Association between physical exercise and cognitive frailty among community-dwelling older adults: the mediating role of self-efficacy

Abstract

Purpose This study aimed to examine the relationship among physical exercise, self-efficacy, and cognitive frailty, and to test the mediating role of self-efficacy in the association between physical exercise and cognitive frailty among community-dwelling older adults. Methods This cross-sectional survey employed a convenience sampling method to recruit community-dwelling older adults from nine communities in Henan Province, China. Data were collected from January to May 2026. The measurements included a general information questionnaire, the Fried Phenotype (FP), the Montreal Cognitive Assessment (MoCA), the Physical Activity Rating Scale-3 (PARS-3), and the General Self-Efficacy Scale (GSES). SPSS 27.0 and R software were used for statistical analysis. Result A total of 570 questionnaires were distributed, and after excluding invalid responses, 563 valid questionnaires were retained. The prevalence of cognitive frailty among community-dwelling older adults was 21.3%. Univariate analysis revealed that age, marital status, education level, smoking, drinking, average monthly income, sleep quality, chronic diseases, subjective cognitive decline (SCD), physical exercise score, and self-efficacy score were significantly associated with cognitive frailty (p < 0.05). Mediation analysis further showed that self-efficacy significantly mediated the association between physical exercise and cognitive frailty, with the mediation effect accounting for 35.17% of the total effect. Conclusion The prevalence of cognitive frailty among community-dwelling older adults was relatively high. Physical exercise was directly associated with cognitive frailty and also indirectly associated with it through self-efficacy, with the indirect effect accounting for 35.17% of the total effect.