This cross-sectional study was conducted on students at School of Borujen Nursing, Shahrekord University of Medical Sciences. The participants in this study were all nursing students (118 students) of Borujen Nursing and Midwifery in February 2015 to July 2015, except for new students of semester one. The inclusion criteria of the research examinees were: at least one semester of education in the university; and lack of diagnosed physical mental disease. The exclusion criteria were: Guest students or students who had below-12 GPA for some specific reasons (such as the death of a family member or illness); and, students who had taken educational leave. After selection of qualified research examinees and acquisition of their written consent forms, the researcher read out the questions and recorded their responses in the questionnaire without any modification.

This study was approved by the Ethics Committee (ethical code: 93-9-20) of the Shahrekord University of Medical Sciences. Information of the present research was gathered using Susan Walker’s health promoting lifestyle profile [16] which was modified by adding demographic questions and few health related behaviour questions. Also, in order to assess the academic status of students, Grade Point Average (GPA) of the last semester was evaluated after acquiring it from the educational department of the nursing school. Walker’s health promoting lifestyle profile questionnaire consists of 52 questions for evaluation of physical activities, dietary habits, and safety habits. In the study by Mohammadi Zeidi I et al., the internal reliability of the questionnaire was obtained as 82% and its content validity was also approved by the specialists [17]. In the tool, eight questions were about amount of physical activity, nine questions belonged to dietary habits and three questions were associated with the status of students’ health-related behaviours such as smoking, use of a seatbelt and tooth brushing. All questions were designed with responses in four choice Likert scale (Never, Sometimes, Often, and Always). Additionally, two questions were included concerning height and weight of students to measure their Body Mass Index (BMI). For classification of mass body attribute, the standard BMI classification proposed by World Health Organization (WHO) was used, in which BMI<18.5 is regarded as “thinness”, 18.5<BMI<24.9 as “normal range”, and 30<BMI<34.9 as “obese class I” [18].

Questionnaire scoring pattern were as follows: all questions related to physical activity and dietary habits and two out of three questions of health related behaviours would obtain scores 1 to 4 according to the above mentioned Likert scale (Never=1, Sometimes=2, Often=3, and Always=4). For the question concerning smoking, the scoring was vice versa (Never=4, Sometimes=3, Often=2, and Always=1). Finally, the scores of the three sections of the questionnaire were added to determine the total lifestyle score for each examinee. Total scores of lifestyle and three sections of the questionnaire were categorized in three groups of poor, moderate, and good. The lifestyle scores between 33 and 43 were regarded as “poor”, between 44 and 54 as “moderate” and those in the range 55-65 as “good”. The scores in three sections i.e., physical activity, dietary habits and health-related behaviours were categorized as follows: for the variable of physical activity; scores between 8 and 15 were regarded as “poor”, between 16 and 22 as “moderate”, and between 23 and 29 as “good”. Regarding the dietary habits, the scores in the range 14-20 represented “poor”, scores in the range 21-26 as “moderate”, and 27-33 as “good”. For health related behaviours variable, the score ranging from 4 to 6 represented “poor”, from 7 to 9 “moderate”, and 10 to 12 “good” [19].

In the present study, the validity of the above mentioned questionnaire was verified using Cronbach’s Alpha coefficient. For this purpose, a pilot study was conducted on 30 students. Cronbach’s alpha coefficient for Walker’s lifestyle profile was reported equal to 0.90 using SPSS software version 16.0. Descriptive statistical methods were used for adjustment of tables. The sampling of the present study lasted for about four months.

The results of data analysis showed that most students (59.3%) were in the 21-24 age group. A total of 56.8% of research examinees were females and the rest 43.2% were males. Most of the participants (90.7%) were single. Other demographic information regarding the participants is shown in [Table/Fig-1]. In addition, based on the acquired results, most students with GPA below 14 (55.55%) and also in the range of 14 to 16 (47.16%) had poor lifestyles whereas 40.81% of them with GPAs in the range of 16-18 had moderate lifestyle and most of them with GPA equal and greater than 18 had good lifestyles [Table/Fig-2]. According to results of Pearson’s correlation coefficient, a positive and significant relationship was observed between lifestyle and academic achievement (r=0.628 and p=0.03).

Research results manifested that a remarkable percentage of students’ lifestyle (61.01%) can be classified in the moderate level. Pecker K and Bermek G had also reached the conclusion in their research on freshman dental students (111 students). The overall health promoting lifestyle behaviours among these students were at a moderate level, indicating that they often engaged in health-promoting behaviours which confirm the findings of the present study [20].

Educational experience influences certain aspects of personality and lifestyle of students such that the students not only gain more knowledge and information following graduation from university but also get more socially transformed, experienced and efficient. The lifestyle of 22.88% of students was evaluated as poor, which is in alignment with the results of the study carried out by Mazurek Melnyk B et al., in their study with 93 health sciences students. They concluded that students with unhealthy lifestyle are at high risk for depression, anxiety and unhealthy behaviours, which could be averted through screening and early evidence based interventions [21].

Based on the results of the present research, majority of students exhibited a poor level of physical activity, which matches with the findings of the study by Nola IA et al., Eating and lifestyle habits of first (n=169) and sixth (n=272) year students, aged 18 to 26 years, attending a Medical School in Zagreb, were compared related to the years of their study. The two studies showed non healthy eating and lifestyle behaviour among medical school students [22]. In another study on 470 university students, by Garrusi B et al., the level of physical activity of students was reported as poor [23]. The condition of physical activity is not appropriate in the study conducted on US students either [24].

In the present study, 31 students did not have proper dietary habits, which is in accordance with the study by Dute DJ et al., in their literature review; they found that most students do not have satisfactory nutritional status [25]. More than half of students (52.54%) were in good condition in terms of safety habits in alignment with the findings of the research by Mishra A et al., [26]. Nowadays, academic achievement greatly matters in higher education system and recognition of the factors associated with educational performance serves as a robust instructional means [27].

The results of the present study indicated that most students with GPAs below 14 (55.55%) and in the range of 14-16 (47.16%) had poor lifestyles whereas 40.81% of those with GPAs between 16 and 18 had moderate lifestyle and 71.42% of the students with GPAs equal or greater than 18 had good lifestyles. Eide R et al., also states that the lifestyle chosen by the person depends on the accessible life opportunities such as academic achievement. Students who undergo academic decline are more likely to tend to negative behaviours and would inflict damages to themselves and the society [28]. The results of the study by Lopes E et al., were in line with present research findings [29].

Based on Pearson’s correlation coefficient, a positive and significant relationship was observed between lifestyle and academic achievement (p=0.03, r=0.628). Results of the study by Francois T and Shephard R are also consistent with our results [30]. Luftenegger M et al., also inferred that progress motivation and academic achievement affects behavioural planning and lifestyle of individuals [31]. The relationship between lifestyle and academic achievement at different educational levels must be evaluated in future studies.

Taking into account the results of the present research and other analogous studies, healthy lifestyle education to students with effective steps can be taken to improve the academic achievement. Accordingly, incorporating the concept of lifestyle promotion in the syllabus of universities will help students, to effectively and efficiently play role in the development of their society. In order to raise positive changes in dietary habits, development of health education programs focusing on regular physical activity is recommended.