Frontiers in Public Health · May 13, 2026

Physical activity, chronic disease, depression, and health-related quality of life among Chinese older adults: a two-wave longitudinal panel study before and during COVID-19

By Li C, Zhou Z, Kim K

BACKGROUND: Population aging and the COVID-19 pandemic have intensified the physical and mental health challenges of older adults in China, highlighting the need for sustainable health behavior strategies. While physical activity (PA) is an important modifiable factor, the impact of different PA intensity levels and the mechanisms of this influence on physical and mental health remain unclear. We examined the associations between PA, chronic disease, depression, and health-related quality of life (HRQoL) before and during the pandemic. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018 and 2020, including 21,425 adults aged ≥ 60 years. Comparative analysis and path analysis were used to assess the associations among PA, chronic disease (i.e., hypertension, dyslipidemia, and diabetes), depression, and HRQoL, as well as the direct and indirect associations of PA on HRQoL. Participants were older adults who engaged in PA at least twice per week. RESULTS: Older adults in China experienced a decline in health status during the pandemic, with higher prevalence of chronic disease, more severe depression symptoms, and reduced HRQoL. In both periods, moderate- and vigorous-intensity PA related to lower chronic disease prevalence, whereas moderate- and low-intensity PA related to less severe depression symptoms. Path analysis indicates that PA related to HRQoL through both physical and mental health pathways, with depression symptoms acting as a key mediator. The indirect mental health benefits of low-intensity PA were more pronounced during the pandemic. CONCLUSION: Regular moderate- and low-intensity PA relates to favorable physical and mental health outcomes in older adults during public health crises. Integrating goal-oriented and intensity-matched PA programs into community-based care and emergency response systems might support physical and mental resilience in future emergencies and improve health sustainability.

doi.org/10.3389/fpubh.2026.1847304Open accessPubMed 42211711Populations