Linking physical activity to health-related quality of life among middle-aged adults: the mediating roles of resilience and physical exercise self-efficacy

Introduction: Middle-aged adults increasingly face cumulative health risks and functional challenges, making the maintenance of health-related quality of life (HRQoL) a key public health concern. Although physical activity is consistently associated with better perceived health, less is known about the psychological resources that may help explain this association during midlife. This study examines whether resilience and physical exercise self-efficacy are associated with the link between physical activity and HRQoL among middle-aged adults. Methods: A cross-sectional survey was conducted among 538 middle-aged adults living in community settings in Hunan Province using a cluster random sampling strategy. Structural equation modelling was used to examine the associations among physical activity, resilience, physical exercise self-efficacy, and HRQoL. Results: Physical activity was positively associated with resilience, physical exercise self-efficacy, and HRQoL. Both resilience and physical exercise self-efficacy were also positively related to HRQoL. Bootstrap analyses indicated a significant indirect association between physical activity and HRQoL through the joint contribution of resilience and physical exercise self-efficacy. Discussion: These findings suggest that physical activity is linked to HRQoL not only directly, but also through key psychological resources among middle-aged adults. By highlighting the joint roles of resilience and physical exercise self-efficacy, this study underscores the importance of integrating behavioral engagement and psychological adaptation when examining well-being in midlife.