The effects of 5x5 exercises on a quality of life of university students, who use smartphones during long periods

Keywords: sleep, neck disability, fatigue, head posture, exercise


Background and Study Aim. The present study investigated the effect of a 5x5 exercise program on sleep quality, fatigue, neck pain, head posture, daily walking, sitting, sleeping and smartphone usage time. Material and Methods. An exercise program was applied to 54 university students (17 males, 37 females) between October and November 2019. The five exercises lasted approximately 15- 20 minutes in each training session (diaphragmatic breathing, axial neck extension, cervical stabilization, pectoral stretch, and shoulder retractor strengthening) that was performed 5 times a day, 5 days a week for 5 weeks. The Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Neck Disability Index (NDI), Forward Head Posture (FHP), number of daily steps, sitting time, sleep time, and smartphone usage time were compared before and after the exercise program. The Paired Samples t-test was used to compare differences between the pre-exercise and post-exercise variables. Statistical significance level was set at 0.05. Results. Following the 5-week exercise program, sleep quality improved, and levels of neck disability and fatigue were lower and the differences were statistically significant (p<0.05). No change was determined in FHP, daily sitting time and daily number of steps, sleep hours, and smartphone usage time (p>0.05). Conclusion. The 5-week program of posture correction, stretching and strengthening exercises improved sleep quality, fatigue levels, and neck disability. The findings of this study can be used to improve the sleep quality, fatigue and neck problems of both students and sedentary workers.


Download data is not yet available.

| Abstract views: 331 | PDF Downloads: 267 |

Author Biographies

Aysenur Tuncer, Hasan Kalyoncu University; Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University; Gaziantep, Turkey.
Tuba Maden, Hasan Kalyoncu University; Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University; Gaziantep, Turkey.
Tugba Badat, Hasan Kalyoncu University; Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University; Gaziantep, Turkey.
Deniz Kocamaz, Hasan Kalyoncu University; Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hasan Kalyoncu University; Gaziantep, Turkey.


1. Bisen SS, Deshpande YM. Understanding internet addiction: a comprehensive review. Mental Health Review, Journal. 2018; 23(3): 165–184.

2. Kuss DJ, Griffiths MD. Online Social Networking and Addiction- A Review of the Psychological Literature. Int J Environ Res Public Health. 2011;8(9):3528–3552.

3. Ben-Yehuda L, Greenberg L, Weinstein A. Internet Addiction by Using the Smartphone-Relationships between Internet Addiction, Frequency of Smartphone Use and the State of Mind of Male and Female Students. J Reward Defic Syndr Addict Sci. 2016; 2(1): 22–27.

4. Lee YS. Biological Model and Pharmacotherapy in Internet Addiction. J Korean Med Assoc. 2006;49(3):209–214.

5. De-Sola Gutiérrez J, Rodríguez de Fonseca F, Rubio G. Cell-Phone Addiction: A Review. Front Psychiatry. 2016;7:175.

6. Peterson NE, Sirard JR, Kulbok PA, DeBoer MD, Erickson JM. Sedentary behavior and physical activity of young adult university students. Research in nursing & health. 2018; 41(1): 30–38.

7. Sahin M, Lok S. Relationship between physical activity levels and internet addiction of adults. J Depress Anxiety. 2018;7:310.

8. Kim HJ; DH, Kim JS. The relationship between smartphone use and subjective musculoskeletal symptoms and university students. J Phys Ther Sci. 2015;27(3):575–579.

9. Park J, Kim J, Kim J, Kim K, Kim N, Choi I, The effects of heavy smartphone use on the cervical angle, pain threshold of neck muscles and depression. Advanced Science and Technology Letters. 2015;91:12–7.

10. Kim MS. Influence of neck pain on cervical movement in the sagittal plane during smartphone use. J Phys Ther Sci. 2015;27(1):15–17.

11. Yip CH, Chiu TT, Poon AT. The relationship between head posture and severity and disability of patients with neck pain. Man Ther. 2008;13(2):148–154.

12. Orzech KM, Salafsky DB, Hamilton LA. The state of sleep among college students at a large public university. J Am Coll Health. 2011;59(7):612–619.

13. Moattari M, Moattari F, Kaka G, Kouchesfahani HM, Sadraie SH, Naghdi M. Smartphone Addiction, Sleep Quality and Mechanism. Int J Cogn Behav. 2017; 1:002.

14. Augner C, Hacker GW. Associations between problematic mobile phone use and psychological parameters in young adults. Int J Public Health. 2012;57(2):437–441.

15. Shaghayegh Fard B, Ahmadi A, Maroufi N, Sarrafzadeh J. Evaluation of forward head posture in sitting and standing positions. Eur Spine J. 2016;25(11):3577–3582.

16. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.

17. Ağargün MY, Kara H, Anlar O. Validity and reliability of Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry. 1996;7:107–115. (In Turkish).

18. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121–1123.

19. Armutlu K, Cetisli Korkmaz N, Keser I, Sumbuloglu V, Irem Akbiyik D, Guney Z, et al. The validity and reliability of the Fatigue Severity Scale in Turkish multiple sclerosis patients: International Journal of Rehabilitation Research, 2007;30:81–5.

20. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity [published correction appears in J Manipulative Physiol Ther 1992 Jan;15(1):followi]. J Manipulative Physiol Ther. 1991;14(7):409–415.

21. Aslan E, Karaduman A, Yakut Y, Aras B, Simsek İE, Yaglý N. The Cultural Adaptation, Reliability and Validity of Neck Disability Index in Patients With Neck Pain: A Turkish Version Study. Spine, 2008;33:E362–5.

22. Li L, Wang YY, Wang SB, et al. Sleep Duration and Sleep Patterns in Chinese University Students: A Comprehensive Meta-Analysis. J Clin Sleep Med. 2017;13(10):1153–1162.

23. Levenson JC, Shensa A, Sidani JE, Colditz JB, Primack BA. The association between social media use and sleep disturbance among young adults. Prev Med. 2016;85:36–41.

24. Keshavarz Akhlagh A, Ghalebandi M F. Sleep Quality and Its Correlation with General Health in Pre-university Students of Karaj, Iran. Iran J Psychiatry Behav Sci. 2009; 3(1):44–9.

25. Demirci K, Akgönül M, Akpınar A. Relationship of smartphone use severity with sleep quality, depression, and anxiety in university students. J Behav Addict. 2015;4 (2): 85–92.

26. Jenaro C, Flores N, Gomez-Vela M, Gonzalez-Gil F, Caballo C. Problematic Internet and cell-phone use: psychological, behavioral and health correlates. Addict Res Theory. 2007;15(3):309–20.

27. Lee JH, Park SY, Yoo WG. Changes in craniocervical and trunk flexion angles and gluteal pressure during VDT work with continuous cross-legged sitting. J Occup Health. 2011;53(5):350–355.

28. Harrison DD, Harrison SO, Croft AC, Harrison DE, Troyanovich SJ. Sitting biomechanics part I: review of the literature. J Manipulative Physiol Ther. 1999;22(9):594–609.

29. Armijo Olivo S, Magee DJ, Parfitt M, Major P, Thie NM. The association between the cervical spine, the stomatognathic system, and craniofacial pain: a critical review. J Orofac Pain. 2006;20(4):271–287.

30. Bababekova Y, Rosenfield M, Hue JE, Huang RR. Font size and viewing distance of handheld smart phones. Optom Vis Sci. 2011;88(7):795–797.

31. Szeto GP, Straker LM, O'Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work-2: neck and shoulder kinematics. Man Ther. 2005;10(4):281–291.

32. Lee NK, Jung SI, Lee DY, Kang KW. Effects of Exercise on Cervical Angle and Respiratory Function in Smartphone Users. Osong Public Health Res Perspect. 2017;8(4):271–274.

33. Kendall F, Kendall McCreary E, Provance P, Rodgers PP, Romani WA. Muscles: Testing and Function with Posture and Pain. 5th ed. Baltimore. MD: Williams & Wilkins; 2005.

34. Park SK, Yang DJ, Kim JH, Kang DH, Park SH, Yoon JH. Effects of cervical stretching and cranio-cervical flexion exercises on cervical muscle characteristics and posture of patients with cervicogenic headache. J Phys Ther Sci. 2017;29(10):1836-1840.

35. Han J, Park S, Kim Y, Choi Y, Lyu H. Effects of forward head posture on forced vital capacity and respiratory muscles activity. J Phys Ther Sci. 2016;28(1):128–131.

36. Varvogli L, Darviri C. Stress management techniques: evidence-based procedures that reduce stress and promote health. Health Science Journal. 2011;5(2): 74–89.

37. Berolo S, Wells RP, Amick BC 3rd. Musculoskeletal symptoms among mobile hand-held device users and their relationship to device use: A preliminary study in a Canadian university population. Appl Ergon. 2011;42(2):371–378.

38. Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Curr Rev Musculoskelet Med. 2019;12(4):562–577.

39. Panjabi MM. The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5(4):383–397.
How to Cite
Tuncer A, Maden T, Badat T, Kocamaz D. The effects of 5x5 exercises on a quality of life of university students, who use smartphones during long periods. Physical education of students. 2020;24(5):271-7.