The Links Between Physical Activity, Metacognition, and Empathy Among Physiotherapy Students

<b>Background:</b> Physical activity, metacognitive awareness, and empathy are interconnected factors that play a significant role in the overall well-being of university students. Together, these elements contribute to the development of more self-aware, emotionally intelligent, and academically engaged students. The aim of this study is to explore the relationship between physical activity, empathy, and metacognition among physiotherapy students, as well as determining whether differences exist between undergraduate and graduate students. <b>Methods:</b> A cross-sectional study evaluated 468 physiotherapy students using the International Physical Activity Questionnaire-short version, the Metacognitive Awareness Inventory, and a shortened version of the Empathy Quotient supplemented with demographic questions. The respondents were students of undergraduate and graduate studies of physiotherapy, were male and female, and were between the ages of 18 and 25 years. <b>Results:</b> Higher levels of vigorous-intensity physical activity, walking, and total physical activity are significantly associated with increases in Declarative Knowledge (<i>p</i> = 0.000; <i>p</i> = 0.001; <i>p</i> = 0.000), Empathy Quotient (<i>p</i> = 0.029; <i>p</i> = 0.000; <i>p</i> = 0.006), and Cognitive Empathy (<i>p</i> = 0.002; <i>p</i> = 0.000; <i>p</i> = 0.001). Undergraduate students demonstrated higher levels of Declarative Knowledge (<i>p</i> = 0.000), whereas graduate students scored higher in Procedural Knowledge (<i>p</i> = 0.020), Planning (<i>p</i> = 0.000), Information Management Strategies (<i>p</i> = 0.000), and Evaluation (<i>p</i> = 0.005). Undergraduate students demonstrated higher overall empathy, cognitive empathy, and social skills (<i>p</i> = 0.000). <b>Conclusions:</b> This is the first study to examine this issue in the context of physiotherapy students. Our findings highlight the importance of creating integrated programs that promote physical activity, metacognitive awareness, and empathy concurrently among physiotherapy students. Enhancing metacognitive skills through targeted educational strategies helps students strengthen their critical thinking and self-regulation, enhance academic outcomes, and better prepare students for their professional role.