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| Chain mediating effects of physical activity volume among middle-aged and elderly patients with type 2 diabetes mellitus |
| TANG Ji1, ZHANG Sisi2, SU Wanying2
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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 |
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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.
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Received: 25 May 2026
Revised: 20 August 2026
Published: 22 September 2026
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