Chain mediating effects of physical activity volume among middle-aged and elderly patients with type 2 diabetes mellitus
TANG Ji1, ZHANG Sisi2, SU Wanying2
1. School of Nursing, Hunan Normal University Health Science Center, Changsha, Hunan 410013, China; 2. Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan 410005, China
Abstract：Objective To analyze the influencing factors of physical activity volume among middle-aged and elderly patients with type 2 diabetes mellitus (T2DM), and the mediating effects of psychological resilience and exercise self-efficacy between quality of life and physical activity volume, so as to provide evidence for improving the physical activity level and health outcomes of T2DM patients. Methods From December 2024 to April 2025, T2DM patients aged ≥45 years in four community health service centers in Changsha City were selected as study participants using convenience sampling method. Data including gender, age and body mass index (BMI) were collected through self-designed questionnaires. Quality of life, psychological resilience, exercise self-efficacy and physical activity volume were assessed using the SF-36 Health Survey, Connor-Davidson Resilience Scale, Exercise Self-Efficacy Scale and Chinese version of International Physical Activity Questionnaire, respectively. A multiple linear regression models was used to analyze the influencing factors of physical activity volume. Model 6 of the Process 5.0 macro was used to analyze the mediating effects of psychological resilience and exercise self-efficacy between quality of life and physical activity volume, and the Bootstrap method was used to test the mediating effects. Results A total of 353 middle-aged and elderly T2DM patients were surveyed, including 165 males (46.74%) and 188 females (53.26%). The mean age of the participants was (67.38±9.09) years. The physical activity volume was (1 507.72±538.66) MET-min/week. Middle-aged and elderly T2DM patients with lower BMI (β' =-0.096), higher psychological resilience scores (β' =0.379), higher exercise self-efficacy scores (β' =0.597) and higher quality of life scores (β' =0.083) had greater physical activity volume (all P<0.05). Quality of life exerted a direct positive effect on physical activity volume (β=0.083, 95%CI: 0.037-0.129). It also indirectly positively affected physical activity volume through psychological resilience (β=0.077, 95%CI: 0.042-0.125), exercise self-efficacy (β=0.064, 95%CI: 0.008-0.123), and the chain mediating effect of the two variables (β=0.055, 95%CI: 0.029-0.088). The mediating effects of psychological resilience, exercise self-efficacy and their chain mediating effect accounted for 27.69%, 22.99% and 19.63% of the total effect, respectively. Conclusions BMI, psychological resilience, exercise self-efficacy and quality of life were influencing factors of physical activity volume among middle-aged and elderly T2DM patients. Higher quality of life can directly increase the physical activity volume of middle-aged and elderly T2DM patients and can also indirectly increase physical activity volume through psychological resilience and exercise self-efficacy.
[1] Sun H,Saeedi P,Karuranga S,et al.IDF Diabetes Atlas:global,regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J/OL].Diabetes Res Clin Pract,2022,183[2026-08-20].https://doi.org/10.1016/j.diabres.2021.109119. [2] Lee C L,Yamada T,Liu W J,et al.Interaction between type 2 diabetes polygenic risk and physical activity on cardiovascular outcomes[J].Eur J Prev Cardiol,2024,31(10):1277-1285. [3] 国家老年医学中心,中华医学会糖尿病学分会,中国体育科学学会.中国2型糖尿病运动治疗指南(2024版)[J].中国运动医学杂志,2024,43(6):419-452. [4] 唐路路,于晓丽,迟春薇,等.中老年人中高强度体力活动轨迹与认知功能的前瞻性关系[J].中华疾病控制杂志,2025,29(8):894-899. [5] Amin M F,Bhowmik B,Rouf R,et al.Assessment of quality of life and its determinants in type-2 diabetes patients using the WHOQOL-BREF instrument in Bangladesh[J/OL].BMC Endocr Disord,2022,22(1)[2026-08-20].https://doi.org/10.1186/s12902-022-01072-w. [6] Moore T L.Resilience of individuals with chronic illness who reside in low resource communities:a concept analysis[J/OL].Int J Nurs Stud Adv,2024,7[2026-08-20].https://doi.org/10.1016/j.ijnsa.2024.100215. [7] 王婷,鞠梅,王琳,等.中老年2型糖尿病病人运动自我效能现状及影响因素[J].护理研究,2024,38(15):2641-2647. [8] Xu J S,Zhang L,Sun H,et al.Psychological resilience and quality of life among middle-aged and older adults hospitalized with chronic diseases:multiple mediating effects through sleep quality and depression[J/OL].BMC Geriatr,2023,23(1)[2026-08-20].https://doi.org/10.1186/s12877-023-04473-1. [9] Zhang F,Liao J,Zhang W H,et al.Association between exercise self-efficacy and health-related quality of life among dialysis patients:a cross-sectional study[J/OL].Front Psychol,2022,13[2026-08-20].https://doi.org/10.3389/fpsyg.2022.875803. [10] Li L,Wang H M,Shen Y.Chinese SF-36 Health Survey:translation,cultural adaptation,validation,and normalisation[J].J Epidemiol Community Health,2003,57(4):259-263. [11] Yu X N,Lau J T F,Mak W W S,et al.Factor structure and psychometric properties of the Connor-Davidson Resilience Scale among Chinese adolescents[J].Compr Psychiatry,2011,52(2):218-224. [12] 裴丽,王燕,刘艳,等.运动自我效能量表在糖尿病患者中应用的信效度检验[J].中国老年学杂志,2017,37(13):3340-3341. [13] 屈宁宁,李可基.国际体力活动问卷中文版的信度和效度研究[J].中华流行病学杂志,2004,25(3):265-268. [14] Mortensen S R,Kristensen P L,Grøntved A,et al.Determinants of physical activity among 6 856 individuals with diabetes:a nationwide cross-sectional study[J/OL].BMJ Open Diabetes Res Care,2022,10(4)[2026-08-20].https://doi.org/10.1136/bmjdrc-2022-002935. [15] Kanaley J A,Colberg S R,Corcoran M H,et al.Exercise/physical activity in individuals with type 2 diabetes:a consensus statement from the American college of sports medicine[J].Med Sci Sports Exerc,2022,54(2):353-368. [16] Toth E E,Ihász F,Ruíz-Barquín R,et al.Physical activity and psychological resilience in older adults:a systematic review of the literature[J].J Aging Phys Act,2024,32(2):276-286. [17] Olson K L,Howard M,McCaffery J M,et al.Psychological resilience in older adults with type 2 diabetes from the Look AHEAD Trial[J].J Am Geriatr Soc,2023,71(1):206-213. [18] 张凯慧,李婉玲,王彦兴,等.老年2型糖尿病患者心理灵活性、运动自我效能在衰弱与社会疏离间的中介效应分析[J].预防医学,2025,37(8):783-788. [19] Kristoffersen S F,Domazet S L,Pouwer F,et al.The temporal interplay between physical activity,emotional well-being,and health-related quality of life in individuals with recently diagnosed type 2 diabetes mellitus:a cross-lagged panel analysis[J/OL].Diabetes Res Clin Pract,2026,234[2026-08-20].https://doi.org/10.1016/j.diabres.2026.113185. [20] Abonie U S,Ofori-Ampomah A K,Makinyi V,et al.Associations between physical activity patterns and quality of life in persons with type 2 diabetes:a cross sectional study[J/OL].PLoS One,2023,18(8)[2026-08-20].https://doi.org/10.1371/journal.pone.0290825. [21] Ting Z,Huicai W,Kudelati Z,et al.Exploring the dynamics of self-efficacy,resilience,and self-management on quality of life in type 2 diabetes patients:a moderated mediation approach from a positive psychology perspective[J/OL].PLoS One,2025,20(1)[2026-08-20].https://doi.org/10.1371/journal.pone.0317753.
