Disentangling direct and weight-mediated effects of physical activity on health-related quality of life in a 12-month real-world digital lifestyle intervention.
8 affiliations
- 1University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- 2Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland.
- 3Healthy Weight Hub, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- 4Department of Medical Physics, Turku University Hospital and University of Turku, Turku, Finland.
- 5Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland. [email protected].
- 6Healthy Weight Hub, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. [email protected].
- 7Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Biomedicum 1, Haartmaninkatu 8, PO Box 63, 00014, Helsinki, Finland. [email protected].
- 8Healthy Weight Hub, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. [email protected].
Abstract
Purpose
To examine whether participation in a 12-month digital lifestyle program was associated with increased physical activity and whether physical activity was associated with health-related quality of life (HRQoL) independently of weight loss.Methods
Self-reported weight and height were used to calculate body mass index (BMI). Physical activity (metabolic equivalent of task hours, MET-h/day) was assessed using a web-based questionnaire at baseline, 3, 6, 9, and 12 months. HRQoL was measured with the RAND-36 at baseline, 6, and 12 months yielding eight domains and physical and mental component scores. Longitudinal mixed-effects models and mediation analyses were used to examine associations between physical activity, BMI, and HRQoL over time.Results
In 1732 individuals (82.9% women, median age 52 years, BMI 39.0 kg/m²), estimated marginal mean physical activity increased from 2.16 to 3.06 MET-h/day (p < 0.001). Periods of higher-than-usual physical activity were associated with lower BMI within individuals (B = - 0.032, 95% CI - 0.053 to - 0.012). Higher physical activity was also associated with better scores in most HRQoL dimensions, including physical and mental component scores. Indirect associations via BMI were largely limited to physical domains, whereas direct associations predominated: 84.9% of the total association with physical functioning and 88.0% of that with bodily pain were attributable to the direct pathway.Conclusion
Participation in a digital lifestyle program was associated with increased physical activity, and physical activity was associated with better HRQoL largely independently of weight change, although follow-up was incomplete and the magnitude of the individual associations was modest. Physical activity merits attention as a treatment goal alongside weight management.Trial registration
The trial is registered at clinicaltrials.gov (Clinical Trials Identifier NCT04019249). Registration date 12 Jul 2019. Retrospectively registered.
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BibTeX
@article{mccann2026disentangling,
title = {{Disentangling direct and weight-mediated effects of physical activity on health-related quality of life in a 12-month real-world digital lifestyle intervention.}},
author = {Isabel McCann and Anu Joki and Laura-Unnukka Suojanen and Mikko S Venäläinen and Kirsi H Pietiläinen and Aila J Ahola},
journal = {Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation},
year = {2026},
month = oct,
doi = {10.1007/s11136-026-04425-3},
url = {https://europepmc.org/article/MED/42911506},
note = {CC BY},
}
RIS
TY - JOUR
TI - Disentangling direct and weight-mediated effects of physical activity on health-related quality of life in a 12-month real-world digital lifestyle intervention.
AU - Isabel McCann
AU - Anu Joki
AU - Laura-Unnukka Suojanen
AU - Mikko S Venäläinen
AU - Kirsi H Pietiläinen
AU - Aila J Ahola
PY - 2026
DA - 2026/10/22
JO - Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
DO - 10.1007/s11136-026-04425-3
UR - https://europepmc.org/article/MED/42911506
AB - Purpose To examine whether participation in a 12-month digital lifestyle program was associated with increased physical activity and whether physical activity was associated with health-related quality of life (HRQoL) independently of weight loss.Methods Self-reported weight and height were used to calculate body mass index (BMI). Physical activity (metabolic equivalent of task hours, MET-h/day) was assessed using a web-based questionnaire at baseline, 3, 6, 9, and 12 months. HRQoL was measured with the RAND-36 at baseline, 6, and 12 months yielding eight domains and physical and mental component scores. Longitudinal mixed-effects models and mediation analyses were used to examine associations between physical activity, BMI, and HRQoL over time.Results In 1732 individuals (82.9% women, median age 52 years, BMI 39.0 kg/m²), estimated marginal mean physical activity increased from 2.16 to 3.06 MET-h/day (p < 0.001). Periods of higher-than-usual physical activity were associated with lower BMI within individuals (B = - 0.032, 95% CI - 0.053 to - 0.012). Higher physical activity was also associated with better scores in most HRQoL dimensions, including physical and mental component scores. Indirect associations via BMI were largely limited to physical domains, whereas direct associations predominated: 84.9% of the total association with physical functioning and 88.0% of that with bodily pain were attributable to the direct pathway.Conclusion Participation in a digital lifestyle program was associated with increased physical activity, and physical activity was associated with better HRQoL largely independently of weight change, although follow-up was incomplete and the magnitude of the individual associations was modest. Physical activity merits attention as a treatment goal alongside weight management.Trial registration The trial is registered at clinicaltrials.gov (Clinical Trials Identifier NCT04019249). Registration date 12 Jul 2019. Retrospectively registered.
SN - 0962-9343
SN - 1573-2649
ER -