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Autonomic echoes of student life: a mixed-method inquiry with meta-inferential integration of autonomic function, lifestyle narratives, and health behaviours among medical students Cover

Autonomic echoes of student life: a mixed-method inquiry with meta-inferential integration of autonomic function, lifestyle narratives, and health behaviours among medical students

Archives of Industrial Hygiene and Toxicology
Volume 77 (2026): Issue 1 (March 2026)
By: Dharani Bhaskaran,  Suba Anagppan,  Logeshwari Vijayagopal,  Abeetha Subramanian,  Chitra Mourali and  Daniel Dev Merlin  
Open Access
|Mar 2026
Figures & tables

Figures & Tables

Figure 1

The flowchart of convergent mixed-method study design, illustrating parallel collection of heart rate variability measurements and lifestyle behaviour scoring, and separate qualitative data analysis and final integration

Figure 2

Prevalence of lifestyle behaviours among first-year medical students (N=90)

Figure 3

Pathways linking lifestyle disruptions, chronic stress, and autonomic balance based on integrated qualitative and quantitative findings

Mean heart rate variability by variables in first-year medical students in South India

HRV variableMeanSDRangeN
Mean heart rate (bpm)91.7313.1163–13090
SDNN (ms)42.7618.21.08–118.8590
RMSSD (ms)28.3713.755.67–60.4490
PNN50 (%)13.2414.870–58.990
FFT LF/HF ratio1.850.870.23–3.9690
Lomb LF/HF ratio1.521.070.45–37.16788
Total power590.371123.378.12–10500.9490

Joint display matrix integrating LBQ-20 scores, HRV variables, and qualitative theme analysis among first-year medical students in South India

Quantitative componentQuantitative variable(s): LBQ-20 score / HRV metricQualitative themeIntegration / Interpretation
LBQ-20 scoreMean=9.46 (SD=3.16): moderate overall adherence to healthy lifestyle practicesLifestyle supports healthStudents report moderate adherence to health behaviours: hygiene and avoidance of smoking & alcohol habits are the most adhered to practices.
LBQ-20 high-score group (>10)High: Maintaining oral hygiene practices (88), Avoid alcohol (86), Non-smoking (86)Lifestyle supports healthPreventive lifestyle behaviours were evident in narratives describing gym participation and conscious self-care practices.
LBQ-20 low-score group (≤10)Processed and sugary food avoidance (21), enough sleep (29), Exercise (29)Balancing responsibilitiesStudents struggle to maintain health behaviours due to workload, academic stress, and time constraints.
Comparison between the low and high LBQ-20 score groupsNo significant difference in SDNN: (45.29 vs 39.87, respectively; p=0.27)Lifestyle changesDespite better lifestyle scores, students show no significant improvement in HRV, indicative of persistent stress or
HRV variable correlations with LBQ-20 scoreWeak and statistically non-significantLifestyle hinders healthIn contrast to reported healthy behaviours, autonomic function remains largely unaffected. This suggests dominant influence of chronic stress and academic strains on autonomic function.
Autonomic imbalance indicatorLomb LF/HF missing for 2 participants due to absent HF signalDaily routinesPossibly due to extreme sympathetic activity towed to rigid schedules and inadequate recovery, reflecting physiological strain.
Stress prevalenceLow adherence to stress management (33) and stress reduction practices (32)Influences on choicesLow adherence to stress management practices, reflecting student narratives of academic burden and fatigue. Stress appears to dominate lifestyle behaviours and might blunt the effect of healthy behaviours, which explains the weak correlation observed with HRV.

HRV Differences in HRV variables between low and high LBQ-20 score groups of first-year medical students in South India (independent t-test)

HRV MetricLow-score group (≤10)High-score group (>10)t-valuep-value
SDNN (ms)45.2939.87−1.1060.272
RMSSD (ms)30.5026.16−1.2580.212
FFT LF/HF Ratio1.941.75−0.8960.373
Lomb LF/HF Ratio1.581.44−0.8290.410

Pearson correlation between LBQ-20 scores and HRV variables in first-year medical students in South India

HRV variableRp-valueN
SDNN−0.1680.11390
RMSSD−0.1880.07690
FFT LF/HF ratio−0.0930.38290
Lomb LF/HF ratio−0.0420.69888
Total power0.1490.16390

Narratives on lifestyle and health perceptions among first-year medical students in South India

Identified themesSummaryExample quotes
Daily routinesRigid and academia-driven schedules with little time left for self-care, leading to exhaustion

  • P55: Currently my environment is not very supportive, because I live in a student residence, so sometimes food is not good and sometimes I do not get time for recreational physical activities or sports because of the hectic schedule.

  • P59: A typical day starts around 7:00 a.m. I get ready, have a quick breakfast, and head to the college by 9:00 a.m. Most mornings are filled with lectures or lab sessions until noon. After lunch, I attend more classes. I usually get to the student residence by early evening, take a short break, and then spend a few hours studying or completing assignments. I try to eat dinner around 8:00 p.m.

  • P49: I wake up at 7:00–7:15 a.m., get ready for college and go to college at around 8:45 a.m. I eat lunch at 12:45 p.m. and attend the second half of classes at 1:15 p.m. After college, I go to a gym at 5:00 p.m. and work out for 1 h and 30 min. I return to the student residence at 6:45 p.m. I take a bath and hang around with friends till 8:00 p.m. when I eat dinner. I start studying at 8:15 p.m. and continue till 1:00 p.m., and then I sleep.

Influences on choicesDecisions driven by stress, social media, mood, peers, and hostel diet limitations

  • P54: Influencers from social media, I like some influencers who follow a structured daily routine.

  • P82: My choices are mostly influenced by my schedule, energy levels, and stress.

  • When I’m busy or tired, I tend to skip exercise, eat whatever’s quick, and sleep later than I should.

  • P84: for food - hunger temptation, exercise - based on health, sleep - based on tiredness and workload

Balancing responsibilitiesStudents struggle to balance health and academic life: time and stress constraints dominate

  • P8: Physically and mentally disturbed by the academic stress and stress at home about finances

  • P35: It hinders it by not letting me spend enough time on each aspect where I want to improve.

Lifestyle supports healthStructured routines, exercise, and some social support from friends and family lead to positive habits.

  • P40: My exercise routine helps me to maintain a good healthy lifestyle

  • P49: My current lifestyle has been both improving my health and destroying my health.

  • Gym is improving my physical and mental health greatly.

Lifestyle hinders healthAcademic pressure, sleep deprivation, sedentary lifestyle, junk food, and mental health issues

  • P36: I consume too much junk food and do very little exercise.

  • P49: Less sleep and more academic stress from medical studies are destroying my physical and mental health.

Lifestyle changes upon enrolment to medical schoolSome students adopted healthier lifestyle behaviour, which was difficult to keep due to fatigue/stress

  • P34: Yes, I joined gym and started eating healthy and reduced weekly consumption of fast food.

  • P52: Tried taking walks for 30 minutes every day, quit six days in because I had more work to do that didn’t allow me these 30 minutes.

DOI: https://doi.org/10.2478/aiht-2026-77-4057 | Journal eISSN: 1848-6312 | Journal ISSN: 0004-1254
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Language: English, Croatian, Slovenian
Page range: 49 - 56
Submitted on: Oct 1, 2025
Accepted on: Mar 1, 2026
Published on: Mar 30, 2026
Published by: Institute for Medical Research and Occupational Health
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
academic stress,
autonomic balance,
diet,
heart rate variability,
medical education,
physiological health,
sleep
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2026 Dharani Bhaskaran, Suba Anagppan, Logeshwari Vijayagopal, Abeetha Subramanian, Chitra Mourali, Daniel Dev Merlin, published by Institute for Medical Research and Occupational Health
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 77 (2026): Issue 1 (March 2026)
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