BIOLOGICAL

10.1177/1099800405282728
3,
Irazusta
ingJanuary
Students
et al.
2006/ Exercise,
RESEARCH Physical
FOR Fitness,
NURSINGand Diet
Vol.of7,
Nurs-
No.

Exercise, Physical Fitness, and Dietary

Habits of First-Year Female Nursing Students

Amaia Irazusta, RN
Susana Gil, MD, PhD
Ftima Ruiz, BSc
Juan Gondra, MD, PhD
Andoni Jauregi, MD
Jon Irazusta, PhD
Javier Gil, PhD

The objective of the present study was to evaluate
the practice of regular physical exercise, the
anthropometrical and physiological characteristics,
and the dietary habits of a group of female nursing stu-
dents (n = 46) and of a control group of female stu-
dents from other disciplines (n = 58) attending the
University of the Basque Country. To this end, diets
and leisure-time physical exercise were analyzed and
the following variables were measured: body mass
index, body composition, blood pressure, maximal
oxygen consumption (VO2 max), and explosive muscle
strength. Results show that the percentage of seden-
tary students was higher among first-year nursing stu-
dents (50%) than among other matched students
(43.6%). Regular physical exercise in nursing students
was found to be positively correlated with higher
absolute (p < .01) and relative VO2 max (p < 0.05) and
with lower diastolic blood pressure (p < 0.05). Analy-
sis of the diets of the nursing students showed that their
energetic intake was deficient and was very low in car-
bohydrates and very high in fat and protein. Statisti-
cally significant differences between the two groups in
anthropometric indices were not observed. The com-
petence to provide adequate nutritional and preven-
tive physical exercise recommendations was higher
among active final-year nursing students than among
sedentary final-year nursing students. Overall, the
BIOLOGICAL RESEARCH FOR NURSING
Vol. 7, No. 3, January 2006, 175-186
DOI: 10.1177/1099800405282728
Copyright 2006 Sage Publications
results of the present study highlight the need for a
greater emphasis on the benefits of regular physical
exercise and an adequate nutritional education early
in the nursing educational program to encourage stu-
dents to adopt healthier behaviors and to provide more
effective preventive physical exercise and nutritional
counseling for their future patients.
Key words: nutrition, exercise, physical fitness,
nursing student, anthropometry, aerobic capacity
Genetic predisposition and unpredictable exoge-
nous factors undoubtedly play important roles in the
development of chronic diseases. Nevertheless, other
Amaia Irazusta, RN, is an assistant professor at the School
of Nursing at the Instituto Mdico Basurto at the University
of the Basque Country, Bilbao, Bizkaia, Spain; Susana Gil,
MD, PhD, is an assistant professor at the Instituto Mdico
Basurto at the University of the Basque Country, Bilbao,
Bizkaia, Spain, and is at the Basque Institute of Physical Ed-
ucation at the University of the Basque Country, Vitoria-
Gasteiz, Araba, Spain; Ftima Ruiz, BSc, is a researcher at
the Instituto Mdico Basurto and is in the Faculty of Medi-
cine at the University of the Basque Country, Bilbao,
Bizkaia, Spain; Juan Gondra, MD, PhD, is an assistant pro-
fessor at the Instituto Mdico Basurto at the University of
the Basque Country, Bilbao, Bizkaia, Spain; Andoni
Jauregi, MD, is a researcher at the Instituto Mdico Basurto
at the University of the Basque Country, Bilbao, Bizkaia,
Spain; Jon Irazusta, PhD, is a professor at the Instituto
Mdico Basurto and is in the Faculty of Medicine at the Uni-
versity of the Basque Country, Bilbao, Bizkaia, Spain; and

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176 BIOLOGICAL RESEARCH FOR NURSING Vol. 7, No. 3, January 2006
factors that can be controlled by people, themselves,
such as sedentarism and eating habits, can contribute
to the development of these diseases (Bouchard, Leon,
Rao, Skinner, & Wilmore, 1990; Caspersen & Meritt,
1995; Sesso, Paffenbarger, & Lee, 2000; Vuori, 2001).
Physical activity is one such controllable factor that
can preserve and improve health, help individuals to
avoid illness, and play a role in rehabilitating patients
who have suffered from mental or physical problems
(American College of Sports Medicine [ACSM],
1998; Martinsen, 1990; Moy et al., 1993). In addition,
it can improve the quality of life of patients suffering
from diseases that involve long-term discomfort and
inconvenience, such as osteoarthrosis, osteoporosis,
and back pain (Pollock & Wilmore, 1990, pp. 100-
110). Regular physical exercise can also be very effec-
tive for preventing depression and anxiety (Dunn,
Trivedi, & ONeal, 2001). Many authors consider ex-
ercise, especially endurance exercise, to be a good
method for decreasing physiological responses caused
by stress and improving psychological symptoms
(Palmer, 2005). It is therefore clear that exercise can
improve not only physical fitness but also psychologi-
cal health and that health professionals, especially
nurses, should regularly recommend physical exercise
to their patients.
Despite the fact that a high percentage of the U.S.
and European population is sedentary (Aarnio, 2003;
Aaron et al., 1995; U.S. Department of Health and Hu-
man Services, 1996), formal studies concerning the ef-
fects of inactivity and exercise on individuals without
Javier Gil, PhD, is an assistant professor at the Instituto
Mdico Basurto and is in the Faculty of Medicine at the Uni-
versity of the Basque Country, Bilbao, Bizkaia, Spain. Ad-
dress for correspondence: Javier Gil, Department of Physi-
ology, Faculty of Medicine, University of the Basque
Country, P.O. Box 699, E-48080 Bilbao, Bizkaia, Spain;
phone: +34-94-601-5671; fax: +34-94-601-5662; e-mail:
ofpgigof@lg.ehu.es.
Ftima Ruiz was supported by a fellowship from the Spanish
Ministry of Education and Culture (AP2001-3618). The
authors wish to thank the Nursing School of the University
of the Basque Country and their students for their coopera-
tion and ACTS (Academic Consulting and Translating Ser-
vices http://www.euskalnet.net/acts) for having corrected
the English in this article.
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diagnosed pathologies are relatively scarce. It has re-
cently been reported that sedentary conduct increases
with age, especially among women (Kristjansdottir &
Vilhjalmsson, 2001; Sallis, 1993). Recent studies
(Aaron et al., 1995; Field, Diego, & Sanders, 2001)
show that high school students who exercise regularly
have a better relationship with their parents, are less
depressed, consume fewer drugs, and have better aca-
demic results compared to students who do not regu-
larly exercise.
Current lifestyles are associated with an increased
prevalence of certain pathologies including, among
others, those related to the cardiovascular system, to
cancer, or to diseases of the digestive system, which
nowadays are the primary causes of morbidity and
mortality in developed countries. Poor nutritional hab-
its, such as over- or underconsumption of macro-
nutrients, represent a very important component in the
etiology of these diseases (Dietary Reference Intakes
[DRI], 2002; Gonzlez Quijano, Guisado, Pacheco,
Ezquerra, & Calzado, 1990). High intake of dietary fat
is a known risk factor for coronary heart disease
(Jakobsen, Overvad, Dyerberg, Schroll, & Heitmann,
2004) and has been implicated in the development of
certain cancers (Vant Veer et al., 1990). In contrast, fi-
ber-rich diets are protective against colorectal cancers
(Martinez, 2005) and chronic heart diseases (Jacobs,
Meyer, Kushi, & Folsom, 1998). Dietary factors also
play a major role in the development of insulin
resistance and type 2 diabetes (Marshall, Hamman, &
Baxter, 1991).
The promotion of health education, particularly re-
lated to physical exercise and nutritional habits, is an
important part of the professional practice of health
workers and, in particular, of nurses (Tanner, 1991).
Nurses can play an important role in the education,
motivation, and persuasion of their patients, especially
the elderly or chronically ill, to initiate or continue a
program to improve physical condition (Allison &
Keller, 1997; Blesch, 1996; Halfmann, Keller, &
Allison, 1997; Johnson, 1999). However, some studies
show that only 30% of nurses give specific recommen-
dations about physical exercise to their patients, de-
spite the fact that more than 60% of the adult popula-
tion does not engage in any regular exercise (Melillo,
Houde, Williamson, & Furtrell, 2000). Inasmuch as
students of the health sciences will be responsible for
the health education of the general population, it is im-
 Irazusta et al. / Exercise, Physical Fitness, and Diet of Nursing Students 177
portant to assess the health status of these students,
that is, their nutritional habits and the degree to which
they regularly exercise, to ascertain if current nursing
education programs encourage salutary attitudes in
this regard.
One of the most important factors for predicting the
physical condition of medical students is their own at-
titudes toward health promotion, illness prevention,
and exercise (Greenlee, Castle, & Wooley, 1992;
Kashani et al., 1992; Liang et al., 1993; Licciardone &
Hagan, 1992; Troyer, Ullrich, Yeater, & Hopewell,
1990). Despite this, in a study that examined percep-
tions of deans and directors of medical education at
schools of medicine in the United States about the im-
portance of physical activity and their perceptions
about the competence of graduating medical students
to advise patients properly about regular physical ac-
tivity, only 10% of the respondents said their students
could design an exercise prescription (Connaughton,
Weiler, & Connaughton, 2001). Further studies of the
eating habits, physical activity, and fitness status of
nursing students need to be done to evaluate the health
status of our future health professionals.
Participants in the current study were nursing stu-
dents who generally have busy class schedules that can
make it difficult to have a healthy diet. We focused on
female students because women in general have been
reported to present higher degrees of sedentarism.
Thus, the objective of the present study was to assess
the exercise and nutritional habits of female nursing
students and to evaluate if a relationship exists between
these parameters, different anthropometrical and
physiological features, and the competence of final-
year nursing students to provide adequate nutritional
and preventive physical exercise recommendations.
Materials and Methods
Participants
All first- and final-year nursing students attending
the University of the Basque Country were invited by
letter to participate in this study: 65.7% of the first-
year (n = 46) and 73.2% of the final-year (n = 52) nurs-
ing students accepted the invitation. One hundred
first-year female students of other disciplines attend-
ing the same university, randomly selected from the
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university register, were also sent the same letter. Of
these, 58% responded positively (n = 58).
All the participants received verbal and written in-
formation about the purpose and procedures of the
study before giving informed consent to participate.
The study was approved by the Research and Ethics
Boards of the Medical School of the University of the
Basque Country and by the Clinical Investigation Eth-
ics Committee of the Basque Health Service
(Osakidetza).
Materials
The following materials were used: cycloergometer
(Monark Model 824E, Monark Exercise AB, Vansbro,
Sweden), pulse meter with an interface system (Polar
Advantage, Polar Electro, Kempele, Sweden),
skinfold caliper (Holtain LTD, Crymych, UK), mea-
suring tape (Rollfix, Argo, Groalmerode, Germany),
blood pressure monitor (Riester, Rudolf Riester
GmbH & Co. KG Bruckstr, Jungingen, Germany),
weighing scale (A Sayol SL, A Sayol, Barcelona,
Spain), height scale (A Sayol SL), Ergojump with
an interface system (Bosco System, Globus, Milano,
Italy), automatic defibrillator (Heartstart FR Laerdal,
Laerdal Medical, Stavanger, Norway), anthro-
pometrical program (Ciberkin, Boehringer Ingelheim,
Ingelheim, Germany), nutritional program (Nutrition-
ist III, N-Squared Computing, San Bruno, CA, USA),
and a Pentium III PC (Dell, Winston-Salem, NC,
USA).
Classification of the Degrees
of Physical Exercise
The degree of physical exercise for each student
was evaluated by asking students how much of their
weekly leisure time during the past year they had spent
doing something physical that involved sweating and
breathlessness (Caspersen & Meritt, 1995; Malina &
Bouchard, 1991, pp. 371-390). Based on their an-
swers, participants were classified into three catego-
ries: (a) Physically inactive or sedentary (less than one
exercise session per week), (b) Irregularly or moder-
ately active (between one and two exercise sessions
per week), and (c) Active (three or more exercise
sessions per week).
178 BIOLOGICAL RESEARCH FOR NURSING Vol. 7, No. 3, January 2006
Resting Physical Examination
Blood Pressure
Participants were seated in a semirecumbent posi-
tion with arms relaxed and supported. After a period of
at least 5 min, at least four blood pressure assessments
were taken at 2-min intervals using mercury manome-
ters. We chose to take four measurements because it is
known that blood pressure tends to decrease with suc-
cessive measurements made at intervals of a few min-
utes, and there is evidence that the difference between
measurements disappears after four measurements. If
there was more than one value in the four measure-
ments, we excluded the first measurement in
calculating the average.
Anthropometry
Analysis of body composition, or anthropometry, is
based on the comparison of different corporal mea-
sures with respect to reference standards. The weight
(kg) and height (cm) of students were measured, and
the associated body mass index (kg/m2) was calcu-
lated. To calculate body composition in terms of fat,
bone, and muscle percentages, the following were
measured: skinfolds (tricipital, subscapular, suprailiac,
abdominal, thigh, and lower leg), diameters (bi-styloid
of the wrist, bi-epicondyle of the humerus, and bi-
condyle of the femur), and perimeters (arm and thigh
and lower leg). Fat weight was calculated using
Yuhaszs (1974) method: fat percentage = (sum of six
skinfolds * 0.1548 + 3.58). Bone weight was deter-
mined using Von Dbelins equation modified by
Rocha (1975): bone weight = (3.02 * (H2 * R * F *
400)0.712) in which H = height, R = bi-styloid diameter,
and F = femoral bi-epicondyle diameter. Residual
weight (e.g., organs, fluids) was determined by the
constants proposed by Wrch in 1974: residual
weight = total weight 0.241. Muscle weight was cal-
culated using the four-compartment model (GREC,
1993): muscle weight = total body weight (fat weight +
bone weight + residual weight). All measurements
were performed by the same person, who holds an
ISAK (International Society for the Advancement of
Kineanthropometry) qualification (second level).
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Assessment of Physical Fitness
Estimation of Maximal
Oxygen Uptake (VO2 max)
VO2 max is the maximum volume of oxygen con-
sumed by the body during exercise. Because oxygen
consumption is linearly related to energy expenditure,
when we measure oxygen consumption, we are indi-
rectly measuring an individuals maximal capacity to
work aerobically. VO2 max is considered the standard
for measuring the efficiency of the bodys engine and
was estimated for this study using the Astrand aerobic
test. Participants cycled for 5 min on a cycloergometer.
The final heart rate and power output (watts) were then
correlated using Astrands normogram. Individual
VO2 max can be indirectly calculated in this manner
(Astrand & Rodahl, 1986). Despite the limitations of
this test, including possible errors of 5% to 15%, it is
the test of choice in both research and sports medicine
because it avoids the use of a maximal test whose use
in the general population may be ethically problem-
atic. In addition, different studies have recently con-
firmed the validity and utility of this test (Kang,
Chaloupka, Mastrangelo, Biren, & Robertson, 2001;
Macsween, 2001; Stevens & Sykes, 1996). VO2 max
can be expressed as an absolute or as a relative value.
Absolute VO2 max is the maximal oxygen uptake ex-
pressed in liters per minute (l/min). Relative VO2 max
is the absolute VO2 max divided by the body weight
and is expressed in milliliters of oxygen per kilogram
of body weight per minute (ml/kg/min).
Determination of Lower
Limb Explosive Power
The vertical jump is a widely used test to measure
lower limb explosive power. Vertical jump was mea-
sured in terms of the height reached by each student
during countermovement jump (CMJ) on a Bosco
platform (Bosco, Luhtanen, & Komi, 1983). The
height attained depends on the speed of takeoff, which
in turn depends on the acceleration that lower limbs
make on the center of gravity (Tumilty, 1993).
 Irazusta et al. / Exercise, Physical Fitness, and Diet of Nursing Students 179
Nutrient Analysis
Food diaries kept by participants on 3 consecutive
days were used to assess the typical macronutrient in-
take of the students. To properly record the weight of
food consumed, each participant was provided with a
weighing scale and a questionnaire on which to record
the type and quantity of food she ate. Detailed infor-
mation was given to the students about how to fill in
the questionnaire correctly. They were also provided
with a telephone number to call if they had any ques-
tions. Participants were requested to register every sin-
gle intake (meal and drink) during 3 days: Sunday,
Monday, and Tuesday. All food diaries were recorded
during the same month to avoid seasonal dietary
changes (fruit, vegetables, and typical seasonal
products).
Dietary analysis was performed using the Nutri-
tionist III program (version 7.0, N-Squared Comput-
ing). All evaluations were analyzed by the same
trained person. From this analysis, detailed informa-
tion about the intake of calories, proteins, carbohy-
drates (total and simple), fats (saturated, monounsatu-
rated, and polyunsaturated), and dietary fiber was
obtained. The unit of analysis was the average of the
sum of nutrient intake over 3 days. This program cal-
culates the absolute measure of the quantity of each
nutrient (in grams, milligrams, or micrograms) and the
corresponding percentages. The RDIs (reference di-
etary intakes) employed in this study are the recom-
mended values for the general population by age and
sex (DRI, 2002).
Competence Regarding Nutritional and
Preventive Physical Exercise Counseling
Final-year nursing students completed an anony-
mous questionnaire developed to evaluate their knowl-
edge of the risks and benefits of exercise, their compe-
tence to prescribe healthy exercise, and their
knowledge of the composition of an adequate diet and
the risks of an inadequate one. The questionnaire con-
tained 10 items that evaluated competence regarding
nutritional counseling and 10 items that evaluated
competence regarding physical-exercise counseling.
They were scored as follows: (a) high competence
(more than 80% of the queries answered correctly), (b)
medium competence (between 80% and 50% of the
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queries answered correctly), and (c) low competence
(less than 50% of the queries answered correctly). The
usable response rate was 73.2% (n = 52).
Statistical Analysis
Data were analyzed statistically using the Statisti-
cal Package for Social Sciences (SPSS) 11.5 (SPSS,
Inc., Chicago, IL). Data were evaluated using the Stu-
dents t test for comparison between two groups, and
one-way analysis of variance (ANOVA) followed by
the Scheff test for comparisons between more than
two groups. Correlation analyses were calculated using
Pearson correlation coefficients. Chi-square analysis
was used to determine if the percentage differences
were statistically significant.
Results
The distribution of sedentary, irregularly active,
and active first- and final-year female nursing students
and other first-year female students is shown in Figure
1. The highest percentage of sedentary students was
found among the first-year nursing student group
(50%), followed by the final-year nursing student
group (47.5%) and the group of other first-year stu-
dents (43.6%). Moreover, a lower percentage of nurs-
ing students practiced regular physical exercise, in
comparison to nonnursing students. However, these
percentage differences were not statistically significant.
In Table 1, the anthropometrical and physiological
characteristics of first-year nursing students and first-
year students in other fields are summarized. No sig-
nificant differences were observed between these
groups in terms of anthropometrical parameters. In
contrast, significant differences in some physiological
parameters were detected. VO2 max (both absolute and
relative) was lower in the nursing students (Students t
test, p < .001), and diastolic blood pressure was higher
in the nursing students compared to the other students
(Students t test, p < .01). No significant differences in
systolic blood pressure or explosive muscle power
(CMJ) were found.
An analysis of the anthropometrical characteristics
of nursing students in terms of their physical activity is
shown in Table 2. No significant differences in any of
the analyzed parameters were found among the
groups.
180 BIOLOGICAL RESEARCH FOR NURSING Vol. 7, No. 3, January 2006
Physical Activity Among Nursing and Other Students
60
50
50 47.5
43.6
40
32.6 32.8
% of students
30
30.9
20
10
0
Sedentary Irregularly Active
Figure 1. Distribution of sedentary, irregularly active, and
active first- and final-year female nursing students and other
female students attending first-year courses at the University
of the Basque Country.
In contrast, significant differences were observed
among the three classifications of first-year nursing
students in physiological parameters, which are indi-
cators of physical fitness (see Table 3). Resting dia-
stolic blood pressure was lower in the active nursing
student group compared to both the sedentary and ir-
regularly active nursing students (ANOVA test p < .05,
F2,43 = 4.55; Scheff test p < .05). Moreover, increased
values of both absolute VO2 max and relative VO2 max
were found to be associated with increased levels of
physical activity (absolute VO2 max: ANOVA test p <
.01, F2,43 = 5.56; Scheff test p < .005; relative VO2 max:
ANOVA test p < .05, F2,43 = 4.77; Scheff test p < .05).
The possible influence of anthropometrical and
physiological parameters on the fitness of first-year
nursing students, measured in terms of relative VO2, is
represented in Figure 2. Relative VO2 max was nega-
tively correlated with weight (r = .370, p < .05), BMI
(r = .412, p < .005), fat percentage (r = .387, p < .01),
resting heart rate (r = .285, p = .055), systolic blood
pressure (r = .294, p < .05), and diastolic blood pres-
sure (r = .391, p < .01). In contrast, relative VO2 max
was positively correlated with the CMJ, but this corre-
lation was not statistically significant (r = .180, p =
.266).
The nutrient intake of first-year nursing students
and other first-year students is shown in Table 4. No
significant differences between the nutritional param-
eters of the groups were observed. An analysis of the
nutritional characteristics of the three physical-activity
classifications of nursing students is also presented in
Table 4. No significant differences in the total energy
First-Year Nursing Students
Final-Year Nursing Students
intake or in the percentage contribution to the total en-
Other Students
ergy intake of protein, fat, and carbohydrates among
these classifications were detected. The comparison
between both groups and the population norms
25.5
showed an excessive contribution of fat to total energy
17.4
19.7
intake, which in both groups and all three nursing-
student classifications exceeded the recommended
20% to 35%. Moreover, the contribution of carbohy-
drates to the total energy intake was found to fall below
Active the recommended 45% to 65% for all student groups.
The mean daily intake of dietary fiber and the corre-
sponding percentage of the adequate intakes (AI) of
the student groups are also displayed in Table 4. Defi-
ciencies in dietary fiber intake were observed in both
groups and all three nursing-student classifications.
Table 5 shows the competence of final-year nursing
students to prescribe adequate nutritional and preven-
tive physical exercise recommendations. There was a
progressive, and significant, increase in the percentage
of students who were competent to prescribe adequate
nutritional counseling from the sedentary group
(24.1%) to the active group (45.5%) (2 = 13.2, p >
.01). The percentage of students with a high compe-
tence to provide adequate physical exercise recom-
mendations was also greater among the active group
(36.4%) than among the sedentary nurse student group
(17.2%). However, these percentage differences were
not statistically significant (2 = 7.15, p = .128).
Discussion
It is well known that the practice of physical exer-
cise, together with adequate nutrition, can have impor-
tant benefits in terms of preventive and therapeutic ef-
fects on health (Dunn et al., 2001; Fagard, 2001; Kohl,
2001). A number of studies have been conducted to
evaluate the physical activity, diet, and fitness status of
university students (Greenlee et al., 1992; Liang et al.,
1993; Troyer et al., 1990). They have revealed that the
physical condition and nutritional habits of students is
very much associated with their own attitudes toward
health promotion and illness prevention (Greenlee
et al., 1992; Kashani et al., 1992; Liang et al., 1993;
Licciardone & Hagan, 1992). Positive attitudes in
these regards are vital for our future health profession-
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 Irazusta et al. / Exercise, Physical Fitness, and Diet of Nursing Students 181

Table 1. Age, Anthropometrical, and Physiological Characteristics (Mean SD) of First-Year Nursing Students and First-Year
Control Students

First-Year Nursing Students (n = 46) Other First-Year Students (n = 55) p*

Age (years) 18.2 0.5 18.5 0.6 .933
Weight (Kg) 59.2 9.5 60.2 8.8 .444
BMI (Kg/m2) 22.4 2.8 22.1 2.4 .639
Sum of skinfoldsa 114 34 109 31 .395
Body fat (%)b 21.3 5.2 20.2 5.1 .450
Body muscle (%)c 39.8 4.2 39.7 4.3 .942
Resting heart rate (beats/min) 74.24 9.1 76.04 10.7 .332
SBP (mm Hg) 114 10.2 110 11.4 .162
DBP (mm Hg) 73.8 10.9 64.5 13.6 .006*
Absolute VO2 max (l/min) 2.09 0.45 2.47 0.58 .001*
Relative VO2 max (ml/Kg/min) 35.7 7.4 41.25 8.5 .001*
Countermovement jump (cm) 28.9 5.1 27.9 4.9 .391

NOTE: BMI = body mass index; DBP = diastolic blood pressure; SBP = systolic blood pressure.
a. Six skinfolds: tricipital, subscapular, suprailiac, abdominal, thigh, and lower leg.
b. Estimated using Yuhaszs formula.
c. Estimated using the four-compartment model (GREC, 1993).
*Students t test, significance at p < .01.

Table 2. Anthropometrical Characteristics (Mean SD) of Sedentary, Irregularly Active, and Active First-Year Nursing Students

Classification
Characteristic Sedentary (n = 23) Irregularly Active (n = 15) Active (n = 8) p*
Weight (Kg) 59.2 9.5 58.3 8.7 60.3 8.8 .881
Height (cm) 160.9 5.0 163.5 4.0 163.8 4.0 .172
BMI (Kg/m2) 22.8 3.0 21.7 2.8 22.4 2.5 .575
Fat (%) 21.4 5.6 20.6 5.0 20.0 5.2 .904
Bone (%) 14.6 1.9 14.8 1.6 15.1 1.1 .758
Muscle (%) 39.5 4.5 40.0 3.8 40.2 4.1 .896

NOTE: BMI = body mass index.

*ANOVA.

Table 3. Physiological Characteristics (Mean SD) of Sedentary, Irregularly Active, and Active First-Year Nursing Students

Classification
Sedentary (n = 23) Irregularly Active (n = 15) Active (n = 8) p
SBP (mm Hg) 113.8 9.5 114.1 11.7 115.0 10.4 .929
DBP (mm Hg) 73.2 10 78.1 10 65.7* 9.1 .016
Absolute VO2 max 1.93 0.4 2.11 0.3 2.50** 0.6 .007
Relative VO2 max 33.3 7.1 36.5 6.3 41.5 7.5 .019
CMJ (cm) 29.0 5.2 28.6 4.7 29.6 6.1 .923

NOTE: CMJ = counter movement jump; DBP = diastolic blood pressure; SBP = systolic blood pressure.
Scheff multiple comparison test, *p < .05; **p < .005 for differences between sedentary and active students.
p < .05 for differences between irregularly active and active students.

als (for example, nursing students), but the current We found that the level of physical activity among
study is the first to characterize this population in first-year female nursing students was lower than that
terms of fitness and nutritional status. of other first-year female students attending the Uni-

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182 BIOLOGICAL RESEARCH FOR NURSING Vol. 7, No. 3, January 2006

Rel VO2 max vs SBP

Rel VO2 max vs Weight
150 r = -0.294
100 r = -0.370
p<0.05
p<0.05

SBP (mmHg)
130
Weight (Kg)

80

60 110

40 90

20 70
15 25 35 45 55 15 25 35 45 55
Rel VO2 max (ml/Kg/min) Rel VO2 max (ml/Kg/min)

Rel VO2 max vs Body Mass Index Rel VO2 max vs DBP
30
r = -0.391
100 p<0.01
r = -0.412
BMI (Kg/m )
2

25 p<0.005
DBP (mmHg)

80

20
60

15
40
15 25 35 45 55
15 25 35 45 55
Rel VO2 max (ml/Kg/min)
Rel VO2 max (ml/Kg/min)

Rel VO2 max vs Body fat Rel VO2 max vs CMJ

35 50
Body fat (%)

30 r = -0.387 r = 0.180
25 p<0.01 40 p = 0.266
VJ (cm)

20
30
15
10 20
15 25 35 45 55
Rel VO2 max (ml/Kg/min) 10
15 25 35 45 55
Rel VO2 max (ml/Kg/min)

Figure 2. Correlations between relative VO2 max and weight (Kg), body mass index (BMI, Kg/m2), body fat (%), systolic blood
pressure (SBP, mm Hg), diastolic blood pressure (DBP, mm Hg), and countermovement jump (CMJ, cm), measured in first-year
female nursing students (n = 46).

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 Irazusta et al. / Exercise, Physical Fitness, and Diet of Nursing Students 183

Table 4. Dietary Intake of Protein, Fat, Carbohydrates, and Fiber for First-Year Nursing Students and Other First-Year Students
(Mean SEM unless otherwise noted)

First-Year Nursing Students

Irregularly Other First-Year Population
Sedentary Active Active All Students Norms
Energy (kcal/day) 2,097 114 2,108 34 2,204 66 2,124 88 2,153 64 2,368a
Carbohydrates (energy
ratio [%]) 40.2 41.5 41.6 41.5 41.8 45-65b
Fat (energy ratio [%]) 40.8 40.7 40.4 40.3 39.3 20-35b
Protein (energy ratio [%]) 19.1 17.7 18.2 18.4 18.9 10-30b
Dietary fiber (g/day) 13.8 0.8 16.2 1.0 15.4 1.8 15.7 1.1 15.4 1.8 36c
Percentage AI (%) 38.3 45.0 43.8 42.6 42.8

a. Recommended dietary allowances.

b. Acceptable macronutrient distribution range.
c. Adequate intake.
SOURCE: Source for all three standards was Dietary Reference Intakes (2002).

Table 5. Competence of Sedentary, Irregularly Active, and Active Final-Year Nursing Students to Prescribe Adequate Nutri-
tional and Preventive Physical Exercise Recommendations

Competence to Prescribe Adequate Competence to Prescribe Adequate

Nutritional Recommendations Physical Exercise Recommendations
Low (%) Medium (%) High (%) Low (%) Medium (%) High (%)
Sedentary 34.48 41.38 24.14 20.69 62.07 17.24
Irregularly active 19.23 57.69 23.08 15.38 65.38 19.23
Active 13.64 40.91 45.45 18.18 45.45 36.36

versity of the Basque Country and that the percentage
of sedentary nursing students was significantly greater
than the percentage of other students (50% vs. 43.6%,
respectively). The level of sedentarism continued to be
very high among final-year nursing students (47.5%).
Similarly high percentages of physically inactive
women have been reported previously (Aarnio, 2003;
Kull, 2002; U.S. Surgeon General, 1997). Our results
revealed that only 17.4% of first-year nursing stu-
dents, 19.7% of final-year nursing students, and 25%
of first-year students of other disciplines met the rec-
ommendation of the American College of Sports Med-
icine (1998) to engage in physical exercise three or
more times per week. These findings raise concern, as
sedentarism is a known risk factor associated with the
development of chronic diseases such as cardiovascu-
lar illnesses (Sesso et al., 2000; Vuori, 2001). But per-
haps a more important reason for concern is that the
final-year nursing students with lower physical activity
levels also revealed low competence to prescribe ade-
quate preventive physical exercise recommendations
(17.2% of sedentary students were highly competent
vs. 36.4% for the active group). This finding indicates
that the lack of regular physical exercise on the part of
graduating nursing students may be a barrier to those
same students later encouraging patients regarding
physical exercise. These results corroborate previous
studies of graduating medical students (Connaughton
et al., 2001). The present study also revealed that
knowledge of provision of adequate nutritional coun-
seling was higher among the physically active gradu-
ating nursing students than among the sedentary stu-
dents (45.5% vs. 24.1%).
The first-year nursing student group presented
lower absolute and relative VO2 max values and higher
diastolic blood pressure values than the other first-year
students. These physiological characteristics may well
reflect the lower level of physical activity observed in
the nursing students and raise further concerns, be-
cause active lifestyles help to prevent weight gain and

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184 BIOLOGICAL RESEARCH FOR NURSING Vol. 7, No. 3, January 2006
to improve and maintain physical condition in healthy
adults (ACSM, 1998; DRI, 2002).
In accordance with previous studies (Kujala,
Viljanen, Taimela, & Viitasalo, 1994; Maaroos &
Landor, 2001), analysis of the physiological parame-
ters of nursing students revealed that increased fitness
as measured by significantly increased values of both
relative and absolute VO2 max and decreased diastolic
blood pressure was associated with more frequent
physical exercise. Improvement of aerobic capacity
has been reported to be the most important component
of physical fitness associated with decreasing the risk
of coronary diseases (Sesso et al., 2000; Vuori, 2001).
The results obtained in this study corroborate those
found by others (Bouchard et al., 1990; Minck, Ruiter,
Van Mechelen, Kemper, & Twisk, 2002) in that statis-
tically significant negative correlations were found be-
tween aerobic capacity, or relative VO2 max, and some
cardiovascular risk factors, such as weight, BMI,
blood pressure, or body fat percentage.
In previous studies (ACSM, 1998; Sesso et al.,
2000), it has been reported that activities involving
moderate and light physical exercise do not signifi-
cantly decrease coronary risks and that it is necessary
to carry out more than two endurance training sessions
per week to improve and maintain physical fitness in
healthy adults. However, our results suggest that exer-
cise undertaken once or twice a week has a tendency to
lead to beneficial effects in terms of VO2 max, a princi-
pal indicator of aerobic capacity, and that moderate ex-
ercise should not be considered to be without measur-
able beneficial effects in terms of fitness maintenance
(Ekelund et al., 2001).
In contrast, analysis of the anthropometrical param-
eters of nursing students did not reveal any significant
differences among the physical-activity classifica-
tions. This finding confirms the idea that anthropo-
metrical indices, like body fat, should not be used as
markers of the physical activity of university students,
as has been reported elsewhere (Aarnio, 2003;
Ekelund et al., 2001; Maaroos & Landor, 2001).
In analyzing the relationship between aerobic ca-
pacity and the explosive power of lower limbs, we ob-
served that higher levels of physical activity in nursing
students were not associated with a significant im-
provement in jump performance. This result contra-
dicts the findings of Kujala and others (1994), who
concluded that improved performance in the vertical
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jump is associated with higher levels of physical exer-
cise, especially that which involves cross training in
which there is a mixture of intensity, duration, and fre-
quency. On the other hand, previous studies have dem-
onstrated that specific power training is necessary to
improve vertical jump performance (Lattier, Millet,
Maffiuletti, Babault, & Lepers, 2003).
Diet analysis showed that there were no significant
differences between the diets of nursing students and
other students. Moreover, we found no differences in
diet among the nursing students in the three different
classes of physical activity levels. However, the diets
of all the analyzed groups presented common charac-
teristics. They were deficient from a nutritional power
point of view, and they presented an imbalance in the
fractional contributions of macronutrients to total en-
ergy intake with respect to recommended values for
this age group (DRI, 2002). Thus, students generally
reported an excess of energy ingested in the form
of proteins and lipids and a deficit in the amount of
energy ingested in carbohydrate form.
These results corroborate those of a previous study
in which the diet of nursing students was examined
(Gonzlez Quijano et al., 1990) and are consistent
with the typical Spanish dietary pattern (Rodrguez-
Artalejo, Banegas, Graciani, Hernndez-Vecino, &
Rey-Calero, 1996; Serra-Majem, Garcia-Closas,
Ribas, Perez-Rodrigo, & Aranceta, 2001). The authors
of these studies suggested that one of the reasons for
the poor dietary habits of nursing students may be their
extensive theoretical and practical class schedules,
which oblige them to eat away from home. Often, stu-
dent meals lack diversity and are characterized by fast
food and similar meals, which are typically rich in fat
and low in carbohydrates (Michaud & Baudier, 1991;
Serra-Majem et al., 2001; Story, Neumark-Sztainer, &
French, 2002). When we analyzed the mean intake of
dietary fiber, none of the student groups reached 50%
of the recommended daily intake. Deficient dietary fi-
ber intake has also been detected in a previous study of
nursing students (Gale, 1998), and this deficiency is
typical in diets characterized by high fat and protein
intake and low complex carbohydrate consumption.
In summary, the results of the present study indicate
that the physiological fitness of first-year female nurs-
ing students, measured in terms of VO2 max and dia-
stolic blood pressure, depends on the degree to which
they practice regular physical exercise. However, our
 Irazusta et al. / Exercise, Physical Fitness, and Diet of Nursing Students 185

study highlights deficiencies in the exercise, nutri- Ekelund, U., Poortvliet, E., Nilsson, A., Yngve, A., Holmberg, A.,
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fitness and body fat in 14- to 15-year-old boys and girls. Euro-
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