Associations between physical exercise and aging anxiety among older adults: a serial statistical mediation analysis involving self-efficacy and health anxiety

Abstract

Background With the acceleration of global population aging, mental health issues among older adults have become increasingly prominent. Aging anxiety, defined as apprehension regarding the aging process and associated physiological, psychological, and social role losses, significantly impacts the quality of life and health of the older adults. Physical exercise has been shown to be associated with better physical and mental health of older adults, yet the theoretical psychological mechanisms underlying their association remain insufficiently clarified. Therefore, this study aims to construct and test a serial mediation model to explore the statistical sequential indirect associations linking physical exercise to aging anxiety via self-efficacy and health anxiety. Methods This study employed a cross-sectional survey design, targeting Chinese adults aged 60 and above. A total of 721 valid questionnaires were collected. Data were gathered using the *Physical Activity Rating Scale (PARS-3)*, the Aging Anxiety Scale, the General Self-Efficacy Scale, and the Health Anxiety Scale. Data analysis was performed using SPSS 27.0 and PROCESS 4.0 software. Common method bias tests, correlation analyses, multiple linear regression, and Bootstrap mediation effect tests were conducted to examine the relationships among physical exercise, self-efficacy, health anxiety, and aging anxiety, as well as the mediating pathways. Results Correlation analysis revealed that physical exercise was significantly negatively correlated with aging anxiety (r = −0.232, p < 0.001), significantly positively correlated with self-efficacy (r = 0.225, p < 0.001), and significantly negatively correlated with health anxiety (r = −0.193, p < 0.001). Aging anxiety was negatively correlated with self-efficacy (r = −0.474, p < 0.001) and positively correlated with health anxiety (r = 0.483, p < 0.001); self-efficacy and health anxiety were significantly negatively correlated (r = −0.420, p < 0.001). Mediation analysis further revealed that the total effect of physical exercise on aging anxiety was −0.0525 (95% CI: [−0.0685, −0.0364]); the direct effect was −0.0221 (95% CI: [−0.036, −0.0081]), accounting for 42.10% of the total effect, and the total statistical indirect effect was −0.0304 (95% CI: [−0.040, −0.0216]), accounting for 57.90% of the total effect. The independent statistical indirect effect of self-efficacy was the most prominent (indirect effect = −0.0159, 95% CI: [−0.022, −0.0105]; accounting for 30.28% of the total effect). The indirect effect through health anxiety alone was −0.0078 (95% CI: [−0.0143, −0.0023]; 14.86%), and the serial indirect effect was −0.0067 (95% CI: [−0.0095, −0.0044]; 12.76%). Conclusion This study supports that physical exercise is not only directly associated with lower aging anxiety in older adults but also shows significant statistical indirect associations through a potential serial pathway involving self-efficacy and health anxiety. Self-efficacy, as a crucial psychological resource, exhibits the strongest statistical indirect effect between physical exercise and aging anxiety. The findings deepen the understanding of the statistical association patterns through which physical exercise is linked to better mental health in older adults. They provide a theoretical basis and practical reference for designing targeted exercise interventions to mitigate aging anxiety among the older adults.