Physical fitness decline and career paths: a longitudinal study of medical undergraduates – BMC Medical Education

In this study, we analyzed the physical fitness changes during university years among 634 undergraduate medical students and further examined the correlation between these physical fitness changes and their career paths. Physical fitness is linked to various aspects of a university student’s performance, including academic studies and research. Elevating students’ physical fitness levels has reached a consensus on an international scale. However, our findings indicate that the physical fitness of undergraduate medical students generally deteriorated during their university years. This decline was evident in factors such as weight gain, increased BMI, longer durations in both long-distance and short-distance runs, reduced standing long jump distances, diminished abdominal muscle endurance, and reduced upper body muscular endurance. The majority of students opted for postgraduate studies after completing their undergraduate degree. Students with a “normal” post-graduation path, compared to those heading to “top” paths, had better BMI, Sit-and-Reach, and Sit-Ups performances during their initial physical fitness test. However, by the time of the final test, only the BMI advantage remained for those heading to “normal” paths compared to their “top” peers. Comparing the differences between the results of the final and the initial physical fitness tests with career paths, we found that students whose BMI remained stable or decreased were more likely to head to “top” paths after graduation, and this difference was statistically significant.

In addition to physical fitness, the post-graduation paths of medical students are influenced by a variety of factors, such as demographic elements that were significant in our study, including gender, major, and ethnicity. However, regarding the changes in physical fitness during university years, the only fitness parameter in our study that showed a statistically significant correlation with post-graduation paths was BMI.

The post-graduation path is the culmination of university studies, and achieving excellent academic performance is often a key to success. Research indicates that physical exercise not only enhances physical health but also improves academic performance [28]. Students with better physical fitness tend to have higher academic achievements [29], with cardiorespiratory fitness being positively associated with academic success [30]. This is supported by cohort studies from the Uniformed Services University in the United States, which also show positive correlations between physical fitness and success in medical studies [8].

Medical students’ physical fitness requires increased attention

While the physical fitness of university students globally has been a subject of broad concern, with countries implementing various measures to enhance their students’ fitness levels, our research suggests a noticeable decline in the fitness status of medical students during their university years. Another studies in China and US also find the overall physical fitness of college students is on a downward trend [31, 32].. Across all tested metrics (with the exceptions of lung capacity and sit-and-reach), there was a decline. Notably, there was a significant increase in weight, while muscle endurance, running, and jumping capabilities all saw a notable decrease.

Weight plays a crucial role in affecting student’s athletic abilities [33]. Performance in events linked with muscle endurance, such as sprints, long-distance running, long jump, sit-ups, and pull-ups, are influenced by weight. On the other hand, the sit-and-reach, which measures body flexibility, has a correlation with height and is less affected by weight. Lung capacity, related to chest cavity development, is also less influenced by weight. Therefore, the scores for lung capacity and sit-and-reach d both increased for medical students during their university tenure.

The decline in physical fitness among medical students during their university years could be attributed to dietary changes leading to weight gain, coupled with decreased physical activity, leading to diminished athletic abilities. The shift in dietary habits may arise from students transitioning from family life to campus life, with fewer familial constraints and freer lifestyle [34]. The decline in physical activity might be due to the intense academic pressures faced by medical students, devoting more time to their studies and neglecting exercise and sports [35]. Moreover, a lack of physical activity can further increase the risk of obesity [36].

Students headed for top career paths demonstrate better physical fitness changes than those heading for normal paths

At the initial stage, students destined for normal paths had a distinct advantage in physical fitness over those aiming for top paths. However, this advantage was not maintained until graduation. Looking retrospectively, during the first fitness test, students heading for normal paths outperformed those headed for top ones in terms of BMI, Sit-and-Reach, Standing Long Jump, Pull-Ups – Male, Sit-Ups – Female, 1000 m Run – Male, and 800 m Run – Female. Specifically, statistically significant differences were found in BMI, Sit-and-Reach, and Sit-Ups – Female. However, by the final fitness test, the advantages were only seen in BMI, Sit-and-Reach, Sit-Ups- Female, and 1000 m Run – Male, with only BMI showing a statistically significant difference. Conversely, by the last test, students aiming for top paths displayed superior results in Lung Capacity, 50 m Dash, Standing Long Jump, Pull-Ups – Male, and 800 m Run – Female when compared to their peers aiming for normal paths, with only Lung Capacity showing statistical significance. This indicates that students heading for top career paths maintained better physical fitness throughout their university years compared to those headed for normal paths. This could be linked to the former’s superior study and lifestyle habits. These students set higher standards for themselves, evident not only in academics but also in their commitment to exercise, whereas those headed for normal paths may have become more complacent in their physical conditioning during their university years.

Good physical fitness among university students can pave the way for a brighter future

Our research indicates that students whose BMI change (from the 1st to the 4th test) remains stable or declines are more likely to secure top career paths compared to those who experienced an increase in BMI change (47.3% to 37.7%, P = 0.04). Given that BMI is calculated based on weight and height, and that the height of medical students generally increased during their university years, a rise in BMI can be attributed to weight gain. This suggests that weight gain can influence the post-graduation prospects of medical students. Those who manage to maintain or slightly reduce their weight during their academic tenure tend to be more competitive upon graduation. Aside from BMI, other physical fitness test metrics did not show statistically significant differences in their influence on post-graduation outcomes for medical students.

Universities should do more to improve the physical fitness of medical students

Universities should take more initiatives to enhance the physical fitness of medical students. This is not only related to their health and academic performance but also has implications for their career development after graduation. Some schools have already begun taking action. For instance, the West China School of Medicine at Sichuan University, starting from 2021, has mandated that all first and second-year students complete a 3-km run five times each semester to boost their physical condition. With encouragement and requirements from the institution, students are more likely to actively participate in physical exercises.