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 Table of Contents  
Year : 2021  |  Volume : 65  |  Issue : 2  |  Page : 116-123  

Relation between body factors, physical activity, and mental health among adult women and men: The Korea national health and nutrition examination survey

1 Adjunct Professor, College of Liberal Art Departmen, Anyang University, Kyunggido Anyang, Busan, South Korea
2 Research Professor, Research Institute of Physical Education and Sport Science, Department of Physical Education, Pusan National University, Busan, South Korea

Date of Submission25-Feb-2020
Date of Decision14-May-2020
Date of Acceptance04-Apr-2021
Date of Web Publication14-Jun-2021

Correspondence Address:
Won Chung Chung
Department of Physical Education, Pusan National University, Busan
South Korea
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.IJPH_129_20

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Background: Insufficient physical activity (PA) has a negative effect on mental health. Many countries try to promote PA. The Korea National Health and Nutrition Examination Survey (KNHANES) aims to promote PA and the importance of the recognition of subjective health and body image and mental health. Objectives: The study aimed to analyze the relationship among body factors, PA, and mental health of Korean adults using the seventh KNHANES (2018) survey. Methods: KNHANES is a cross-sectional survey and investigates every 3 years. Data contain 4416 households (19–65-year-old) responses, and it was weighted average or sample fraction by reflecting the sampling and response rate of population ratio. International PA Questionnaire, metabolic equivalents tasks, Health Enhancing PA, Patient Health Questionnaire-9, Body factors, subjective health recognition, and subjective body image recognition were analyzed by t-test, ANOVA, Chi-square test, and Pearson's r. Results: Correlation among PA and mental health, PA of females was correlated with stress. The PA of males was highly related to the overall mental health. In the differences by gender and PA, females enjoying exercise have a tendency of less body mass index (BMI) and more satisfied with subjective body image. Males showed no difference in BMI but on body factors; males with vigorous activity were higher on height and weight than males with walking activity. Mental health with PA, females with walking activity showed higher depression than females with moderate activity. Likewise, males with walking activity exhibited higher depression than males with moderate and vigorous activity. Females and males showed their PA affects perceived stress. Conclusion: These results suggest promoting PA may lead to enhance mental health.

Keywords: Body factors, mental health, metabolic equivalents task, physical activity, The Korea National Health and Nutrition Examination Survey

How to cite this article:
Kim WK, Chung WC. Relation between body factors, physical activity, and mental health among adult women and men: The Korea national health and nutrition examination survey. Indian J Public Health 2021;65:116-23

How to cite this URL:
Kim WK, Chung WC. Relation between body factors, physical activity, and mental health among adult women and men: The Korea national health and nutrition examination survey. Indian J Public Health [serial online] 2021 [cited 2023 Mar 26];65:116-23. Available from:

   Introduction Top

Physical activity (PA) refers to physical movements of the human that essentially involves energy consumption with muscles in the human body. However, gradually less PA occurred from the contemporary lifestyle in Korean. For instance, The Korea National Health and Nutrition Examination Survey (KNHANES)[1] indicated a slightly decreasing trend in walking exercise among adults over 19 years old from 40.9% to 39.1% from 2008 to 2018.

Based on evidence from many studies, some countries have taken the initiative to increase PA of the public. Earlier studies indicated the association of obesity and mental health with sadness[2] and also correlation between physical health and mental health.[3] Health-enhancing PA (HEPA) was also found to be associated with decreased prevalence of the major depressive and obsessive-compulsive disorder.[4]

Insufficient PA has a negative effect on mental health. Global and regional trends reported by pooled data from population-based surveys estimated insufficient PA. KNHANES presents the goal of national survey and provision for the incentive for attracting people including noninstitutionalized Korean. KNHANES aims to promote PA and the importance of the recognition of subjective health and body image and mental health.[5] This study reports the global age-standardized prevalence of insufficient PA which explained a negative effect on mental health in 27% in 2016, also showed a difference of more than 8% points between gender (24% men vs. 31% women). The trend of KNHANES data is similar to a high-income country in which PA level and a different prevalence between men and women would appear meaningful verifying generalization.[6] As obesity and mental health are correlated with PA, many countries have tried to promote PA of the public in many ways. The incentive of participating in PA is related to improving the recognition of subjective health and body image and mental health.[7] Since obesity is related to the risk of many diseases[8] such as including diabetes, heart disease, hypertension, stroke, and cancer; it focused on the public recognition of subjective health, body image, and mental health.

In contemporary life, people find interest in their body image because of the impact of mass media influence.[9] Comparing own image to exaggerated images of commercial models, many individuals try to lose weight and find ways to improve body image.[10] A study has shown a discrepancy between self-body image and expectations decreases self-esteem and increases the feeling of depression.[11],[12]

Additionally, physical discrepancies could affect public mental health.[13] A study revealed that subjective dissatisfaction with the body image interferes with ways of losing weight, which can include fasting and drug abuse.[14] Since this psychological abuse could happen regardless of gender, this problem is dealt with in the sphere of community mental health care.[15] Many community health care projects have developed plans to promote the public recognition of subjective and mental health, by increasing PA.[16]

Therefore, this study aimed to analyze the relationship among body factors, PA, and mental health of Korean adults using the seventh KNHANES survey for the Korean women and men adult health promotion and proliferating PA in daily life.

   Materials and Methods Top

Research subjects and data

Data were obtained from a cross-sectional national survey conducted by the Korea Centre for Disease Control and Prevention. KNHANES is a national survey that has collected data about health and nutrition since 1998. The seventh KNHANES classified its subject with the region (city/suburb), residential status (individual house, public house), gender, age, and residence size. Total data contain 4416 households (8150 individuals). This research analyzed 4415 individuals (age 19–65) including 2496 females and 1919 males.

This data set that weighted average or weighted sample fraction was applied to all the results of this national survey and the weight was calculated by reflecting the sampling and response rate, and population ratio of each year. Final Data sampling was based on the 2014 KNHANES population sample.

The protocol did not require any institutional review board approval because KNHANES data is opened for the public. However, it was conducted with the approval (1040782-180808-HR-12-31 ethics and bioethics) exemption from deliberation from Sangji University Life Ethics Deliberation Committee.

Definitions of variables

International Physical Activity Questionnaire

The International Physical Activity Questionnaire (IPAQ) uses to measure PA that is consisted of a comparable standardized self-report measurement method for habitual PA.[17] IPAQ contains items of the level of PA during the past 7 days. IPAQ has been used since it evaluates the level of PA regarding their weekly body mass index even though the individual level could be different. Many studies used IPAQ such as the European PA Surveillance System,[18] European Health Interview Survey,[19] New Zealand PA Questionnaire,[20] Countrywide Integrated Noncommunicable Disease Intervention,[21] WHO World Health Survey,[22] and KNHANES. In general, Korea nationally uses the Korean IPAQ.[23]

The level of PA was divided into three groups by the scoring system of IPAQ-walking, moderate, and vigorous. The average energy consumption level was 3.3, 4, and 8 respectively. To compare the level of PA among subjects, metabolic equivalents tasks (MET) were calculated per minute and week.[24] The MET was converted into a continuous and categorical score. The continuous score was the sum of walking, moderate, and vigorous MET. PA <10 min does not count. The specific method of how the continuous scores were calculated is explained in the following section.

Continuous score: metabolic equivalents task values and formula for calculating metabolic equivalents task (min/week)

The selected MET was derived from the IPAQ reliability study performed in 2000-2001. Using the compendium from Ainsworth et al.,[25] an average MET score was derived for each type of activity. For example, all types of walking, moderate and vigorous-intensity activity were included and an average MET score for walking was created. The values continue to be used for the analysis of IPAQ data: walking = 3.3 METs, moderate = 4.0 METs, and vigorous = 8.0 METs. Four METs values continuous scores were;

  • Walking MET-minutes/week = 3.3 (MET) × walking minutes × walking days
  • Moderate MET-minutes/week = 4.0 (MET) × moderate-intensity activity minutes × moderate days
  • Vigorous MET-minutes/week = 8.0(MET) × vigorous-intensity activity minutes × vigorous-intensity days
  • Total PA MET-minutes/week = sum of walking + moderate + vigorous MET minutes/week scores.

Categorical score

The categorical division of IPAQ defined 3 levels. Inactive comprised “category 1,” the lowest PA level. Categories 2 and 3 comprised “insufficiently” active. Minimally active was comprised “category 2,” minimum pattern of activity was classified “sufficiently active."

HEPA active (KNHANES)[26] was comprised “category 3"that is 2 criteria for classification as “HEPA active” are;

  1. Vigorous-intensity activity on at least 3 days achieving a minimum of at least 1500 MET-min/week
  2. 7 or more days of any combination of walking, moderate-intensity, or vigorous-intensity activities achieving a minimum of at least 3000 MET-min/week.

Mental health: Patient Health Questionnaire-9 and perceived stress scale

This research applied the Patient Health Questionnaire-9(PHQ-9)[27] to analyze the effects of PA on mental health, especially on depression. Nine items were included. These items measure subjects' experience reflecting back on the past 2 weeks with a 4-point Likert scale. To analyze the effect of PA on stress, this study used the perceived stress Scale developed by the Ministry of Health and Welfare which was applied in the KNHANES. This scale includes one item measured with a 4-point Likert scale.

Body factors, subjective health recognition, and subjective body image recognition

This research used body factors such as age, height, weight, body mass index (BMI), subjective recognition of health, and subjective body image to analyze the relations between the PA level and body-related measurement factors. Subjective recognition of health contains one question measured by a 5-point Likert scale. Subjective body image is also evaluated with a 5-point Likert scale.

Socio-demographic characteristics

Socio-demographic variables include the following aspects; region (city/suburb), household monthly income (low under 1000$/mid-low 1000–2000$/mid-high 2000–3000 $/high 3000 $ above), education (elementary/middle/high school/college), marital status (live together/separately, bereaved, divorced, single), and job occupation (yes/no).

Statistical analysis and data processing

SPSS statistical software version 21.0 (Chicago, IL, USA) was used for data analysis. General characteristics and PA of subjects were calculated by number, percentage, mean and standard deviation. The correlations among PA (IPAQ), depression, and stress were analyzed. Means between gender and PA were compared through t-test, one-way ANOVA, Scheffe's multiple range tests, Chi-square test, and correlation coefficient Pearson's r.

   Results Top

Subjects' characteristics

[Table 1] summarizes subjects' body-related measurement factors, sociodemographic variables, and mental health. There were no significant differences between mean age of female and male participants (42.94 and 42.82 years, respectively). However, significant differences (t = 68.88, P < 0.001) were found regarding the height of females (159.12 ± 5.86) and males (171.93 ± 6.11) and also regarding weight (t = 45.25, P < 0.001) and BMI (t = 14.78, P < 0.001).
Table 1: Characteristics and physical activity level of study subjects

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Subjective health (χ2 = 18.12, P < 0.01) and perceived body image (χ2 = 55.55, P < 0.001) showed significant differences between male and female participants.

Among sociodemographic variables, region (χ2 = 0.34, P > 0.05) and household income (χ2 = 2.45, P > 0.05) did not show significant differences between gender. However, the level of education was higher in females (χ2 = 36.52, P < 0.001), and there were more single males than females (χ2 = 99.27, P < 0.001). Furthermore, males (84.6%) showed a higher percentage of employment (χ2 = 332.86, P < 0.001) than females (58.1%).

Females showed significantly higher levels of depression than males (t = 7.66, P < 0.001). However, there were no statistically significant differences regarding perceived stress (χ2 = 1.40, P >.05) [Table 1].

Level of physical activity

Males showed statistically higher MET in total PA with 1140.36 MET (min/week) compared to females scored 988.04 MET (min/week) (t = 3.61, P < 0.001). With regard to walking, the differences in PA level between females (mean = 763.19) and males (mean = 729.20) were not statistically significant (t = 1.04, P > 0.05). However, significant differences were found regarding moderate and vigorous PA. In moderate PA, males scored 180.19MET while females scored 135.04 MET (t = 3.84, P < 0.001). Regarding vigorous PA, males (230.97 MET) also scored higher MET than females (89.81 MET) (t = 8.34, P < 0.001) [Table 2].
Table 2: Physical activity International Physical Activity Questionnaire and accordance with activity intensity and pattern

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With regard to the categorical scores of PA, there were 1318 females (52.8%) and 974 males (50.8%) in category 1, 1011 females (40.5%), and 756 males (39.4%) in category 2, and 167 females (6.7%) and 189 males (9.8%) in category 3. This distribution was statistically significant (χ2 = 14.63, P < 0.01) [Table 2].

Furthermore, [Table 2] presents PA levels according to intensity and pattern between genders. In general, inactive, minimally active, active PA scores were higher for females regarding walking. However, males scored higher MET (min/week) when performing vigorous PA. With regard to total PA, females scored higher MET (min/week) in Category 1 and males scored higher in Category 3.

Differences of parameters by gender and physical activity

[Table 3] shows that females' three types of PA and total PA did not show a significant difference with age (F = 0.63, P > 0.05), height (F = 1.82, P > 0.05), and weight (F = 1.20, P > 0.05). However, BMI showed a significant difference (F = 3.31, P < 0.05). Through Scheffe's test, females' BMI on females with moderate PA was higher than females BMI on female vigorous PA. And subjective health (χ2 = 25.59, P < 0.001) and subjective body image (χ2 = 17.15, P < 0.05) were found that they differ in accordance with PA.
Table 3: Anthropometric, depression and stress parameters by physical activity

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In males, three types of PA and total PA didn't show a significant difference with age (F = 0.88, P > 0.05) and BMI (F = 1.54, P > 0.05). But height (F = 4.32, P < 0.05), and weight (F = 4.15, P < 0.05) showed a significant difference. In Scheffe's test, males with vigorous PA were higher in height and weight than males with walking. The subjective health of males (χ2 = 84.41, P < 0.001) exhibited a significant difference, but not subjective body image of males (χ2 = 8.12, P > 0.05) [Table 3].

[Table 3] exhibits the cross-analysis of socio-demographic factors in accordance with gender and PA. In the case of female, three types of PA and total PA showed statistical differences with the region (χ2 = 25.28, P < 0.001), household income (χ2 = 33.58, P < 0.001), education (χ2 = 6.34, P < 0.001), marital status (χ2 = 23.44, P < 0.01), and job occupation (χ2 = 17.29, P < 0.001). In all PA levels of females, city residents showed a higher level than suburb residents, the less household income females chose walking and the more income females showed a higher tendency of vigorous PA. The correlation of PA with education showed almost the same tendency of household income. However, job-occupied females showed to choose walking and the other to choose vigorous PA.

In the case of males, vigorous PA and total PA showed statistical difference with the region (χ2 = 19.43, P < 0.001), household income (χ2 = 34.81, P < 0.001), education (χ2 = 27.00, P < 0.001), and job occupation (χ2 = 12.68, P < 0.01). The correlation with household income was very similar to the result of females. Lower-income males tend to choose walking and higher-income males show to choose vigorous PA. The correlation with education exhibited almost the same result as household income [Table 3].

[Table 3] shows the difference in mental health in relation to gender and their PA. In the case of females, a significant difference in the level of depression has shown in accordance with walking, moderate, vigorous, total PA (F = 3.87, P < 0.05). In Scheffe's test, females with walking showed higher depression than females with moderate PA. Likewise, males showed a similar result (F = 5.79, P < 0.01). In Scheffe's test, males with walking exhibited higher depression than males with moderate and vigorous PA. Both females (χ2 = 32.27, P < 0.001) and males (χ2 = 16.49, P < 0.05) showed that PA affects perceived stress [Table 3].

Correlations between physical activity, depression, and stress

The correlation coefficient Pearson's r between women appeared below [Table 4]. In the case of females, walking showed a positive correlation with moderate PA (r = 0.14, P < 0.001), vigorous PA (r = 0.06, P < 0.01), and total PA (r = 0.89, P < 0.001). This result shows that females who are active at walking are also active on moderate PA, vigorous and total PA. However, it did not show a significant correlation between PHQ-9 score (r = 0.01, P > 0.05) and perceived stress (r = 0.03, P > 0.05). Moderate PA of females showed a positive correlation with vigorous PA (r = 0.20, P < 0.001) and total PA (r = 0.47, P < 0.001). That is, females who are eager to do moderate PA are also active on vigorous and total PA. And with PHQ-9 score (r = −0.06, P < 0.01), moderate PA showed a negative correlation. That means that as females being active on moderate PA, the level of depression decreases. However, it did not show a significant correlation with perceived stress (r = 0.03, P > 0.05). Vigorous PA of females showed s positive correlation with total PA (r = 0.43, P < 0.001). Therefore, this can be understood as females who are active on vigorous PA are also active in total PA. However, vigorous PA of females did not show a significant correlation with PHQ-9 score (r = 0.01, P > 0.05) and perceived stress (r = 0.02, P > 0.05). Though total PA did not show a significant correlation with PHQ level (r = −0.01, P > 0.05), it has revealed as significantly correlated with Perceived stress (r = 0.04, P < 0.05). That means as total PA grows, perceived stress decreases. Finally, the PHQ level of females showed a significant correlation with perceived stress (r = −0.46, P < 0.001). This tells us that the level of depression is highly related to stress. After all, the only correlation with female depression was moderate and total PA showed the correlation with female stress.
Table 4: Correlation among physical activity measured by International Physical Activity Questionnaire and Patient Health Questionnaire-9, stress (Pearson's r)

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Table 4 exhibits the correlation between PA of males and their mental health. As result, walking of males expresses a positive correlation with moderate (r = 0.14, P < 0.001), vigorous (r = 0.08, P < 0.001), and total PA (r = 0.79, P < 0.001). That is, men who are enthusiastic about walking can also be regarded as enthusiastic about moderate, vigorous, and total PA. However, there was no significant correlation between PHQ-9 score (r = −0.05, P > 0.05) and perceived stress level (r = 0.05, P > 0.05).Moderate PA of males showed a positive correlation with vigorous (r = 0.33, P < 0.001) and total PA (r = 0.52, P < 0.001). This result exhibits that males who are active at moderate PA are also active at vigorous and total PA. And with PHQ-9 score (r = −0.06, P < 0.05), moderate PA of males showed a negative correlation. That is, as the males being active at moderate PA, the less depression the males experience. Likewise, perceived stress (r = 0.05, P < 0.05) also showed a significant correlation. It means that the males who are active at moderate PA feel less stress. Vigorous PA of males showed a positive correlation with total PA (r = 0.62, P < 0.001). This result can be understood as males who are active at vigorous PA also enjoy PA itself. But vigorous PA of males did not show a significant correlation with PHQ-9 score (r = −0.03, P > 0.05) and perceived stress (r = 0.04, P > 0.05).The total PA of males showed a statistically significant correlation with PHQ-9 score (r = −0.07, P < 0.01), and perceived stress (r = 0.07, P < 0.01). Therefore, this result shows that males who are active at total PA show less depression and stress. Finally, the PHQ-9 score of males showed a statistically significant correlation with perceived stress (r = −0.41, P < 0.001). Therefore, males experiencing less depression can be understood as experiencing less stress [Table 4]. After all, the correlates with male depression and stress are moderate and total PA.

   Discussion Top

Through this study, the relationship between body-related measurement factors, PA, and the mental health of Korean adults using data from the seventh KNHANES was analyzed by comparing gender differences.

Comparison with the results that appeared similar with Switzerland NHANES 2005–2016 to KNHANES about the weight perception that was related depression as well.[28] At this point, the body-related factors were statistically significant higher tendency to perceive overweight females showed a lower rate in perceiving themselves as thin in those national survey results. Regarding the women who showed significantly higher depression levels than men, however, these results do not disagree with common knowledge or indicate the cultural difference. We focused on depression level could be appeared higher in females, since gender-related depression exists.[29]

In assessing PA levels within gender, males obtained statistically higher MET in continuous scores. By MET (min/week) analysis results could be understood considering previous studies have been limited by low numbers of women reporting vigorous PA.[30],[31] Moreover, a study about PA showed men appeared higher MET scores as if the 2015 National Health and Morbidity Survey in Malaysia.[32] Such an overweight factor was related to PA measured by IPAQ, normal-weight and overweight/obese men's total PA a50 MET-hours/week was higher. In comparison with women's low and moderate PA was higher. It means further studies should verify to different gender background characteristics can be affected PA intensity.

By analyzing differences in gender and PA, this research derived different results. Females who enjoyed vigorous exercise tended to have less BMI and were more satisfied with their subjective body image. A cohort study concerning body image related to normal and overweight adults shows body image perseverance.[33] Males showed significant differences in the body-related measurement factors but not regarding BMI. Males who performed vigorous PA had greater measures regarding height and weight than walking activity. Besides, a study[34] explains between genders in body image misperception, on the BMI, PA that showed a high tendency.

The relation between PA and mental health, women and men's PA was correlated with their perceived level of stress, however, men's PA was related to their overall mental health highly. Whereas, sports participation doesn't carry out a positive result with mental health and health behavior in young adulthood among males, nevertheless, health-related related behavior brings out the influence of mental health outcomes.[35] Analyzing mental health with PA, females who perform walking activity show higher depression levels than performed moderate PA. To support this study, a research result using IPAQ scale presents a cross-sectional research report that has verified moderate-to-vigorous PA associated with depressive symptoms and status by 4556 females over 50-year-old.[36] Thus, males who perform walking activity exhibited higher depression levels than moderate and vigorous PA. Similarly, Lindberg et al.[37] invested that adult office workers enhanced related-physical activities reduced physiological and perceived stress. Therefore, the type of PA performs by women and men affects their perceived level of stress.

   Conclusion Top

Our analysis indicates that the type of PA performed by Korean adults between women and men has a strong association with their subjective body image and mental health. In addition, less depression or stress is experienced as stronger PA is performed. These results suggest that promoting PA with a higher level of intensity may be an effective way to enhance people's perceived body image and mental health.

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Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4]


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