Path analysis of biopsychosocial correlates of physical activity among patients with colorectal cancer

This study explored the underlying pathways linking physical activity (PA) and associated factors among Chinese patients with colorectal cancer (CRC) using path analysis. Although the benefits of PA in cancer care are well established, participation rates among CRC patients in China remain unclear, and influencing pathways are not fully understood. A cross-sectional survey was conducted with 211 inpatients at a tertiary cancer hospital in Southwest China from January to June 2024. Data on PA levels, fatigue, anxiety, depression, perceived exercise barriers and benefits, social support, and exercise self-efficacy were collected. The hypothesized model was tested using Mplus version 8.3. The median PA level was 3066 MET-min/week (i.e., metabolic equivalent minutes per week; IQR: 1584-4914), with 56.87% meeting the American College of Sports Medicine's guidelines. The model showed good fit: χ2/df = 1.418, CFI = 0.988, TLI = 0.974, RMSEA = 0.045, and SRMR = 0.021. Fatigue, perceived barriers, and exercise self-efficacy showed direct associations with PA, whereas anxiety, depression, and perceived benefits related indirectly via self-efficacy and/or social support. Our path analysis disentangles direct vs indirect links, pinpoints self-efficacy as the key modifiable target, and highlights fatigue and perceived barriers as priority levers-informing multidimensional, targeted interventions.