The relationship between physical activity and quality of life among community-dwelling middle-aged and older adults with type 2 diabetes: a chain mediation model of psychological resilience and exercise self-efficacy.

BACKGROUND

Middle-aged and older adults with type 2 diabetes mellitus (T2DM) often experience insufficient physical activity (PA) and reduced quality of life (QOL). Understanding how psychosocial factors are associated with this relationship is important for developing effective nursing interventions. Therefore, this study aimed to investigate the mediating roles of psychological resilience and exercise self-efficacy in the association between PA and QOL among community-dwelling populations.

METHODS

A cross-sectional survey was conducted among 328 middle-aged and older adults (≥ 45 years old) with T2DM in Changsha, China. Data were collected using validated instruments, including the International Physical Activity Questionnaire (IPAQ-SF), Connor-Davidson Resilience Scale (CD-RISC), Exercise Self-Efficacy Scale, and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Structural equation modeling and 5,000-bootstrap resampling were used to test mediation effects.

RESULTS

Given the high collinearity observed between physical activity and exercise self-efficacy in the partial mediation model, a full mediation model was retained as the final model. PA was indirectly and positively associated with QOL primarily through exercise self-efficacy (standardized indirect effect = 0.195, 95% CI [0.103, 0.287]). The sequential pathway through psychological resilience and exercise self-efficacy was also significant (standardized indirect effect = 0.009, 95% CI [0.002, 0.017]), whereas psychological resilience alone was not a significant mediator. The final model demonstrated acceptable fit (χ²/df = 3.26, RMSEA = 0.083, CFI = 0.960, NFI = 0.944, IFI = 0.961, TLI = 0.920).

CONCLUSIONS

This study tested a chain mediation model suggesting that the observed association between PA and QOL may be partly explained by a sequential psychosocial pathway involving psychological resilience and exercise self-efficacy. These findings highlight the potential value of integrating psychological empowerment and behavioral strategies in future interventions aimed at supporting better QOL among middle-aged and older adults with T2DM.