Factors associated with changes in physical activity levels among Chinese international students in South Korea
Article information
Abstract
[Purpose]
Physical activity is widely recognized for its physical and mental health benefits that are significant for international students who often encounter environmental and cultural challenges. This study aimed to assess the physical activity levels and changes among Chinese international students in South Korea and identify the factors associated with these changes.
[Methods]
The study included 192 Chinese students from a single university, recruited via an anonymous survey link on WeChat that collected data on sociodemographics, health behaviors, acculturative stress, depression, and social support. Physical activity levels were assessed using the Global Physical Activity Questionnaire and changes in physical activity in South Korea were also evaluated. Multivariate multinomial logistic regression analysis was used to identify factors associated with decreased and increased physical activity among the students.
[Results]
Among the participants, 33.9% indicated decreased physical activity, whereas 29.7% reported increased physical activity compared with their home country. Barriers include academic stress, time constraints, and unfamiliar environments, whereas facilitators include exercise facility accessibility and support from others. Increased physical activity was positively associated with older age, weight changes, and recreational activities. Poor self-health perception was positively associated with reduced physical activity, whereas perceived discrimination and transportation-related physical activity were negatively associated with reduced physical activity.
[Conclusion]
Changes in physical activity levels and their associated factors among Chinese international students in South Korea were revealed. Multidimensional factors must be addressed to improve physical activity levels, especially considering the challenging circumstances faced by international students.
INTRODUCTION
According to recent statistics, nearly six million students pursue higher education in countries outside their home nations [1], with Asian students constituting the largest overall proportion, representing 57% of these international students [2]. In 2023, the number of foreign students in South Korea was 181,842, with Chinese students constituting the largest proportion at 37.4% [3]. International students encounter unique circumstances and often face pressures related to educational and cultural differences, language barriers, psychological factors, and interpersonal challenges [4]. Such pressures can influence both their physical and mental health; however, they have generally received limited attention.
Physical activity (PA) is defined as any bodily movement produced by the skeletal muscles that requires energy expenditure and has various health benefits [5]. Therefore, the World Health Organization (WHO) recommends at least 150-300 minutes of moderate-intensity aerobic PA per week, or 75-150 minutes of vigorous-intensity aerobic PA, or an equivalent combination of moderate- and vigorous-intensity activities for adults [5]. Despite these recommendations, more than a quarter of the world’s adults are not sufficiently active. Globally, 27.5 to 31.1% of adults do not meet the WHO recommendations for PA [6,7]. In 2020, adults’ PA adherence was reported to be 45.6% in South Korea and 37.2% in China [8,9]. According to a previous systematic review, PA adherence was significantly associated with sex, age, education levels, obesity, and self-rated health [10].
In addition to the well-known physical health benefits, PA is known to alleviate psychological stress through various mechanisms [11]. Previous research revealed that Chinese students who regularly engaged in PA exhibited reduced anxiety and depression and higher life satisfaction during the COVID-19 pandemic [12]. Furthermore, various types and intensities of PA, including aerobics, strength training, and mixed-type exercises, have been shown to reduce depressive symptoms by boosting mood and energy, enhancing mental resilience, and promoting overall well-being [13]. Potential mechanisms include enhancement of self-esteem, increased social support, and mitigation of stress responses through endorphin release and cortisol reduction, thereby enabling PA to serve as an effective coping strategy [14].
For international students, pursuing overseas education can have a bidirectional impact on PA levels. Cultural and language differences, academic pressures, and changes in daily routines may hinder PA, whereas favorable environmental factors and infrastructure can create opportunities to enhance it. Therefore, specific factors that influence international students’ PA levels must be considered from a multifaceted perspective, particularly the psychological and social challenges they face, such as acculturative stress and the availability of social support.
Acculturative stress is defined as the psychological and social pressure that individuals face when adapting to a new culture. It arises from various challenges encountered during cross-cultural contact, including cultural conflicts, language barriers, lack of social support, identity crises, and potential experiences of discrimination and prejudice [15]. Social support refers to the emotional, instrumental, informational, and appraisal resources that individuals receive from their social relationships such as family, friends, colleagues, and broader social networks [16] and it is inversely associated with psychological issues, such as anxiety and depression [17].
A qualitative longitudinal study conducted among international students in the United States highlighted that PA plays a significant role in facilitating a smoother transition by promoting social and intercultural engagement and preserving cultural identity [18]. Thus, engagement in PA can significantly reduce acculturative stress among international students by providing social interaction and emotional support that mitigate the psychological pressures of acculturation.
Promoting PA activity among international students is an important public health issue; however, its significance is underemphasized. In addition, knowledge of PA levels and their associated factors among international students in South Korea remains limited. Therefore, this study aimed to assess the PA levels of Chinese international students in South Korea, who constitute the largest proportion of the international student population. Additionally, this study aimed to examine changes in PA levels and identify the key factors associated with these changes. Through this study, we hope to provide valuable insights that will promote the health of this unique population of international students and support their adaptation to life and studying in foreign countries.
METHODS
Participants
Participants were enrolled by posting an anonymous survey link to Chinese international students in a WeChat group at the Pukyong National University. WeChat was selected for recruitment, as it hosts the most active and largest group chat for Chinese international students at Pukyong National University (500 out of 738), making it the most effective social network to reach and engage with this specific population. This survey focused on collecting sociodemographic and health behavioral information, PA levels, acculturative stress, depression, and social support. All the participants voluntarily participated in the survey and agreed to a sign informed consent form before starting the survey.
Measurement variables
1) Sociodemographic and health behavioral information
Through the survey, we collected sociodemographic information including sex, age, height, weight, marital status, residence type, household income, educational course, and Korean language proficiency. Health behavior data were also gathered, including smoking status (yes or no), alcohol consumption (yes or no), smartphone usage (less than 2 h, 2–4 h, 4–6 h, more than 6 h), sleep duration (less than 4 h, 4–6 h, 6–8 h, more than 8 h), and general self-health perception (1: very poor, 5: very good). Furthermore, changes in weight and PA levels in South Korea compared to those in China (increased, no change, and decreased) as well as the barriers and facilitators influencing PA were evaluated.
2) PA level
To investigate the participants’ PA, the Chinese version of the Global Physical Activity Questionnaire (GPAQ), a standardized questionnaire developed by the WHO, was used [19]. The GPAQ consists of a series of standardized questions designed to evaluate the types and amounts of moderate-to-vigorous-intensity PA performed during a typical week, including activities related to work, transportation, and recreation. PA adherence was defined as participants’ PA levels meeting the WHO guidelines of at least 150 min of moderate-intensity aerobic PA per week, 75 min of vigorous-intensity aerobic PA, or an equivalent combination of moderate- and vigorous-intensity activity for adults [5]. We converted the vigorous-intensity activity time into an equivalent amount of moderate-intensity activity time by multiplying it by two.
3) Acculturative stress
The Acculturative Stress Scale for Chinese Students, originally developed for use in the United States were adapted for use in South Korea [20]. This scale consists of 32 items and is introduced with the statement: “This scale describes some stressful situations that might occur to you after you come to Korea. Please select the number that best describes your experience.” using the following scale: 1 = never to 7 = all the time. It is divided into five domains: inadequate language proficiency (10–70), social isolation (8–56), perceived discrimination (7–49), academic pressure (4–28), and guilt toward family (3–21), with higher scores indicating higher levels of acculturative stress.
4) Depression
Depressive mood was assessed using the Chinese version of the Zung Self-Rating Depression Scale [21]. The scale comprises 20 items that evaluate four key aspects of depression using a 4-point Likert scale (1 = rarely, 4 = most of the time): pervasive affect (depressed affect, crying spells, hopelessness, and suicidal rumination), physiological disturbances (decreased appetite, weight loss, and tachycardia), other associated disturbances (fatigue, confusion, and indecisiveness), and psychomotor activity (sleep disturbance, psychomotor retardation, psychomotor agitation, and irritability). After inversely scoring 10 negatively worded items, the total score ranged from 25 to 100, and was categorized as normal (25–49), mild depression (50–59), moderate depression (60–69), or severe depression (70 and above).
5) Social support
The Social Support Self-Rating Scale (SRSS), one of the most widely used tools in China [22], was used to assess the students’ social support. This scale comprises 10 items and is introduced with the statement, “The following questions are designed to measure your support received in society. Depending on this fact, please complete the rating scale in accordance with the specific requirements of each issue.” It evaluates three distinct dimensions: subjective support (8–32), objective support (1–22), and support-seeking behavior (3–12). The total SRSS score (12–66) was further categorized into three levels: low (≤ 22), moderate (23–44), and high support (≥45).
Statistical analysis
After the survey was distributed, 225 responses were collected. After initial screening, 192 valid responses were included in the final analysis. Descriptive analysis was used to determine participants’ sociodemographic and health-related characteristics. Differences in variables according to sex and changes in PA were analyzed using Student’s t-test, one-way analysis of variance (ANOVA), or a chi-square test. Scheffé’s test was used with post-hoc comparison in one-way ANOVA. Given the three levels of change in PA, multivariate multinomial logistic regression analysis was employed to examine the variables associated with changes in PA. This method, an extension of binary logistic regression analysis, is particularly suitable for categorical dependent outcomes with more than two levels [23]. Through this analysis, odds ratios (OR) and 95% confidence intervals (CI) were calculated for increased and decreased PA levels. Statistical significance was set at α = 0.05 and all statistical analyses employed SPSS Statistics version 29 (IBM Corp., Armonk, NY, USA).
Ethical statement
This study was approved by the Institutional Review Board of Pukyong National University (Approval No.1041386-202401-HR-11-02) and all procedures adhered to ethical guidelines to protect the privacy and rights of the participants.
RESULTS
Characteristics of the participants
Table 1 presents the characteristics of the participants (N = 192). The mean age was 27.51 years, and 91 patients were female (47.4%). Alcohol consumption, smoking status, and body mass index differed significantly according to sex. In addition, male students showed significantly higher perceived discrimination and guilt toward family among the components of the Acculturative Stress Scale (P<0.05).
Characteristics of the participants
PA levels among Chinese international students
Table 2 shows participants’ aerobic PA levels. Their total aerobic PA and sedentary behaviors were 459.5 and 440.3 minutes/week, respectively (Table 2). A total of 125 Chinese international students (66.8%) were adherent to WHO PA guidelines. In addition, regarding changes in PA in South Korea compared to China, 65 participants (33.9%) experienced a decrease in PA, 70 participants (36.5%) maintained a similar PA level, and 57 (29.7%) experienced an increase in PA (Table 2). All these variables showed no significant difference by sex.
Physical activity levels among Chinese international students
Barriers to PA in South Korea were identified as academic stress, time constraints, and unfamiliar environments. Conversely, PA facilitators included accessibility to exercise facilities, time availability, support and encouragement from others, and favorable climate and environmental conditions (Figure 1).
Barriers and facilitators of physical activity levels of Chinese international students in South Korea.
Differences in factors according to PA adherence
Differences in factors according to PA adherence, there was a statistically significant difference in PA adherence between undergraduate and graduate students (P = 0.001). In addition, PA-adherent participants showed significantly higher perceived discrimination among the components of Acculturative Stress Scale than PA-non-adherent groups (16.3 vs 14.0, P = 0.027). However, other factors such as age, sex, marital status, household income, Korean proficiency, smoking and alcohol status, obesity, depression, and social support did not show significant differences between the PA-adherent and non-adherent groups (Table 3).
Differences in factors according to physical activity adherence
Differences in factors according to changes in PA levels among Chinese international students in South Korea
Table 4 presents the results of the univariate analysis of the differences in factors according to changes in PA levels among Chinese international students in South Korea. There were significant differences in age, residence type, obesity, general health perception, total depression score, and objective social support according to changes in PA levels. In addition, moderate-intensity work-related PA and moderateand vigorous-intensity recreation-related PA were significantly different according to changes in PA levels.
Differences in factors according to changes in physical activity levels
Post-hoc analysis indicated that the total depression score was significantly higher in the group with decreased PA than in the group with increased PA. In addition, moderate-intensity work-related PA was significantly higher in the group with increased PA than in the group with decreased PA, whereas moderate- and vigorous-intensity recreation-related PA was significantly higher in the group with increased PA than in the group with decreased and similar PA levels.
Associating factors in changes in PA levels among Chinese international students in South Korea
Table 5 presents the results of the multivariate multinomial logistic regression analysis used to identify the factors associated with changes in PA levels among Chinese international students in South Korea compared with those in China. When comparing decreased PA versus similar PA between China and Korea, individuals with poor self-health perception were more likely to experience decreased PA than those with fair health perception (OR 3.68, 95% CI: 1.05–12.84, P = 0.041). Additionally, higher levels of acculturative stress related to perceived discrimination (OR 0.92, 95% CI: 0.85–0.99, P = 0.024) and higher transportation-related PA (OR 0.76, 95% CI: 0.61–0.96, P = 0.021) were associated with a lower likelihood of decreased PA. When comparing increased PA versus similar PA, individuals aged over 30 (OR 4.05, 95% CI: 1.31–12.54, P = 0.015), those who engaged in more recreational activities (OR 1.10, 95% CI: 1.02–1.18, P = 0.011), individuals who lost weight (OR 3.85, 95% CI: 1.11–13.34, P = 0.033), and those who gained weight (OR 3.21, 95% CI: 1.15–8.99, P = 0.026) in Korea were associated with a higher likelihood of increased PA.
Associating factors with decreased or increased physical activity levels of Chinese international students
DISCUSSION
This study investigated PA adherence and changes in PA levels among Chinese international students in South Korea. Additionally, multivariate analysis revealed significant factors associated with changes in PA levels.
Overall, 65.1% of the Chinese international students in South Korea adhered to the WHO aerobic PA recommendation of engaging in at least 150 minutes of moderate-intensity PA per week. Previous research has identified PA adherence among Chinese students studying in their own nations with inconsistent results, and several studies have indicated high PA adherence among Chinese students at 74.2 to 85% [24,25]. Univariate analysis identified that only the educational course and perceived discrimination were significantly different based on PA adherence; graduate students and people with higher perceived discrimination were likely to be PA-adherent.
Approximately 30% of the Chinese international students reported a decrease in their PA levels when studying in South Korea. Academic stress has been identified as the most prevalent barrier preventing students from maintaining adequate PA. This finding is consistent with that of a previous study conducted in Puerto Rico that demonstrated that high academic stress was associated with lower PA levels [26]. Furthermore, several studies have also highlighted the potential benefits of addressing academic stress through the promotion of sports and PAs [27,28]. PA can serve as an effective coping strategy to alleviate academic stress among college students by promoting sports interest, fostering a supportive sports environment, and enhancing resilience through improved psychological well-being and social interactions [27]. However, multivariate analysis revealed no significant association between academic pressure and decreased PA levels in this study, indicating the intricate nature of this relationship.
We identified several significant factors that influenced the participants’ decreased PA levels. Specifically, poor general self-health perception was significantly associated with decreased PA levels. Regular PA, including both aerobic and strength training exercises, was positively correlated with self-rated health among university students, whereas smoking and alcohol consumption were negatively correlated [30]. This suggests that promoting healthy lifestyles, including enhancing PA among university students, could significantly enhance their overall health perception.
Acculturative stress and social support are considered specific factors that influence international students’ behavior. In this study, we found that the perceived discrimination component of acculturative stress was negatively associated with decreased PA levels, and that students with higher perceived discrimination were more likely to adhere to PA guidelines. This finding is comparable to those of previous studies: Chinese international students in Korea who experienced higher levels of acculturation and received more social support were more likely to engage in health-promoting behaviors [31], and engaging in sports helped reduce feelings of discrimination among immigrant youths in Switzerland through improved intercultural relationships and a sense of belonging within the community [32]. In addition, several studies have suggested positive associations between social support and PA and a negative association between depression and PA [31,33]. However, our study did not reveal any significant association between changes in PA levels and social support or depression. The depression scores of all participants in this study were below 60, indicating normal to mild depression. This limited range may have resulted in insufficient variability for detecting statistically significant associations.
Among categories of PA, higher levels of PA related to daily transportation (such as walking or cycling) were significantly associated with a lower likelihood of decreased PA. This suggests that the regular incorporation of PA into individual daily routines for transportation purposes could serve as a protective factor against decreases in overall PA, rather than focusing solely on leisure–related PA. This finding aligns with the broader literature emphasizing the importance of integrating PA into daily routines [34,35]. Active transportation not only helps meet PA recommendations but also contributes to overall health and well-being [35]. However, work-related PA was not significantly associated with changes of Chinese international students in PA.
Interestingly, approximately 30% of the participants experienced increased PA levels in South Korea compared with their home country. The main facilitators of PA were access to exercise facilities and time. Similarly, there was a strong positive correlation between the accessibility of sports facilities and the frequency of PA among Korean adults [36], highlighting the need to develop an accessible exercise infrastructure to promote PA for public health.
Regarding demographic factors, older age was positively associated with increased PA in this study, although PA levels generally declined with age in men and women of all races/ethnicities [37]. For international students in this study, we theorized that older students may experience unique circumstances that encourage PA, such as more time availability than younger students, or heightened awareness of the health benefits of PA because of maturity and life experience. In addition, age is often associated with a growing awareness of health-related behaviors [37], and older students may be more motivated to enhance their PA.
Another significant factor associated with increased PA was weight change; both weight loss and weight gain were positively associated with increased PA. Weight and PA levels have a bidirectional relationship, indicating that weight can serve as a motivational factor and outcome of PA. This relationship partly reflects a dynamic in which students may adjust their PA behavior in response to changes in weight to manage or achieve their desired weight outcomes. Some studies support the role of PA in effective weight management, emphasizing that regular PA is crucial for both weight loss and maintenance [38].
These associations between demographic factors and PA levels have significant public health implications and provide helpful guidance for planning targeted interventions for international students. Such interventions may include age-specific strategies and weight management programs that address the motivational role of PA in improving health outcomes. Universities play a pivotal role in promoting the health of this unique population.
Among the various types of PA, recreation-related activities are positively associated with increased PA levels in South Korea. College students’ participation in recreational sports activities has been demonstrated to have a positive impact on their current PA levels [39], consistent with our findings. Additionally, engagement in multiple types of recreational activities is associated with higher levels of PA and reduced sedentary behaviors [40,41]. These findings highlight the significant role of recreational activities in enhancing overall PA level and mitigating sedentary behaviors across different populations.
Although this study focused on Chinese international students in South Korea, its findings are significant for international students from various cultural backgrounds. Cross-cultural stress and adjustment challenges are common issues faced by most international students regardless of their country of origin, and they often experience emotional and psychological distress [41]. Therefore, the results of this study are applicable to different cultural settings. However, acculturative stress, coping strategies, and health-related behaviors may vary among students from diverse cultural backgrounds, particularly among those from non-Asian countries. Therefore, future research should explore PA levels and their associated factors among international students from various backgrounds. Additionally, in this era of globalization, universities should consider implementing health promotion programs tailored to various cultural differences, encompassing health behaviors, coping mechanisms, and social support systems.
For international students, the time spent in different environments is challenging. However, they can also provide the opportunity to adopt a healthier lifestyle, which is beneficial to their overall health. By living in different cultures and environments, they can embrace positive changes and establish better habits that contribute to their well-being.
This study had some limitations. First, convenience sampling at a single institution may limit the generalizability of the findings to other international student groups in South Korea and the recruitment method may introduce a potential selection bias. However, the proportion of Chinese students at Pukyong National University (44.0%) was comparable to the national average for Chinese students in South Korea (37.4%) [3]. Second, because we used self-reported questionnaires, a subjective method, the results may have either overestimated or underestimated the participants’ PA levels, although the GPAQ has been previously validated. Objective measurements such as accelerometers can be used to overcome this limitation in future research. Third, we did not include physiological variables, such as body composition and physical fitness. Fourth, the cross-sectional design of this study limits the ability to infer causal relationships because it captures PA levels at a single time point. Future research focusing on a longitudinal design is needed to assess changes in PA over time and to identify potential causal relationships. Furthermore, the scope of this study should be expanded to include a large sample of international students from diverse backgrounds. Continuing to focus on this under-researched population and exploring the role of acculturation and university support services in promoting PA among international students can provide actionable insights for policymakers and educators.
In conclusion, this study revealed that 65.1% of Chinese international students in South Korea adhered to PA guidelines. In addition, 33.9% and 29.7% of the students exhibited decreased and increased PA levels, respectively, compared with their home country. Poor self-health perception was positively associated with decreased PA, whereas perceived discrimination among acculturative stress and transportation-related PA was negatively associated with decreased PA. Conversely, older age, weight change, and recreational PA were positively associated with increased PA levels. Universities can implement policies, such as providing accessible facilities or organizing social integration activities, to enhance international students’ PA. Additionally, policies that address multidimensional factors, such as personal, social, and environmental, should be considered, particularly given the challenging situations faced by international students. The results of this study will guide the development of tailored interventions to promote the health of international students.
Notes
No potential conflict of interest relevant to this article was reported.