Association between physical activity and quality of life among breast cancer survivors in China: a cross-sectional mediation analysis
Abstract
Abstract Objectives Physical activity is essential for breast cancer survivorship, yet its relationship with quality of life (QoL) remains inconsistent. This study investigated the psychological associations underlying this ‘activity paradox’ by examining the parallel mediating roles of unmet healthcare-seeking and health behaviour needs. Design A cross-sectional survey design. Setting A tertiary cancer centre in Hunan, China, between May 2025 and November 2025. Participants 630 breast cancer survivors who had completed primary anti-tumour treatments within the past 1–5 years. Main outcome measures Physical activity was assessed using the International Physical Activity Questionnaire-Short Form. QoL was measured using the Functional Assessment of Cancer Therapy-Breast. Unmet needs were evaluated using the Cancer Survivor Profile-Breast Cancer. The parallel mediation model was tested using the PROCESS macro. Results The overall association between physical activity and QoL was non-significant (p=0.152), indicating a potential statistical suppression relationship. Physical activity was associated with lower unmet healthcare-seeking needs (B=−1.18, p=0.026). However, higher physical activity was associated with significantly higher unmet health behaviour needs (B=1.90, p<0.001). Through unmet health behaviour needs, physical activity showed a negative indirect association with lower overall QoL (indirect estimate: −1.57, 95% CI −2.96 to −0.25), which statistically counterbalanced the potential positive indirect association through unmet healthcare-seeking needs. Conclusions In this cross-sectional cohort, higher physical activity levels showed opposite-direction associations with unmet needs. Higher physical activity was associated with fewer unmet healthcare-seeking needs but with higher unmet needs for advanced lifestyle guidance. These findings suggest that clinical survivorship programmes may benefit from addressing the specific informational gaps reported by active survivors rather than relying solely on generic advice.