The Relationship Between Menstruation Cycle and Exercise Participation in Korean Female College Students

DOI: https://doi.org/10.21203/rs.3.rs-107764/v1

Abstract

Background: The purpose of this study was to examine how Korea female university students participate in physiological and psychological exercises according to differences in their menstrual cycles and health consciousness, exercise participation, and exercise intention. This study analyzed how these female students feel about their own health, participating in exercises, and the duration of the exercise according to the different menstrual cycles and their various patterns.

Methods: The study surveyed women university students in Gangwon-do, Busan, and Ulsan metro city in Korea. A total of 464 questionnaires were analyzed using the statistical programs SPSS Win 22 and AMOS Win 22. We used cross-analysis, T-tests, one-way ANOVA analysis, and correlation analysis to analyze differences in health consciousness, intensity of exercise, and degree of intent to exercise in terms of the menstrual cycle and exercise pattern during the cycle.

Results: First, there were no significant differences between menstrual pattern (regular vs. irregular) and general exercise periods during the non-menstrual period (X2 = 5.828, p < 0.212). However, the study showed that more female university students who had regular menstrual cycle were back to regular exercise right after their menstruation cycle ended, and the girls with irregular menstrual cycles did not exercise as much right after their menstruation cycle ended. Second, there were significant differences in the relationship between health consciousness (p = 0.000), amount of exercise (p = 0.002), and grade of intention to exercise (p = 0.002) according to the differences in menstrual cycles and pattern of Korean female university students. Female university students with a regular menstrual cycle showed higher health consciousness, amount of exercise, and intent to exercise than did ones with irregular menstrual cycles. Third, there was a significant difference in the relationship between health consciousness (p = 0.000), amount of exercise (p = 0.000), and intent to exercise (p = 0.000) in accordance with exercise period (did not exercise, before menstruation, after menstruation, and when not menstruating, always) of Korean female university students. In other words, female university students who exercised were higher than female university students who did not exercise.

Conclusions: In this study, Korean female university students who had regular menstrual cycles exercised regularly and showed a high level of their own health consciousness, amount of exercise, and intention to exercise. Also, female university students who exercise regularly have a higher level of health consciousness, amount of exercise, and intention to exercise. This study will be valuable as a pilot study related to physiological, psychological factors, and exercise of women.

Backgrond

Society in the 21st century can easily obtain information about people’s exercise and diet through various media. Particularly, university students who are interested in their appearance will try to manage their body shape somewhat with more vigorous effort. Also, some university students often experience physical and mental issues because of excessive effort to control weight [1]. A university student generally goes through a period of becoming an adult from adolescence and is prone to health issues because of unhealthy habits and behaviors [2]. Korean university students are exposed to psychological and social stresses that threaten their health (smoking, drinking, irregular eating habits, lack of sleep, etc.) as well as to a competitive social atmosphere, such as staying on top of the class, relationship issues, and worries about employment and career. In particular, they develop irregular lifestyles because of sudden changes in their lives, being given freedom and independence they did not experience before, resulting in an irregular pattern in daily life which leads to some health issues [3]. In other words, most Korean university students are freed from the pressure they had during their high-school days. They are free from social expectations that burdened them while they were in high school, and this sudden freedom often leads them to form irregular lifestyles while not recognizing the importance of their physical and mental health [4]. Another problem is that Korean university students go through excessive diet routines to maintain their body shape in order to seek employment after their graduation. Unfortunately, this is expected by the society, and these students go through excessive diet routines even though they know it is not good for their health [5, 6]. Also, Korean female university students pay great attention to their body shape, diet habits, and exercise. In the end, their self-awareness of their health leads to their behavior.

One obstacle these students face while trying to maintain their health is menstruation. Women's menstrual cycles differ from person to person, but occur, on average, every 28 days [7]. Menstrual phase, proliferative phase, secretory phase, follicular phase, ovulation, luteal phase, and the menstrual cycle is controlled by one’s hormones [8]. Menstruation can present complexity in achieving the healthy body and mind these female students wish to have. In particular, female university students are stressful and sensitive due to various factors (study, career, employment, physical health, etc.) [9, 10]. Furthermore, women's physiology may cause problems, such as poor academic efficiency, cheating at school, and crime, it may adversely affect an individual or society to the extent that it impairs daily life. From the physical and psychological perspective of female college students, understanding and paying attention to

their menstrual attitudes, interests, and conflicts is important, and will need to take care of self body. Therefore, the purpose of this study is to analyze the differences in health consciousness, amount of exercise, and intent to exercise according to the menstrual cycle(regular and irregular) and exercise period (before menstruation, after menstruation, and when not menstruating, always) of Korean female university students.

Methods

Sampling Method

This study surveyed 500 female university students who are attending K University in Gangwon-do, D University in Busan, and U University in Ulsan. The purpose and content of the study were fully explained to these participants, and a survey was obtained with their consent. A total of 36 surveys were excluded that were not answered properly or were not available for this study out of total 464 surveys answered. This study was approved by the Institutional Review Board of Kangwon National University (2019-04-001-001). It was conducted in accordance with the Declaration of Helsinki. The general characteristics of the study subjects are shown in Table 1. In this study, “regular menstruation” refers to the case of regular bleeding for about 3–7 days at 28–34 days interval every month, and “irregular menstruation” refers to all cases except for this. Also, in the period of exercise, “before menstruation” refers to one week before the first day of menstruation, and “after menstruation” refers to one week after the last day of menstruation. “Always” refers to every day regardless of menstruation, and “when not menstruating” refers to all days except for the period of menstruation(bleeding).

Health consciousness of the Questionnaire

This study used tools for analyzing the survey questions and differences of individual characteristics of the research subjects. As a survey tool for health consciousness [11, 12], the questionnaires used in the previous study (Cronbach’s a .890) were directly modified by a professor and a researcher to suit the actual condition of this study. The questions on health consciousness were 6 in total:

‘I usually care about my health’,

‘I am aware of my condition’,

‘I feel responsible for my health’,

‘I strive to maintain and promote my health’,

‘I have more interest in my health than others’, and

‘I think the most important thing is health’.

Intention to exercise of the Questionnaire

The survey tools [13] on intent to persist in exercise was modified from the items used in the previous study (Cronbach's a .915) to suit the present conditions. Questions on intention to exercise were 4 in total:

‘I will continue to participate in exercise even if I do not have time’,

‘I will continue to participate in the exercise’,

‘I will continue to participate in exercise even though I am tired’,

‘I will continue to participate in exercise even if I can't afford it’.

The questionnaire used a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree).

Statistical Analysis

The collected data were analyzed using SPSS 22.0 and AMOS 22 in order to confirm whether the collected questionnaires were suitable for factor analysis. Kaiser-Meyer-Olkin (KMO) > .5 and Bartlett test p < .05 were also used. We did an exploratory factor analysis to extract common factors for each question. The factor rotation method used Varimax, a right-angle rotation method. Factor extraction was set to an eigenvalue of 1.0 or more and a factor-loading value of .4 or more. We did confirmatory factor analysis for health consciousness and intent to exercise for exploratory factor analysis.

In order to analyze the validity and reliability of the variables, we measured the fitness by a content validity test, Reliability was analyzed using Cronbach's α, and discriminant validity was assessed by AVE. We used Pearson Χ2 test, T-test, and one-way ANOVA to analyze the differences in health consciousness, amount of exercise, and intent to exercise according to the menstrual cycle and the exercise period of Korean university college students. Last, to find out the relationship among factors we carried out correlation analysis.

Exploratory factor analysis

Exploratory factor analysis found that KMO was .934, which was higher than the standard value of .80. The Bartlett test result also showed p = .000, and the sample was appropriate, lower than the baseline of p = .05. The Cronbach’s α was more than .9 in the reliability of each factor. AVE was also higher than .8, which ensured reliability and validity. The exploratory factor analysis results are shown in Table 2.

Confirmatory factor analysis

The standardized path coefficients for confirmatory factor analysis are shown in Fig. 1, and the goodness-of-fit index is shown in Table 3. Χ2 = 708.586, df = 164, p = .000, CFI = .910, TLI = .895, NFI = .886, RMSEA = .079, and CFI, TLI, NFI indices were over .8. RMSEA and RMR were below .1, indicating a reasonable value.

Results

The results of the Pearson Χ2 test of exercise period according to the menstrual cycle of Korean female university students are shown in Table 4. There were no significant differences in the exercise period (Χ2 = 5.828, p < .212) according to the menstrual cycle. However, the study shows that female university students with a regular menstrual cycle exercise a lot more than do female university students with irregular menstrual cycles after their menstrual cycle end.

The results of the Pearson Χ2 test shows the difference between health consciousness, amount of exercise, and intention to exercise according to the menstrual cycle of Korean female university students are shown in Table 5. First, there were statistically significant differences in health consciousness (p = .000). Female university students with regular menstrual cycles (M = 3.732) had higher health consciousness than did irregular female students (M = 3.416). Second, there were statistically significant differences in the amount of exercise (p = .002). Female university students with regular menstrual cycle (M = 2.828) exercised more than did irregular female students (M = 2.401). Third, there were statistically significant differences in intention to exercise (p = .002), regular female university students (M = 3.243) intended to exercise more than irregular female university students did (M = 2.992).

The analyzed results of differences between health consciousness, amount of exercise, and intention to exercise according to exercise period of Korean female university students are shown in Table 6. First, the health consciousness index for the female university students who exercised regularly during the non-menstrual period was higher than that of exercising irregularly. Indexes are as followed; female students who exercise before menstruation (M = 3.745), after menstruation (M = 3.702), and during non-menstrual period (M = 3.781) compared to female students not exercising (M = 3.338). Second, the exercise degree indexes were as follows: female students who exercise before menstruation (M = 3.208), after menstruation (M = 3.318), always (M = 3.611) and during non-menstrual period (M = 3.145) compared to female students not exercising (M = 2.780). Third, the exercise intention indexes were as follows: female students who exercise before menstruation (M = 3.305), after menstruation (M = 3.337), always (M = 3.449) and during non-menstrual period (M = 3.474) compared to female students not exercising (M = 2.581).

Finally, to analyze the relationship among variables we brought correlation analysis to effect. As a result, like showing in Table 7, it showed that the relationship among health consciousness, exercise degree and exercise intention had a positive correlation at the p < .05 level.

Discussion

The purpose of this study is to examine how Korea female university students participate in physiological and psychological exercises according to differences in their menstrual cycles and health consciousness, exercise participation, and exercise intention. This study analyzed the relationships between health consciousness, amount of exercise, and intention to exercise according to menstrual cycle and exercise period in Korean female university students. Discussions of the results are as follows.

First, there were no significant differences in exercise period according to menstrual cycle in the relationship between menstrual cycle and exercise period of Korean female university students. However, the study showed that female university students with regular menstrual cycles exercise a lot after menstruation compared to female university students with irregular menstrual cycle. In other words, it can be inferred that female university students with irregular menstrual cycle have less tendency to exercise. The more irregular the menstrual cycle, the higher the menstrual discomfort in women. To relieve menstrual discomfort, an active lifestyle (exercises) is more beneficial in the long run than is a not-so-active lifestyle (such as resting or sleeping excessively, starving, or using painkillers) [14]. In particular, A study of Korean female university students showed only 51.7 ~ 63.0% of female university students had regular menstrual cycles, and more than 30% had irregular menstrual [15, 16, 17, 18]. As shown from the results of this study, it can be inferred that 30% of female university students with irregular menstrual cycle do not exercise as much as they should. Menstrual discomfort occurs in female university students whether they have a regular or an irregular menstrual cycle. However, female university students who participate in exercise will benefit from maintaining a regular menstrual cycle and will be more effective at reducing menstrual discomfort. Therefore, an appropriate exercise program is needed to improve the quality of life for female university students.

Second, there were significant differences in the relationships between health consciousness, amount of exercise, and intention to exercise according to the menstrual cycle of Korean female university students. The ones with regular menstrual cycles showed higher health consciousness, amount of exercise, and intention to exercise than did ones with irregular menstrual cycles. A study of women's health showed that the higher the level of concern for health they have, the more they [19]. The first result showed that female university students who had regular menstrual cycle exercise more often and are more health conscious. Furthermore, it can be inferred that female university students with regular menstrual cycles are more advantageous in terms of amount of exercise and intention to exercise.

Third, there were significant differences in the relationships between health consciousness, amount of exercise, and intention to exercise according to the exercise period of Korean female university students. The health consciousness was higher in the ones who exercised before menstruation, after menstruation, and during the non-menstrual period than in those who did not exercise regularly. The amount of exercise was higher in female university students who exercised before menstruation, after menstruation, always, and during non-menstrual period than in those who did not exercise. The intention to exercise was higher in ones who exercised before menstruation, after menstruation, always, and during non-menstrual period than in those who did not exercise. Korean female university students usually have complex physical, emotional, and behavioral symptoms 2 ~ 10 days before menstruation begins and experience a menstrual syndrome that disappears immediately after menstruation (Lim & Park, 2010). In Korea, 80% of women of child bear age complain of premenstrual syndrome, 20% of which are severe and cause difficulty in daily life [20] About 82.4 ~ 100% of female university students in their 20 s experience menstrual discomfort [21]. That means over 75% of women experience menstrual syndrome. Menstruation syndrome experienced by women in their teens and late 20 s brings physical and mental symptoms, mood swings, anxiety, loss of control, and fatigue [22, 23]. Menstrual syndrome is even referred to as a mental and physical illness that arises from psychological and social interactions [24]. The results of this study show that female university students do more exercise after menstruation, which is psychologically and physically more comfortable than before menstruation. After all, students who exercise a lot are interested in their own health. Furthermore, it can be inferred that the amount of exercise and the intent to exercise are related. Women who participate in exercise during menstruation have fewer menstrual pains than women who do not exercise [25, 26]. Therefore, it is positive for Korean female university students to always participate in exercise for long-term health benefit.

Conclusion

In this study, Korean female university students who had regular menstrual cycles exercised regularly and showed a high level of their own health consciousness, amount of exercise, and intention to exercise. Also, female university students who exercise regularly have a higher level of health consciousness, amount of exercise, and intention to exercise. This study will be valuable as a pilot study related to physiological, psychological factors, and exercise of women.

Abbreviations

SPSS

Statistical package for the Social Sciences; KMO:Kaiser-Meyer-Olkin.

Declarations

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Kangwon National University (2019-04-001-001). It was conducted in accordance with the Declaration of Helsinki. The purpose and content of the study were fully explained to these participants, and a survey was obtained with their consent. All data were collected concerning the participants’ privacy and anonymity.

Consent for publication

Not applicable.

Availability of data and materials

The datasets for current study are available from the corresponding author on reasonable request.

Competing Interests

All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2018S1A5A8026812), funded the collection, analysis and interpretation of the data for this manuscript.

Authors’ contributions

ShK and WSCh contribute to conception of design of the study. iBP implemented the measurements and research data. All authors approved and read the final version of the manuscript.

Acknowledgments

We would like to thank the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea for their support in this research.

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Tables

Table 1 Characteristics of subjects (N=464)

Variables

Variables

n

%

Age

19s

29

6.3

20s

161

34.7

21s

109

23.5

22s

94

20.3

Over 23s

71

15.3

Exercise Period

Do not exercise

129

27.8

Before menstruation

99

21.4

After menstruation

134

28.8

Always

54

11.6

When not menstruation

48

10.4

Exercise

degree

Exercise

during

None

129

27.8

Less than 6 months

141

30.4

6month~1year

50

10.8

1year~2years

39

8.4

Over 2years

105

22.6

Exercise

frequency

(1week)

None

129

27.8

1time

80

17.2

2times

95

20.5

3times

87

18.8

over 4times

73

15.7

Exercise

Time

(1day)

None

129

27.8

Between 0 and 1hour

86

18.5

Between 1 and 2hour

156

33.6

Between 2 and 3hour

50

10.8

More than 3hour

43

9.3

 

Table 2 Validity and Reliability Analysis

Variable

Question

Factor

loading

Eigen

values

Cronbach’s α

AVE

Health consciousness

B1 I usually care about my health

.847

3.977

.864

.943

B2 I am aware of my condition

.812

B4 I feel responsible for my health

.765

B3 I strive to maintain and promote my health

.737

B5 I have more interest in my health than others

.644

B6 I think the most important thing is health

.432

Exercise intention

C4 I will continue to participate in exercise even if I can't afford it

.875

1.817

.912

.970

C3 I will continue to participate in exercise even though I am tired

.820

C1 I will continue to participate in exercise even if I do not have time

.715

C2 I will continue to participate in the exercise

.696

KMO = .924, Bartlett test = 6117.178, df = 190, p = .000.

 

Table 3 Goodness-of-fit index of confirmatory factor analysis

X2

df

p

CFI

GFI

TLI

NFI

RMSEA

RMR

257.707

34

.000

.921

.894

.895

.910

.087

.047

 

Table 4 Differences between exercise period according to menstrual cycle

Variable

Menstrual cycle

Regular(%)

Irregular(%)

Total(n)

X2(p)

Exercise period

288

176

464

5.828(.212)

Did not exercise

69

60

129

Before menstruation

63

36

99

After menstruation

89

45

134

Always

36

18

54

When not menstruation

31

17

18

 

Table 5 Differences between Health consciousness, Exercise degree, and Exercise Intention by menstrual cycle

Variable

Regular

Irregular

t

p

M

SD

M

SD

Health consciousness

3.732

.6478

3.416

.000

5.122***

.000

Exercise degree

2.829

1.242

2.401

.002

3.659***

.002

Exercise intention

3.243

.8639

2.992

.002

3.092***

.002

 

Table 6 Differences between Health consciousness, Exercise Level, and Exercise Intention by Exercise Time

Variable

N

M(SD)

f

p

 

Health

conscious

ness

Exercise

period

do not exercise (a)

129

3.338(.6332)

8.478

.000

b,c,e > a

before menstruation (b)

99

3.745(.6363)

after menstruation (c)

134

3.702(.5646)

always (d)

54

3.642(.6740)

when not menstruation (e)

48

3.781(.8158)

Exercise

degree

Exercise

period

do not exercise (a)

129

2.374(.7453)

14.001

.000

b,c,d,e > a

before menstruation (b)

99

2.925(.8060)

after menstruation (c)

134

3.010(.7957)

always (d)

54

2.827(.8824)

when not menstruation (e)

48

3.104(.7844)

Exercise

intention

Exercise

period

do not exercise (a)

129

2.581(.8023)

23.854

.000

b,c,d,e > a

before menstruation (b)

99

3.305(.7656)

after menstruation (c)

134

3.337(.7178)

always (d)

54

3.449(.8261)

when not menstruation (e)

48

3.474(.8965)

 

Table 7 Correlation analysis

Variables

1

2

3

Health consciousness

1

 

 

Exercise degree

.274**

1

 

Exercise intention

.448**

.468**

1