particularly a lack of motivation, time constraints, unwillingness, and other personal factors ( 9 , 19 – 21 ). For instance, a systematic review identified 'lack of time,' 'lack of motivation,' and 'lack of adequate facilities' as the most frequently reported barriers among university students ( 9 ). Similarly, it has been demonstrated that students with high activity levels perceive fewer personal barriers and exhibit more autonomous forms of motivation ( 21 , 22 ). The absence of a significant difference in social and physical environmental barriers between the groups in your study is consistent with certain findings in the literature. Several studies indicate that social and environmental barriers (e.g., lack of facilities, insufficient social support) are perceived similarly across all activity levels, suggesting that the key differentiating factor ultimately manifests in the realm of personal barriers ( 20 , 21 ). It has been suggested that external barriers, particularly those pertaining to the social environment and access to facilities, may exert a similar level of influence on all students within the university setting ( 9 , 20 ). These findings suggest that interventions aimed at enhancing motivational and time management skills at the individual level may be a priority for increasing physical activity participation among university students( 19 , 22 ). Furthermore, the fact that social and environmental barriers are perceived similarly across all groups suggests that improvements in these areas could potentially benefit the broader student population. In this study, the finding that students with high levels of PA had significantly higher total HBMSE scores compared to their low-level counterparts indicates that health beliefs related to exercise are directly associated with physical activity behavior. Since the scale's total score holistically reflects individuals' multidimensional belief components such as perceived benefits of exercise, self-efficacy, barrier management, and maintenance tendencies this finding demonstrates that a higher activity level in university students coincides with stronger health beliefs. Previous studies have similarly reported significant relationships between exercise health belief model framework and levels of physical activity. For instance, Sheng et al. (2023) demonstrated that exercise health belief model scale scores were positively associated with physical activity among Chinese university students, noting that self-efficacy and perceived benefits, in particular, strengthened this relationship( 23 ). Studies utilizing the HBMSE scale developed by Wu et al. (2020) have also emphasized the predictive power of the total score for physical activity participation ( 24 ). This consistency indicates that the current findings align with the international literature. This difference observed in the total score indicates that a holistic set of positive exercise beliefs comprising perceived benefits, self-efficacy, barrier management, and maintenance tendencies supports physical activity behavior. As noted in the literature, students with a stronger multidimensional health belief profile, rather than strength in just a single belief dimension, are more likely to be physically active ( 25 ). From a practical standpoint, the findings indicate that interventions aimed at increasing physical activity should not solely focus on the transmission of information but should also prioritize strengthening students' health beliefs regarding exercise. The literature has reported that health belief-based interventions are particularly effective in enhancing self-efficacy and supporting individuals' determination to maintain exercise ( 26 ). Furthermore, recent studies have demonstrated that a holistic approach to health belief model constructs (perceived benefits, perceived barriers, self-efficacy, and cues to action) significantly improves not only knowledge levels but also behavioral outcomes ( 27 ). Accordingly, it is recommended that programs targeting the improvement of physical activity levels among university students be designed to holistically develop the various dimensions of health beliefs. The present study found no evidence of differential postural habits, awareness, or overall posture scores among individuals with varying PA levels. This suggests that elevated PA, in isolation, is not a reliable predictor of superior postural behavior or consciousness. Posture is inherently multifactorial, determined by a complex confluence of musculoskeletal, behavioral, and psychosocial determinants, and therefore cannot be attributed to activity levels alone. Evidence suggests that the relationship between physical activity and posture is limited. Salsali and colleagues' (2023) meta-analysis identified merely a weak correlation (C = 0.100; 95% CI = 0.012–0.186), concluding that posture is multifactorial and influenced predominantly by biopsychosocial elements beyond PA ( 28 ). Similarly, Tezcan et al. (2023) reported weak but positive correlations between PA levels and postural habits (r = 0.145), and between postural habits and postural awareness (r = 0.124), suggesting that while PA may slightly support better postural habits, the effect is small ( 29 ).This is supported by findings from de Assis et al. (2021), which, despite noting an effect of activity on posture, found no significant difference in postural habits across activity levels, highlighting the critical contribution of other behavioral and contextual factors( 30 ). Consequently, these results imply that elements other than physical activity—including entrenched behavioral patterns, ergonomic awareness, habitual postural practices, and environmental settings likely play a more pivotal role in determining postural habits and awareness. Limitations Several limitations should be acknowledged. First, the cross-sectional nature of the study inhibits causal inference regarding the associations among physical activity, exercise beliefs, barriers, and posture. Second, the exclusive use of self-report measures carries the risk of biases, such as social desirability. Third, the recruitment of a convenience sample from a single vocational school in Turkey constrains the external validity of the results, limiting their applicability to broader populations, diverse age groups, or different cultural settings. Future Directions Future research should employ longitudinal or intervention-based designs to elucidate how changes in physical activity levels influence exercise-related beliefs, perceived barriers, and postural habits over time. Incorporating objective measures—such as accelerometers for physical activity and biomechanical assessments for posture—would significantly enhance the accuracy of the data. Furthermore, investigating the role of ergonomic education, sedentary behavior, and digital device usage alongside physical activity could yield a more comprehensive understanding of the factors shaping musculoskeletal health in young adults. Finally, expanding recruitment to include diverse educational and cultural contexts would improve the generalizability of the findings. Conclusion The findings demonstrate that higher PA levels among university students are associated with more robust exercise-related health beliefs and reduced perception of barriers, highlighting the centrality of psychosocial determinants in adherence to active lifestyles. Conversely, postural behaviors and awareness were independent of activity level, indicating that posture is governed by distinct mechanisms. This dissociation suggests that effective interventions for musculoskeletal health must be dual-focused: concurrently encouraging physical activity to foster positive health beliefs and delivering targeted education on posture and ergonomics. Ultimately, mitigating sedentary lifestyles and modifying habitual and environmental factors are critical components of a comprehensive strategy for sustainable musculoskeletal health. Abbreviations PA: Physical activity IPAQ: International Physical Activity Questionnaire MET: Metabolic Equivalent of Task PABS: Physical Activity Barriers Scale HBMSE: Health Belief Model Scale for Exercise PHAS : Postural Habits and Awareness Scale Declarations Ethics approval and consent to participate Ethical approval was sought and obtained on 30/07/2025 from the relevant institutional ethics committee (Protocol number: 2025.11.306.). All participants provided informed consent before participating in the study. Data were collected during face-to-face interviews led by the researcher. Consent for publication Not applicable. Availability of data and materials The data presented in this study are available from the corresponding author upon request. Competing interests The author declares that there is no conflict of interest. Funding No financial support was received for this study. Authors' contributions The author contributed to all aspects of this work, including the conception and design of the study, data collection and analysis, interpretation of results, and drafting of the manuscript. The author has approved the final version of the manuscript and is accountable for all aspects of the work. Acknowledgement The author thanks the students who participated in this study. References García-Lorenzo E, Visos-Varela I, Pintos-Rodríguez S, Salgado-Barreira A, Corral-Varela M, Figueiras-Guzmán A, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7687781","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532289110,"identity":"e075e30f-46cd-4e7a-b324-61cc34bc6304","order_by":0,"name":"Muhammet ÖZALP","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIie3PMUvDQBTA8ZNAupzcegWpX+GJIIJ+mBwOWTxpcckYl3Yw4ia46Fe4IKS4XThsB8+94Rah4OSQsUOhvaSISxIcHe4/hEfIj5eHkMv1P9uT9hHs5mgzgHqA007zS6T2jgF5FaF/JPnYY6ImqJ0Qoj7V6FJdkYd3tiy1H057929iNaSITG6DJtKPZ6AeM3VNDX8BGWH+mii/SOyPUf0hmgjkMaj9TLHY8IxKTblYXPgLbAnYuZGoXlmTZ8Onq3wMIVhSrLvIDO+2CLvFnh8EFTFdW/oJHtpbQpbaW6jW8khodWIOgOK2WwiZp8tRdsaeDE/LKJKHML/5Kr7X5wMyuWskVV7jW9z2eTtxuVwu109bX9dxuXY8gvcAAAAASUVORK5CYII=","orcid":"","institution":"Kozakli Vocational School, Nevsehir Haci Bektas Veli University","correspondingAuthor":true,"prefix":"","firstName":"Muhammet","middleName":"","lastName":"ÖZALP","suffix":""}],"badges":[],"createdAt":"2025-09-23 02:08:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7687781/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7687781/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94227505,"identity":"8c390613-f75b-4c7b-b573-2e8e654c21ef","added_by":"auto","created_at":"2025-10-23 20:12:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93861,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7687781/v1/4bee07532915741805cb6f66.docx"},{"id":94227643,"identity":"daeb557a-995f-4549-8144-e713fec19b77","added_by":"auto","created_at":"2025-10-23 20:20:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23391,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7687781/v1/797c476898782f40e11889b7.docx"},{"id":94227502,"identity":"a24bb00b-8d7b-46b5-a6ea-bf708ab1ae53","added_by":"auto","created_at":"2025-10-23 20:12:46","extension":"json","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3827,"visible":true,"origin":"","legend":"","description":"","filename":"dacbef7ca5ab49438aa29edb0392fb7a.json","url":"https://assets-eu.researchsquare.com/files/rs-7687781/v1/f077fee2eb7f851c82a599da.json"},{"id":94227640,"identity":"e3337d0f-2622-4bb5-9452-eddfb5b2a206","added_by":"auto","created_at":"2025-10-23 20:20:46","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92065,"visible":true,"origin":"","legend":"","description":"","filename":"dacbef7ca5ab49438aa29edb0392fb7a1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7687781/v1/2658efa8dd1666fa9d51e28a.xml"},{"id":94227952,"identity":"4edc3237-881c-4c15-b9d0-64b50cabd27c","added_by":"auto","created_at":"2025-10-23 20:28:46","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92145,"visible":true,"origin":"","legend":"","description":"","filename":"dacbef7ca5ab49438aa29edb0392fb7a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7687781/v1/9656d900c62b82338ffde64b.xml"},{"id":94227506,"identity":"698b9213-72a7-44c0-a99b-3263ef715d3c","added_by":"auto","created_at":"2025-10-23 20:12:46","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99455,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7687781/v1/bc18f3330066a6b4ae50bfcf.html"},{"id":94228121,"identity":"6799be4a-4401-42f2-a694-af42303ee002","added_by":"auto","created_at":"2025-10-23 20:36:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":705073,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7687781/v1/a252238d-8f90-436c-94eb-f2b8b796e099.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship Between Physical Activity, Exercise-Related Health Beliefs, Barriers to Exercise and Postural Habits in University Students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUniversity students are at a pivotal stage for establishing lifelong health behaviors; however, research consistently indicates that many fail to meet recommended physical activity (PA) levels and are adopting increasingly sedentary lifestyles (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Evidence from a large survey underscores this issue, finding that although less than 10% of students were considered physically active, a plurality exceeding 40% were classified as extremely sedentary, spending most of their day seated for over six hours (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe well-documented benefits of regular PA for university students encompass improved physical health, a reduced risk of chronic diseases, enhanced mental well-being, and superior academic performance(\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, student engagement in PA is mediated by a range of factors. Positive health beliefs\u0026mdash;such as the perception that exercise improves appearance or reduces stress\u0026mdash;can motivate participation, whereas negative perceptions and low self-efficacy often act as deterrents (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Social support, especially from peers and family, also significantly influences the adoption and maintenance of PA habits (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe barriers to PA engagement in the university population are complex and varied. Predominant among these are perceived time constraints from heavy academic workloads, insufficient motivation, inadequate access to recreational facilities, and the absence of social support for exercise(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Evidence from a systematic review indicates that barriers to PA\u0026mdash;categorized as psychological (e.g., low motivation), environmental (e.g., lack of accessible facilities), and socioeconomic (e.g., limited financial resources) are common among heterogeneous student populations (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePostural habits and PA are closely interrelated. The high prevalence of sedentary activities (e.g., prolonged screen time and studying) correlates with increased risks of musculoskeletal pain and poorer sleep quality(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Students with higher levels of Postural Habits and Awareness Scale (PHAS) typically exhibit healthier postural habits and report a lower incidence of musculoskeletal complaints(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUnderstanding the interplay between PA levels, health beliefs, postural habits, and barriers is essential for developing effective interventions. Research consistently shows that addressing both psychological (e.g., self-efficacy, motivation) and environmental (e.g., facility access, social support) factors is key to promoting active lifestyles and reducing sedentary behavior among university students (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis context underscores the importance of investigating these relationships to inform health promotion strategies tailored to the unique needs and challenges of university populations.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis research is a descriptive and cross-sectional study conducted among students at Vocational School. The total student population at the school was 550. The required sample size was calculated as 227 using the formula: n= [Nt2pq]/[d2(N-1)\u0026thinsp;+\u0026thinsp;t2 pq], where N\u0026thinsp;=\u0026thinsp;550, p\u0026thinsp;=\u0026thinsp;0.5, q\u0026thinsp;=\u0026thinsp;0.5, d\u0026thinsp;=\u0026thinsp;0.05 and t\u0026thinsp;=\u0026thinsp;1.96.\u003c/p\u003e\u003cp\u003eA convenience sampling approach was used, where students who met inclusion criteria and were present during classroom announcements were invited to voluntarily participate in the study. A total of 251 students initially agreed, but 7 were excluded based on the exclusion criteria, resulting in a final sample of 244.\u003c/p\u003e\u003cp\u003e All university students between the ages of 18 and 25 who volunteered and signed an informed consent form were included in the study. Individuals with a health condition that prevented physical activity, professional athletes, and those who filled out the survey incompletely or invalidly were excluded\u003c/p\u003e\u003cp\u003eEthics\u003c/p\u003e\u003cp\u003e This research followed ethical guidelines outlined in the Declaration of Helsinki. The study protocol received approval from Nevşehir Hacı Bektaş Veli University the Scientific Research and Publication Ethics Committee. (Decision #2025.11.306, dated July 30, 2025). All participants provided written informed consent before taking part in the study.\u003c/p\u003e\u003cp\u003eData collection\u003c/p\u003e\u003cp\u003eData were collected through face to face or telephone interviews under the researcher's supervision. Before participating in the study, the purpose and procedures were explained to the participants in detail, and their written or verbal consent was obtained. The interviews were conducted over two weeks at Kozakli Vocational School. Each survey session lasted approximately 10 minutes.\u003c/p\u003e\u003cp\u003eInternational Physical Activity Questionnaire-Short Form (IPAQ-Short Form)\u003c/p\u003e\u003cp\u003eIt was developed by by Craig et al. in 2003 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The validity and reliability of this instrument for a Turkish population were subsequently established by Sağlam in 2010 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The questionnaire assesses an individual's physical activity over the preceding seven-day period. To quantify activity levels, the Metabolic Equivalent of Task (MET) method was employed. Adhering to the official IPAQ scoring protocol, a total weekly MET-minute score was computed. This was achieved by multiplying the reported frequency (in days per week) and duration (in minutes per day) for each activity category\u0026mdash;walking, moderate, and vigorous\u0026mdash;by their respective MET values (3.3, 4.0, and 8.0). The sum of these weighted values across all intensity levels yielded the final MET-minutes/week score.\u003c/p\u003e\u003cp\u003ePhysical Activity Barriers Scale (PABS)\u003c/p\u003e\u003cp\u003eThe Physical Activity Barriers Scale (PABS) was employed to evaluate participants' perceived barriers to physical activity. Originally developed as a 24-item instrument by Ibrahim et al. (2013) in Malaysia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Turkish adaptation and validation were performed by Yurt\u0026ccedil;i\u0026ccedil;ek et al. (2018) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Confirmatory analyses upheld a three-factor structure comprising 22 items distributed across the following subscales: personal barriers (14 items), social environment barriers (3 items), and physical environment barriers (5 items).\u003c/p\u003e\u003cp\u003eThis self-report measure utilizes a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree) and contains no reverse-scored items. Higher total and subscale scores reflect a greater perceived level of barriers. For the Turkish version, the internal consistency reliability, as measured by Cronbach's alpha, was reported as 0.91 for the total scale, 0.88 for the personal barriers subscale, 0.79 for the social environment barriers subscale, and 0.83 for the physical environment barriers subscale.\u003c/p\u003e\u003cp\u003eHealth Belief Model Scale for Exercise (HBMSE)\u003c/p\u003e\u003cp\u003eThe Health Belief Model Scale for Exercise (HBMSE), developed by Caz and Paktaş (2023), was used in this study to assess participants' health beliefs regarding exercise (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This multidimensional scale comprehensively evaluates core beliefs about the importance of exercise for health, perceptions of its potential benefits, and beliefs concerning personal control over exercise behavior. The reliability of the scale was established through both test-retest and internal consistency analyses. These analyses revealed excellent reliability, with a stability coefficient of 0.852 and a Cronbach's alpha internal consistency coefficient of 0.943.\u003c/p\u003e\u003cp\u003eThe HBMS comprises three main sub-dimensions:\u003c/p\u003e\u003cp\u003eHealth Promotion: This sub-dimension measures the belief in exercise's ability to improve and maintain general health. It assesses perceptions of exercise's effectiveness in reducing the risk of chronic disease, improving physical function, increasing energy levels, and enhancing overall quality of life.\u003c/p\u003e\u003cp\u003eCognitive Health: This subscale evaluates beliefs about the effects of exercise on cognitive functions (e.g., memory, attention, and focus) and mood. It encompasses perceived benefits such as reducing stress and anxiety, alleviating symptoms of depression, increasing mental clarity, and improving overall mood.\u003c/p\u003e\u003cp\u003ePersistence: This subscale assesses individuals' self-efficacy, motivation, and intention to maintain exercise behavior long-term. It measures the belief in one's ability to adhere to an exercise program, persevere through challenges, and integrate exercise into daily life.\u003c/p\u003e\u003cp\u003ePostural Habits and Awareness Scale (PHAS)\u003c/p\u003e\u003cp\u003eThe Postural Habits and Awareness Scale (PHAS) is a validated instrument created by Bayar et al. (2023) to evaluate healthy adults' self-perceived postural habits and awareness. This 19-item tool employs a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The maximum score for posture habits is 35, and the maximum score for postural awareness is 60, for a total of 95. A high score indicates good posture and awareness. Postural habits items include statements about the individual's preferred posture in daily activities such as standing, sitting, lying, shopping, and carrying certain items. Postural awareness items, on the other hand, include statements regarding subjective conscious awareness of body posture. The scale demonstrates good reliability, with a Cronbach's alpha of 0.73 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData analysis was performed using Turcosa Cloud statistical software (Turcosa Ltd. Co., Turkey). The distribution of continuous variables was assessed using histograms, Q-Q plots, and the Shapiro-Wilk test. Since the variables did not show normal distribution, descriptive statistics were presented as median and interquartile range (IQR: 25th\u0026ndash;75th percentile). Categorical variables were reported as frequency and percentage. To examine differences in exercise health belief and postural awareness subdimensions across physical activity levels, the Kruskal-Wallis test was used. For variables with significant overall differences, pairwise comparisons were conducted using Dunn\u0026rsquo;s test with Holm correction. The association between gender and physical activity level was evaluated using the chi-square test. A p-value less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe analysis included 244 university students (88.9% female, 21.1% maşe: mean age 19 years), categorized into low (36.8%), moderate (39.7%), and high (23.3%) physical activity groups. The groups were demographically similar, with no significant differences in age, weight, height, BMI, or gender distribution (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant Characteristics by Physical Activity Level\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;244)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLow PA\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003ePA (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003cp\u003ePA (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u0026sup1;\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19(18.5\u0026ndash;20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.479\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57(50\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58(50\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56(50\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56(52.5\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.780\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e163(160\u0026ndash;168)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162(159-166.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e164(160-169.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e165(160\u0026ndash;169)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.123\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBmi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.06(19.2\u0026ndash;23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.09(19.3\u0026ndash;23.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.04(18.9\u0026ndash;23.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.9(19.5\u0026ndash;23.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.884\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.244\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e217 (88.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84(93.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84(86.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49(85.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (11.06%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(6.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(13.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(14.03%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical Activity Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (36.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97(39.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57(23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026sup1; p-values calculated using Kruskal-Wallis test for continuous variables and Chi-square test for categorical variables.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSignificant differences emerged in personal and total barrier scores across activity groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Post-hoc analysis showed that highly active students reported notably fewer personal and overall barriers than their less active and moderately active peers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, barriers related to the social or physical environment did not differ between groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Total and Sub-Dimension Scores of the Physical Activity Barriers Scale Across Physical Activity Levels (Kruskal-Wallis and Dunn-Holm Tests)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical Activity Barriers Scale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical Activity Level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003cp\u003e(IQR:%25\u0026ndash;%75)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSignificant Pairwise Differences (Dunn)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePersonal barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(28.7\u0026ndash;41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e23.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLow - High (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003cp\u003eModerate -High (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003cp\u003eLow - Moderate(p\u0026thinsp;=\u0026thinsp;0.489)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(41\u0026thinsp;\u0026minus;\u0026thinsp;14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(34\u0026thinsp;\u0026minus;\u0026thinsp;14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSocial environment barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNot Performed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePhysical environment barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.929\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNot Performed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58(47-66.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e14.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLow - High (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003cp\u003eModerate -High (p\u0026thinsp;=\u0026thinsp;0.003)\u003c/p\u003e\u003cp\u003eLow - Moderate(p\u0026thinsp;=\u0026thinsp;0.538)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57(46.5\u0026ndash;66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49(40.5\u0026ndash;57.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSignificant differences in persistence scores were observed across the physical activity groups (p\u0026thinsp;=\u0026thinsp;0.003). Post-hoc tests revealed that the high PA group reported significantly higher persistence than both the low and moderate PA groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Furthermore, the high PA group also demonstrated significantly higher total scores compared to the low PA group (p\u0026thinsp;=\u0026thinsp;0.033; pairwise p\u0026thinsp;=\u0026thinsp;0.043). In contrast, scores for the health promotion and cognitive health sub-dimensions were comparable across all groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Total and Sub-Dimension Scores of the Health Belief Model Scale for Exercise According to Physical Activity Levels (Kruskal-Wallis and Dunn-Holm Tests)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Belief Model Scale for Exercise\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical Activity Level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003cp\u003e(IQR:%25\u0026ndash;%75)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSignificant Pairwise Differences (Dunn)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHealth Promotion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(41- 54.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNot Performed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49(42\u0026ndash;54)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52(45.5\u0026ndash;56)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCognitive Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(31.7\u0026ndash;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNot Performed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(33\u0026ndash;39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(34.5\u0026ndash;36.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePersistence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e11.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLow - High \u0026nbsp;(p\u0026thinsp;=\u0026thinsp;0.004)\u003c/p\u003e\u003cp\u003eModerate -High (p\u0026thinsp;=\u0026thinsp;0.007)\u003c/p\u003e\u003cp\u003eLow - Moderate(p\u0026thinsp;=\u0026thinsp;0.726)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15(\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e101(91\u0026ndash;114)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e6.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLow - High (p\u0026thinsp;=\u0026thinsp;0.043)\u003c/p\u003e\u003cp\u003eModerate -High (p\u0026thinsp;=\u0026thinsp;0.052)\u003c/p\u003e\u003cp\u003eLow - Moderate(p\u0026thinsp;=\u0026thinsp;0.773)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e104(93-113.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108(97.5\u0026ndash;121)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, no significant differences were observed between PA groups for any postural measure, including habits (p\u0026thinsp;=\u0026thinsp;0.184), awareness p\u0026thinsp;=\u0026thinsp;0.068), or total scores (p\u0026thinsp;=\u0026thinsp;0.393) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Total and Sub-Dimension Scores of the Postural Habits and Awareness Scale According to Physical Activity Levels (Kruskal-Wallis)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostural Habits and Awareness Scale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical Activity Level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003cp\u003e(IQR:%25\u0026ndash;%75)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePostural habits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(\u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(\u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePostural awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.5(37.7\u0026ndash;46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e5.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42(37\u0026ndash;46)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39(34.5\u0026ndash;34.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65(58\u0026ndash;70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.393\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65(59\u0026ndash;70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62(57\u0026ndash;69)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study demonstrated that university students with high levels of PA had significantly lower personal and total barrier scores compared to their low and moderately active counterparts. These findings are largely consistent with the existing literature and underscore the determinant role of individual barriers in the participation of university students in PA. Numerous studies indicate that students with low levels of PA perceive a greater number of barriers, particularly a lack of motivation, time constraints, unwillingness, and other personal factors (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). For instance, a systematic review identified 'lack of time,' 'lack of motivation,' and 'lack of adequate facilities' as the most frequently reported barriers among university students (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similarly, it has been demonstrated that students with high activity levels perceive fewer personal barriers and exhibit more autonomous forms of motivation (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The absence of a significant difference in social and physical environmental barriers between the groups in your study is consistent with certain findings in the literature. Several studies indicate that social and environmental barriers (e.g., lack of facilities, insufficient social support) are perceived similarly across all activity levels, suggesting that the key differentiating factor ultimately manifests in the realm of personal barriers (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). It has been suggested that external barriers, particularly those pertaining to the social environment and access to facilities, may exert a similar level of influence on all students within the university setting (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). These findings suggest that interventions aimed at enhancing motivational and time management skills at the individual level may be a priority for increasing physical activity participation among university students(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Furthermore, the fact that social and environmental barriers are perceived similarly across all groups suggests that improvements in these areas could potentially benefit the broader student population.\u003c/p\u003e\u003cp\u003eIn this study, the finding that students with high levels of PA had significantly higher total HBMSE scores compared to their low-level counterparts indicates that health beliefs related to exercise are directly associated with physical activity behavior. Since the scale's total score holistically reflects individuals' multidimensional belief components such as perceived benefits of exercise, self-efficacy, barrier management, and maintenance tendencies this finding demonstrates that a higher activity level in university students coincides with stronger health beliefs. Previous studies have similarly reported significant relationships between exercise health belief model framework and levels of physical activity. For instance, Sheng et al. (2023) demonstrated that exercise health belief model scale scores were positively associated with physical activity among Chinese university students, noting that self-efficacy and perceived benefits, in particular, strengthened this relationship(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Studies utilizing the HBMSE scale developed by Wu et al. (2020) have also emphasized the predictive power of the total score for physical activity participation (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This consistency indicates that the current findings align with the international literature. This difference observed in the total score indicates that a holistic set of positive exercise beliefs comprising perceived benefits, self-efficacy, barrier management, and maintenance tendencies supports physical activity behavior. As noted in the literature, students with a stronger multidimensional health belief profile, rather than strength in just a single belief dimension, are more likely to be physically active (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). From a practical standpoint, the findings indicate that interventions aimed at increasing physical activity should not solely focus on the transmission of information but should also prioritize strengthening students' health beliefs regarding exercise. The literature has reported that health belief-based interventions are particularly effective in enhancing self-efficacy and supporting individuals' determination to maintain exercise (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Furthermore, recent studies have demonstrated that a holistic approach to health belief model constructs (perceived benefits, perceived barriers, self-efficacy, and cues to action) significantly improves not only knowledge levels but also behavioral outcomes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Accordingly, it is recommended that programs targeting the improvement of physical activity levels among university students be designed to holistically develop the various dimensions of health beliefs.\u003c/p\u003e\u003cp\u003eThe present study found no evidence of differential postural habits, awareness, or overall posture scores among individuals with varying PA levels. This suggests that elevated PA, in isolation, is not a reliable predictor of superior postural behavior or consciousness. Posture is inherently multifactorial, determined by a complex confluence of musculoskeletal, behavioral, and psychosocial determinants, and therefore cannot be attributed to activity levels alone. Evidence suggests that the relationship between physical activity and posture is limited. Salsali and colleagues' (2023) meta-analysis identified merely a weak correlation (C\u0026thinsp;=\u0026thinsp;0.100; 95% CI\u0026thinsp;=\u0026thinsp;0.012\u0026ndash;0.186), concluding that posture is multifactorial and influenced predominantly by biopsychosocial elements beyond PA (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Similarly, Tezcan et al. (2023) reported weak but positive correlations between PA levels and postural habits (r\u0026thinsp;=\u0026thinsp;0.145), and between postural habits and postural awareness (r\u0026thinsp;=\u0026thinsp;0.124), suggesting that while PA may slightly support better postural habits, the effect is small (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).This is supported by findings from de Assis et al. (2021), which, despite noting an effect of activity on posture, found no significant difference in postural habits across activity levels, highlighting the critical contribution of other behavioral and contextual factors(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Consequently, these results imply that elements other than physical activity\u0026mdash;including entrenched behavioral patterns, ergonomic awareness, habitual postural practices, and environmental settings likely play a more pivotal role in determining postural habits and awareness.\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eSeveral limitations should be acknowledged. First, the cross-sectional nature of the study inhibits causal inference regarding the associations among physical activity, exercise beliefs, barriers, and posture. Second, the exclusive use of self-report measures carries the risk of biases, such as social desirability. Third, the recruitment of a convenience sample from a single vocational school in Turkey constrains the external validity of the results, limiting their applicability to broader populations, diverse age groups, or different cultural settings.\u003c/p\u003e\u003cp\u003eFuture Directions\u003c/p\u003e\u003cp\u003eFuture research should employ longitudinal or intervention-based designs to elucidate how changes in physical activity levels influence exercise-related beliefs, perceived barriers, and postural habits over time. Incorporating objective measures\u0026mdash;such as accelerometers for physical activity and biomechanical assessments for posture\u0026mdash;would significantly enhance the accuracy of the data. Furthermore, investigating the role of ergonomic education, sedentary behavior, and digital device usage alongside physical activity could yield a more comprehensive understanding of the factors shaping musculoskeletal health in young adults. Finally, expanding recruitment to include diverse educational and cultural contexts would improve the generalizability of the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings demonstrate that higher PA levels among university students are associated with more robust exercise-related health beliefs and reduced perception of barriers, highlighting the centrality of psychosocial determinants in adherence to active lifestyles. Conversely, postural behaviors and awareness were independent of activity level, indicating that posture is governed by distinct mechanisms. This dissociation suggests that effective interventions for musculoskeletal health must be dual-focused: concurrently encouraging physical activity to foster positive health beliefs and delivering targeted education on posture and ergonomics. Ultimately, mitigating sedentary lifestyles and modifying habitual and environmental factors are critical components of a comprehensive strategy for sustainable musculoskeletal health.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePA: Physical activity\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIPAQ: International Physical Activity Questionnaire\u003c/p\u003e\n\u003cp\u003eMET: Metabolic Equivalent of Task\u003c/p\u003e\n\u003cp\u003ePABS: Physical Activity Barriers Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHBMSE: Health Belief Model Scale for Exercise\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePHAS : Postural Habits and Awareness Scale\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was sought and obtained on 30/07/2025 from the relevant institutional ethics committee (Protocol number: 2025.11.306.). All participants provided informed consent before participating in the study. Data were collected during face-to-face interviews led by the researcher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented in this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo financial support was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author contributed to all aspects of this work, including the conception and design of the study, data collection and analysis, interpretation of results, and drafting of the manuscript. The author has approved the final version of the manuscript and is accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author thanks the students who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGarc\u0026iacute;a-Lorenzo E, Visos-Varela I, Pintos-Rodr\u0026iacute;guez S, Salgado-Barreira A, Corral-Varela M, Figueiras-Guzm\u0026aacute;n A, et al. Physical activity and sedentarism among university students: an approach using a real-life survey. The European Journal of Public Health. 2024;34.\u003c/li\u003e\n\u003cli\u003eLenkov\u0026aacute; R, \u0026Scaron;krečkov\u0026aacute; G, Luk\u0026aacute;čov\u0026aacute; E. Level of physical activity among university students. Education and New Developments 2024 \u0026ndash; Volume 1. 2024.\u003c/li\u003e\n\u003cli\u003eClemente F, Nikolaidis P, Martins F, Mendes R. Physical Activity Patterns in University Students: Do They Follow the Public Health Guidelines? PLoS ONE. 2016;11.\u003c/li\u003e\n\u003cli\u003eAlkhawaldeh A, Abdalrahim A, Albashtawy M, Ayed A, Omari OA, Albashtawy Sd, et al. University Students\u0026rsquo; Physical Activity: Perceived Barriers and Benefits to Physical Activity and Its Contributing Factors. SAGE Open Nursing. 2024;10.\u003c/li\u003e\n\u003cli\u003eHerbert C. Enhancing Mental Health, Well-Being and Active Lifestyles of University Students by Means of Physical Activity and Exercise Research Programs. Frontiers in Public Health. 2022;10.\u003c/li\u003e\n\u003cli\u003eNiu X. Physical Exercise on the Physical and Mental Health of Obese University Students. American Journal of Health Behavior. 2024.\u003c/li\u003e\n\u003cli\u003eSheng J, Gong L, Zhou J. Exercise health belief model mediates the relationship between physical activity and peer support among Chinese college students: A cross-sectional survey. Frontiers in Psychology. 2023;14.\u003c/li\u003e\n\u003cli\u003eCarballo-Fazanes A, Rico-D\u0026iacute;az J, Barcala-Furelos R, Rey E, Rodr\u0026iacute;guez-Fern\u0026aacute;ndez J, Varela-Casal C, Abelairas‐G\u0026oacute;mez C. Physical Activity Habits and Determinants, Sedentary Behaviour and Lifestyle in University Students. International Journal of Environmental Research and Public Health. 2020;17.\u003c/li\u003e\n\u003cli\u003eSilva RMF, Mendon\u0026ccedil;a C, Azevedo VD, Memon AR, Noll P, Noll M. Barriers to high school and university students\u0026rsquo; physical activity: A systematic review. PLoS ONE. 2022;17.\u003c/li\u003e\n\u003cli\u003eArzu D, Tuzun E, Eker L. Perceived barriers to physical activity in university students. Journal of sports science \u0026amp; medicine. 2006;5 4:615-20.\u003c/li\u003e\n\u003cli\u003eJajat, Sultoni K, Suherman A. Barriers to Physical Activity on University Student. IOP Conference Series: Materials Science and Engineering. 2017;180.\u003c/li\u003e\n\u003cli\u003eGrasdalsmoen M, Engdahl B, Fjeld M, Steingr\u0026iacute;msd\u0026oacute;ttir \u0026Oacute;, Nielsen C, Eriksen H, et al. Physical exercise and chronic pain in university students. PLoS ONE. 2020;15.\u003c/li\u003e\n\u003cli\u003eCraig CL, Marshall AL, Sj\u0026ouml;str\u0026ouml;m M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-95.\u003c/li\u003e\n\u003cli\u003eSaglam M, Arikan H, Savci S, Inal-Ince D, Bosnak-Guclu M, Karabulut E, Tokgozoglu L. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111(1):278-84.\u003c/li\u003e\n\u003cli\u003eIbrahim S, Karim NA, Oon NL, Ngah WZ. Perceived physical activity barriers related to body weight status and sociodemographic factors among Malaysian men in Klang Valley. BMC Public Health. 2013;13:275.\u003c/li\u003e\n\u003cli\u003eYurtcicek Eren S. FİZİKSEL AKTİVİTE ENGELLERİ \u0026Ouml;L\u0026Ccedil;EĞİ\u0026apos;NİN T\u0026Uuml;RK\u0026Ccedil;E FORMUNUN GE\u0026Ccedil;ERLİK VE G\u0026Uuml;VENİRLİK \u0026Ccedil;ALIŞMASI. the Journal of Academic Social Sciences. 2018;71:396-404.\u003c/li\u003e\n\u003cli\u003eCaz \u0026Ccedil;, PaktaŞ Y, Yazıcı \u0026Ouml;. Egzersize Y\u0026ouml;nelik Sağlık İnan\u0026ccedil;ları Tutum \u0026Ouml;l\u0026ccedil;eğinin Ge\u0026ccedil;erlik ve G\u0026uuml;venirlik \u0026Ccedil;alışmasıThe Validity and Reliability Study of the Health Belief Model Scale for Exercises (HBS-E). Ege \u0026Uuml;niversitesi Hemşirelik Fak\u0026uuml;ltesi Dergisi. 2023;39.\u003c/li\u003e\n\u003cli\u003eBayar B, G\u0026uuml;p AA, \u0026Ouml;zen Oruk D, İpek Dongaz \u0026Ouml;, Doğu E, Bayar K. Development of the postural habits and awareness scale: a reliability and validity study. Int J Occup Saf Ergon. 2023;29(2):815-20.\u003c/li\u003e\n\u003cli\u003eSilva RMF, Terra LF, Fernandes M, Noll P, Abreu L, Noll M. Barriers to Physical Activity among Full-Time Students: A Case Study during the COVID-19 Pandemic. Sustainability. 2022.\u003c/li\u003e\n\u003cli\u003eKgokong D, Parker R. Physical activity in physiotherapy students: Levels of physical activity and perceived benefits and barriers to exercise. The South African Journal of Physiotherapy. 2020;76.\u003c/li\u003e\n\u003cli\u003eFinley J-C. Perceptions of Barriers Distinguish Young College Students Who Have Higher or Lower Physical Activity Levels. The New School psychology bulletin. 2019;16:39-54.\u003c/li\u003e\n\u003cli\u003eSevil J, Pr\u0026aacute;xedes A, Abarca-Sos A, Del Villar F, Garc\u0026iacute;a-Gonz\u0026aacute;lez L. Levels of physical activity, motivation and barriers to participation in university students. The Journal of sports medicine and physical fitness. 2016;56 10:1239-48.\u003c/li\u003e\n\u003cli\u003eSheng J, Gong L, Zhou J. Exercise health belief model mediates the relationship between physical activity and peer support among Chinese college students: A cross-sectional survey. Front Psychol. 2023;14:1103109.\u003c/li\u003e\n\u003cli\u003eWu S, Feng X, Sun X. Development and evaluation of the health belief model scale for exercise. International Journal of Nursing Sciences. 2020;7:S23-S30.\u003c/li\u003e\n\u003cli\u003eGong L, Sheng J. The Current Health Belief of Exercise Conditions of Chinese College Students and Ways of Improvements: An Analysis Based on the Health Belief Model. Front Psychol. 2022;13:906297.\u003c/li\u003e\n\u003cli\u003eKhodaveisi M, Azizpour B, Jadidi A, Mohammadi Y. Education based on the health belief model to improve the level of physical activity. Phys Act Nutr. 2021;25(4):17-23.\u003c/li\u003e\n\u003cli\u003eFaghih M, Kaveh MH, Nazari M, Khademi K, Hasanzadeh J. Effect of health belief model-based training and social support on the physical activity of overweight middle-aged women: a randomized controlled trial. Front Public Health. 2024;12:1250152.\u003c/li\u003e\n\u003cli\u003eSalsali M, Sheikhhoseini R, Sayyadi P, Hides JA, Dadfar M, Piri H. Association between physical activity and body posture: a systematic review and meta-analysis. BMC Public Health. 2023;23(1):1670.\u003c/li\u003e\n\u003cli\u003eTezcan S, Nemati F, Deniz B. Investigation of Postural Habit, Postural Awareness and Physical Activity Levels of Physiotherapy Students. Experimental and Applied Medical Science. 2025;6(2):195-205.\u003c/li\u003e\n\u003cli\u003ede Assis SJC, Sanchis GJB, de Souza CG, Roncalli AG. Influence of physical activity and postural habits in schoolchildren with scoliosis. Arch Public Health. 2021;79(1):63.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Physical activity, exercise barriers, health beliefs, posture","lastPublishedDoi":"10.21203/rs.3.rs-7687781/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7687781/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study examines whether exercise-related health beliefs, perceived barriers to exercise, and habitual postural behaviors differ across physical activity levels in university students. Understanding these differences can identify behavioral and ergonomic targets for promoting musculoskeletal health and sustaining physical activity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study included 244 university students from a vocational school in Turkey. Participants were recruited via voluntary in-class announcements. Validated self-report instruments were employed for data collection. Physical activity was measured with the International Physical Activity Questionnaire–Short Form -Short Form, exercise barriers with the Physical Activity Barriers Scale, exercise-related health beliefs with the Health Belief Model Scale for Exercise, and postural status with the Postural Habits and Awareness Scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 244 participants demonstrated similar distributions of age, gender, body mass index, and height across the different physical activity groups. However, significant differences emerged in personal barriers, total exercise barriers, and persistence and total scores of the Health Belief Model Scale, with students in the high activity group reporting fewer barriers and stronger persistence and belief scores compared to low and moderate groups (p \u0026lt; 0.05). No significant differences were observed in postural habits and awareness (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found that more active students held stronger convictions about the benefits of exercise and perceived fewer obstacles to being active. However, postural awareness and habits did not vary significantly with activity level.\u003c/p\u003e","manuscriptTitle":"The Relationship Between Physical Activity, Exercise-Related Health Beliefs, Barriers to Exercise and Postural Habits in University Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 20:12:42","doi":"10.21203/rs.3.rs-7687781/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-12T21:04:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105093625581524574013086097300736889459","date":"2025-10-12T13:49:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-10T11:44:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-09T11:50:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-24T13:21:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-24T13:19:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-09-22T19:56:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"90e3e3a7-a478-4de8-b7de-213962a72e05","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T20:12:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 20:12:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7687781","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7687781","identity":"rs-7687781","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}