Effect of Exercise on Reported Physical Sexual Satisfaction of University Students

The purpose of this study was to examine sexually active university students’ reported level of physical sexual satisfaction and perceived impact of exercise on physical satisfaction. In addition, this study investigated whether reported physical sexual satisfaction and perceived impact of exercise on physical sexual satisfaction differed based on current exercise status, body mass index, and gender. A sample of 678 college students completed a two page, 35-item survey instrument. Results indicated that students who were regular exercisers (engaged in vigorous physical activity for 20 minutes ≥ 3 days per week) were significantly more likely than students who were not regular exercisers to report higher levels of physical sexual satisfaction. Body mass index was also significantly correlated to physical sexual satisfaction. A series of multivariate analyses of variance revealed that physical sexual satisfaction and perceived impact of exercise on physical sexual satisfaction differed significantly based on gender. Overall, students perceived body image, sexual desirability perception, and physical strength as the three leading components of physical sexual satisfaction impacted by exercise. Since regular exercise may increase physical sexual satisfaction levels, health professionals could use the results of this study to help motivate individuals to enhance their physical sexual satisfaction by becoming more physically active. © 2007 Californian Journal of Health Promotion. All rights reserved.


Introduction
In 2002, heart disease and stroke were the first and third leading causes of death in the United States killing over 800,000 Americans combined (National Center for Health Statistics [NCHS], 2004).These illnesses are the result of health conditions such as high blood pressure, high cholesterol, Type 2 diabetes, and obesity all of which can be reduced and prevented through regular physical activity (American College of Sports Medicine [ACSM], 2000).Currently in the United States, 100 million people are obese, 51 million have high cholesterol, 50 million have high blood pressure and 8 million have type 2 diabetes.These health conditions contribute to more frequent visits to the physician, more medication, more hospital visits, and higher health care expenditures.The annual cost of obesity alone is $117 billion in the United States.
Physical activities have been studied in several laboratory-based research studies and have been documented to have various health benefits (ACSM, 2000).People who already have a chronic disease can enhance their ability to perform daily living activities through exercise (USDHHS, 2000a).Exercise can enable adults to improve and maintain strength and agility, decreasing the risk of falling, and thereby allow older adults to continue living independently and experiencing a higher quality of life.Along with these benefits, physiological benefits of exercise include: increased stroke volume, increased blood flow and circulation, increased aerobic capacity, decreased stress and depression, decreased risk of injury, decreased fatigue, reduced chance of dying prematurely, reduced chance of developing diabetes/high blood pressure/colon cancer, helps build and maintain health bones, muscles and joints, and assists in weight control (CDC, 1999).
While such health problems are highly preventable through regular physical activity, only 15% of individuals in the United States currently participate in the recommended weekly amount of physical activity (30 minutes of moderate physical activity for five or more days per week) and 40% participate in no leisure-time activity at all (USDHHS, 2000a).There have been a number of strategies used to motivate Americans to be physical active.Many of these strategies try to highlight all the benefits of physical activity.One of these strategies is educating individuals about the health benefits of physical activity.Another benefit mentioned in the literature is to increase physical sexual satisfaction.The research, however, conducted on this relationship has been scarce.The present study has been conducted to more fully explore this possible association.
Research studies that have examined the relationship between exercise and physical sexual satisfaction have all concluded that exercise increases physical sexual satisfaction levels (White, 1990).White found that the men who exercised regularly experienced enhanced sexual encounters including frequency of intimate activities, increased percentages of pleasing orgasms, and sufficient functioning during sex.A recent longitudinal study has found a positive correlation between exercise and sexual satisfaction in women experiencing menopause (Gerber, Johnson, Bunn, & O'Brien, 2005).In addition, women who reported a decrease in frequency of exercise throughout the five year period also had a decrease in sexual satisfaction scores.Results of a study on females who began an exercise program revealed an increase in vaginal pulse amplitude and vaginal blood volume in both sexual functioning and sexually impaired women, suggesting that an increase in sympathetic nervous system arousal may produce the outcome of physiological responses in women (Meston & Gorzalka, 1996).Exercise intensifies the sympathetic nervous system thus possibly enhancing physical sexual satisfaction.In a study conducted with cardiac male individuals, researchers concluded that the benefits of exercise training were correlated to improvements in sexual activity (Belardinelli, Lacalaprice, Faccenda, Purcaro, & Perna, in press).Research involving active, older adults similarly found a correlation between physical sexual satisfaction and degree of fitness (Bortz & Wallace, 1999).
The present study examines whether sexually active university students' perceived levels of physical sexual satisfaction differ based on exercise status, body mass index (BMI), and gender.In addition, it was studied whether perceived impact of exercise of physical sexual satisfaction differed based on gender and exercise status.Perceived impact of exercise on physical sexual satisfaction was defined for the purpose of this study as an individual's perception on the effects that exercise had on physical sexual satisfaction.There has been no study conducted that does a comparative analysis between exercise and physical sexual satisfaction.It should also be noted that the present study only examined components of physical sexual satisfaction, not emotional, since the physiology involved in exercise may influence physical aspects of sex but not emotional.If there was a more definite understanding of the association between exercise and physical sexual satisfaction then this may positively impact individual's to exercise.

Participants
The participants of this study consisted of students attending a Midwestern university during the Spring Quarter of 2005 (n=678).Students were enrolled in general education courses taken by the general student population (i.e., Anatomy and Physiology, Physical Conditioning, Personal Behavior, Community Health, Racquetball, Yoga: Stress Management, and Group Fitness).Courses more likely to enroll regular exercisers were not targeted.

Instrumentation
A two page, 35-item survey instrument consisting of two subscales and a demographic segment was developed for this study.Subscale Procedures one assessed an individual's reported physical sexual satisfaction and required participants to indicate how satisfied or dissatisfied they were with each of the 18 items by using a five-point Likert-type scale (1 = strongly dissatisfied, 5 = strongly satisfied).Individual item scores were totaled to achieve an overall sexual satisfaction score (potential range=18-90).
After approval was granted from the institutional review board for human subjects, the study was undertaken.Permission to distribute the surveys was received from the instructors of eight Undergraduate level classes, a total of 17 classes.Arrangements were made with each individual instructor for convenient class days and time for the students to complete the survey.Students were informed of the research purpose and importance of the study through in class announcements made prior to survey distribution.Students were encouraged to complete the survey and reminded that it was voluntary and anonymous.The students were instructed to place their finished survey in a box placed in the front of the room face down.After each classroom completed the survey, the results were entered for data analysis.
Subscale two assessed individuals' perceived impact of exercise on physical sexual satisfaction and required participants to indicate how strongly they agreed or disagreed with each of the 12 items by using a five-point Likert-type scale (1 = strongly disagree, 5 = strongly agree).All statements were worded in the positive direction, hence the higher the score, the higher the belief that exercise effects physical sexual satisfaction.For analysis purposes, individuals received a score of 5 for strongly agree, 4 for agree, 3 for neutral, 2 for disagree, and 1 for strongly disagree.Individual item scores were total 12 to 60.

Data Analysis
SPSS for Windows was used to analyze all data in the present study.A series of means, standard deviations, and frequency analyzes were conducted on demographic variables and individual subscale items.Pearson r correlations were computed to determine whether physical sexual satisfaction significantly correlated with body mass index.Multivariate analyses of variance were used to determine whether reported physical sexual satisfaction and perceived impact of exercise on physical sexual satisfaction significantly differed based on current exercise status and gender.
A panel of selected experts in health education and survey development and research were distributed the survey instrument to establish content validity.Successive adjustments were made in the instrument based on the recommendations offered from the panel of experts.Reliability and validity was determined for each of the subscales in the survey preceding the distribution of the survey for data collection.A test-retest design was used to determine the reliability of each subscale.A convenience sample of 20 individuals were distributed the survey during a Tuesday morning class.One week later, the same 20 individuals were redistributed the survey.Pearson correlation coefficients found stability reliability to be .749for physical sexual satisfaction, .830for exercise behaviors and .685for perceived impact of exercise on physical sexual satisfaction.Internal consistency reliability analyses yielded Cronbach alphas of .914for physical sexual satisfaction and .934for perceptions on the effects of exercise on physical sexual satisfaction.

Demographic and Background Characteristics
Surveys were distributed to students (n=678) at a Midwestern university in courses taken by the general student population.A total of 678 surveys were completed, resulting in an overall participation rate of 100% (678/678).Most students were female (69.6%) and heterosexual (97.6%) (Table 1).Nine in ten students were either single and not in a steady relationship or single and in a steady relationship with 85% of the steady relationships lasting longer that six months.Means for age, height, weight and body mass index is listed below in Table 1.Exercise Behavior Results indicated that students reported exercising an average of 3.03 (SD=1.850)days during an average week.On average, students reported that they exercised 2.82 (SD=1.968)days of the past seven days.Students who had partners reported that their partners exercised an average of 2.79 (SD=2.140)days during a typical week and that their partners exercised 2.61 (SD=2.192)days during the past 7 days.One in ten (9.8%) students reported no participation in exercise during the past 6 months.Three in five (62.1%) students exercised regularly, meaning that they exercised at least three days each week.Of those students, eight in ten (78.6%) students participated in cardiovascular exercise, one in two (49.9%)participated in weight training, and one in five (20.2%) in flexibility training.More specifically, 85% of the individuals who reported participating in flexibility training were female.

Sexual Behavior
Regarding sexual behavior, results indicated that one in five (20.1%) students have never engaged in sexual activity.One in five (18.9%) students reported engaging in sexual activity at some point in their life but not within the past 30 days.One in five (21.4%) students also reported engaging in sexual activity within the past 30 days.Three in ten (29.2%) students reported engaging in sexual activity within the past seven days.Of those students who reported engaging in sexual activity within the past seven days, an average of 2.13 (SD=1.816)days of sexual activity was reported.

Reported Physical Sexual Satisfaction
Physical sexual satisfaction was rated on an 18 question, five point Likert-type scale that resulted in an overall physical sexual satisfaction score (1 point=extremely dissatisfied, 5 points=extremely satisfied).When comparing variables, results found that sexually active students were most satisfied with the frequency of their partner's orgasm (M=4.

Reported Physical Sexual Satisfaction Based on Exercise Status, BMI, and Gender
A multivariate analysis of variance (MANOVA) was conducted to examine the effect of exercise on physical sexual satisfaction.Results found that there was a significant difference between students who were sexually active and who exercised regularly and students who were sexually active and did not exercise regularly regarding physical sexual satisfaction F(18, 509) = 1.738, p = .030.More specifically, those who regularly exercised reported higher satisfaction regarding physical strength during sexual activity (M = 3.97, SD = .827)than nonexercisers (M = 3.95, SD = .827),F(1,526) = 12.877 p < .001.Also, those who regularly exercised reported higher satisfaction regarding energy during sexual activity (M = 4.07, SD = .692)than those who did not exercise regularly (M = 3.96, SD = .778),F(1,526) = 6.744, p = .010.Regular exercisers also reported higher satisfaction concerning duration of sexual activity (M = 3.88, SD = .885)than those who did not regularly exercise (M = 3.78, SD = .942),F(1,526) = 5.632, p = .018.Those who exercised regularly also reported higher satisfaction concerning frequency of sexual activity (M = 3.36.SD = 1.009) than those who did not regularly exercise (M = 3.49, SD = 1.033),F(1,526) = 4.891, p = .027.In addition, those who exercised regularly reported higher overall satisfaction during sexual activity (M = 4.13, SD = .715)than those who did not exercise regularly (M = 4.04, SD = .737),F(1,526) = 4.634, p = .032.

Perceived Impact of Regular Exercise on Sexual Satisfaction
Perceived impact of regular exercise on sexual satisfaction was rated on a 12 question, five point Likert-type scale that gave each respondent an overall regular exercise belief score (1 point=strongly disagree, 5 points= strongly agree).When comparing variables, results found that students perceived body image (M=4.29,SD=.766), sexual desirability perception (M=3.94,SD=.839), and physical strength (M=3.82,SD=.863) as the top three components of physical sexual satisfaction that are affected by exercise.Orgasm frequency (M=3.14, SD=.914), orgasm intensity (M=3.16,SD=.920), and frequency (M=3.25,SD=1.050) were the lowest three components of sexual satisfaction affected by exercise.Regular exercise belief scores ranged from 12 points (strongly disagree) to 60 points (strongly agree).The average score was 43.04 (SD=8.600)(Table 3).

Impact of Exercise on Physical Sexual Satisfaction Based on Exercise Status
A MANOVA conducted to examine the effect of regular exercise on perceived impact of exercise on physical sexual satisfaction indicated that students who exercised regularly differed significantly from students who did not exercise regularly regarding perceived impact of exercise on physical sexual satisfaction, F(12,646) = 1.735, p = .05.Univariate analyses conducted on individual physical sexual satisfaction items revealed additional significant differences based on exercise status (Table 4).Means based on a five point scale (1=extremely dissatisfied, 5=extremely satisfied).Only significant differences shown.a Regular exerciser defined as an individual that participates in physical activity 3 or more times per week, at least 20 minutes each session that makes you sweat or breathe hard.
b Non-exerciser defined as an individual that does not participate in physical activity 3 or more times per week, at least 20 minutes each session that makes you sweat or breathe hard.

Impact of Exercise on Physical Sexual Satisfaction Based on Gender
Regarding effect of gender on perceived impact of exercise on physical sexual satisfaction, results found that there was a significant difference between males and females regarding perceived impact of exercise on physical sexual satisfaction, F(18, 646) = 2.899, p = .001.More specifically, females reported higher levels of perceived impact of exercise on physical sexual satisfaction regarding body image during sexual activity (M = 4.34, SD = .731)than males (M = 4.18, SD = F(1,657) = 9.721, p = .002.Males reported higher levels of perceived impact of exercise on physical sexual satisfaction regarding their partner's orgasm frequency during sexually activity (M = 3.60, SD = .867)than females (M = 3.49, SD = .930),F(1,657) = 5.716, p = .017(Table 5).Means based on a five point scale (1=extremely dissatisfied, 5=extremely satisfied); Only significant differences shown A MANOVA was conducted to examine the combined effect of regular exercise and gender on perceived impact of exercise on physical sexual satisfaction.Results found no significant difference between males and females who exercised regularly regarding perceived sexual satisfaction, F(12,646) = 1.366, p = .177(Table 6).(2000b) reported that one in four adults who have an advanced degree in education engage in a high level of physical activity.The present study found that three in five college students working towards an advanced degree, were considered to exercise regularly (three or more times per week for at least 20 minutes each session).This may be because the participants consisted of college students.A recent study found that only 29% of college students reported not exercising (Racette, Deusinger, Strube, Highstein, & Deusinger, 2005).
Sexual behaviors among college students in the present study indicated that 29% engaged in sexual activity within the past seven days, 21% within the past 30 days, 19% at some point in their life but not within the past 30 days, and 20% had never engaged in sexual activity.Such findings parallel closely to those found by Ratliff-Crain et Al. (1999) in which 65% of college students had engaged in sexual intercourse at least once in their life.
The present study found a significant relationship between physical sexual satisfaction and regular exercise in college students.This relationship was also found in past studies involving males (White et al., 1990;Belardinelli et al., in press), females (Gerber et al., 2005;Meston & Gorzalka, 1996), older adults (Bortz & Wallace, 1999), athletes (Whitten, 1994), and sexually dysfunctional individuals (Belardinelli et al., in press, Meston & Gorzalka, 1996;White et al., 1990).Regular exercisers may experience physiological benefits that could enhance their physical sexual satisfaction such as increased blood flow, joint and muscular flexibility, release of endorphins, and skeletal muscular strength.A past study suggested that through increased skeletal muscle tone, orgasmic pleasure could be increased (Mandall, 1979).
Psychological benefits of exercise such as decreased depression or stress (Ensel & Lin, 2004) could also impact an individual's physical sexual satisfaction.Therefore, if an individual is seeking to increase his/her physical sexual satisfaction, a possible solution could be to exercise regularly.Also, health educators will now have an additional incentive to motive individuals to get involve in an exercise program.Since it is concluded from the abundant sales of sexual materials in American that most individuals want active, satisfying sex lives, knowing that exercise can help enhance their sex lives may lead more people to actually exercise.
While no previous study has found a difference between male and female levels of physical sexual satisfaction, the present study has found a relationship between gender and physical sexual satisfaction.Males reported higher levels of physical sexual satisfaction regarding orgasm frequency, body image, and orgasm intensity.This may indicate males have more selfconfidence and therefore a better body image or that males are not as affected by society's push to have a particular body image as many females may be.It may also be noted that orgasmic females are often unable to reach climax due to premature ejaculation by the male and the refractory period (Wikipedia Encyclopedia, 2005).Therefore, it may be concluded that males are more satisfied with their orgasm frequency because they achieve an orgasm more often than females.According to a study that examined gender differences in sexual intercourse experiences among college students, males were more likely to have an orgasm than females (Sprecher, Barbee, & Schwartz, 1995).
Females Sexual satisfaction levels are affected not only from an individual's physiology or physical make-up but also from emotional state of the individual/relationship, societal impact, and psychological factors.The current study examined sexual satisfaction from a physical stand point only.It may be noted that sexual satisfaction cannot be solely determined through physical measures but would require a complete examination of all components impacting sexuality.
Finally, the limitations of this study should be noted.Such limitations included participants' willingness to report their answers honestly, participants' belief that their responses would be kept confidential, and participants' comfort level of responding to sensitive items regarding sexual behavior and physical sexual satisfaction.In addition, since the sample comprised students from one Midwestern university, caution should be taken when attempting to generalize the findings of this study.

Recommendations
Based on the findings of this study several recommendations are offered.Health educators could educate individuals on the potential positive effects of regular exercise and low BMI levels on physical sexual satisfaction.Becoming more aware of the potential benefits of regular exercise and decreased body mass index may help to motivate some individuals to begin engaging in regular physical activity and participate in behaviors that decrease their body mass index (e.g., healthy diet and exercise).Additional research is needed to more thoroughly explore the effect of physical activity on sexual satisfaction.Future research should examine individuals in a controlled environment, similar to the previous research (Gerber et al., 2005;Meston & Gorzalka, 1996;White et al., 1990).A case-control study is greatly needed.Such a study could consist of two experimental conditions.The first group would consist of sexually active couples who do not exercise during the entire course of the study.The second group would consist of sexually active couples who do not exercise at the beginning of the study but are taught to exercise during the study.Both groups would be surveyed regarding their physical sexual satisfaction at pretest and posttest to determine any potential differences.In this manner, possible cause-and-effect results could be determined.Finally, future studies should examine additional factors, affecting physical sexual satisfaction such as how exercise impacts emotional sexual satisfaction.Do partners who exercise together feel more emotionally close and do they report higher levels of overall sexual satisfaction?Much research is clearly warranted regarding this issue.

Table 1
Demographic and background characteristics of participants N=678; %=Valid Percent; Missing values excluded from analyses

Table 3
Participants' Perceived Impact of Exercise on Physical Sexual Satisfaction

Table 4
Reported Physical Sexual Satisfaction Based on Exercise Status

Table 5
Reported Physical Sexual Satisfaction Based on Gender

Table 6
Perceived impact of exercise on physical sexual satisfaction based on gender