# Physical exercise and health-related quality of life in mid- to late-adulthood: a multi-group chain-mediation analysis

## TL;DR

This study explores how physical exercise improves health-related quality of life in middle-aged and older adults, with self-esteem and resilience acting as key psychological mediators.

## Contribution

The study identifies self-esteem and psychological resilience as joint mediators linking physical exercise to health-related quality of life, with gender differences in the direct effect.

## Key findings

- Physical exercise is directly and positively associated with health-related quality of life.
- Self-esteem and psychological resilience jointly mediate the relationship between exercise and health-related quality of life.
- The direct effect of exercise on health-related quality of life is stronger in men than in women.

## Abstract

As longevity rises in China, supporting healthy ageing has become imperative. However, the psychological pathways linking physical exercise to health-related quality of life (HRQOL), and whether they differ by gender, remain insufficiently understood.

Using data from 762 adults aged 45 + in Shandong and Hunan, we examined how physical exercise relates to HRQOL and whether psychological resources explain this link. A cross-sectional survey was analyzed with confirmatory factor analysis and structural equation modeling. Bias-corrected bootstraps were used to test indirect and sequential pathways, and multiple-group models compared men and women.

Physical exercise showed a positive direct association with HRQOL. This association was jointly mediated by self-esteem and psychological resilience, with the mediators operating both independently and sequentially. The overall pattern was broadly comparable across genders; however, the direct association was stronger among men (β = 0.315) than among women (β = 0.115).

The findings clarify cognitive–affective mechanisms connecting activity to later-life wellbeing and indicate that combining regular exercise with programs that foster self-esteem and psychological resilience is associated with health-related quality of life among middle-aged and older adults. Combining opportunities for regular exercise with programs that cultivate self-esteem and resilience could be an efficient avenue for enhancing HRQOL among middle-aged and older adults.