{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:05:45Z","timestamp":1760238345428,"version":"build-2065373602"},"reference-count":51,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T00:00:00Z","timestamp":1655856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Madeira Regional Government and Regional Secretary of Education, Science and Technology","award":["UIDB\/50009\/2020","51NF40-185901"],"award-info":[{"award-number":["UIDB\/50009\/2020","51NF40-185901"]}]},{"name":"LARSyS\u2014Portuguese national funding agency for science, research and technology (FCT) pluriannual funding 2020\u20132023","award":["UIDB\/50009\/2020","51NF40-185901"],"award-info":[{"award-number":["UIDB\/50009\/2020","51NF40-185901"]}]},{"name":"Swiss National Science Foundation","award":["UIDB\/50009\/2020","51NF40-185901"],"award-info":[{"award-number":["UIDB\/50009\/2020","51NF40-185901"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: People more socioeconomically vulnerable tend to have a poorer health-related quality of life (HRQoL). Studies are trying to analyse the factors that may condition this relationship, including physical activity (PA), which may influence the relationship between socioeconomic status (SES) and HRQoL. This study aimed to analyse the relationship between SES and HRQoL through specific domains of PA. Methods: A total of 381 adults (\u226518 years) from the Autonomous Region of Madeira completed the measurements. Mediation analyses using bootstrapping methods adjusted for confounding variables were performed to relate SES and HRQoL; the latter was evaluated using the physical component score (PCS) of the SF-12, the mental component score (MCS) of the SF-12, and the total score in the SF-12 questionnaire (SF-12 score), through physical activity. Results: Educational level was positively related to PCS and SF-12 score. Leisure-time PA (not including sports PA) and PA at work, as single mediating variables, did not mediate the relationship between SES and HRQoL. The total PA suppressed the socioeconomic gradient of HRQoL by 8\u201310%, 39\u201346%, and 15\u201316%, respectively, for the PCS, MCS, and the SF-12 score; sports PA mediated the relationship by 13\u201316%, 50%, and 15\u201321%, respectively. Conclusions: The results suggest that sports PA contributes to reducing the socioeconomic gradient of HRQoL.<\/jats:p>","DOI":"10.3390\/ijerph19137608","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T04:12:01Z","timestamp":1655871121000},"page":"7608","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the Role of Physical Activity in Mediating the Association between Educational Level and Health-Related Quality of Life in an Adult Lifespan Sample from Madeira Island"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7212-1974","authenticated-orcid":false,"given":"Jes\u00fas","family":"Garc\u00eda-Mayor","sequence":"first","affiliation":[{"name":"Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, 30720 San Javier, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0927-692X","authenticated-orcid":false,"given":"\u00c9lvio R\u00fabio","family":"Gouveia","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal"},{"name":"LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal"},{"name":"Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9850-7771","authenticated-orcid":false,"given":"Adilson","family":"Marques","sequence":"additional","affiliation":[{"name":"Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, 1499-002 Lisbon, Portugal"},{"name":"Instituto de Sa\u00fade Ambiental (ISAMB), University of Lisbon, 1649-020 Lisbon, Portugal"}]},{"given":"Ernesto","family":"De la Cruz-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, 30720 San Javier, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0168-4806","authenticated-orcid":false,"given":"Antonio","family":"Moreno-Llamas","sequence":"additional","affiliation":[{"name":"Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, 30720 San Javier, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8364-6832","authenticated-orcid":false,"given":"C\u00edntia","family":"Fran\u00e7a","sequence":"additional","affiliation":[{"name":"Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal"},{"name":"LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal"}]},{"given":"Bruna R.","family":"Gouveia","sequence":"additional","affiliation":[{"name":"LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal"},{"name":"Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland"},{"name":"Regional Directorate of Health, Secretary of Health of the Autonomous Region of Madeira, 9004-515 Funchal, Portugal"},{"name":"Saint Joseph of Cluny Higher School of Nursing, 9050-535 Funchal, Portugal"}]},{"given":"Andreas","family":"Ihle","sequence":"additional","affiliation":[{"name":"Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland"},{"name":"Department of Psychology, University of Geneva, 1205 Geneva, Switzerland"},{"name":"Swiss National Centre of Competence in Research LIVES\u2014Overcoming Vulnerability: Life Course Perspectives, 1015 Lausanne, Switzerland"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s40273-016-0389-9","article-title":"Health, Health-Related Quality of Life, and Quality of Life: What Is the Difference?","volume":"34","author":"Karimi","year":"2016","journal-title":"Pharmacoeconomics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1001\/jama.2018.0158","article-title":"The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States","volume":"319","author":"Mokdad","year":"2018","journal-title":"JAMA"},{"key":"ref_3","unstructured":"World Health Organization (2022, March 20). The Top 10 Causes of Death. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1136\/jech.2004.023531","article-title":"Indicators of Socioeconomic Position (Part 1)","volume":"60","author":"Galobardes","year":"2006","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.socscimed.2007.11.011","article-title":"Socioeconomic Status and Health-Related Quality of Life among Elderly People: Results from the Joint Canada\/United States Survey of Health","volume":"66","author":"Huguet","year":"2008","journal-title":"Soc. Sci. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1177\/1757913920914952","article-title":"The Impact of Socioeconomic Position on Non-Communicable Diseases: What Do We Know about It?","volume":"141","author":"Rivera","year":"2021","journal-title":"Perspect. Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1001\/jama.2010.297","article-title":"Association of Socioeconomic Position with Health Behaviors and Mortality","volume":"303","author":"Stringhini","year":"2010","journal-title":"JAMA"},{"key":"ref_8","unstructured":"World Health Organization (2022, March 20). WHO Guidelines on Physical Activity and Sedentary Behaviour: At a Glance. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240014886."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.ypmed.2007.07.017","article-title":"Physical Activity Level and Health-Related Quality of Life in the General Adult Population: A Systematic Review","volume":"45","author":"Bize","year":"2007","journal-title":"Prev. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1590\/S1413-81232010000100017","article-title":"Physical Activity and Quality of Life","volume":"15","author":"Silva","year":"2010","journal-title":"Cien. Saude Colet."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1477-7525-4-37","article-title":"Physical Activity Is Related to Quality of Life in Older Adults","volume":"4","author":"Acree","year":"2006","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/j.1447-0594.2008.00478.x","article-title":"Relationship between Intensity of Physical Activity and Health-Related Quality of Life in Portuguese Institutionalized Elderly","volume":"8","author":"Lobo","year":"2008","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1136\/bjsports-2017-097965","article-title":"The Physical Activity Paradox: Six Reasons Why Occupational Physical Activity (OPA) Does Not Confer the Cardiovascular Health Benefits That Leisure Time Physical Activity Does","volume":"52","author":"Holtermann","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hallman, D.M., Birk J\u00f8rgensen, M., and Holtermann, A. (2017). On the Health Paradox of Occupational and Leisure-Time Physical Activity Using Objective Measurements: Effects on Autonomic Imbalance. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0177042"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1136\/bjsm.2010.079582","article-title":"The Health Paradox of Occupational and Leisure-Time Physical Activity","volume":"46","author":"Holtermann","year":"2012","journal-title":"Br. J. Sports Med."},{"key":"ref_16","first-page":"1","article-title":"Physical Activity, Exercise and Self-Rated Health: A Population-Based Study from Sweden","volume":"8","author":"Sundquist","year":"2008","journal-title":"BMC Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1477-7525-5-64","article-title":"Recommended Level of Physical Activity and Health-Related Quality of Life among Japanese Adults","volume":"5","author":"Shibata","year":"2007","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1023\/B:QURE.0000021313.51397.33","article-title":"Leisure Time Physical Activity and Health-Related Quality of Life: Cross-Sectional and Longitudinal Associations","volume":"13","author":"Schuit","year":"2004","journal-title":"Qual. Life Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.ypmed.2005.01.006","article-title":"Leisure Time Physical Activity and Health-Related Quality of Life","volume":"41","author":"Vuillemin","year":"2005","journal-title":"Prev. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1348\/135910705X59951","article-title":"Physical Activity and Self-rated Health: Interactive Effects of Activity in Work and Leisure Domains","volume":"11","author":"Parkes","year":"2006","journal-title":"Br. J. Health Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e027751","DOI":"10.1136\/bmjopen-2018-027751","article-title":"Relationship of Different Domains of Physical Activity Practice with Health-Related Quality of Life among Community-Dwelling Older People: A Cross-Sectional Study","volume":"9","author":"Scarabottolo","year":"2019","journal-title":"BMJ Open"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Stalsberg, R., and Pedersen, A.V. (2018). Are Differences in Physical Activity across Socioeconomic Groups Associated with Choice of Physical Activity Variables to Report?. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15050922"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1479-5868-9-116","article-title":"Socioeconomic Inequalities in Occupational, Leisure-Time, and Transport Related Physical Activity among European Adults: A Systematic Review","volume":"9","author":"Beenackers","year":"2012","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ihle, A., Gouveia, B.R., Gouveia, \u00c9.R., Cheval, B., Nascimento, M.D.M., Concei\u00e7\u00e3o, L., Marconcin, P., Peralta, M., Ferrari, G., and Oliveira, D. (2021). Physical Activity Dimensions Differentially Predict Physical and Mental Components of Health-Related Quality of Life: Evidence from a Sport for All Study. Sustainability, 13.","DOI":"10.3390\/su132313370"},{"key":"ref_25","unstructured":"American College of Sports Medicine (2018). ACSM\u2019s Guidelines for Exercise Testing and Prescription, Wolters Kluwer. [10th ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual Framework and Item Selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_27","unstructured":"Ribeiro, J.L.P. (2005). O Importante \u00e9 a Sa\u00fade: Estudo de Adapta\u00e7\u00e3o de Uma T\u00e9cnica de Avalia\u00e7\u00e3o Do Estado de Sa\u00fade-SF-36, Merck Sharp & Dolme."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1093\/ajcn\/36.5.936","article-title":"A Short Questionnaire for the Measurement of Habitual Physical Activity in Epidemiological Studies","volume":"36","author":"Baecke","year":"1982","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.archger.2014.03.001","article-title":"Multivariate Analysis of Lifestyle, Constitutive and Body Composition Factors Influencing Bone Health in Community-Dwelling Older Adults from Madeira, Portugal","volume":"59","author":"Gouveia","year":"2014","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"717","DOI":"10.3758\/BF03206553","article-title":"SPSS and SAS Procedures for Estimating Indirect Effects in Simple Mediation Models","volume":"36","author":"Preacher","year":"2004","journal-title":"Behav. Res. Methods Instrum. Comput."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The Moderator\u2013Mediator Variable Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.brat.2016.11.001","article-title":"Regression-Based Statistical Mediation and Moderation Analysis in Clinical Research: Observations, Recommendations, and Implementation","volume":"98","author":"Hayes","year":"2017","journal-title":"Behav. Res. Ther."},{"key":"ref_33","unstructured":"Kenny, D., Kashy, D., and Bolger, N. (1998). Data Analysis. The Handbook of Social Psychology: Vols. 1 and 2, McGraw-Hill."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"879","DOI":"10.3758\/BRM.40.3.879","article-title":"Asymptotic and Resampling Strategies for Assessing and Comparing Indirect Effects in Multiple Mediator Models","volume":"40","author":"Preacher","year":"2008","journal-title":"Behav. Res. Methods"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1023\/A:1026595011371","article-title":"Equivalence of the Mediation, Confounding and Suppression Effect","volume":"1","author":"MacKinnon","year":"2000","journal-title":"Prev. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1093\/geronb\/gbp012","article-title":"Socioeconomic Status and Age Variations in Health-Related Quality of Life: Results from the National Health Measurement Study","volume":"64","author":"Robert","year":"2009","journal-title":"J. Gerontol. Ser. B"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1038\/eye.2017.99","article-title":"Impact of Socioeconomic Status on Vision-Related Quality of Life in Primary Open-Angle Glaucoma","volume":"31","author":"Kuo","year":"2017","journal-title":"Eye"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e002418","DOI":"10.1136\/bmjopen-2012-002418","article-title":"A cross-sectional study on socioeconomic status and health-related quality of life among elderly Chinese","volume":"3","author":"Ma","year":"2013","journal-title":"BMJ Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1037\/0882-7974.15.2.187","article-title":"Influences of Socioeconomic Status, Social Network, and Competence on Subjective Well-Being in Later Life: A Meta-Analysis","volume":"15","author":"Pinquart","year":"2000","journal-title":"Psychol. Aging"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1007\/s11136-014-0898-y","article-title":"Relationship between Socioeconomic Status and Quality of Life in Older Adults: A Path Analysis","volume":"24","author":"Bielderman","year":"2015","journal-title":"Qual. Life Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3323","DOI":"10.1007\/s11136-017-1672-8","article-title":"The Significance of Frailty in the Relationship between Socioeconomic Status and Health-Related Quality of Life in the Korean Community-Dwelling Elderly Population: Mediation Analysis with Bootstrapping","volume":"26","author":"Kim","year":"2017","journal-title":"Qual. Life Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2596","DOI":"10.1016\/j.socscimed.2008.02.012","article-title":"How Socio-Economic Status Contributes to Participation in Leisure-Time Physical Activity","volume":"66","author":"Cerin","year":"2008","journal-title":"Soc. Sci. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1006\/pmed.2002.1115","article-title":"Socioeconomic Status Differences in Recreational Physical Activity Levels and Real and Perceived Access to a Supportive Physical Environment","volume":"35","author":"Donovan","year":"2002","journal-title":"Prev. Med."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Finger, J.D., Tyllesk\u00e4r, T., Lampert, T., and Mensink, G.B.M. (2012). Physical Activity Patterns and Socioeconomic Position: The German National Health Interview and Examination Survey 1998 (GNHIES98). BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-1079"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e006034","DOI":"10.1136\/bmjopen-2014-006034","article-title":"Objectively-Assessed and Self-Reported Sedentary Time in Relation to Multiple Socioeconomic Status Indicators among Adults in England: A Cross-Sectional Study","volume":"4","author":"Stamatakis","year":"2014","journal-title":"BMJ Open"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1123\/jpah.9.2.270","article-title":"Correlates of Sitting Time in Working Age Australian Women: Who Should Be Targeted with Interventions to Decrease Sitting Time?","volume":"9","author":"Heesch","year":"2012","journal-title":"J. Phys. Act. Health"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Wallmann-Sperlich, B., Bucksch, J., Hansen, S., Schantz, P., and Froboese, I. (2013). Sitting Time in Germany: An Analysis of Socio-Demographic and Environmental Correlates. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-196"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Wallmann-Sperlich, B., Bucksch, J., Schneider, S., and Froboese, I. (2014). Socio-Demographic, Behavioural and Cognitive Correlates of Work-Related Sitting Time in German Men and Women. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-1259"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1136\/jech.2006.054098","article-title":"Contribution of Neighbourhood Socioeconomic Status and Physical Activity Resources to Physical Activity among Women","volume":"61","author":"Lee","year":"2007","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1007\/s00038-020-01488-y","article-title":"Physical Activity Barriers According to Social Stratification in Europe","volume":"65","year":"2020","journal-title":"Int. J. Public Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1123\/jpah.4.2.138","article-title":"Relationship between Regular Walking, Physical Activity, and Health-Related Quality of Life","volume":"4","author":"Blacklock","year":"2007","journal-title":"J. Phys. Act. Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/13\/7608\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:37:08Z","timestamp":1760139428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/13\/7608"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,22]]},"references-count":51,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["ijerph19137608"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19137608","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,6,22]]}}}