Socio-ecological factors of health literacy and physical activity among middle-aged and older Chinese adults.

Regular exercise and sleep duration were identified as positive correlates of physical activity among middle-aged and older Chinese adults.

• PA was assessed using the Physical Activity Rating Scale-3.
• Correlates were identified using LASSO regression spanning individual, behavioral, interpersonal, and community domains.
• The robustness of selected correlates was evaluated through bootstrap resampling and repeated random cross-validation.
• The sample consisted of N = 508 Chinese adults aged ≥40 years surveyed between July and September 2023.

Female sex and longer daily sedentary time were identified as negative correlates of physical activity.

• These correlates were selected via LASSO regression from variables spanning individual, behavioral, interpersonal, and community domains.
• Robustness was confirmed through bootstrap resampling and repeated random cross-validation.
• The sample was predominantly urban-dwelling and highly educated, with most participants aged 40–54 years.

Monthly income and regular exercise were identified as positive correlates of health literacy.

• HL was measured using the Chinese version of the 12-item Health Literacy Scale Short-Form.
• Correlates were identified using LASSO regression and confirmed through bootstrap resampling and repeated random cross-validation.
• Monthly income represents an individual-level socioeconomic factor, while regular exercise represents a behavioral factor.

Regular exercise was a common positive correlate for both physical activity and health literacy.

• Regular exercise appeared as a positive correlate in LASSO-selected variable sets for both PA and HL outcomes.
• This overlap suggests a potential shared behavioral pathway linking exercise habits to multiple healthy aging components.
• The cross-sectional design precludes causal interpretation of this association.

The study sample was predominantly urban-dwelling, highly educated, and mostly aged 40–54 years, limiting generalizability.

• The survey was conducted online among N = 508 Chinese adults aged ≥40 years between July and September 2023.
• Convenience sampling was used, which the authors acknowledge as a limitation.
• The authors state findings 'should be interpreted as descriptive and hypothesis-generating rather than causal.'
• Future studies using 'longitudinal designs and more representative samples are needed to confirm these associations and clarify their underlying mechanisms.'