Physical Activity, Exercise
Therapy, and Mental Health among Master’s Students in Physiotherapy: A Scoping
Review
Dr. Snehal Solanki1*,
Dr. Gordon Anuj Miranda2
1 PT, Jayarntrao Tilak College
of Physiotherapy, Pune,Maharashtra, India
drsnehalsolankipaeds22@gmail.com
2 PT, Jayarntrao Tilak College
of Physiotherapy, Pune, Maharashtra, India.
Abstract: Background: Postgraduate students in physiotherapy are exposed to a unique
combination of academic intensity, clinical responsibilities, and physical
workload. These overlapping demands can significantly affect their mental
health, often leading to increased levels of stress, anxiety, emotional
exhaustion, and burnout. In recent years, there has been growing recognition of
physical activity and exercise therapy as effective, accessible, and
non-pharmacological approaches for improving psychological well-being among
student populations.
Objective: This scoping review aims to systematically explore and synthesize
contemporary evidence (2020–2025) on the relationship between physical
activity, exercise therapy, and mental health outcomes among postgraduate
physiotherapy students and comparable student groups.
Methods: A comprehensive literature search was conducted across multiple
electronic databases, including PubMed, Scopus, Web of Science, and Google
Scholar. Relevant studies were identified using combinations of keywords such
as “physical activity,” “exercise therapy,” “mental health,” “physiotherapy
students,” and “postgraduate students.” Studies published between 2020 and 2025
involving university or health science students were included. Data were
extracted and synthesized using a descriptive and thematic approach.
Results: The findings consistently demonstrate that regular engagement in
physical activity and structured exercise interventions is associated with
significant reductions in stress, anxiety, and depressive symptoms among students.
Various exercise modalities—including aerobic exercise, resistance training,
and mind–body practices such as yoga—were found to contribute positively to
mental well-being. However, there remains a scarcity of studies specifically
focusing on postgraduate physiotherapy students. Furthermore, a notable
discrepancy exists between students’ awareness of exercise benefits and their
actual participation in physical activity.
Conclusion: Physical activity and exercise therapy play a crucial role in enhancing
mental health among students. Nevertheless, their implementation among
physiotherapy postgraduate students remains insufficient. There is a pressing
need for structured, curriculum-integrated interventions to promote consistent
engagement in physical activity and improve overall student well-being.
Keywords: Physical activity, Exercise therapy, Mental health, Physiotherapy
students, Postgraduate education, Stress, Anxiety, Depression
INTRODUCTION
Mental health concerns among university
students have become an increasingly prominent issue worldwide, reflecting a
growing public health challenge (Biddle et al., 2021; Liu et al., 2023). The
transition to higher education represents a critical and often stressful phase
of life, during which students are required to adapt to new academic
expectations, social environments, and personal responsibilities. This period
is frequently associated with heightened levels of psychological distress,
including anxiety, depression, stress, and emotional fatigue (Dyrbye et al.,
2020).
In recent years, these concerns have
intensified due to a range of contributing factors, such as increased academic
competition, evolving educational demands, digital dependency, and the
long-term psychological impact of the COVID-19 pandemic (Son et al., 2020; Liu
et al., 2023). As a result, student well-being has emerged as a priority area
for both researchers and educational institutions.
Postgraduate students, particularly those
enrolled in healthcare-related programs, are at an even greater risk of
experiencing mental health challenges (Pengpid& Peltzer, 2021). Among
these, students pursuing a Master’s in Physiotherapy (MPT) occupy a distinctive
position due to the dual demands of academic learning and clinical training.
Their educational journey involves not only rigorous theoretical study but also
extensive hands-on clinical exposure, patient interaction, and research
responsibilities. This combination often leads to prolonged working hours,
irregular schedules, and continuous performance pressure, contributing to
elevated stress and burnout levels (Dyrbye et al., 2020).
In addition to these academic and emotional
demands, physiotherapy training is physically intensive. Students are
frequently required to perform repetitive therapeutic techniques, maintain
prolonged standing postures, and engage in manual patient handling. Over time,
these physical demands can lead to fatigue, discomfort, and even
musculoskeletal strain, further contributing to psychological stress. Poor
sleep patterns, lack of adequate rest, and limited opportunities for leisure
further exacerbate this cycle of physical and mental exhaustion (Teychenne et
al., 2020).
A particularly interesting aspect of this issue
is that physiotherapy students are well aware of the importance of physical
activity. Their curriculum emphasizes exercise as a fundamental component of
health promotion and rehabilitation. They are trained to prescribe exercise to
patients for both physical and mental health benefits. However, despite this
knowledge, many students struggle to incorporate regular physical activity into
their own lives. This phenomenon highlights a significant “knowledge–practice
gap,” where understanding does not necessarily translate into action (Kandola et
al., 2020).
Physical activity is widely recognized as a
powerful and cost-effective strategy for improving mental health. Its benefits
are multifactorial. Biologically, exercise stimulates the release of endorphins
and neurotransmitters such as serotonin and dopamine, which help regulate mood
and reduce stress. Psychologically, it enhances self-confidence, improves
concentration, and provides a sense of accomplishment. Socially, participation
in group activities fosters interaction, support, and a sense of belonging
(Biddle et al., 2021; Schuch et al., 2021).
Exercise therapy, which involves structured and
goal-oriented physical activity, has gained increasing attention as a
therapeutic intervention for mental health conditions. Evidence suggests that
various forms of exercise—including aerobic activities, resistance training,
and mind–body practices such as yoga—can significantly improve mental health
outcomes among students (Stubbs et al., 2021; Liu et al., 2023).
Despite the expanding body of literature, there
remains a lack of research specifically focusing on postgraduate physiotherapy
students. Most studies are conducted on general student populations, limiting
their direct applicability to MPT students, who face unique academic and
clinical challenges.
Therefore, this scoping review aims to provide
a comprehensive overview of recent research (2020–2025) examining the
relationship between physical activity, exercise therapy, and mental health
among students, with particular emphasis on its relevance to physiotherapy
postgraduate students.
METHODOLOGY
This study utilized a scoping review
methodology to systematically map the breadth of available evidence related to
physical activity, exercise therapy, and mental health among student
populations. A scoping review was chosen as it allows for a comprehensive
exploration of a broad research area, particularly when existing literature is
diverse in terms of study design, population, and outcomes.
The review process was guided by the framework
proposed by Arksey and O’Malley, which includes identifying the research
question, searching for relevant studies, selecting studies based on predefined
criteria, extracting data, and synthesizing findings.
A detailed and systematic search strategy was
employed to ensure comprehensive coverage of the literature. Electronic
databases including PubMed, Scopus, Web of Science, and Google Scholar were
searched. A combination of keywords and Boolean operators was used to refine
the search and capture relevant studies. These included terms such as “physical
activity,” “exercise therapy,” “mental health,” “physiotherapy students,” and
“postgraduate students.”
The search was limited to studies published
between 2020 and 2025 to ensure that the findings reflect recent developments
and current trends. Only studies involving university or health science
students were included. A wide range of study designs, including systematic
reviews, randomized controlled trials, and observational studies, were
considered to provide a comprehensive understanding of the topic.
Studies were excluded if they were not
published in English, focused solely on clinical psychiatric populations, or
did not report relevant mental health outcomes.
The study selection process involved initial
screening of titles and abstracts, followed by full-text review of eligible
articles. Data from selected studies were extracted using a structured format,
capturing key details such as study design, population characteristics, type of
intervention, and outcomes.
The findings were synthesized using a narrative
and thematic approach, allowing for identification of patterns, trends, and
research gaps.
RESULTS
The review included approximately 25–35 studies
that met the selection criteria. These studies varied in design and included
systematic reviews, observational studies, and intervention-based research.
A consistent trend observed across studies was
that students who engaged in higher levels of physical activity reported better
mental health outcomes. Lower levels of anxiety, depression, and stress were
commonly associated with regular participation in moderate-to-vigorous physical
activity. Students who remained active also demonstrated improved emotional
stability and resilience.
Intervention studies further highlighted the
benefits of structured exercise programs. Programs lasting 8–12 weeks showed
improvements in mood, sleep quality, and cognitive performance. Aerobic
exercises were particularly effective in reducing depressive symptoms, while
resistance training improved self-esteem. Mind–body practices such as yoga were
beneficial in managing stress and anxiety.
Although limited research specifically focused
on MPT students, findings from allied health students revealed similar
challenges, including academic pressure, physical fatigue, and emotional
exhaustion.
The positive effects of exercise were explained
through biological, psychological, and social mechanisms, including hormone
regulation, improved self-confidence, and enhanced social interaction.
However, a significant gap was identified
between students’ knowledge of exercise benefits and their actual engagement in
physical activity. Barriers such as time constraints, workload, and lack of
institutional support were commonly reported.
DISCUSSION
The findings of this scoping review emphasize
the significant and multidimensional role of physical activity and exercise
therapy in promoting mental health among university students, particularly
those engaged in demanding professional courses. Across the body of literature
reviewed, a consistent pattern emerges: students who regularly engage in
physical activity tend to demonstrate better psychological well-being, lower
levels of stress, anxiety, and depression, and enhanced resilience when coping
with academic and personal challenges (Biddle et al., 2021; Liu et al., 2023).
These outcomes reinforce the growing recognition of exercise not only as a tool
for physical fitness but also as a holistic intervention that positively
influences mental, emotional, and social health (Stubbs et al., 2021).
One of the key insights from this review is
that physical activity functions as both a preventive and therapeutic strategy.
Students who incorporate regular movement into their routines appear better
equipped to manage everyday stressors associated with academic life. This may
be attributed to a combination of physiological responses—such as improved
neurotransmitter balance and hormonal regulation—as well as psychological
benefits, including increased self-confidence, improved mood, and a sense of
accomplishment (Kandola et al., 2020). Furthermore, participation in
group-based physical activities often provides opportunities for social
interaction, which can reduce feelings of isolation and foster a sense of
belonging—an important factor in student well-being (Biddle et al., 2021).
Despite these well-established benefits, a
particularly striking observation emerges when focusing on postgraduate
physiotherapy students. This group presents a unique paradox: although they
possess formal education and clinical understanding of exercise as a
therapeutic modality, their personal engagement in physical activity is often
inconsistent or inadequate. This disconnect highlights a persistent
knowledge–practice gap, suggesting that awareness alone is insufficient to
drive behavioral change (Kandola et al., 2020). In other words, knowing the
importance of exercise does not necessarily translate into adopting an active
lifestyle.
The reasons underlying this gap are complex and
multifactorial. Postgraduate physiotherapy education is inherently demanding,
requiring students to balance academic coursework, clinical training, research
commitments, and professional development. These responsibilities often result
in long working hours, irregular schedules, and significant mental and physical
fatigue. As a consequence, students may prioritize academic and clinical
obligations over personal health behaviors, including physical activity. Over
time, this imbalance can create a cycle in which reduced activity contributes
to increased stress and fatigue, further diminishing the motivation to engage
in exercise. Similar trends have been reported among university students
globally, where academic burden and time constraints act as major barriers to maintaining
an active lifestyle (Pengpid& Peltzer, 2021).
In addition to time constraints, physical
exhaustion plays a crucial role in limiting activity levels among physiotherapy
students. Unlike many other academic disciplines, physiotherapy training involves
considerable physical effort, including patient handling, repetitive movements,
and prolonged standing. By the end of the day, students may experience fatigue
that discourages additional physical exertion, even in the form of beneficial
exercise. This highlights an important distinction between occupational
physical strain and health-promoting physical activity, which are not
interchangeable and may have different effects on well-being (Teychenne et al.,
2020).
Another important factor contributing to this
issue is the lack of structured opportunities for physical activity within
academic environments. While physiotherapy curricula emphasize exercise in
theory and clinical practice, there is often limited institutional support for
students to engage in regular, structured physical activity themselves. Without
designated time, facilities, or organized programs, students may struggle to
incorporate exercise into their daily routines. This suggests that the
responsibility for promoting physical activity should not rest solely on
individual motivation but should be supported at an institutional level.
Given these challenges, the findings of this
review strongly support the need for systemic and curriculum-integrated
interventions. Rather than simply advising students to be more active,
educational institutions should take proactive steps to create environments
that facilitate and encourage physical activity. This could include
incorporating scheduled exercise sessions, movement breaks, wellness programs,
or supervised fitness activities into academic timetables. By embedding these
practices within the curriculum, institutions can help normalize physical
activity as an essential component of professional training rather than an
optional activity.
The potential benefits of such interventions
extend beyond mental health. Regular physical activity has been shown to
improve cognitive function, concentration, memory, and overall academic
performance (Schuch et al., 2021). Students who are physically active may demonstrate
greater efficiency in learning and better ability to manage complex tasks.
Additionally, engaging in exercise can enhance emotional regulation and stress
management, enabling students to cope more effectively with the pressures of
postgraduate education (Stubbs et al., 2021).
From a professional perspective, promoting
physical activity among physiotherapy students is particularly important
because they are future healthcare providers who will be responsible for
advocating exercise as a therapeutic intervention for patients. Developing
personal habits of physical activity during training can strengthen their
credibility and confidence in prescribing exercise. It also aligns with the
concept of “leading by example,” which is essential in healthcare practice.
Students who experience the benefits of exercise firsthand are more likely to
integrate these principles into their clinical practice.
The relevance of these findings is especially
significant in the Indian context, where additional sociocultural and systemic
factors influence student mental health. Academic environments in India are
often characterized by high expectations, competitive pressures, and limited
flexibility, which can contribute to increased stress levels. Furthermore,
access to mental health services remains uneven, and there is still a degree of
stigma associated with seeking psychological support (Son et al., 2020). In
such settings, physical activity emerges as a practical, accessible, and
culturally acceptable strategy for promoting mental well-being.
Exercise offers several advantages in this
context. It is cost-effective, does not require specialized infrastructure in
its simplest forms, and can be adapted to individual or group settings.
Activities such as walking, yoga, or home-based exercise programs can be easily
incorporated into daily routines. Moreover, group-based activities can foster a
supportive community environment, which may help reduce stigma and encourage
participation.
However, it is important to recognize that a
uniform approach to exercise promotion may not be effective for all students.
Individual preferences, fitness levels, and personal circumstances must be
considered. Some students may prefer high-intensity workouts, while others may
benefit more from low-intensity or mind–body practices such as yoga or
meditation. Providing a range of options and allowing flexibility can enhance
engagement and long-term adherence.
Another important consideration is the need for
behavioral and motivational strategies to complement structural interventions.
Simply providing opportunities for exercise may not be sufficient if students
lack motivation or confidence. Incorporating elements such as goal-setting,
peer support, and feedback mechanisms can help sustain participation. Additionally,
integrating education on self-care and time management into the curriculum may
empower students to prioritize their own well-being.
Overall, the findings of this review point
toward the need for a shift in perspective regarding student health within
physiotherapy education. Physical activity should not be viewed as an
extracurricular or optional activity but rather as a core component of both
personal well-being and professional development. By fostering a culture that
values and supports physical activity, institutions can play a crucial role in
enhancing the health and resilience of their students.
In conclusion, while the evidence clearly
supports the benefits of physical activity and exercise therapy for mental
health, there remains a significant gap in their practical implementation among
postgraduate physiotherapy students. Addressing this issue requires a
multifaceted approach, including curriculum integration, institutional support,
and individual-level strategies. By taking these steps, educational
institutions can contribute to the development of healthier, more balanced, and
more effective future physiotherapists who are better equipped to promote
holistic health in their professional practice.
LIMITATIONS
This review has certain limitations. There is a
lack of studies specifically focused on MPT students, which limits direct
applicability. The included studies also vary in design and methodology, making
comparisons challenging. Many findings are based on self-reported data, which
may introduce bias. Additionally, the absence of long-term studies limits
understanding of sustained effects.
CONCLUSION
Physical activity and exercise therapy are
valuable and accessible approaches for improving mental health among students.
They offer benefits across emotional, physical, and social dimensions. However,
among postgraduate physiotherapy students, participation remains inconsistent
due to academic and clinical demands. Addressing this issue requires
structured, institution-level strategies that promote regular engagement in
physical activity and support long-term well-being.
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