Preserving the health of university students is a priority task for preventive medicine and hygiene. The university years are formative for the development of behavioural habits and work–rest patterns; moreover, during this period, factors in the educational environment begin to exert a substantial influence on the body’s functional reserves [1]. Young men and women, while preparing for their future profession, are highly intellectually active but also considerably susceptible to environmental influences. This makes adaptation to the educational environment one of the central issues in research on the hygiene of education and lifestyle [1, 2]. According to Russian studies, even in the absence of clinically evident pathology, a substantial proportion of students show signs of functional strain associated with academic workload, an inadequately organised daily routine, insufficient sleep, reduced physical activity, and other behavioural factors [2, 3].

Medical students represent a distinct group within the university population. Their studies are characterized by a heavy academic workload, intensive schedules, frequent examinations, extensive independent learning, and early exposure to the professional environment. Consequently, they are considered particularly vulnerable to maladaptation, sleep disturbances, increased anxiety, stress reactions, and functional alterations in cardiovascular and autonomic nervous system function [2, 4–6]. Research indicates that even successful academic performance may be associated with marked psycho-emotional strain and considerable depletion of physiological reserves [4–9].

From a hygienic perspective, the adaptive capacities of students represent an integral characteristic reflecting the body's ability to maintain functional stability, satisfactory performance, and well-being under the combined influence of educational, social, and behavioral factors [2, 10–12]. Within this approach, the analysis considers not only students' subjective experiences but also their sleep patterns, nutrition, physical activity profile, living conditions, and digital workload [2, 3, 13–16]. Objective indicators of autonomic regulation, hemodynamic status, and psychophysiological state are equally important [10–12, 17, 18].

In recent years, the adoption of remote and hybrid learning formats, the expanding use of social media and mobile devices, changes in daily routines, and the growing amount of time students spend in digital environments have drawn considerable attention to the issue of student adaptation [3, 14–16]. This is particularly relevant for medical students, as the demands of digital technology compound the already stressful nature of medical education and may exacerbate disruptions to sleep, nutrition, daily routines, and emotional well-being. At the same time, there is an increasing need for preventive approaches aimed not only at correcting individual behaviors but also at creating a health-promoting educational environment [19].

Although adaptive reserves have been extensively studied, knowledge of the hygienic determinants of medical students' adaptive capacity remains scarce. Some relevant studies have examined psychological maladaptation, whereas others have focused on isolated lifestyle or physiological indicators. However, efforts to synthesize and analyze the combined effects of the learning environment, behavioral factors, and regulatory mechanisms have thus far been insufficient.

This study aimed to analyze current Russian and international research on hygienic factors affecting the adaptive capacity of students.

Materials and methods

We reviewed publications retrieved from eLIBRARY.RU, CyberLeninka, and PubMed that were published between 2015 and 2025. The review focused on studies addressing the hygienic aspects of adaptation of medical students. The included publications examined the effects of academic workload, stress, sleep, physical activity, nutrition, and digital workload, as well as physiological and psychophysiological indicators, on students' adaptive capacity. The analysis was descriptive and analytical.

Adaptation of medical students to the educational environment

Adaptation to university education is a long and heterogeneous process comprising didactic, social, psychological, and professional components [5, 7–9]. The didactic component involves adjusting to a new pace of learning, a substantial workload of independent study, and new forms of academic assessment. The social component includes integration into an academic group, the specifics of interpersonal relationships, and the ability to function in a new social environment. The psychological component encompasses anxiety, emotional stability, and the capacity to cope with stressors. The professional component concerns acceptance of the chosen specialty and integration into the value system of the future profession [5, 7]. In medical students, all of these components operate simultaneously, increasing the likelihood of a stressful course of adaptation.

The initial stage of medical training is widely regarded as the most critical period. A study of first-year medical students found that this is when they experience pronounced difficulties related to the curriculum, teaching methods, workload, assessment procedures, and the need to develop individual coping strategies [5]. First-year medical students often experience anxiety and emotional distress, which may persist despite satisfactory academic performance. Adaptation to their new lifestyle typically occupies a substantial part of the first year and may take even longer [8, 9]. Similar patterns have been observed among international medical students [20].

From a hygiene perspective, it is of primary importance that adaptation should not be judged solely by subjective feelings of happiness and security. Even when the external signs of academic success are present, a student may exhibit functional disturbances. A study that monitored and analyzed functional indicators of the central nervous system and heart rate variability in students with different levels of adaptive potential showed that more effective social adaptation may be accompanied by increased strain on both central and autonomic regulatory mechanisms [17]. Therefore, the assessment of a student's adaptive capacity should take into account not only subjective and external indicators but also objective markers of the body's functional state.

The level of adaptation depends on the year of study, age, academic profile, motivation to learn, and sociodemographic characteristics [6]. Studies have shown that health status of first-year students affects how they respond morphofunctionally and physiologically during the adaptation period [21]. There have also been reported differences in the adaptive regulatory capacity of medical students that are gender-dependent [22]. These findings indicate that a single universal approach to assessing students' adaptive status does not fully capture all of the specific features of the process. A hygienic assessment should take into account the composition of the student population, the year of study, and students' initial health status.

A particularly interesting aspect is the combination of adaptation-related difficulties with behavioral factors. According to the available evidence, impaired adaptation rarely is an isolated phenomenon among medical students; it is commonly accompanied by sleep disturbances, changes in the structure of daily activities, increased anxiety, and a deteriorating general well-being [3, 8, 13]. Hence, adaptive capacity should be considered not only as a psychological characteristic but also as an integral indicator of a student's resistance to the combined effects of the learning environment and lifestyle.

Academic workload and psychoemotional stress

In medical students, academic workload is a central factor influencing the adaptation process and its physiological consequences. Medical education involves a highly demanding schedule that combines lectures and practical training, intensive preparation for continuous assessment and end-of-semester examinations, and a substantial amount of independent study. Collectively, these demands generate sustained psycho-emotional strain, which becomes particularly pronounced during examination periods. [10, 23].

The strain on adaptive mechanisms in medical students may manifest not only during examination periods but also between end-of-semester assessment sessions, when the academic workload remains routine. In a study comparing cardiovascular and psychophysiological parameters during these two phases, researchers observed an increase in the index of functional changes and longer completion times on the Schulte table test. These findings indicate pronounced strain on adaptive mechanisms and reduced mental performance [10]. Thus, overexertion may arise not only from acute examination-related stress but also from routine day-to-day academic activities.

The psychophysiological response to stress is closely associated with students' adaptive potential. Among third-year medical students, those with a more pronounced stress response had lower values of Kerdo index, endurance coefficient, pulse pressure, heart rate, and several other integral indicators [11]. The authors interpreted these findings as evidence of sympathicotonia, reduced stress tolerance, and impaired adaptive potential. Similar conclusions were reported in another study, in which the endurance coefficient was regarded as a predictive marker for stress tolerance and adaptive capacity in medical students [12].

Academic performance is not the only factor that causes psychoemotional stress in medical students. Even during the early years of study, a substantial proportion of them experience anxiety and signs of maladaptation affecting communication, daily functioning, and psychosomatic well-being [4]. This is particularly evident among students who strive for high achievement and are highly sensitive to the demands of the educational environment. Studies investigating both objective and subjective manifestations of adaptation have shown that high motivation is often accompanied by greater internal tension and anxiety, whereas students who appear less engaged may subjectively experience the adaptation period more calmly [8, 9]. This ambiguity highlights the need to interpret academic success cautiously and underscores the importance of assessing students' psychoemotional state. Research on the role of emotional patterns in the development of anxiety and depression has demonstrated that dysfunctional emotional regulation strategies are closely associated with symptoms of anxiety, depression, somatization, and interpersonal sensitivity [24].

International data confirm the high prevalence of stress among medical students. A study of medical students and students in related disciplines found that perceived stress and learning-related stress were closely associated with poorer quality of life [25]. Similar findings have been reported in studies examining stress, mental health, and quality of life among medical students in different countries [26–28]. Collectively, this evidence suggests that learning-related stress is not episodic but systemic, adversely affecting both emotional well-being and physiological regulatory mechanisms.

A significant component of learning stress is exam stress, which can be regarded as a specific but highly informative form of acute adaptive stress. Previous studies have shown that examination anxiety and sleep disturbances form a mutually reinforcing cycle: anxiety impairs sleep, while poor sleep, in turn, increases anxiety and reduces academic performance [29]. For medical students, who have to undergo various assessments frequently, this mechanism may become chronic. Therefore, exam stress should not be analyzed in isolation from other lifestyle and daily-routine factors.

Sleep and daily routine as factors of adaptive capabilities

Sleep is one of the most important lifestyle factors influencing students’ adaptive capacity. Disrupted sleep-wake patterns are particularly common during the university years, arising from an uneven academic workload, late-night independent study, evening use of digital devices, and generally poor sleep hygiene. This issue is especially relevant for medical students, who often face time constraints and emotional stress alongside a strong motivation for academic achievement, which may lead them to deliberately reduce their sleep duration [3, 13].

A study that investigated sleep patterns among medical students found significant associations between poor sleep hygiene and poorer nighttime sleep quality, increased daytime sleepiness, and a less pronounced morning chronotype [13]. Behavioral patterns involving non-adherence to sleep hygiene are not merely a background driver but a real, modifiable risk factor for deterioration of functional status.

Major international reviews have confirmed a strong association between poor sleep, insomnia symptoms, and stress among students [30, 31]. A systematic review and meta-analysis showed that sleep disturbance and stress are interrelated in student populations and that this association persists across different educational contexts [30]. In addition to educational factors, the quality of students' sleep is influenced by physical activity, diet, caffeine intake, interpersonal relationships, and daily activity patterns [31].

The problem of sleep quality has specific features among students in medical specialties. A review of sleep disorders in this population reported a high prevalence of sleep disturbances and their associations with stress, psychological distress, and academic workload [32]. Other studies have found that daytime sleepiness, sleep deprivation, and reduced quality of life are associated with mental health symptoms and an unfavorable perception of the academic environment [26].

Among students in general, poorer sleep quality is associated with both reduced well-being and impaired academic performance. The association between insomnia and lower academic achievement has been confirmed in medical students [33]. Similar findings have been reported in broader student populations, where sleep duration and quality influenced the level of stress and academic performance [34]. Therefore, sleep hygiene assessment should be considered an integral component of the evaluation of adaptive capacity, as sleep is one of the key mechanisms mediating the impact of academic workload on students’ daily functioning.

Distance learning has increased the importance of sleep as an adaptive factor. According to a study conducted in Russia, the transition to distance learning was accompanied by changes in sleep and rest patterns and daily routines, as well as a decline in students' overall well-being [3]. International data similarly indicate that the intensive use of digital technologies during the pandemic was associated with poorer sleep quality and reduced academic productivity [35]. In this context, sleep disorders should be viewed not only as a consequence of academic stress, but also as one of the key adverse effects of the changed educational environment.

It is also important that sleep disorders among students can be addressed through preventive interventions. Several studies have demonstrated the effectiveness of short-term sleep hygiene training programs in improving sleep and reducing stress [36–39]. Sleep hygiene therefore remains a promising and important area of support for students' adaptive capacity.

Lifestyle and behavioral adaptation factors

The lifestyle of medical university students is shaped by a consistently high academic workload, which often gives rise to factors unfavorable to the preservation of adaptive reserves. Domestic and international studies have shown that insufficient physical activity, poor nutrition, an irregular daily routine, and reduced rest time are significant factors associated with poorer well-being, increased anxiety, and greater strain on regulatory systems. [2, 3, 40–42].

According to Russian studies, even in the absence of overt pathology, the balance between exercise and rest, as well as nutritional and living conditions, are important components of the comprehensive risk assessment for medical university students [2]. A study of second- and fifth-year students showed that, with respect to the domain assessing the balance between academic workload and rest, less favorable values were observed among fifth-year students. This suggests that this group may be more vulnerable to everyday hygienic factors [2].

Physical activity is a particularly important behavioral factor, as it influences not only physical health but also resilience to psychological stress. Both Russian and international studies have found that it contributes to emotional well-being and reduces the severity of psychological distress [3, 40–42]. A sufficient level of physical activity is associated with lower psychological distress and better emotional well-being [41, 42]. Medical students are no exception to this pattern: for them, physical activity is considered a protective factor against mental distress [40].

Nutrition is an equally important component of adaptive capacity. According to the study, during the period of distance learning, students developed disordered eating patterns accompanied by weight gain and a deterioration in overall well-being [3]. A comprehensive assessment of the socio-hygienic factors affecting medical university students included a domain evaluating living and dietary conditions as indicators relevant to risk assessment [2].

The data indicate that lifestyle and behavioral factors do not act in isolation but rather in combination. Poor sleep, low physical activity, prolonged sitting, unhealthy nutrition, and high stress levels often co-occur, mutually reinforcing their adverse effects [30, 31, 41, 42].

Deterioration in students' adaptive status may manifest not only as psychological complaints but also as morphofunctional and hormonal-metabolic changes. A review of studies that recruited first-year students stated that university adaptation is associated with changes not only in psychological indicators but also in morphofunctional and hormonal-metabolic parameters [43].

Digital load and its impact on adaptive capacity

In recent years, digital load has become a major factor influencing students' living conditions. Smartphones, social media, messaging applications, educational platforms, and other electronic resources are now integral to both academic and leisure activities. For medical students, who must process a large volume of educational material, this burden is often twofold: academic digital engagement is combined with prolonged recreational screen time [3, 14–16].

Russian studies have shown that among medical students, prolonged use of social media and mobile electronic devices is associated not only with changes in behavioral habits but also with objectively adverse health outcomes. In a multicenter survey, medical students spent an average of 250 minutes per day on social media, and social media use exceeding two hours per day was associated with an increased relative risk of Internet-dependent behavior [15].

The relationship between digital load and autonomic regulation is a particularly interesting matter. In a study of medical students, daily social media use exceeding two hours was associated with an increased risk of autonomic dysfunction [14]. Excessive use of electronic devices is also associated with adverse lifestyle changes, including reduced physical activity and sleep disturbances, highlighting the need to develop modern approaches to hygiene education [16].

International studies have confirmed the association between digital technology use, sleep quality, and academic performance. It has been shown that intensive use of digital devices during the COVID-19 pandemic was associated with poorer sleep quality and impaired academic effectiveness [35]. In a randomized study, reducing smartphone screen time improved mental health, well-being, and sleep quality among students [44].

A number of studies have demonstrated the positive effects of software designed to reduce stress and improve sleep and emotional well-being among students [36–39]. A meta-analysis of studies evaluating such programs has shown that digital interventions can be beneficial when used as tools for prevention and self-help rather than a tool enabling an unsupervised self-care session [36].

Physiological and psychological criteria for assessing adaptive capabilities

The current approach to assessing students' adaptive capacity largely relies on the combined use of subjective and objective criteria. Although psychological surveys and self-administered health-status questionnaires remain important, they do not fully capture the strain on regulatory systems or the physiological cost of adaptation. Consequently, cardiovascular, autonomic, and psychophysiological indicators have gained popularity in recent years as more objective measures of adaptive status [10–12, 17, 18].

Recording heart rate variability and related integrative indicators is one of the most informative approaches to assessing an individual's functional state. The mechanisms of autonomic regulation and hemodynamics are sensitive to the load placed on adaptive systems, making their markers useful for the early detection of functional disturbances [11, 17]. Studies of psychophysiological responses to stress and endurance capacity have shown that the Kerdo index, Baevsky index, pulse pressure, heart rate, circulatory efficiency index, and other integrative parameters respond to stress-related distress and can be used to characterize the adaptive potential of students. [11, 12].

A separate block comprises psychophysiological methods for assessing the functional state of the central nervous system. In a study of students with different levels of personal adaptive potential, the combined use of simple visual-motor reaction data and heart rate variability revealed features of central and autonomic regulation associated with differences in adaptive status [17]. Other studies have demonstrated relationships between EEG indicators, autonomic regulation, and the adaptive resources of the body [18].

The analysis of these indicators in the context of the actual academic workload is a particularly promising avenue. In a study of medical students, heart rate, blood pressure, the functional changes index, the Baevsky index, and the Robinson index, as well as the Schulte and Spielberger–Khanin tests, were assessed during the examination period and during regular lectures and practical sessions [10]. This approach demonstrated that adaptive disadvantage manifests simultaneously at several levels, including cardiovascular, cognitive, and emotional changes.

A review devoted to the assessment of stress by biomarkers in saliva shows the promise of using biological indicators in combination with psychological assessment [45].

Adaptive capacity deterioration: key methods of prevention

Preventing a decline in medical students' adaptive capacity cannot be limited to individual recommendations regarding daily routines. Given the nature of the contributing factors, effective prevention requires a combination of individual, educational, and organizational measures. The Russian scientific literature emphasizes the need for the systematic deployment of health-promoting educational technologies as an integral component of modern higher education [19]. This approach implies that the preservation of students' health should be regarded not as an additional task, but as one of the prerequisites for a high-quality educational process.

The importance of a health-promoting environment is supported by research on social and hygienic factors. The heterogeneity of risk factors identified among medical university students, including studying and rest patterns, health status, living conditions, and nutrition, highlights the need for individualized preventive programs, particularly for junior students. Measures to preserve the adaptive capacity in this population should be implemented from the early years of medical education, and they should be closely integrated with ongoing monitoring of their health status. Publications addressing healthcare organization and the assessment of factors affecting student health [46–48] describe approaches to creating a favorable university environment. These sources complement the empirical evidence indicating the need for systematic preventive work within educational institutions.

Given the evidence of an association between prolonged social media use, Internet addiction, and autonomic disorders among medical students [14, 15], hygienic education should include the development of skills for the rational use of mobile devices, limitation of continuous screen time, incorporation of regular digital breaks, and prevention of excessive use of mobile devices in the evening. Modern information technologies may serve as a supportive resource when used for monitoring, education, and the promotion of a healthy lifestyle [16, 48].

An important preventive strategy is the normalization of sleep. This domain has generated a substantial body of evidence supporting the effectiveness of relatively brief and affordable, easily implemented interventions. International studies have demonstrated the efficacy of programs designed to improve sleep hygiene, as well as digital and mobile-based interventions that help reduce stress and improve sleep [36–39]. This approach also appears relevant to the Russian student population, as the high prevalence of sleep disorders among medical students makes it a particularly promising area for intervention [13].

Equally important is the prevention of psychoemotional stress. According to foreign randomized studies, students can benefit from short-term mindfulness practice programs, music therapy, muscle relaxation, and other methods designed to reduce anxiety and stress [37-39, 49].

Organizational measures are also essential. These include optimizing timetables, addressing uneven academic workloads, facilitating physical activity sessions, improving the availability and quality of food, providing first-year students with informational and psychological support, and fostering a culture of self-monitoring and self-regulation [2, 19]. At medical universities, it is particularly important to implement support programs for junior-year students, as this period is associated with the highest incidence of maladaptive changes [5, 8, 9].

Therefore, preventing impairments in the adaptive capacity of medical university students requires a comprehensive approach that integrates monitoring of functional status, lifestyle modification, digital load management, support for psycho-emotional well-being, and improvement of the educational environment.

CONCLUSION

An analysis of domestic and foreign literature has shown that the adaptive capacity of medical university students is a complex, integral characteristic shaped by the learning environment, lifestyle factors, psycho-emotional stress, and the body's regulatory mechanisms. From a hygiene perspective, adaptation to university education reflects the ability to maintain functional stability, performance, and satisfactory well-being under prolonged exposure to a combination of adverse factors.

The early years of academic study are the most vulnerable period, as high academic workloads, changes in daily routines, and the need to rapidly develop self-organization skills can increase anxiety, impair sleep quality, and place greater stress on adaptive systems. Among the key risk factors are academic and examination stress, poor sleep hygiene, insufficient physical activity, inadequate nutrition, and digital overload. For medical students, these stressors are particularly pronounced because they are compounded by the demands of professionally oriented education.

An analysis of Russian and international data suggests that the assessment of adaptive capacity should be underpinned by an integrated approach. Subjective complaints and psychological scales alone are insufficient. The most informative method is to combine data on daily routine and lifestyle with objective indicators of autonomic regulation, hemodynamics, heart rate variability, and psychophysiological status. This approach enables the timely identification of prenosological signs of distress and the formation of risk groups.

The most promising preventive strategies include the implementation of health-promoting educational technologies, support for first-year students, optimization of sleep and rest, increased physical activity, improved dietary habits, reduced use of digital devices, and the development of self-regulation skills. In the current context, these measures should be integrated into medical education and incorporated into routine monitoring of students' health.