The association between health anxiety and frequency of participation in physical education classes and physical...

Health anxiety, defined as excessive worry about illness, is increasingly common among university students. It may both reduce engagement in physical activity for some individuals and be alleviated by regular exercise. Psychosocial resources such as self-efficacy, enjoyment, and social support may mediate these relations, but evidence among Chinese university students is limited. This study examined psychosocial pathways linking moderate-to-vigorous physical activity (MVPA) during physical education (PE) classes and overall activity patterns with health anxiety among Chinese university students.

A cross-sectional study (March-April 2025) sampled 4,256 third-year undergraduates from 16 universities in Guangzhou (mean age 21.01 ± 0.34 years; 57.4% female) using stratified cluster random sampling. Health anxiety (Whiteley-7), self-reported physical activity (IPAQ-short), exercise self-efficacy (SEE-C), enjoyment (PACES), and social support (PASSS-C) were assessed by validated questionnaires. Objective MVPA during PE classes was measured with ActiGraph accelerometers (mean across three classes). Some demographic variables including sex and BMI were also collected for covariate analysis. Structural equation modeling with bias-corrected bootstrapping (5,000 resamples) tested direct and indirect associations.

Enjoyment positively predicted MVPA during PE (β = 0.142, p = 0.007), whereas BMI negatively predicted it (β = -0.092, p = 0.045). Greater MVPA during PE classes was associated with higher overall activity (β = 0.183) and higher self-efficacy (β = 0.157). Higher self-efficacy (β = -0.172, p = 0.003) and social support (β = -0.098, p = 0.015) were associated with lower physical inactivity, while BMI showed a positive association (β = 0.097, p = 0.019). Higher physical inactivity predicted greater health anxiety (β = 0.276, p < 0.001). Also, enjoyment indirectly reduced health anxiety through higher MVPA and lower physical inactivity; self-efficacy and social support also exerted indirect protective effects via decreased physical inactivity. MVPA itself contributed to lower health anxiety by reducing physical inactivity. Indirect effects of gender and BMI were non-significant.

Psychosocial resources -including self-efficacy, enjoyment, and social support-mediate the links between MVPA during PE classes, physical inactivity, and health anxiety. Enhancing affective and social engagement in PE classes may help reduce physical inactivity and health anxiety among Chinese university students.