Health literacy and combined adherence to aerobic and muscle-strengthening physical activity guidelines among Korean adults: findings from the 2023 Korea National Health and Nutrition Examination Survey

Regular physical activity is essential for preventing noncommunicable diseases; however, combined adherence to aerobic and muscle-strengthening physical activity guidelines remains low. Although health literacy may influence individuals’ ability to understand and implement recommended health behaviors, its association with combined adherence to aerobic and muscle-strengthening physical activity guidelines remains unclear. This study used nationally representative data to examine the association between health literacy and combined adherence to aerobic and muscle-strengthening physical activity guidelines among Korean adults. We conducted a secondary analysis of the 2023 Korea National Health and Nutrition Examination Survey, including 5,384 adults aged 19 years or older. Combined adherence was defined as meeting both aerobic and muscle-strengthening physical activity guidelines based on World Health Organization recommendations. Health literacy was assessed using a 10-item scale and categorized as adequate or inadequate. Complex sample logistic regression analyses were performed, adjusting for sociodemographic, health-related, behavioral, and psychological factors. Overall, 18.7% of Korean adults met both physical activity guidelines, and 61.9% had adequate health literacy. Participants with adequate health literacy had higher odds of combined adherence than those with inadequate health literacy (OR = 1.31, 95% CI = 1.09–1.58). Several sociodemographic, health-related, and behavioral factors were also associated with combined adherence. Adequate health literacy was associated with higher odds of combined adherence to aerobic and muscle-strengthening physical activity guidelines among Korean adults. These findings provide population-level evidence on health literacy as a factor associated with meeting both guideline components. Longitudinal research is needed to clarify the temporal direction and potential mechanisms underlying this association.