Exercise before braces: the mediating effect of pain on the association between physical activity and self-efficacy

Introduction Self-efficacy is an important psychological factor influencing adherence to orthodontic treatment, and it is itself affected by pain. Although physical activity is associated with pain perception and oral health is closely related to orthodontic pain, the combined effects of these factors on self-efficacy and the mediating mechanism of pain remain unclear. Methods 295 orthodontic patients were surveyed. Physical activity level was assessed using the Physical Activity Rating Scale-3, oral health with the Oral Health Impact Profile-14, pain with the Numeric Rating Scale, and self-efficacy with the General Self-Efficacy Scale. Mediation analyses were performed with structural equation modeling to test whether pain mediated the relationships between physical activity, oral health, and self-efficacy. Results Physical activity was negatively associated with pain (a = −0.018, p < 0.001), and pain was negatively associated with self-efficacy (b = −1.124, p < 0.001). The indirect effect of physical activity on self-efficacy through pain was significant (a × b = 0.020, 95% CI [0.009, 0.037]), while the direct effect was not significant, indicating full mediation. Oral health problems were positively associated with pain (a = 0.046, p < 0.001) and negatively associated with self-efficacy both directly (c′ = −0.124, p = 0.001) and indirectly through pain (a × b = −0.052, 95% CI [−0.092, −0.023]), indicating partial mediation. Conclusion Pain serves as a mediator linking preoperative physical activity level and oral health status with self-efficacy. Encouraging patients to engage in regular physical activity and maintain good oral hygiene before orthodontic treatment may strengthen patients’ ability to cope with pain and improve long-term outcomes.