Abstract
BACKGROUND: The COVID-19 pandemic exacerbated mental health challenges among adolescents, yet the protective role of regular physical exercise (PE) in enhancing life satisfaction (LS) and quality of life (QOL) remains underexplored in this population. This study aimed to investigate the direct and indirect effects of PE on LS and QOL among Chinese adolescents during the pandemic, with a focus on its mediating pathways through alleviating depressive and anxious symptoms. METHODS: Adolescents aged 12 to 17 seeking for psychological services at Shandong Provincial Hospital were recruited between June 2021 and May 2022. Using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), 6-items QOL questionnaire (QOL-6), and Adolescent Students' Life Satisfaction Scale (ASLSS), we assessed depressive symptoms, anxious symptoms, QOL, and LS. RESULTS: A total of 392 adolescents (133 regular physical exercisers (PEs) vs. 259 non-regular physical exercisers (NPEs)) were included. Significant differences were observed in educational level, residence, general health status, and regular diet between PE and NPEs. A one-way ANOVA showed that PEs had significantly lower scores on GAD-7 and PHQ-9, higher QOL-6 scores, and greater LS across all six ASLSS dimensions compared to NPEs. The mediation analysis showed regular exercise indirect positive effects on QOL-6 and ASLSS 6 dimensions through the alleviation of anxious and depressive symptoms. Stepwise regression confirmed the significant positive effect of exercise on QOL, as well as LS with friendship, academic performance, and autonomy. CONCLUSION: PE alleviates emotional distress and enhances subjective well-being in adolescents through dual pathways, underscoring its value as a low-cost intervention during public health crises. Findings advocate integrating structured physical activity into school-based mental health programs to foster resilience. Longitudinal studies are needed to validate causal mechanisms and optimize exercise protocols for diverse adolescent populations.