The dual links of health literacy in driving exercise adherence: the interactive effects of emotional management ability and life satisfaction

Based on the Health Action Process Approach theory, this study aims to explore how health literacy influences exercise adherence among Chinese university students. It focuses on examining the chain mediating effects of emotional management ability and life satisfaction. This study used a stratified, cluster, and phased sampling approach to gather demographic information. Data were collected through the Wenjuanxing platform. The survey gathered information on health literacy, emotional management ability, life satisfaction, and exercise adherence among university students. A total of 11,272 valid questionnaires were collected. Health literacy directly predicted exercise adherence positively (β = 0.618, P < 0.001). Emotional management Ability (effect size = 0.281, 95% CI = [0.254, 0.308]) and life satisfaction (effect size = 0.054, 95% CI = [0.044, 0.065]) both served as independent mediators. Life satisfaction also emerged as a significant, albeit relatively small, independent mediator. The chain mediation path of health literacy → emotional management ability → life satisfaction → exercise adherence was significant (effect size = 0.061, 95% CI = [0.051, 0.071]). Health literacy not only directly promotes exercise adherence among Chinese university students but also exerts an indirect effect through the chain mechanism of improved emotional management ability and enhanced life satisfaction. This finding validates the progressive cognitive-affective-behavioral pathway in the Health Action Process Approach theory. Future interventions should integrate health education, emotional management ability training, and life satisfaction enhancement strategies. This approach will systematically optimize the long-term maintenance of exercise behaviors.