ArticleFrontiers in public health2026
Physical activity and health-promoting lifestyles in adults with chronic diseases: serial indirect associations through subjective well-being and self-efficacy in multiethnic areas of Yunnan, China.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To examine the association between physical activity and health-promoting lifestyle among adults with chronic diseases in multiethnic areas of Yunnan, China, and to assess the serial indirect associations involving subjective well-being and self-efficacy to manage chronic disease. Methods: A cross-sectional survey was conducted from October 2024 to June 2025 among 1,988 adults with chronic diseases in ethnic minority-concentrated areas of Yunnan Province, China. A multistage stratified site-based sampling framework with quota-based participant recruitment was used. Yunnan Province was stratified into four geographic regions, prefecture-level areas with high concentrations of ethnic minority populations were identified, community-based and medical-institution-based survey sites were selected, and eligible adults were recruited after standardized screening until site quotas were reached. Health-promoting lifestyle, physical activity, subjective well-being, and self-efficacy to manage chronic disease were assessed using the HPLP-IIR, PARS-3, WHO-5, and SEMCD-6, respectively. Descriptive statistics, t tests or ANOVA, Pearson correlation analysis, multivariable regression analysis, and PROCESS Model 6 with 5,000 bootstrap samples were used. Results: Participants reported low physical activity (10.22 ± 19.92) and below-moderate health-promoting lifestyle (114.94 ± 39.28). Health-promoting lifestyle differed by age, ethnicity, marital status, employment status, and tobacco/alcohol use. Physical activity, subjective well-being, self-efficacy, and health-promoting lifestyle were positively correlated, and physical activity, subjective well-being, and self-efficacy were each positively associated with health-promoting lifestyle in adjusted regression models. The total association between physical activity and health-promoting lifestyle was 0.565, with a total indirect association of 0.174 (30.9%) through subjective well-being and self-efficacy; all indirect association pathways had 95% CIs excluding zero. Conclusion: Among adults with chronic diseases in multiethnic areas of Yunnan, physical activity was positively associated with health-promoting lifestyle, with significant serial indirect associations involving subjective well-being and self-efficacy to manage chronic disease.
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