From self-perception to behavioral drive: the dual-motivational interactive pathways of how body satisfaction and health evaluation affect physical activity - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice BMC Public Health . 2026 Mar 9;26:1235. doi: 10.1186/s12889-026-26913-4 Search in PMC Search in PubMed View in NLM Catalog Add to search From self-perception to behavioral drive: the dual-motivational interactive pathways of how body satisfaction and health evaluation affect physical activity Kaijie Feng Kaijie Feng 1 Department of Physical Education and Research, Peking University, Beijing, China Find articles by Kaijie Feng 1 , Jiyan Xu Jiyan Xu 2 School of Sport Management and Communication, Capital University of Physical Education And Sports, Beijing, China Find articles by Jiyan Xu 2 , Yanzhi Hao Yanzhi Hao 2 School of Sport Management and Communication, Capital University of Physical Education And Sports, Beijing, China Find articles by Yanzhi Hao 2 , Weiwei Xu Weiwei Xu 3 College of Humanities and Law, Beijing University of Chemical Technology, Beijing, China Find articles by Weiwei Xu 3, ✉ Author information Article notes Copyright and License information 1 Department of Physical Education and Research, Peking University, Beijing, China 2 School of Sport Management and Communication, Capital University of Physical Education And Sports, Beijing, China 3 College of Humanities and Law, Beijing University of Chemical Technology, Beijing, China ✉ Corresponding author. Received 2026 Jan 16; Accepted 2026 Mar 2; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13085298 PMID: 41803850 Abstract Objective This cross-sectional study examined the associations between body satisfaction, health evaluation, and physical activity among university students. It investigated the mediating roles of intrinsic and extrinsic motivation and tested whether body satisfaction moderates the relationship between health evaluation and these motivational pathways. The study aims to elucidate an integrated mind-body synergy framework for understanding health behaviors. Methods A survey was conducted among 2016 Chinese university students (mean age 19.50 ± 1.57 years; 71.4% male) from November to December 2025. Participants completed the Multidimensional Body-Self Relations Questionnaire, the Sport Motivation Scale, and the Physical Activity Rating Scale. Data were analyzed using SPSS 25.0 and PROCESS v4.0 for mediation, moderation, and moderated mediation analyses. Structural equation modeling was performed using Stata 16.0. Results Body satisfaction and health evaluation were positively correlated with physical activity (r = 0.228, p < 0.01; r = 0.059, p < 0.01). Intrinsic motivation mediated the associations of both body satisfaction (indirect effect = 2.444, 95% CI [1.744, 3.257]) and health evaluation (indirect effect = 1.286, 95% CI [0.443, 2.208]) with physical activity. Extrinsic motivation also served as a mediator for body satisfaction (indirect effect = 0.774, 95% CI [0.321, 1.291]) and health evaluation (indirect effect = 0.924, 95% CI [0.427, 1.529]). Body satisfaction moderated the associations between health evaluation and both intrinsic (β = 0.031, p < 0.05) and extrinsic motivation (β = 0.041, p < 0.05), with stronger associations observed at higher levels of body satisfaction. The moderated mediation model demonstrated acceptable fit (RMSEA = 0.057, CFI = 0.921, TLI = 0.926). Conclusion These findings suggest that health evaluation and body satisfaction are associated with physical activity through intrinsic and extrinsic motivational pathways, with body satisfaction potentially enhancing the motivational impact of health evaluation. The observed interplay between affective experience (body satisfaction) and rational cognition (health evaluation) may inform future health promotion strategies. Interventions that foster positive body image alongside health knowledge dissemination could potentially support physical activity engagement. Keywords: Body satisfaction, Health evaluation, Mind-body synergy, Sports motivation, Physical activity Introduction Physical activity (PA) is a cornerstone for promoting individual health and well-being, playing a vital role in enhancing physical fitness, mental health, and quality of life [ 1 , 2 ]. However, insufficient physical activity is a widespread global concern, with 80% of adolescents and 31% of adults failing to meet the recommended levels of PA [ 3 ]. This reveals a significant behavioral gap between health awareness and actual engagement in exercise. Physical inactivity has become a major risk factor contributing to poor physical health among students and the development of chronic non-communicable diseases. Traditional theories, such as the Health Belief Model (HBM), which focus on individuals’ rational assessment of health threats and behavioral benefits, hold important value in explaining health behaviors but have demonstrated limited effectiveness in promoting physical exercise. This observation indicates a considerable disparity between the understanding of health benefits and the actual adoption of physical exercise behaviors. Insufficient physical activity now serves as a primary contributing factor to declining student physical fitness levels and the rising incidence of chronic non-communicable diseases. In previous studies, an individual’s cognitive appraisal of their own health status, known as health evaluation, originates from the Health Belief Model. It refers to the rational weighing of personal disease risk, behavioral benefits, and barriers, and is primarily viewed as an instrumental driver that can stimulate autonomous motivation to promote physical activity [ 4 ]. Body satisfaction (BS) is a multidimensional construct encompassing affective, cognitive, and behavioral components, reflecting an individual’s level of appreciation and approval of their own physical appearance [ 5 ]. It predominantly emphasizes the affective dimension—namely, the positive emotional attitude one holds toward their own body [ 6 ]. In this study, body satisfaction is conceptualized as a positive affective experience. It is positively associated with more autonomous forms of intrinsic motivation, such as deriving enjoyment from exercise and perceiving physical competence [ 7 ]. Moreover, it not only reinforces individuals’ health-related cognitions but also directly enhances the spontaneity and adherence to physical activity [ 8 ]. Research indicates that relying solely on cognitive intentions to drive behavior may lead to insufficient motivation over time during the transition to long-term, spontaneous action [ 9 ]. Conversely, high body satisfaction is associated with a more positive physical self-concept and the fulfillment of fundamental psychological needs such as autonomy and competence. These factors subsequently motivate individuals to engage in activities based on the inherent enjoyment, pleasure, or challenge they offer [ 10 ]. Furthermore, body satisfaction positively predicts enjoyment-oriented exercise participation and reduces exercise avoidance driven by physique anxiety [ 11 ]. Therefore, body satisfaction may serve as a key psychological context that moderates the process by which cognitive evaluation enhances motivation formation. Research has found that individuals who feel satisfied and confident with their own bodies are more likely to internalize external reasons for exercising, such as health concerns, into their self-concept, thereby enhancing the autonomy of their motivation [ 12 ]. Conversely, individuals with low body satisfaction may see their willingness to translate health awareness into actual behavior diminished due to anxiety about body exposure or doubts about their physical capabilities, even when they have significant health concerns [ 11 ]. This suggests that body satisfaction may serve as a critical psychological context that moderates the process by which cognitive evaluations strengthen the formation of motivation. High body satisfaction is likely to enhance the driving effect of health assessments on both intrinsic and extrinsic motivation, and further facilitate their internalization into more autonomous forms. Consequently, it amplifies the overall impact of health assessments on physical activity engagement. Although existing studies have separately examined the independent contributions of health evaluation or body satisfaction to physical activity, the current literature has two limitations: a lack of attention to interaction effects and an unclear understanding of the regulatory mechanisms underlying the internalization of motivation. Most studies treat health evaluation and/or body satisfaction as parallel or independent predictors, with little research exploring whether and how body satisfaction moderates the motivational effectiveness of health evaluation. While self-determination theory suggests that external motivation can be internalized into intrinsic motivation, empirical evidence on the factors that promote or hinder this internalization process, particularly in the context of body image—remains fragmented. This study introduces a dynamic interactive perspective, treating body satisfaction as a holistic psychological construct and health evaluation as parallel predictors to explore their dynamic interactive process in driving behavior. By systematically elucidating: (1) the association between the dual mediating pathways of intrinsic and extrinsic motivation and physical activity, as informed by health evaluation and body satisfaction; and (2) the moderating role of body satisfaction in influencing the efficacy of health evaluation in stimulating both types of motivation, thereby moderating its indirect effect on physical activity, this research aims to reveal mechanisms for more effectively synergizing different psychological resources to promote individual participation in physical activity. Theoretically, it deepens the understanding of the synergistic effects between cognitive factors and multidimensional self-body perception, aiming to more effectively bridge the knowledge-attitude-behavior gap and facilitate the transformation from the synergy of physical and mental resources to sustainable health actions. Based on this, the study constructs a comprehensive model to elucidate the pathways of influence among the variables (see Figure 1 ) and proposes the following hypotheses: H1: Body satisfaction and health evaluation have significant positive predictive effects on both intrinsic and extrinsic motivation. H2: Body satisfaction and health evaluation have significant positive predictive effects on physical activity. H3: Both intrinsic motivation and extrinsic motivation exhibit significant mediating effects in the association between body satisfaction and physical activity, as well as in the association between health evaluation and physical activity. H4: Body satisfaction has a significant moderating effect on the positive association between health evaluation and intrinsic motivation, as well as on the positive association between health evaluation and extrinsic motivation. Fig. 1. Open in a new tab A model framework for the interactive effects of body satisfaction and health evaluation on physical activity Methods Participants A questionnaire survey was conducted among 2016 college students using random sampling from early November to late December 2025. The average age of the participants was 19.50 ± 1.57 years. Among them, 1439 (71.4%) were male and 577 (28.6%) were female. This study was approved by the Ethics Committee of the Academic Committee of Capital University of Physical Education and Sports (Approval No.: 2025A0153). Research instruments Multidimensional Body-Self Relations Questionnaire (MBSRQ) The Multidimensional Body-Self Relations Questionnaire (MBSRQ) was originally developed by American psychologist Thomas F. Cash in 1989 and later culturally adapted for the Chinese population by scholar Ma Rumeng [ 13 ]. For this study, the Body Satisfaction and Health Evaluation subscales were selected, comprising 9 and 6 items, respectively. Responses were recorded using a 5-point Likert scale, where higher scores indicate greater body satisfaction and a more positive perception of one’s health status. In this measurement, the Kolmogorov–Smirnov (K-S) normality test was significant ( P < 0.001, df = 2016), indicating that the data do not follow a normal distribution. The Cronbach’s α values for the two dimensions were 0.839 and 0.713, respectively. The confirmatory factor analysis revealed that the scale demonstrated good overall model fit: Root Mean Square Error of Approximation (RMSEA) = 0.078 (below the 0.08 threshold), Comparative Fit Index (CFI) = 0.917, Tucker-Lewis Index (TLI) = 0.912 (both exceeding 0.9), and Standardized Root Mean Square Residual (SRMR) = 0.072 (below the 0.08 criterion). Sport Motivation Scale (SMS) The study employed the Sport Motivation Scale (SMS), originally developed by Pelletier et al. [ 14 ], and subsequently translated and culturally adapted into Chinese by Peng Jing and colleagues [ 15 ]. The study focused on two dimensions: intrinsic motivation and extrinsic motivation, each comprising 12 items. Responses were measured using a 5-point Likert scale, with higher scores reflecting greater motivational strength. In this measurement, the K-S normality test was significant ( P < 0.001, df = 2016), indicating that the data do not follow a normal distribution. The Cronbach’s α for Intrinsic Motivation was 0.945, with its three sub-dimensions—Intrinsic Motivation to Know, Intrinsic Motivation to Accomplish, and Intrinsic Motivation to Experience Stimulation—achieving Cronbach’s α values of 0.858, 0.868, and 0.861, respectively. The Cronbach’s α for Extrinsic Motivation was 0.904, with its three sub-dimensions—Identified Regulation, Introjected Regulation, and External Regulation—achieving Cronbach’s α values of 0.827, 0.793, and 0.791, respectively. The confirmatory factor analysis showed that the scale had a good overall model fit, with RMSEA = 0.071 (below 0.08), CFI = 0.913 and TLI = 0.915 (both above 0.9), and SRMR = 0.076 (below 0.08). Physical Activity Rating Scale-3 (PARS-3) The Physical Activity Rating Scale comprises 3 items [ 16 ], adapted from Liang Deqing’s research (1994), which assess exercise intensity, exercise duration, and exercise frequency. Each item is scored using a 5‑point Likert scale. The overall physical activity level is calculated as follows: Physical Activity Score = Exercise Intensity * (Exercise Duration − 1) * Exercise Frequency. Higher scores indicate higher levels of physical activity. In the present study, exercise intensity was graded on a 1‑to‑5 scale, with the highest level corresponding to vigorous intensity (i.e., intensity at or slightly below the lactate threshold, VT/LT), rather than maximal or exhaustive intensity. In this measurement, the K-S normality test was significant ( P < 0.001, df = 2016), indicating that the data do not follow a normal distribution. The Cronbach’s α for the scale was 0.700. Statistical methods The collected data were quantified by assigning values to each option in Excel. SPSS 25.0 was used to test for common method bias, perform descriptive statistics, correlation analysis, and regression analysis. PROCESS v4.0 was employed to examine mediating effects, moderating effects, and moderated mediating effects. Stata 16.0 was utilized for structural equation modeling and related tests. The significance level was set at α = 0.05. Results Common method bias The results of Harman’s single-factor test were examined to assess the threat of common method bias. Unrotated exploratory factor analysis revealed seven factors with eigenvalues greater than 1. The first factor accounted for 32.923% of the total variance, which is below the critical threshold of 40% [ 17 ]. This indicates that no single factor explains the majority of the variance, suggesting that common method bias is not a serious issue in this dataset and does not pose a significant threat to the interpretation of the study’s findings. Descriptive statistics and correlation analysis Descriptive statistics and Pearson correlation analyses were conducted using SPSS 25.0. The descriptive statistics and correlation coefficients for all variables are presented in Table 1 . The results showed that HE, BS, IM, EM, and PA were all significantly positively correlated, with statistical significance. This suggests that individuals with higher levels of HE and BS also exhibit higher levels of IM and EM, as well as higher PA levels. Table 1. Descriptive Statistics and Correlation Analysis of Variables in College Student Research Variable M ± SD HE BS IM EM PA HE 3.10 ± 0.61 1 BS 2.59 ± 0.70 0.508** 1 IM 3.66 ± 0.75 0.260** 0.094** 1 EM 3.49 ± 0.69 0.309** 0.191** 0.862** 1 PA 21.69 ± 21.03 0.228** 0.059** 0.410** 0.395** 1 Open in a new tab Note: * indicates P < 0.05, ** indicates P < 0.01; the same applies hereafter Mediation effect test Using Model 4 developed by Hayes, the Bootstrap estimation method was applied with 5000 resamples to estimate the 95% Confidence Intervals (CI) of the mediation effects in a sample of 2016 university students, including the Lower Limit Confidence Interval (LLCI) and the Upper Limit Confidence Interval (ULCI). The results are shown in Table 2 . The indirect effect of health evaluation on physical activity through intrinsic motivation was 2.444 (95% CI: 1.744–3.257), while the indirect effect through extrinsic motivation was 1.286 (95% CI: 0.443–2.208). Both confidence intervals did not include zero. Similarly, the indirect effect of body satisfaction on physical activity through intrinsic motivation was 0.774 (95% CI: 0.321–1.291), and through extrinsic motivation was 0.924 (95% CI: 0.427–1.529). Again, neither confidence interval included zero. These findings indicate that both intrinsic motivation and extrinsic motivation play significant mediating roles in the relationship between body satisfaction/health evaluation and physical activity, thereby supporting hypotheses H1, H2, and H3. Table 2. Results of Mediation Effect Tests Path Effect Boot SE LLCI ULCI Effect Size HE→IM→PA 2.444 0.385 1.744 3.257 31.37% HE→EM→PA 1.286 0.449 0.443 2.208 16.51% Direct effect 4.06 0.723 2.641 5.478 52.12% Total effect 7.790 0.743 6.333 9.247 BS→IM→PA 0.774 0.248 0.321 1.291 31.60% BS→→EM→PA 0.924 0.276 0.427 1.529 37.73% Direct effect 0.751 0.265 0.232 1.270 30.67% Total effect 2.449 0.672 1.133 3.776 Open in a new tab Moderation effect test A stepwise regression analysis was conducted to examine the interaction effect between health evaluation and body satisfaction. As shown in Table 3 , Models 1–3 used intrinsic motivation as the dependent variable, while Models 4–6 used extrinsic motivation as the dependent variable. In Model 1, with health evaluation as the independent variable, the explained variance (R²) was 0.067. After sequentially adding body satisfaction and the interaction term between health evaluation and body satisfaction in Model 2, R² increased to 0.157. In Model 3, R² further increased to 0.182, indicating a significant improvement in model explanatory power. The interaction term was statistically significant (β = 0.031, P < 0.05), suggesting that the synergistic effect between health evaluation and body satisfaction enhanced their ability to predict intrinsic motivation. Similarly, R² increased from 0.096 in Model 4 to 0.207 in Model 5 and 0.215 in Model 6, demonstrating a gradual enhancement in model explanatory power. The interaction term was also significant (β = 0.041, P < 0.05), indicating that the synergistic effect strengthened the prediction of extrinsic motivation. These results confirm Hypothesis H4. As indicated by the regression residual plot analysis, the standardized residuals are randomly distributed around the standardized predicted values, with no discernible curvilinear trend and a generally consistent spread width. This suggests that the model satisfies the assumptions of linearity and homoscedasticity. Table 3. Stepwise Regression Analysis of the IM between HE and BS Variable Intrinsic Motivation Extrinsic Motivation Model1 Model2 Model3 Model4 Model5 Model6 Constant 2.684** 2.728** 2.466** 2.416** 2.380** 2.043** HE 0.316** 0.347** 0.426** 0.347** 0.320** 0.422** BS 0.155** 0.152** 0.260** 0.283** HE*BS 0.031* 0.041* R 2 0.067 0.157 0.182 0.096 0.207 0.215 ΔR 2 0.067 0.090 0.025 0.096 0.111 0.008 F 145.640** 187.620** 149.212** 212.891** 262.761** 183.506** Open in a new tab As shown in Table 4 , the multicollinearity diagnostics indicate that in all models, the Variance Inflation Factor (VIF) values for each variable range from 1.000 to 1.445, which falls between 1 and 5 and is below the critical threshold. The Tolerance (Tol) values range from 0.692 to 1.000, all exceeding 0.1. These results suggest that there are no severe multicollinearity issues in any of the models, meaning there is no high degree of linear correlation among the predictor variables. Table 4. Diagnostic results of multicollinearity for each model Variable Model1 Model2 Model3 Model4 Model5 Model6 HE Tol 1.000 0.742 0.739 1.000 0.742 0.739 VIF 1.000 1.348 1.353 1.000 1.348 1.353 BS Tol 0.742 0.692 0.742 0.692 VIF 1.348 1.445 1.348 1.445 HE*BS Tol 0.927 0.927 VIF 1.079 1.079 Open in a new tab To further analyze the nature of the interaction, simple slope analyses were conducted to examine the associations between health evaluation (HE) and intrinsic motivation (IM) as well as extrinsic motivation (EM) at low (mean − 1 SD), medium (mean), and high (mean + 1 SD) levels of body satisfaction (BS). As shown in Figure 2 , the left panel illustrates the moderating effect of BS on the relationship between HE and IM, while the right panel depicts the moderating effect of BS on the relationship between HE and EM. The analysis revealed that HE was significantly positively associated with IM at low (β = 0.499, P < 0.01), medium (β = 0.528, P < 0.01), and high (β = 0.557, P < 0.01) levels of BS. Similarly, HE was significantly positively associated with EM at low (β = 0.485, P < 0.01), medium (β = 0.506, P < 0.01), and high (β = 0.528, P < 0.01) levels of BS. Notably, the positive relationships between HE and both IM and EM gradually strengthened as the level of BS increased. Fig. 2. Open in a new tab The Moderating Effect of BS on the Relationship between HE and IM (Left) and EM (Right) Moderated mediation effect test This study employed Hayes’s (2022) Model 7 to examine whether intrinsic motivation (IM) and extrinsic motivation (EM) mediate the relationship between health evaluation (HE) and physical activity (PA) under different levels of body satisfaction (BS). In the analysis, all continuous predictor variables were mean-centered to reduce the impact of multicollinearity on the estimation of interaction terms. Bootstrapping with 5000 resamples was applied to generate 95% bias-corrected confidence intervals (CIs) to assess the significance and stability of the moderated mediation effects. The results, presented in Table 5 , show that in the HE → IM → PA pathway, the indirect effect through IM was 2.544 at low BS levels. As BS levels increased, the indirect effect gradually rose, reaching 2.841 at high BS levels. All three levels of BS showed 95% CIs that did not include zero. Similarly, in the HE → EM → PA pathway, the indirect effect through EM was 1.099 at low BS levels and increased to 1.282 at high BS levels. Again, the 95% CIs at all three BS levels did not include zero. These findings indicate that both mediation pathways are statistically significant across the observed range of BS, and that higher levels of BS significantly strengthen the indirect effects of IM and EM on the relationship between HE and PA. Table 5. Analysis of Mediation Effect Tests at Different Levels of BS Path Level Effect Boot SE LLCI ULCI HE→IM→PA Low level 2.544 0.447 1.714 3.483 Moderate level 2.679 0.433 1.896 3.601 High level 2.841 0.493 1.922 3.865 HE→EM→PA Low level 1.099 0.393 0.380 1.926 Moderate level 1.182 0.409 0.422 2.029 High level 1.282 0.448 0.454 2.223 Open in a new tab Structural Equation Modeling (SEM) test Using Stata 16.0, a structural equation model was constructed to examine the relationships among health evaluation, body satisfaction, their interaction term, intrinsic motivation, extrinsic motivation, and physical activity, and to analyze the corresponding pathways. Given that the chi-square value tends to increase with larger sample sizes and may lead to the rejection of any model, it was not used as a criterion for evaluating model fit in this study. As shown in Figure 3 , the absolute values of the critical ratios (CR) for all paths in the model exceeded 1.96, indicating that the parameters were significant at a confidence level greater than 95%; thus, the null hypothesis was not rejected. All standard errors (SE) were less than 1, suggesting accurate parameter estimation. Furthermore, all paths reached statistical significance ( P < 0.05). Model fit was assessed using multiple indices: RMSEA was 0.057 (< 0.08, indicating acceptable fit), CFI was 0.921 (> 0.9), and TLI was 0.926 (> 0.9), collectively suggesting good model fit. Fig. 3. Open in a new tab A structural equation model diagram of health health evaluation, body satisfaction, and physical activity As shown in Figure 3 , health evaluation exhibited significant positive correlations with intrinsic motivation (β = 0.430, P < 0.001), extrinsic motivation (β = 0.420, P < 0.001), and physical activity (β = 0.520, P < 0.001). Body satisfaction also demonstrated significant positive correlations with intrinsic motivation (β = 0.052, P = 0.003), extrinsic motivation (β = 0.180, P < 0.001), and physical activity (β = 0.210, P < 0.001). The interaction term between health evaluation and body satisfaction was positively associated with both intrinsic motivation (β = 0.031, P = 0.029) and extrinsic motivation (β = 0.040, P = 0.021), though the effect sizes were relatively modest. Furthermore, both intrinsic motivation and extrinsic motivation showed significant positive correlations with physical activity (β = 0.720, P < 0.001; β = 0.430, P < 0.001). All pairwise relationships among the variables in the model were significantly positive. These results indicate that higher levels of health evaluation and body satisfaction, as well as their interaction, can directly contribute to increased physical activity. Additionally, they can indirectly enhance physical activity by strengthening both intrinsic and extrinsic motivation. Discussion The present study proposes an integrated multidimensional model delineating the psychological pathway from mind-body synergy to behavioral engagement in physical activity. The findings reveal a dual-pathway motivational mechanism through which health evaluation and body satisfaction jointly influence physical activity, with three principal observations emerging: Dual-pathway motivational mediation: Both health evaluation and body satisfaction demonstrate direct positive effects on physical activity, while simultaneously operating through distinct yet parallel motivational pathways. Health evaluation primarily facilitates physical activity by enhancing intrinsic motivation, whereas body satisfaction exerts its influence predominantly through the reinforcement of extrinsic motivation. Moderating role of body satisfaction: Body satisfaction functions as a significant contextual moderator in the cognitive-motivational process. Higher levels of body satisfaction strengthen the positive relationship between health evaluation and both intrinsic and extrinsic motivation, thereby amplifying the indirect effects of health evaluation on physical activity through these enhanced motivational channels. Integrated moderated mediation framework: The validated model demonstrates satisfactory statistical fit, confirming an interactive system wherein body satisfaction, health evaluation, and their synergistic interaction collectively shape motivational dynamics that subsequently determine physical activity behavior. These results extend theoretical understanding beyond traditional health behavior models by demonstrating how cognitive evaluations and affective self-perceptions operate not as independent determinants, but as dynamically interacting components within an integrated psychological system governing health behavior engagement. Physical activity behavior is synergistically driven by both cognitive and affective resources. Individuals’ rational evaluation of their own health-based on cognition of long-term health benefits and avoidance of potential risks-provides an extrinsic, goal-oriented motivation for physical activity. Physical satisfaction, as a positive self-body image, can directly stimulate individuals’ intrinsic interest and pleasure in participating in physical activity. According to Self-Determination Theory, motivation is not a simple binary opposition but rather a continuous process of internalization ranging from external regulation to intrinsic motivation. In this study, the role of physical satisfaction corresponds precisely to the satisfaction of basic psychological needs [ 18 ], thereby establishing an action linkage between emotion and self-internalization. Specifically, a positive perception of one’s body image satisfies an individual’s need for competence and autonomy. The fulfillment of these psychological needs facilitates a smoother transition from external motivation to intrinsic motivation. Individuals with high physical satisfaction are more likely to perceive the cognitive input of health assessment as a result of autonomous choice, thereby stimulating more sustained behavioral engagement. Body satisfaction, as a positive self-body image, directly stimulates individuals’ intrinsic interest and enjoyment in physical activity engagement, aligning with the core concept of autonomous motivation in Self-Determination Theory. This study further reveals that both cognitive pathway (health evaluation) and affective pathway (body satisfaction) not only independently enhance physical activity through increased intrinsic and extrinsic motivation but also exhibit significant interactive effects. Specifically, body satisfaction positively moderates the effect of health evaluation on both types of motivation: when individuals hold a more positive attitude toward their own bodies, their health beliefs can be more effectively translated into stronger behavioral motivation. Furthermore, when individuals experience satisfaction with their body image, they are more inclined to perceive physical activity as a means of self-expression and enjoyment rather than a compulsory task. From the perspective of Social Cognitive Theory, individual behavior is influenced by the dynamic interaction among cognitive, affective, and environmental factors, as well as the behavior itself. In this model, health assessment represents the individual’s outcome expectancy regarding behavioral results, while body satisfaction constitutes the individual’s emotional state and self-referential system. The moderating effect of body satisfaction indicates that a positive emotional state enhances an individual’s judgment of their own capabilities, namely, self-efficacy. This perspective fosters a synergistic interaction between rational drivers (e.g., health goals) and affective reinforcement (e.g., positive bodily experiences). Such synergy not only enhances personal well-being [ 19 ], and fosters positive emotional states but also strengthens the motivation for engagement by linking physical activity to clear health-oriented objectives. Consequently, this integrated motivational framework promotes greater spontaneity and sustainability in health behavior adherence. Moreover, body satisfaction may reduce exercise avoidance stemming from physique-related anxiety [ 20 ], thereby reinforcing interest-based and affective dimensions that mitigate the fluctuations and insufficiencies often observed in purely cognitive motivation. Although there is a statistically positive association between body satisfaction and physical activity, the effect size is small, suggesting that the direct contribution of body satisfaction to physical activity may be limited. Its role is more likely to be realized indirectly through mediating variables such as motivation. Motivation plays a mediating role in the behavioral drive chain, with its nature and intensity being shaped by antecedent variables. Mediation effect tests indicate that both intrinsic and extrinsic motivation serve as intermediary variables through which health evaluation and body satisfaction influence physical activity. The moderating effect of body satisfaction is primarily manifested in its impact on motivational intensity. When body satisfaction is low, the driving effect of health evaluation on motivation is relatively weak. This suggests that even when individuals possess a clear awareness of health risks, the resulting motivation tends to be limited and more likely to remain at the stage of external regulation. Such a weak linkage between cognition and motivation impedes the transformation of health beliefs into sufficient behavioral drive. Conversely, a high level of body satisfaction not only strengthens the direct influence of health evaluation on extrinsic motivation but also facilitates the transformation of extrinsic motivation into more autonomous forms [ 21 ]. This enhancement in motivational quality, in turn, improves the consistency and sustainability of health-related behaviors, thereby internalizing health goals into the individual’s personal value system. This finding reveals a deeper mechanism of mind-body synergy: body satisfaction amplifies the behavioral impact of health cognition by optimizing the quality of motivation. The moderated mediation model validated in this study constitutes an integrated framework for explaining the formation of health behaviors, characterized by satisfactory fit and clearly delineated pathways. Structural equation modeling revealed that the full model—incorporating health evaluation, body satisfaction, their interaction term, dual motivational pathways, and physical activity—demonstrated acceptable fit indices, with all hypothesized paths reaching statistical significance. These findings collectively confirm the plausibility of the theoretical pathway wherein cognitive inputs, interacting with positive emotional experiences, shape motivations of varying quality and ultimately drive behavior. This model advances beyond previous health behavior theories, such as the Health Belief Model, which often emphasized either cognitive or affective pathways in isolation. Instead, it integrates rationality and emotion, cognition and self-perception, as well as external goals and internal experiences within a dynamic system, thereby providing a referential integrated model for future research. Simultaneously, the results indicate that effective health promotion should not remain confined to the cognitive level but should aim to cultivate a positive state of mind-body unity. Only when individuals cognitively recognize the importance of health while also establishing a positive emotional connection with their own bodies can exercise behavior be sustained over time. Based on the findings of this study, future interventions should evolve from health communication to holistic mind-body empowerment. Specifically, health promotion initiatives targeting university students should adopt a dual-track strategy integrating cognitive empowerment and experiential reshaping, with a focus on enhancing body satisfaction to amplify the impact of health-related information. Higher education institutions should systematically incorporate the cultivation of positive body image into curricula and campus culture, alongside disseminating evidence-based fitness knowledge and strengthening health risk awareness. This approach can foster students’ identification with their body morphology and exercise participation, thereby enhancing their psychological capacity to translate health awareness into autonomous and sustained motivation for physical activity. Such an integrated strategy offers a promising pathway to address the public health challenge of physical inactivity. Research limitations Although this study has certain contributions, several limitations should be noted. First, the cross-sectional design can only reveal correlational relationships among variables and cannot establish causal direction or temporal sequence; future research should employ longitudinal tracking or experimental designs to verify the causal pathways among mind-body variables, motivation, and behavior. Second, all variables were collected through self-report measures. Although statistical tests indicated that common method bias did not seriously compromise the results, it remains difficult to completely avoid influences such as memory bias and social desirability. Future studies could incorporate objective measurement tools such as accelerometers. Third, Third, although the total sample size of this study is sufficient to support the current statistical analyses, there is a significant gender imbalance in the sample distribution (71.4% male, 28.6% female). Due to the relatively low proportion of female participants, the research findings may more accurately reflect the characteristics and relationship patterns of the male population, while their interpretation may be limited when applied to female populations or gender-based comparisons. Future research should aim to achieve more balanced gender distribution during sample recruitment, or employ stratified sampling to ensure adequate subsample sizes, thereby enabling more precise examination of gender differences or ensuring the generalizability of research conclusions across different gender groups. Finally, the measurement of body satisfaction did not fully capture its sub-dimensions such as functional appreciation, and the model did not include potential variables such as social support or physical environment. Future research should aim to construct more comprehensive ecological models to explore differentiated pathways across diverse populations. Conclusion This study developed an integrated model incorporating body satisfaction, health evaluation, exercise motivation, and physical activity, offering preliminary insights into a potential psychological pathway from mind–body synergy to behavioral implementation. Health evaluation and body satisfaction were positively associated with intrinsic and extrinsic motivation, respectively, and were indirectly related to physical activity through the mediating role of motivation. Furthermore, body satisfaction moderated the positive relationship between health evaluation and both types of motivation, such that the association between health evaluation and behavioral motivation was stronger among individuals with higher levels of body satisfaction. These findings suggest that the initiation of health-related behavior may not only rely on rational health cognition but may also depend on positive bodily experiences as a psychological foundation. Future health promotion practices could consider integrating cognitive and experiential strategies beyond traditional knowledge dissemination models. Specifically, interventions aimed at enhancing both health awareness and body satisfaction may improve the efficiency and quality of translating health cognition into actual behavior, thereby facilitating increased physical activity. Acknowledgements We extend our sincere gratitude to all scholars who contributed to this study and the students who participated in the survey. Authors’ contributions F KJ was responsible for the questionnaire design and analyzed the data, and wrote the introduction, methodology, and results sections of the article; X JY and H YZ provided in-depth analysis and discussion of the results, and completed the discussion section. X WW provided research ideas and guidance and reviewed the article. Funding This study did not receive any funding. Data availability Our data were obtained in collaboration with a group from the Capital University of Physical Education And Sports, and our data will be followed by other analyses, which we are unable to provide for the sake of data privacy. We have put the descriptive statistics of the data and related results of the analysis are placed in the main text, if you have questions about the data we will actively cooperate, we guarantee that our data is true and reliable. Declarations Ethics approval and consent to participate This study strictly adheres to the ethical principles outlined in the Declaration of Helsinki. The research protocol was reviewed and approved by the Academic Ethics Committee of Capital University of Physical Education and Sports (Approval No. 2025A0153). Prior to data collection, informed consent forms were distributed to all participants, detailing the study’s purpose, procedures, potential risks and benefits, as well as the right to withdraw at any time without penalty. Written informed consent was obtained from all participants. All data were collected and processed anonymously to ensure participant privacy and confidentiality. This manuscript does not contain any images or information that could lead to the identification of individual participants. The data were used solely for academic research purposes. Participants did not receive any monetary or material compensation for their involvement in the study. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Hallgren M, Kandola A, Stubbs B, et al. Associations of exercise frequency and cardiorespiratory fitness with symptoms of depression and anxiety - a cross-sectional study of 36,595 adults. Ment Health Phys Act. 2020;19:100351-. 10.1016/j.mhpa.2020.100351. [ Google Scholar ] 2. Yan W, Wang Y, Yuan Y, et al. Timing matters: a longitudinal study examining the effects of physical activity intensity and timing on adolescents’ mental health outcomes. J Youth Adolesc. 2024;53(10):2320–31. 10.1007/S10964-024-02011-9. [ DOI ] [ PubMed ] [ Google Scholar ] 3. WHO.Physical Activity.World Health Organization(. 2022). https://www.who.int/zh/news-room/fact-sheets/detail/physical-activity . 4. Lilian JMJC, A C B LW, et al. Clustering of motivational constructs based on self-determination theory for diet and physical activity and their associations with behaviour: a cross-sectional study. J Nutritional Sci. 2022;11(22):e22–22. 10.1017/JNS.2022.12. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 5. Amaral SCA, Ferreira CEM. Body dissatisfaction and associated factors among Brazilian adolescents: a longitudinal study. Body Image. 2017;22:32–8. 10.1016/j.bodyim.2017.04.006. [ DOI ] [ PubMed ] [ Google Scholar ] 6. Jake L, Zoe M, L T T, et al. Body appreciation and its psychological correlates: a systematic review and meta-analysis. Body Image. 2022;42287–296. 10.1016/J.BODYIM.2022.07.003. [ DOI ] [ PubMed ] 7. Lundqvist C, Kolbeinsson Ö, Asratian A, et al. Untangling the relationships between age, gender, type of sport, perfectionistic self-presentation and motivation on body satisfaction: a cross-sectional study on aesthetic and non-aesthetic female and male athletes aged 10 to 22 years. BMJ Open Sport Exerc Med. 2024;10(3):e001975. 10.1136/BMJSEM-2024-001975. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 8. S D C, J E B, Paschal S. (2015). The impact of positive affect on health cognitions and behaviours: a meta-analysis of the experimental evidence. Health Psychology Review, 2015, 9 (3): 345 – 65. 10.1080/17437199.2014.923164. [ DOI ] [ PubMed ] 9. Gardner B, Lally P, Rebar LA. Does habit weaken the relationship between intention and behaviour? Revisiting the habit-intention interaction hypothesis. Soc Personal Psychol Compass. 2020;14(8):n/a-n/a. 10.1111/spc3.12553. [ Google Scholar ] 10. Bassett-Gunter R, McEwan D, Kamarhie A. Physical activity and body image among men and boys: a meta-analysis. Body Image. 2017;22:114–28. 10.1016/j.bodyim.2017.06.007. [ DOI ] [ PubMed ] [ Google Scholar ] 11. Sabiston C, Pila E, Vani M, et al. Body image, physical activity, and sport: a scoping review. Psychol Sport Exerc. 2019;4248–57. 10.1016/j.psychsport.2018.12.010. 12. Eva P, Angela S, Andree C, et al. Body-related envy: a social comparison perspective in sport and exercise. J Sport Exerc Psychol. 2014;36(1):93–106. 10.1123/jsep.2013-0100. [ DOI ] [ PubMed ] [ Google Scholar ] 13. Ma RM. Initial revision of mbsro and the research on relativity between mbsro and personality types. Air Force Med Univ. 2006. 10.7666/d.y887040. [ Google Scholar ] 14. Pelletier L, Tuson K, Fortier M, et al. Toward a new measure of intrinsic motivation, extrinsic motivation, and amotivation in sports: the sport motivation scale (sms). J Sport Exerc Psychol. 1995;17:35–53. 10.1123/jsep.17.1.35. [ Google Scholar ] 15. Peng J. (2012). Correlations between motivational variables from self-determination theory and dispositional flow in sports. Capital Univ Phys Educ Sports. https://doi.org/CNKI:CDMD:2.1012.522411 16. Liang DQ. Stress levels among college students and their relationship with physical exercise. Chin Ment Health J. 1994;01:5–6. 10.1000/JATP.42.e012345. [ Google Scholar ] 17. Jeong-Yeon MPPBSM L, et al. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol 2003. 2003;88(5):879–903. 10.1037/0021-9010.88.5.879. [ DOI ] [ PubMed ] [ Google Scholar ] 18. Yagawara R. Facilitating patient flourishing through the application of positive psychology: cultivating motivation through self-determination theory. AJOB Neurosci. 2025;16(3):192–5. 10.1080/21507740.2025.2519447. [ DOI ] [ PubMed ] [ Google Scholar ] 19. Murray K, Dawel A, Batterham JP, et al. Cognitive reappraisal moderates the protective effect of body satisfaction on mental health and wellbeing in adults: a prospective study during COVID-19 lockdown. J Affect Disord. 2024;351:268–77. 10.1016/J.JAD.2024.01.253. [ DOI ] [ PubMed ] [ Google Scholar ] 20. More RK, Phillips AL, Colman EHM. Evaluating the potential roles of body dissatisfaction in exercise avoidance. Body Image. 2019;28:110–4. 10.1016/j.bodyim.2019.01.003. [ DOI ] [ PubMed ] [ Google Scholar ] 21. Matthew F, Stephanie D, Isabel K, et al. Motive- and appearance awareness-based explanations for body (dis)satisfaction following exercise in daily life. Br J Health Psychol. 2018;23(4):982–99. 10.1111/bjhp.12334. [ DOI ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement Our data were obtained in collaboration with a group from the Capital University of Physical Education And Sports, and our data will be followed by other analyses, which we are unable to provide for the sake of data privacy. We have put the descriptive statistics of the data and related results of the analysis are placed in the main text, if you have questions about the data we will actively cooperate, we guarantee that our data is true and reliable. Articles from BMC Public Health are provided here courtesy of BMC ACTIONS View on publisher site PDF (1.3 MB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top