ABSTRACT Objective To test a moderated mediation model linking physical activity (PA) to health‐related quality of life (HRQoL) via symptom burden, with hope as a moderator, in lung cancer patients. Methods A cross‐sectional study of 203 adults with stage III‐IV lung cancer (205 enrolled, 2 excluded due to incomplete data) from a Chinese hospital analyzed PA (IPAQ‐LF), symptom burden (MDASI‐C), hope (HHI), and HRQoL (SF‐8). Covariates were identified via univariable screening ( p < 0.05). Spearman correlations, hierarchical regression, and PROCESS (Model 7; 5000 bootstraps) tested the moderated mediation model, with simple‐slope probing at hope ± 1 SD. Results PA correlated with higher HRQoL ( ρ = 0.53) and lower symptom burden ( ρ = −0.48), while symptom burden negatively predicted HRQoL ( ρ = −0.71) and hope positively predicted HRQoL ( ρ = 0.59) and lower symptom burden ( ρ = −0.56). Hierarchical models explained 57.7% of HRQoL variance, with PA (0.132), symptom burden (0.231), and hope (0.046) as key predictors. The PA‐by‐hope interaction was significant ( B = 0.018, p = 0.008), with stronger PA effects on reduced symptom burden at low hope ( B = −0.270, p < 0.001). The moderated mediation index was −0.017 (95% CI −0.032 to −0.003). Conclusions PA improves HRQoL via reduced symptom burden, with this effect stronger at lower hope levels. Enhancing hope in interventions may maximize HRQoL benefits.
Zhang et al. (Fri,) studied this question.