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.
Su W, Xie J, et al. • Frontiers in endocrinology • 2026
Physical activity was indirectly and positively associated with quality of life among middle-aged and older adults with type 2 diabetes primarily through exercise self-efficacy, and through a sequential chain of psychological resilience followed by exercise self-efficacy.
Key Findings
Results
Physical activity was indirectly and positively associated with quality of life primarily through exercise self-efficacy as a mediator.
Standardized indirect effect = 0.195, 95% CI [0.103, 0.287]
5,000-bootstrap resampling was used to test the mediation effect
The confidence interval did not include zero, confirming statistical significance
A full mediation model was retained as the final model due to high collinearity between physical activity and exercise self-efficacy in the partial mediation model
Results
The sequential chain mediation pathway through psychological resilience followed by exercise self-efficacy was a significant mediator between physical activity and quality of life.
Standardized indirect effect = 0.009, 95% CI [0.002, 0.017]
The confidence interval did not include zero, confirming statistical significance
This pathway represents a chain mediation model where psychological resilience precedes exercise self-efficacy
5,000-bootstrap resampling was used to confirm the sequential indirect effect
Results
Psychological resilience alone was not a significant mediator in the relationship between physical activity and quality of life.
The single mediation pathway through psychological resilience only was not statistically significant
Psychological resilience was only significant when paired sequentially with exercise self-efficacy
This finding distinguished the role of psychological resilience as a precursor to exercise self-efficacy rather than an independent mediator
Data were collected using the Connor-Davidson Resilience Scale (CD-RISC)
Results
The final full mediation structural equation model demonstrated acceptable fit to the data.
The full mediation model was selected over a partial mediation model due to high collinearity between physical activity and exercise self-efficacy
Structural equation modeling with 5,000-bootstrap resampling was the primary analytic approach
Methods
The study sample consisted of 328 community-dwelling middle-aged and older adults with type 2 diabetes mellitus aged 45 years or older.
Participants were recruited in Changsha, China
Eligibility required age ≥ 45 years and a diagnosis of type 2 diabetes mellitus
Study design was cross-sectional
Validated instruments used included the IPAQ-SF (physical activity), CD-RISC (psychological resilience), Exercise Self-Efficacy Scale, and SF-36 (quality of life)
Conclusions
The study identified a chain mediation model suggesting the association between physical activity and quality of life may be partly explained by a sequential psychosocial pathway involving psychological resilience and exercise self-efficacy.
The chain mediation model highlights potential value of integrating psychological empowerment and behavioral strategies in interventions
The findings are positioned as relevant for developing nursing interventions for middle-aged and older adults with T2DM
Physical activity was not directly associated with quality of life in the final full mediation model
The study underscores psychosocial factors as mechanisms linking physical activity to quality of life outcomes
What This Means
This research suggests that simply being physically active may not directly improve quality of life for middle-aged and older adults with type 2 diabetes — instead, the benefit of physical activity appears to work through psychological factors. Specifically, the study found that physical activity was linked to better quality of life mainly because it boosted people's confidence in their ability to exercise (called exercise self-efficacy). There was also a secondary pathway: physical activity first strengthened psychological resilience (the ability to cope with adversity), which then increased exercise self-efficacy, which in turn improved quality of life. Psychological resilience on its own, without leading to greater exercise confidence, did not significantly improve quality of life.
The study surveyed 328 adults aged 45 and older with type 2 diabetes living in the community in Changsha, China. Researchers used established questionnaires to measure physical activity levels, psychological resilience, exercise self-efficacy, and quality of life, then used statistical modeling to test how these factors were connected to each other.
This research suggests that interventions aimed at improving quality of life in people with type 2 diabetes should not focus solely on increasing physical activity levels, but should also address psychological factors — particularly building people's confidence in their ability to exercise and strengthening their overall resilience. Programs that combine exercise promotion with psychological support strategies may be more effective than exercise-focused programs alone.
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Su W, Xie J, Wu H, Yang C, Dai X, Ma L, et al.. (2026). 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.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1784397