Study Concerning the Physical Fitness of Romanian Students and Its Effects on Their Health-Related Quality of Life

: All of the studies regarding movement have concluded that physical exercises (PEs) hold a very important part in improving people’s quality of life (QL). QL is comprised of several indicators inﬂuencing each other. One of these indicators is physical ﬁtness (PF). PF is directly inﬂuenced by the degree of physical activity (PA) and it represents a precondition of being healthy physically, mentally and socially. The purpose of this research was to identify certain exercise programs which are meant to increase the PF of university students. In this regard, we introduced, in the physical education lessons of the experimental group, exercises from Pilates, Tae Bo, Stretching and Workout at Fitness Machines. Control group carried out typical activities of the ordinary Physical Education curriculum throughout the research. The PF components reported improvements in the values of the experimental group at the end of the research. There were signiﬁcant improvements for balance ( p = 0.009), speed of execution ( p = 0.006), ﬂexibility ( p = 0.013), explosive strength ( p = 0.001), static strength ( p = 0.009), muscular endurance of the trunk ( p = 0.0008), muscular endurance of the arms ( p = 0.010) and agility ( p = 0.0001). The results of our research support the idea of diversifying physical education lessons with students and orienting physical activities towards increasing their QL, because the improvement of QL for all age groups has become a major focus of modern society.


Introduction
The improvement of quality of life (QL) has become a major part of modern society considering the fact that ordinary persons find it harder and harder to adapt to external demands. QL represents the global quality of every sphere that encompasses life and the degree of life that produces satisfaction. The World Health Organization Quality of Life Groups (WHOQOL) considers QL to be a complex concept with both objective and subjective dimensions which includes the aspects related to the health, psychological and social relational status [1]. The concept of QL is very often associated with the term "wellbeing". Well-being is a part of the quality of life, and in order to reach this state of being, there needs to be a balance between physical exercises (PEs), a rational dietary plan and emotional balance [2].
QL includes the following dimensions: physical wellness, functional wellness, social wellness, economical wellness, psychological wellness and spiritual wellness. Wellness is a subjective measurement, it is not really quantifiable, but it can be understood as a product influenced by several objective factors [3]. Therefore, when it comes to the subjective approach, which covers people's experience regarding the quality of their life, we spotted multiple needs that need to be satisfied [4]. The European Commission presents several aspects of well-being, combining objective indicators with the subjective evaluation of personal situations [5,6]. Lastly, QL can also be defined from the perspective of several dimensions which are correlated with one another such as: physical well-being, material well-being, social wellness, emotional balance and professional development [7].
All of these dimensions and indicators of QL influence each other, forming a system. When it comes to the field of Physical Education, we mainly focus on the physical wellbeing which in turn focuses on the physical fitness (PF). PF is directly influenced by the direct level of involvement of physical activities (PA) and it represents a precondition of physical, psychological, spiritual and social well-being. In this regard, there is a plethora of studies which have proven the relationship between PF and QL of people; more specifically, they proved that physical activities led to the improvement of physical fitness, and, of course, of quality of life in general [8][9][10][11][12].
There are two different types of fitness with separate goals and components. There is the physical condition of the athlete, which follows the performance (performance-related fitness) and the physical condition of the ordinary individual, which characterizes the level of adjustment to the daily run activities (health-related fitness). Health-related fitness is considered an attribute of QL [13].
PF can be defined as the "ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and to meet unforeseen emergencies" [14,15]. PF is associated with health status, with the emotional well-being and with some behavioral aspects which are based around the overall quality of the innerworkings of the vital systems from within the human body [16]. A certain level of fitness is also correlated with some affirmative answers to questions related to: the execution of daily activities vigorously, the body's attitude, the energy during free time, a supple body and being a part of long periods of physical exertion [17]. Components of health-related fitness include: flexibility, balance, body composition, muscular endurance, strength, power, cardiorespiratory endurance, coordination and agility [18][19][20].
Health-related fitness is our main focus throughout this research. This is an indicator of QL. Optimal PF can improve QL offering physical and psycho-emotional well-being. One of the ways through which you can increase PF and specifically improve QL is through PE [21]. A study conducted in Finland, on a group of 25-years-old men, discovered a correlation between good physical conditioning and certain aspects related to QL, which had proved that fitness must be a constant part of the daily activities of every person [22]. Other studies investigating the relationship between PF and QL have also showcased the fact that young people from Denmark (aged 16 to 20) and Spain (aged 10 to 13) who practice PE are healthier and they have a better perception of themselves than their sedentary counterparts [23,24]. In addition, PE reduces the negative mental states, improving the general quality of their life [25][26][27][28].
Nowadays, PF, specifically the overall quality of some people's lives, has dropped down exponentially, with the main reason behind it being a lack of PA. For example, following the evaluation of some ordinary people's quality of life, Romania ended up placing amongst the last places in Europe. This ranking was related to the overall level of PE practicing [29]. In 2014, the percentage of young Romanian females who had not completed any PA was 64% [30]. Therefore, the lack of PA is the greatest public health problem of the 21st century [31]. From a global standpoint, 1 in 4 adults and as many as 80% of young people and teenagers are not sufficiently physically active [32]. According to WHO, the lack of PA represents 1 of the 10 main factors that lead to death, on a global scale [33]. In addition to that, the number of obese people has also doubled on a global scale, going far back into the 1980s, resulting from the fact that, in the year 2014, 13% of the adult population of the world were classified as overweight, and from the 18-year-old young people of the world, 39% (38% boys and 40% girls) were overweight [34].
PA brings several important benefits for both physical and mental health. It contributes to the prevention and treatment of diseases and helps in maintaining a healthy body [35,36]. PA is mentioned as a key factor in preventing diseases, and this can improve QL together with adopting a healthy life [37]. PA is heavily related to social relationships, with health improvement and physical conditioning, with the well-being across all plans and lastly, with QL. From the White Paper on Sport and the recommendations of the European Council, we can discern that PA has an important role, which ensures important services in the wellness of society [38]. All of the European members recognize the value of sport considering that these cannot be limited to just the physical sphere because they also encompass a larger range of abilities [39].
PA has an important role in physical well-being, where PF and well-being are the main attributes. In addition these, PA is also the key for improving emotional well-being. PA positively influences the well-being and the self-confidence, providing psychological comfort [40]. Even more so, it favors social contacts, cooperation and social relationships, bringing about contributions towards the betterment of the well-being and health. Amongst the beneficial effects of PA in regards to the overall increase in QL, we should also mention: positive changes of the self-perception and well-being; the improvement of self-confidence; positive changes regarding the mood; tension relief; further improvement of positive thinking [41]. In addition, in the European Council's Code of Ethics, it is mentioned that sport "allows the individual to know themselves better, to express themselves better, to earn the science of acting out ("savoir-faire") and to prove their competence; sport allows social interaction, is a source of pleasure and propagates good feelings" [42].
All of the benefits of PA represent the imagery attributed to a high-quality life, where all of the psychological, emotional and social characteristics are balanced out with the physical, functional and motor functions.

The Purpose of the Experimental Research
The purpose of this research was to identify certain PA programs which are meant to increase all of the components of PF of the university students. In this context, we introduced exercises like Pilates, Tae Bo, Stretching and Workout at Fitness Machines into the physical education lessons. The efficiency of the physical activities program proposed was identified by analyzing the somatic, functional and motor effects and by comparing the results obtained with the values of students from control group who participated at physical education lessons traditionally held at our university, using standard exercises such as running, gymnastics and sports games.

Hypothesis
The introduction of Tae Bo, Pilates, Stretching and Workout at Fitness Machines in the physical education lessons, while respecting the principles of correct form and the individual particularities of each of the students, will determine the improvement of all of the PF components related to health (speed of execution, running speed, static and explosive strength, muscular endurance, balance, flexibility and body composition).

Participants
For this experiment, we had two groups (each consisting of 24 subjects) of undergraduate female students: the experimental group (19.87 ± 1.07 years old; height 163.95 ± 5.24; weight 57.91 ± 6.78; BMI 21.53 ± 2.58) to which we applied the new exercise workout, and the control group (19.75 ± 0.79 years; height 163.66 ± 6.37; weight 57.20 ± 7.21; BMI 21.32 ± 2.32). The inclusion criteria were: to be undergraduate students at Stefan cel Mare University of Suceava, female, aged between 19 and 23 years old, good health status without diseases that interfere with practicing of physical exercises, a good level of physical fitness and the exclusion criteria were: age over 23 years old, practicing elite sport, health issues and comorbidities, male, participating in other similar research. Participants gave their consent to use these personal data for scientific purpose and the conduct of this study was approved by the University Research Ethics Committee.

Measurements and Tests
We used the Eurofit battery to investigate PF level. The Eurofit Program was created by the European Council as a means of evaluating the fitness level of the populations from the European Union countries [43,44]. The undertaken tests were the following: Weight (W), Body Mass Index (BMI), Flamingo Balance Test (FBT), Plate Tapping (PT), Sit and Reach (SaR), Standing Broad Jump (SBJ), Handgrip Test (HT), Sit-Ups in 30 s (SUps), Bent Arm Hang (BAH) and Shuttle Run 5 × 10 m (SRun).
All assessments (pre-and post-testing) were conducted at the same location and were completed at the same time of the day by the same testers.

Procedures and Research Design
First, we want to emphasize that this experimental research was conducted following a preliminary study through which we identified the fitness level of female students from Stefan cel Mare University of Suceava, using Eurofit battery (N = 172 undergraduate female students, aged between 18 and 23 years). All participants were informed about the aim of the study, and they provided their informed consent prior to participation. The results obtained were compared with other studies which investigated the fitness level of young people [45,46] and were also compared with some evaluation scales [47][48][49]. In summary, the data resulted proved to be small with the PF of the students being at a low level. For the FBT, 42% of the students scored below average; for the PT, 33% receiving a "mediocre" ranking; for the SaR, 34% had mediocre results (25-29 cm); for the SBJ, none of the students were able to receive a positive ranking; for the HT, 74% received values greater than 30 kg, getting an "above average" ranking; for the SUps, 33% of the females had mediocre results between 17 and 19 repetitions; for the BAH, 46% had results between 11 and 18 s receiving a "poor" ranking; for the SRun, only 20% were able to receive an "above average" ranking.
Starting from the results of the preliminary study, we considered it necessary to conduct an experimental research that would lead to the improvement of the students' physical fitness by elaborating some exercise programs that would influence all the components. At the beginning of the experiment, we randomly chose two groups of female students (experimental group and control group) and we evaluated their PF. The next step was to design a physical activities program that included exercises from Tae Bo, Pilates, Stretching and Workout at Fitness Machines, in order to increase all components of PF. The program consisted of 2 physical education lessons per week, each lesson with a duration of 100 min, for a period of 28 weeks (one academic year). During this period, the students of the control group prepared with classic physical exercises such as running, gymnastics and sports games (carrying out typical activities of the ordinary Physical Education curriculum throughout the research). There were no extra physical activities during the winter and spring holidays. At the end of the research, we assessed the PF components through the Eurofit battery in order to demonstrate the effectiveness of the program we proposed. The proportion of the Tae Bo exercises was 25% in our program; the same share was used for Pilates exercises; for Workout at Fitness Machines, we used 30% of the total time; and for Stretching we used 20%.

Data Analyses
For the statistical analysis, we used descriptive statistics (the mean-M and standard deviation-SD), and also Pearson correlation and ANOVA were calculated on the basis of the collected data by using IBM SPSS version 26, to determine if significant changes in PF occurred. To achieve statistical significance, the value was set at p < 0.05 (p-value < 0.05 was considered statistically significant). Pearson correlation was applied to determine the concordance between data sets. We analyzed the intragroup and the intergroup results.

Results
The results of the descriptive data of all participants are presented in Tables 1 and 2.  Table 1 shows the means (M) and standard deviations (SD) of the experimental group (intragroup analysis). Table 2 shows the means (M) and standard deviations (SD) of the control group, and also the intragroup analysis (pre-test and post-test results). In addition, Pearson correlation and ANOVA were calculated on the basis of the collected data, in order to determine if significant changes in PF occurred.  Regarding Table 1, the results showed that there were significant differences between pre-test and post-test in the experimental group, p < 0.05. All variables show a strong or medium positive correlation. These results provide evidence that the introduction of new exercises can elicit significant changes in PF. Regarding Table 2, the results showed that there were no significant differences between pre-test and post-test in the control group, except for flexibility (Sit and Reach Test), where p = 0.04, F = 4.31.
In Table 3, we present the intergroup analysis (pre-test experimental group-pre-test control group; post-test experimental group-post-test control group). As we can see, there were no statistically significant differences between the two groups at the beginning of the study in any of the variables. At the end of the study, we found significant differences in four of the eight components of PF. The experimental group showed a significant increase in explosive strength evaluated by SBJ (p = 0.002), muscular endurance of the trunk evaluated by SUps (p = 0.024), muscular endurance of the arms evaluated by BAH (p = 0.0005) and in speed running-agility evaluated by SRun (p = 0.0002).

Discussion
The results revealed that university students following a different PA program with new exercises like Tae Bo, Pilates, Stretching and Workout at Fitness Machines during physical education lessons had achieved improvements in their PF compared to university students who follow the normal curriculum of the Physical Education subject.
The PF components and the morphological parameters have all reported visible improvements of the values for the experimental group. Females in the experimental group lost 3.54 kg (54.37 ± 4.76 vs. 57.91 ± 6.76) and the control group showed a very small decrease in weight (56.87 ± 5.81 vs. 57.20 ± 7.21). In addition, the BMI of the experimental group was improved (21.53 ± 2.58 vs. 20.17 ± 1.65). All of the students reported a BMI indicating a normal weight to height ratio at the end. The individual BMI results are also similar with the results from the other female students of the same age from different countries [50][51][52].
During the Flamingo Balance Test, the experimental group improved their balance by 1.25 and the control group by just 0.62. For the experimental group, F(1,46) = 7.48, p = 0.009 which means there is statistical significance. It has been proven that with the transition from adolescence to youth there are improvements in balance. For example, the girls between the ages of 14 and 15 years old recorded an average value of 13.5 at FBT, and the 17-year-old girls recorded a mean of 7.5 [53,54]. Our young females had an initial mean of 3.12 ± 1.87 during the FBT. According to studies that assessed the PF of male students (aged 18 to 22) by Eurofit battery, there were much lower values of balance in this test (14.83 ± 5.05) [55].
For the Plate Tapping Test, the progress that was reported on the experimental group was 0.90 s, and the control group was only 0.29. F = 8.21, p = 0.006 which also means the hypothesis is accepted, p < 0.05. The results of our students (13.42 ± 0.94) are far lower compared to those of Serbian female students (10.15 s) [46].
For the Sit and Reach Test, we recorded a progress of 3.01 cm for the experimental group and 2.83 for the control group. At the end of the study, the experimental group showed a significant increase in flexibility (31.16 ± 3.78) compared to the baseline (28.15 ± 4.29), p = 0.013, F(1,46) = 6.65. The control group also showed a significant increase at the end of the study (29.57 ± 5.03), compared to the baseline (26.74 ± 4.35), p = 0.043, F = 4.31. The values resemble the ones of the Serbian female students (30.83) [46]. In addition, the male students (aged 18 to 22) obtained lower values of flexibility in this test (8.26 ± 3.91) [55], but of course, they received a better ranking for the Handgrip, Shuttle Run and Sit-Ups Tests. This is due to the development particularities and the fact that most of the time, boys went through more intense workout than girls [56,57].
During the Standing Broad Jump Test, the experimental group reported a progress of 5.66 cm, the difference between the means (162.9 ± 5.29 vs. 157.2 ± 6.52) showed a significant increase in explosive strength, p = 0.001, F = 10.91. In the control group, there were no significant differences between pre-test and post-test, p = 0.0.86, F = 0.03. The values of our female students are close to the ones of Russian female students (aged 17 to 21)-153.6 ± 0.54 cm [58].
For the Handgrip Test, at the end of the study, the experimental group showed a significant (p = 0.009) increase in static strength of the arms compared to the baseline. The control group also showed an increase compared to the baseline, but the difference was not statistically significant (p = 0.055, F = 0.35). The values of our students are far smaller in comparison to the ones of the Serbian female students (M = 41.65) [46] and they are far greater than the values from the Tunisian female students (aged 20 to 23), which had 31.0 ± 4.31 kg [59].
For the Sit-Ups Test, at the end of the study, the experimental group showed a significant increase in muscular endurance of the trunk (abdominal muscle) (22.25 ± 2.38) compared to the baseline (19.41 ± 3.07), which was statistically significant. The control group also showed an increase (M ± SD = 20.62 ± 2.46) compared to the baseline (M ± SD = 19.25 ± 3.02), but the difference was not statistically significant. For this test, the results of Russian female students (23.6 ± 0.22) are far greater than those of our students [58], and the Croatian female students reported M = 13.86, with the individual values being far smaller [45].
For the Bent Arm Hang Test, the experiment group reported a progress of 9.15 s, and the control group only 0.88. The experimental group showed a significant increase in muscular endurance of the arms, confirmed by ANOVA (p = 0.010, F = 7.07). The control group also showed an increase, but the difference was not statistically significant (p = 0.077). It is worth mentioning that our female students reported equal initial values to those of the Greek female students (aged 19.4 ± 2.7 years), with an average of 26 s [60].
For the Shuttle Run Test, the experimental group showed a statistically significant improvement of the running speed-agility. The control group showed an increase, but not enough to be the statistically significant.
Intragroup correlation showed a strong positive one for each test, with values ranging between 0.900 and 0.983 for the experimental group. It was moderate to strong for the control group, with values between 0.648 and 0.972. Intergroup correlation was poor to moderate with alternance of positive and negative values.
In some Eurofit Tests, Spanish children (aged between 11 and 14), Lithuanian and Croatian children (12.4 ± 1.6 years), Kosovo and Montenegrin children (13 years old) reported values not significantly different than those of the female students. For example, both for the SUps (M ± SD = 19.54 ± 5.55) and the SRun Tests (M±SD = 16.30 ± 1.64), the results of Spanish children are better than those of the university students. This fact convinced us that during their preteen years, children are trained a lot more and they are a lot more physically active than university students [61][62][63].
The low PF is associated with the increased risk factor of different pathology, with the overall dissatisfaction regarding the health status, the work capacity, the rate of fatigue and the insufficient energy needed for daily tasks being significant. All of these come as a result of sedentary behavior, because more and more youth are physically inactive nowadays [64][65][66][67]. When people are more physically active, their health status, PF and specifically their quality of their life are at a far superior level because all of these elements influence each other, being in a direct interdependency relationship [68,69].

Conclusions
The introduction of some exercises from Tae Bo in an aerobics program led to the improvement of certain morphological indices. Although in the development of Tae Bo programs we have mainly aimed at improving body harmony, they have also contributed to the development of execution speed through arm techniques, to the development of the strength of the muscles engaged in the execution of the techniques of the knees, legs and elbows and to the development of skill, through the technical combination execution. The Tae Bo techniques have a complex character and they mainly focused on the development of all motor qualities.
The exercises for Workout at Fitness Machines led to the development of strength, but also influenced the development of speed. Doing the four circuits (30 to 50% of the maximum possibilities) led to the development of the strength, running and execution speed.
The introduction of some static stretching exercises at the end of physical education lessons has led to the development of flexibility. The four static stretching programs (15-20"), performed throughout 28 weeks, led to the development of flexibility.
Lastly, adding Pilates exercises, while upholding the principles that lay at the foundation of the method, led to the improvement of balance and stability. Despite the fact that during the Pilates programs (performed for 28 weeks) we focused on the balance development, the exercises also led to the improvement of flexibility and strength.
The female students improved their QL, expressed by better somatic and motor indices obtained at the final testing. The results of our research support the idea of diversifying physical education lessons with students and orienting physical activity towards increasing their QL, because the improvement of QL for all age groups has become a major focus of modern society.
A limitation of this research includes the relatively small sample size, which may prevent generalization to a wider population. Additionally, we did not measure behavioral variables such as what types of PA the participants partook in, if they participated in other PA individually or as a group in their leisure time. Another limitation is represented by the variety of the concept "quality of life", which cannot be fully understood, given the fact that it has many dimensions and objective indicators, but especially a strong subjective character. Exercise does not influence all areas of QL, but only those related to physical, social and psychological well-being.
There are future directions of this research. Hoping for improvement of physical education lessons in university, we will initiate the proposal of a new curriculum. The activity with the students must be a process aimed at improving QL and at ensuring an optimal level of effort that will lead to changes in morphological, functional, motor and last, but not least, psycho-social plan. The strategies implemented in this study could be a starting point for designing interventions in the context of Physical Education, in order to improve PF in young people.