Independent and Joint Associations of Physical Fitness and Mental Health Symptoms in University Students: A Cross-sectional Analysis

The relationship between physical fitness and mental health is recognized, with evidence suggesting that physical fitness components may offer added protection against mental health issues. However, whether this applies to university students, who commonly experience anxiety and depression, is less clear. This cross-sectional study explores the association of physical fitness with anxiety and depression symptoms in ≥18-year-old students from seven Brazilian universities. Mental health was evaluated using the Diagnostic and statistical manual of mental disorders (DSM-5), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). Physical fitness was assessed via handgrip strength, vertical jump, and the 20m Shuttle-Run test, with students classified into low or high fitness based on genderspecific medians. Poisson regression with robust variance was used to analyze the relationship between physical fitness, anxiety, and depression. The sample included 199 students (52.6% women; median age=21). Those scoring above the median in 2 or 3 physical fitness tests had lower rates of depressive symptoms (PR= 0.53; 95%Confidence Interval (CI): 0.33 - 0.84) compared to those with 0 or 1 tests. Higher jump height also corresponded with reduced depression risk (PR=0.65; 95%CI: 0.44-0.97) and lower co-occurrence of depression and anxiety (Adjusted PR = 0.55; 95%CI = 0.31 - 0.99). 2 or 3 tests above the median corresponded to a decreased likelihood of co-ocurrence of anxiety and depressive symptoms (PR= 0.43; 95%CI: 0.26 - 0.71). No significant association was found between physical fitness and anxiety alone. Thus, higher physical fitness was associated with fewer depressive symptoms among university students.