Walking activity and emotional distress among breast cancer survivors: the parallel mediating effects of posttraumatic growth and body image

Purpose: Although the antidepressant effects of physical activity have been well established, the underlying psychological mechanisms are understudied among cancer survivors. The present study aims to examine the parallel mediating effects of posttraumatic growth and body image on the association between walking activity and emotional distress (anxiety and depression) among Chinese breast cancer survivors. Methods: Chinese breast cancer survivors (n = 235) completed a cross-sectional questionnaire that assessed walking activity, anxiety, depression, posttraumatic growth, and body image over the past week. Path analysis was conducted to test the hypothesized mediation model. Results: The hypothesized model was supported: walking activity was positively associated with posttraumatic growth and body image satisfaction, which were then negatively associated with anxiety and depression. After controlling for the mediators, the direct effect of physical activity on depression was still significant, whereas the direct effect of physical activity on anxiety was no longer significant. Conclusion: Our findings suggest that posttraumatic growth and body image may be essential psychological pathways underlying the association between walking activity and emotional distress among Chinese breast cancer survivors. Researchers and health practitioners should consider supplementing physical activity interventions with mental health services that facilitate psychological growth and a positive body image to enhance the potential psychological benefits of physical activity.