BACKGROUND: The study of physiotherapy is challenging and can affect the students' well-being and quality of life. The aim of this study was to describe and compare factors that could affect well-being among students across Europe. METHODS: In this descriptive cross-sectional study using an online questionnaire survey, students of bachelor's physiotherapy programs from 23 European faculties, from 8 countries, were interviewed on mental health and stress burden, sleep quality, dietary habits, and physical activity. RESULTS: Although 75% of students rated their quality of life positively and 47% were satisfied with their mental health, 65% showed higher levels of stress and 51% described impaired sleep quality. The minimum physical activity of 150 min weekly was described by 79% of students, within which 67% engaged in strengthening twice a week. Students with a higher stress load/worse psychological health also showed worse sleep quality and lower amount of physical activity, women were significantly worse off. In terms of physical activity and sleep quality, students from Finland and Kosovo achieved the best results, while students from Italy, Greece, and Portugal achieved the worst. Students from Italy indicated the greatest dissatisfaction with the organisation of the study system and communication with teachers, while in Kosovo students rated the communication and study organisation the highest. All students had a problem with adhering to nutritional habits. Students from Italy and Spain, with the lowest body mass indexes and weight averages, were closest to the nutrition recommendations. CONCLUSION: We demonstrated that physiotherapy students are burdened with stress, suffer from sleep disorders, and do not follow the recommendations regarding nutrition nor physical activity. There are significant differences between universities and countries in some aspects.

Biomechanics Laboratory Physiotherapy Department University of the Peloponnese Sparta Greece

Center for Innovative Care and Health Technology Polytechnic of Leiria Leiria Portugal

Coordinator of Physiotherapist School Traineeship AOU Sassari Italy

Department of Health Care Disciplines and Population Protection Faculty of Biomedical Engineering Czech Technical University Prague Prague Czechia

Department of Health Professions Faculty of Health and Education Manchester Metropolitan University Manchester United Kingdom

Department of Hygiene 3rd Faculty of Medicine Charles University Prague Czechia

Department of Nursery and Physiotherapy Faculty of Nursery and Physiotherapy Universidad de Salamanca Salamanca Spain

Department of Physiatry Balneology and Medical Rehabilitation Faculty of Medicine PJ Safarik University Kosice Slovakia

Department of Physiotherapy Faculty Nursing and Professional Health Studies Slovak Medical University in Bratislava Bratislava Slovakia

Department of Physiotherapy Faculty of Physical Culture Palacky University Olomouc Czechia

Department of Physiotherapy School of Health Rehabilitation Sciences University of Patras Aigio Greece

Department of Rehabilitation 3rd Faculty of Medicine Charles University Prague Czechia

Department of Rehabilitation and Sports Medicine 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czechia

Division of Musculoskeletal and Dermatological Sciences University of Manchester Manchester United Kingdom

Faculty of Health Sciences University of Ss Cyril and Methodius in Trnava Trnava Slovakia

Faculty of Physical Education and Sport Charles University Prague Czechia

Health Assessment and Quality of Life Lab Department of Physiotherapy University of Thessaly Volos Greece

IRCCS Fondazione Don Carlo Gnocchi ONLUS Milan Italy

Laboratory of Neuromuscular and Cardiovascular Study of Motion Department of Physiotherapy University of West Attica Egaleo Greece

Physiotherapy in Motion Multispecialty Research Group Department of Physiotherapy Faculty of Physiotherapy University of Valencia Gascó Oliag n Valencia Valencia Spain

SAMK Satakunta University of Applied Sciences Pori Finland

Savonia University of Applied Sciences School of Health Care Kuopio Finland

Tampere University of Applied Sciences Tampere Finland

Universum International College Pristina Pristina Kosovo

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Front Med (Lausanne). 2024 Apr 08;11:1408214. doi: 10.3389/fmed.2024.1408214. PubMed

See more in PubMed

Rasova K, Feys P, Henze T, Van Tongeren H, Cattaneo D, Jonsdottir J, et al. . Emerging evidence-based physical rehabilitation for multiple sclerosis – towards an inventory of current content across Europe. Health Qual Life Outcomes. (2010) 8:76. doi: 10.1186/1477-7525-8-76, PMID: PubMed DOI PMC

Tucker B, Jones S, Mandy A, Gupta R. Physiotherapy students’ sources of stress, perceived course difficulty, and paid employment: comparison between Western Australia and United Kingdom. Physiother Theory Pract. (2006) 22:317–28. doi: 10.1080/09593980601059550, PMID: PubMed DOI

Jacob T, Itzchak EB, Raz O. Stress among healthcare students – A cross disciplinary perspective. Physiother Theory Pract. (2013) 29:401–12. doi: 10.3109/09593985.2012.734011, PMID: PubMed DOI

Hodselmans AP, Hemdal E, Lundberg S, Bjarnegård A, Hobbelen H, Svantesson U. Physiotherapy students’ perceived stress, stressors, and reactions to stressors: a comparative study between Sweden and the Netherlands. Physiother Theory Pract. (2018) 34:293–300. doi: 10.1080/09593985.2017.1390805, PMID: PubMed DOI

Wikström-Grotell C. Physiotherapy and physiotherapy education – from an international to a global and value-based perspective. Eur J Phys. (2021) 23:133–4. doi: 10.1080/21679169.2021.1907967 DOI

Martinková P, Freeman J, Drabinová A, Erosheva E, Cattaneo D, Jonsdottir J, et al. . Physiotherapeutic interventions in multiple sclerosis across Europe: regions and other factors that matter. Mult Scler Relat Disord. (2018) 22:59–67. doi: 10.1016/j.msard.2018.03.005 PubMed DOI

World Health Organization . Promoting well-being. (2023), Available from: https://www.who.int/activities/promoting-well-being

Ramón-Arbués E, Echániz-Serrano E, Martínez-Abadía B, Antón-Solanas I, Cobos-Rincón A, Santolalla-Arnedo I, et al. . Predictors of the quality of life of university students: a cross-sectional study. IJERPH. (2022) 19:12043. doi: 10.3390/ijerph191912043, PMID: PubMed DOI PMC

Buchanan JL. Prevention of depression in the college student population: a review of the literature. Arch Psychiatr Nurs. (2012) 26:21–42. doi: 10.1016/j.apnu.2011.03.003, PMID: PubMed DOI

Ghrouz AK, Noohu MM, Dilshad Manzar M, Warren Spence D, BaHammam AS, Pandi-Perumal SR. Physical activity and sleep quality in relation to mental health among college students. Sleep Breath. (2019) 23:627–34. doi: 10.1007/s11325-019-01780-z PubMed DOI

Odriozola-González P, Planchuelo-Gómez Á, Irurtia MJ, De Luis-García R. Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university. Psychiatry Res. (2020) 290:113108. doi: 10.1016/j.psychres.2020.113108, PMID: PubMed DOI PMC

Junaid M, Auf A, Shaikh K, Khan N, Abdelrahim S. Correlation between academic performance and anxiety in medical students of Majmaah university – KSA. J Pak Med Assoc. (2020) 1:19099. doi: 10.5455/JPMA.19099 PubMed DOI

Sklempe Kokic I, Znika M, Brumnic V. Physical activity, health-related quality of life and musculoskeletal pain among students of physiotherapy and social sciences in eastern Croatia – cross-sectional survey. Ann Agric Environ Med. (2019) 26:182–90. doi: 10.26444/aaem/102723, PMID: PubMed DOI

Sabih F, Siddiqui FR, Baber MN. Assessment of stress among physiotherapy students at Riphah Centre of Rehabilitation Sciences. J Pak Med Assoc. (2013) 63:346–9. PMID: PubMed

Posadzki P, Musonda P, Debska G, Polczyk R. Psychosocial conditions of quality of life among undergraduate students: a cross sectional survey. Appl Res Qual Life. (2009) 4:239–58. doi: 10.1007/s11482-009-9064-z DOI

Moutinho ILD, De CP MN, Roland RK, ALG L, SHC T, Da S EO, et al. . Depression, stress and anxiety in medical students: a cross-sectional comparison between students from different semesters. Rev Assoc Med Bras. (2017) 63:21–8. doi: 10.1590/1806-9282.63.01.21 PubMed DOI

Wassif G, Gamal-Eldin D, Boulos D. Stress and burnout among medical students. J High Inst Public Health. (2019) 1:189–97. doi: 10.21608/jhiph.2019.63794 DOI

Ranasinghe AN, Gayathri R, Priya VV. Awareness of effects of sleep deprivation among college students. Drug Invent Today. (2018) 10:1806.

Rathi A, Ransing RS, Mishra KK, Narula N. Quality of sleep among medical students: relationship with personality traits. JCDR [Internet], (2018), cited 2023; Available from: http://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&volume=12&issue=9&page=VC01&issn=0973-709x&id=12025

Betancourt-Nuñez A, Márquez-Sandoval F, González-Zapata LI, Babio N, Vizmanos B. Unhealthy dietary patterns among healthcare professionals and students in Mexico. BMC Publ Health. (2018) 18:1246. doi: 10.1186/s12889-018-6153-7, PMID: PubMed DOI PMC

Szypowska A, Jeziorek M, Regulska-Ilow B. Assessment of eating and lifestyle habits among polish cosmetology and physiotherapy students. Rocz Panstw Zakl Hig. (2020) 11:157–63. doi: 10.32394/rpzh.2020.0111 PubMed DOI

Lerner J, Burns C, de Róiste Á. Correlates of physical activity among college students. Recreat Sports J. (2011) 35:95–106. doi: 10.1123/rsj.35.2.95 DOI

Romero-Blanco C, Rodríguez-Almagro J, Onieva-Zafra MD, Parra-Fernández ML, Del P-LM, Hernández-Martínez A. Physical activity and sedentary lifestyle in university students: changes during confinement due to the COVID-19 pandemic. IJERPH. (2020) 17:6567. doi: 10.3390/ijerph17186567 PubMed DOI PMC

Pagnin D, de Queiroz V, Carvalho YTMS, Dutra ASS, Amaral MB, Queiroz TT. The relation between burnout and sleep disorders in medical students. Acad Psychiatry. (2014) 38:438–44. doi: 10.1007/s40596-014-0093-z, PMID: PubMed DOI

Džaferović A, Ulen K. Sleep habits among medical students and correlation between sleep quality and academic performance. Eur J Publ Health. (2018) 28:185766. doi: 10.1093/eurpub/cky214.141/5185766 DOI

Pacheco Salles FL, Maciel Ferreira D, Bozi P, Furtado MA, Mai JF, et al. . Evaluation of the perception of stress in university students: implications for symptoms and health complaints and nutritional habits. J Educ. (2022) 202:211–20. doi: 10.1177/0022057420969427 DOI

Carpi M, Cianfarani C, Vestri A. Sleep quality and its associations with physical and mental health-related quality of life among university students: A cross-sectional study. IJERPH. (2022) 19:2874. doi: 10.3390/ijerph19052874, PMID: PubMed DOI PMC

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. (1989) 28:193–213. doi: 10.1016/0165-1781(89)90047-4 PubMed DOI

Jurgita A, Šarūnė B, Asta M, Akvilė V. Relations among poor sleep, anxiety and depression among the students of health sciences. Appl Res Health Soc Sci. (2017) 14:26–38. doi: 10.1515/arhss-2017-0003 DOI

World Health Organization . Food-based dietary guidelines in the WHO European region [internet]. Copenhagen: WHO Regional Office for Europe; (2003). Available from: https://iris.who.int/handle/10665/107490

World Health Organization. Healthy diet [Internet], (2020). Available from: https://www.who.int/news-room/fact-sheets/detail/healthy-diet

Murray EK, Auld G, Baker SS, Barale K, Franck K, Khan T, et al. . Methodology for developing a new EFNEP food and physical activity behaviors questionnaire. J Nutr Educ Behav. (2017) 49:777–783.e1. doi: 10.1016/j.jneb.2017.05.341, PMID: PubMed DOI

World Health Organization . Who guidelines on physical activity and sedentary behaviour, vol. 17. Geneva: (2020). 17 p. PubMed

German Society for Nutrition e. V. D-A-CH Referenzwerte für die Nährstoffzufuhr – Wasser [Internet]. Available from: https://www.dge.de/wissenschaft/referenzwerte/wasser/

Aslan I, Ochnik D, Çınar O. Exploring perceived stress among students in Türkiye during the COVID-19 pandemic. IJERPH. (2020) 17:8961. doi: 10.3390/ijerph17238961, PMID: PubMed DOI PMC

Owczarek JE, Lion KM, Radwan-Oczko M. The impact of stress, anxiety and depression on stomatognathic system of physiotherapy and dentistry first-year students. Brain Behav. (2020) 10:1797. doi: 10.1002/brb3.1797 PubMed DOI PMC

Eller T, Aluoja A, Vasar V, Veldi M. Symptoms of anxiety and depression in Estonian medical students with sleep problems. Depress Anxiety. (2006) 23:250–6. doi: 10.1002/da.20166, PMID: PubMed DOI

Volken T, Zysset A, Amendola S, Klein Swormink A, Huber M, von Wyl A. Depressive symptoms in Swiss university students during the COVID-19 pandemic and their correlates. IJERPH. (2021) 18:1458. doi: 10.3390/ijerph18041458, PMID: PubMed DOI PMC

Pacheco JP, Giacomin HT, Tam WW, Ribeiro TB, Arab C, Bezerra IM. Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Rev Bras Psiquiatr. (2017) 39:369–78. doi: 10.1590/1516-4446-2017-2223, PMID: PubMed DOI PMC

Cetinkaya S, Todil T, Kara M. Future anxiety and coping methods of nursing students during COVID-19 pandemic: a cross-sectional study. Medicine. (2022) 101:e28989. doi: 10.1097/MD.0000000000028989, PMID: PubMed DOI PMC

Akgun S, Ciarrochi J. Learned resourcefulness moderates the relationship between academic stress and academic performance. Educ Psychol. (2003) 23:287–94. doi: 10.1080/0144341032000060129 DOI

Lavoie-Tremblay M, Sanzone L, Aubé T, Paquet M. Sources of stress and coping strategies among undergraduate nursing students across all years. Can J Nurs Res. (2022) 54:261–71. doi: 10.1177/08445621211028076, PMID: PubMed DOI PMC

Chowdhury R, Mukherjee A, Mitra K, Naskar S, Karmakar P, Lahiri S. Perceived psychological stress among undergraduate medical students: role of academic factors. Indian J Public Health. (2017) 61:55–7. doi: 10.4103/0019-557X.200253, PMID: PubMed DOI

Ribeiro ÍJS, Pereira R, Freire IV, de Oliveira BG, Casotti CA, Boery EN. Stress and quality of life among university students: a systematic literature review. Health Prof Educ. (2018) 4:70–7. doi: 10.1016/j.hpe.2017.03.002 DOI

Rafidah K, Azizah A, Norzaidi MD, Chong SC, Salwani MI, Noraini I. The impact of perceived stress and stress factors on academic performance of pre-diploma science students: a Malaysian study. (2009)

Sk J, Nk I, An F, Fa B, Ra A, Ym M, et al. ., Sleep quality among medical students at king Abdulaziz university: a cross-sectional study. J Community Med Health Educ. (2017), Available at: https://www.omicsonline.org/open-access/sleep-quality-among-medical-students-at-king-abdulaziz-university-a-crosssectional-study-2161-0711-1000561-94560.html

Preišegolavičiūtė E, Leskauskas D, Adomaitienė V. Associations of quality of sleep with lifestyle factors and profile of studies among Lithuanian students. Medicina. (2010) 46:482. doi: 10.3390/medicina46070070 PubMed DOI

De CC, De OFK, Pizzamiglio DS, EVP O, SAT W. Sleep quality in medical students: a comparison across the various phases of the medical course. J Bras Pneumol. (2017) 43:285–9. doi: 10.1590/s1806-37562016000000178 PubMed DOI PMC

Zailinawati AH. Daytime sleepiness and sleep quality among Malaysian medical students, vol. 64 (2009). PubMed

Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. . Recommended amount of sleep for a healthy adult: a joint consensus statement of the American academy of sleep medicine and sleep research society. SLEEP. (2015) 56:4716. doi: 10.5665/sleep.4716 PubMed DOI PMC

Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L. National sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. (2015) 1:40–3. doi: 10.1016/j.sleh.2014.12.010, PMID: PubMed DOI

Taylor DJ, Bramoweth AD, Grieser EA, Tatum JI, Roane BM. Epidemiology of insomnia in college students: relationship with mental health, quality of life, and substance use difficulties. Behav Ther. (2013) 44:339–48. doi: 10.1016/j.beth.2012.12.001, PMID: PubMed DOI

Alyoubi A, Halstead EJ, Zambelli Z, Dimitriou D. The impact of the COVID-19 pandemic on students’ mental health and sleep in Saudi Arabia. IJERPH. (2021) 18:9344. doi: 10.3390/ijerph18179344, PMID: PubMed DOI PMC

Wirt A, Collins CE. Diet quality – what is it and does it matter? Public Health Nutr. (2009) 12:2473–92. doi: 10.1017/S136898000900531X PubMed DOI

Bernal-Orozco MF, Salmeron-Curiel PB, Prado-Arriaga RJ, Orozco-Gutiérrez JF, Badillo-Camacho N, Márquez-Sandoval F. Second version of a Mini-survey to evaluate food intake quality (Mini-ECCA v.2): reproducibility and ability to identify dietary patterns in university students. Nutrients. (2020) 12:e809. doi: 10.3390/nu12030809 PubMed DOI PMC

Hilger J, Loerbroks A, Diehl K. Eating behaviour of university students in Germany: dietary intake, barriers to healthy eating and changes in eating behaviour since the time of matriculation. Appetite. (2017) 109:100–7. doi: 10.1016/j.appet.2016.11.016, PMID: PubMed DOI

Breitenbach Z, Raposa B, Szabó Z, Polyák É, Szűcs Z, Kubányi J, et al. . Examination of Hungarian college students’ eating habits, physical activity and body composition. Eur J Integr Med. (2016) 8:13–7. doi: 10.1016/j.eujim.2016.11.007 DOI

Mogre V, Stevens F, Aryee PA, Scherpbier AJJA. Nutrition in medicine: medical students’ satisfaction, perceived relevance and preparedness for practice. Health Prof Educ. (2018) 4:31–8. doi: 10.1016/j.hpe.2017.02.003 DOI

Rodríguez-Larrad A, Mañas A, Labayen I, González-Gross M, Espin A, Aznar S, et al. . Impact of COVID-19 confinement on physical activity and Sedentary behaviour in Spanish university students: role of gender. IJERPH. (2021) 18:369. doi: 10.3390/ijerph18020369, PMID: PubMed DOI PMC

Kgokong D, Parker R. Physical activity in physiotherapy students: levels of physical activity and perceived benefits and barriers to exercise. South Afr J Physiother. (2020) 76:1399. doi: 10.4102/sajp.v76i1.1399, PMID: PubMed DOI PMC

Zalewska A, Gałczyk M, Sobolewski M, Białokoz-Kalinowska I. Depression as compared to level of physical activity and internet addiction among polish physiotherapy students during the COVID-19 pandemic. IJERPH. (2021) 18:10072. doi: 10.3390/ijerph181910072, PMID: PubMed DOI PMC

Dąbrowska-Galas M, Ptaszkowski K, Dąbrowska J. Physical activity level, insomnia and related impact in medical students in Poland. IJERPH. (2021) 18:3081. doi: 10.3390/ijerph18063081, PMID: PubMed DOI PMC

Kowalska J, Wójtowicz D, Szczepańska-Gieracha J. Physical activity and the emotional state of physiotherapy students who finish their education. IJERPH. (2021) 18:4572. doi: 10.3390/ijerph18094572, PMID: PubMed DOI PMC

Chew E, Ho Y, Kee G, Sirisena D. Scoping review and international multi-centre cohort study investigating teaching, knowledge and beliefs regarding physical activity as a health intervention among medical students: a comparison between Singapore and the UK. SMEDJ. (2019) 60:642–51. doi: 10.11622/smedj.2019051, PMID: PubMed DOI PMC

Memon AR, Gupta CC, Crowther ME, Ferguson SA, Tuckwell GA, Vincent GE. Sleep and physical activity in university students: a systematic review and meta-analysis. Sleep Med Rev. (2021) 58:101482. doi: 10.1016/j.smrv.2021.101482, PMID: PubMed DOI

Tonon GH. Student’s quality of life at the university: a qualitative study. Appl Res Qual Life. (2021) 16:1517–35. doi: 10.1007/s11482-020-09827-0 DOI