Dual pathways construction: a prospective study on how physical activity predicts medical students' professionalism via reducing academic burnout and enhancing self-efficacy.

Objective: This two-wave prospective study examined whether physical activity was indirectly associated with perceived professionalism among medical students through academic burnout and self-efficacy. Methods: A total of 625 medical students completed validated measures of physical activity (IPAQ-SF), academic burnout (MBI-SS), general self-efficacy (GSES), and professionalism (PAS) at two time points, 6 months apart. Data were analyzed using structural equation modeling with bootstrapping. Results: The prospective indirect-effect model showed good fit. T1 physical activity was negatively associated with T2 academic burnout and positively associated with T2 self-efficacy. In turn, T2 burnout and T2 self-efficacy were associated with T2 perceived professionalism. The direct path from T1 physical activity to T2 perceived professionalism was not significant. Significant prospective indirect associations were observed through both burnout and self-efficacy, with no significant difference between the two indirect pathways. Conclusion: Physical activity was prospectively associated with perceived professionalism through lower burnout and higher self-efficacy. Given the two-wave observational design and the concurrent assessment of mediators and outcome at T2, these findings should be interpreted as prospective indirect associations rather than evidence of causal or full mediation.