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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.
Yu et al. (Fri,) studied this question.