Traditional Physical Practice Participation and Vision-Related Quality of Life in Adolescents: The Serial Mediating Roles of Exercise Self-Efficacy and Visual Function Anomalies

This study demonstrates that traditional physical practice participation significantly enhances vision-related quality of life among junior secondary school students through both direct effects and a serial mediation pathway involving increased exercise self-efficacy and reduced visual function anomalies.

The Gist

🏫 The Big Picture: Exercise, Confidence, and Eye Strain

Imagine a teenager's life as a high-stakes video game. The main character (the student) spends hours staring at a screen (or a book), trying to level up in school. But here's the problem: the screen is making their eyes feel like they've been sandblasted. They get headaches, their vision blurs, and they feel like they can't see the "game world" clearly anymore. This is what researchers call a drop in "Vision-Related Quality of Life."

This study asked a simple question: Can playing "traditional" physical games (like Tai Chi or school martial arts routines) help fix this eye trouble?

The answer is YES, but not just because they are moving their bodies. It's because of a special chain reaction that happens inside the student's brain and body.

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🧩 The Chain Reaction: How It Works

The researchers found that doing these traditional exercises doesn't just magically heal eyes. Instead, it sets off a domino effect involving three key players:

1. The Starting Block: Traditional Physical Practice 🥋

Think of this as the fuel. These are structured, calm exercises (like Tai Chi) done in school. They aren't just running laps; they require focus, breathing, and balance.

• The Result: It gets the student moving, but more importantly, it starts a psychological shift.

2. The Middleman: Exercise Self-Efficacy (The "I Can Do It" Muscle) 💪

This is the most important part. "Self-efficacy" is a fancy word for confidence.

• The Analogy: Imagine your confidence is a battery. When a student masters a difficult Tai Chi move or keeps their balance, their "confidence battery" charges up. They start thinking, "I can control my body. I can handle challenges."
• The Connection: The study found that the more students did these exercises, the more their "confidence battery" charged up.

3. The Victim: Visual Function Anomalies (The Eye Glitch) 👁️

This refers to the annoying symptoms: tired eyes, blurry text, headaches, and the feeling that your eyes are "crossing" when you read.

• The Analogy: Think of these symptoms as static on a TV screen. The more static you have, the harder it is to watch the show (read the book).
• The Connection: Here is the magic link. When a student has a full confidence battery (from step 2), they are better at managing their daily habits. They might sit up straighter, take better breaks, or just feel less stressed. This reduces the "static" on their TV screen.

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🚀 The "Serial" Magic: The Domino Effect

The study didn't just look at these steps separately; they looked at the chain. This is called a "serial mediation."

Imagine a Rube Goldberg machine:

1. Action: The student does Traditional Exercise.
2. Trigger: This builds their Confidence (Exercise Self-Efficacy).
3. Reaction: High confidence leads to better habits and less stress, which reduces Eye Strain (Visual Function Anomalies).
4. Final Outcome: With less eye strain, the student's Quality of Life goes up. They can read comfortably, play, and feel good about their vision.

The Study's Numbers:

• Direct Effect: About 68% of the benefit came directly from the exercise itself (maybe because moving around helps blood flow to the eyes).
• The Chain Effect: The other 32% came from that confidence chain we just described.
  • 15% came just from the confidence boost.
  • 11% came just from the reduction in eye strain.
  • 6% came from the full chain (Exercise → Confidence → Less Strain → Better Life).

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🎓 Why This Matters for Schools

Think of schools as factories that produce students. Currently, these factories are full of kids staring at books and phones, causing their "eye engines" to overheat.

This study suggests that schools don't need expensive new glasses or high-tech eye surgery to help. They just need to turn on the "confidence switch."

By adding simple, traditional movement routines to the school day:

1. Kids feel more capable and in control.
2. That feeling of control helps them manage their eye strain.
3. Suddenly, reading becomes easier, and life feels brighter.

🏁 The Bottom Line

You don't have to be a martial arts master to save your eyes. But, if you get kids moving in a way that makes them feel strong and capable, they will naturally take better care of their eyes, and their vision-related quality of life will improve. It's not just about the eyes; it's about the mind-body connection working together to clear up the static.

Technical Summary

1. Problem Statement

Adolescent visual health is a critical public health concern, characterized by high rates of myopia and functional visual problems (e.g., eye strain, headaches, blurred vision) driven by intensive near-work and digital exposure. While Vision-Related Quality of Life (VRQOL) captures the functional impact of these issues on daily life, the mechanisms linking lifestyle behaviors to VRQOL remain under-explored. Specifically, there is a lack of empirical evidence regarding how Traditional Physical Practices (TPP) (e.g., Tai Chi, Qigong, health-oriented martial arts) influence adolescent VRQOL. Furthermore, the psychological (exercise self-efficacy) and functional (visual function anomalies) pathways through which TPP might operate have not been examined within a unified serial mediation framework.

2. Methodology

The study employed a four-wave time-lagged longitudinal survey design to establish temporal ordering and reduce common method bias.

• Participants: A sample of 1,579 junior secondary school students (Grades 7–9) from schools implementing traditional physical practice programs. The sample was balanced by gender (50.47% male), grade level, and residence (urban/rural).
• Procedure: Data were collected at two-week intervals:
  • Wave 1: Traditional Physical Practice Participation.
  • Wave 2: Exercise Self-Efficacy.
  • Wave 3: Visual Function Anomalies.
  • Wave 4: Vision-Related Quality of Life.
• Measures:
  • TPP: Assessed via the Physical Activity Rating Scale (PARS-3).
  • Exercise Self-Efficacy: Measured using the Exercise Self-Efficacy Scale (ESES).
  • Visual Function Anomalies: Assessed via the Convergence Insufficiency Symptom Survey (CISS).
  • VRQOL: Measured using the Low Vision Quality-of-Life Questionnaire (LVQOL).
• Statistical Analysis:
  • Reliability/Validity: Confirmatory Factor Analysis (CFA) confirmed a four-factor model with excellent fit indices (CFI = 0.981, RMSEA = 0.030). Common Method Bias (CMB) was ruled out via Harman's single-factor test and Unmeasured Latent Method Construct (ULMC) modeling.
  • Mediation Testing: Structural Equation Modeling (SEM) was used to test the hypothesized paths. Indirect effects were evaluated using the bias-corrected percentile bootstrap method with 5,000 resamples.

3. Key Contributions

• Novel Framework: This is one of the first studies to integrate Traditional Physical Practices with VRQOL in adolescents, moving beyond refractive outcomes (myopia) to functional quality of life.
• Serial Mediation Model: The study proposes and validates a specific causal chain: TPP $\rightarrow$ Exercise Self-Efficacy $\rightarrow$ Visual Function Anomalies $\rightarrow$ VRQOL. This highlights a psychological-to-functional mechanism where confidence in physical activity reduces symptom burden, thereby improving quality of life.
• Methodological Rigor: The use of a four-wave time-lagged design with short intervals (2 weeks) provides stronger inferential clarity regarding temporal precedence compared to cross-sectional studies, while rigorous CMB diagnostics ensure data validity.

4. Key Results

• Direct Effect: Traditional physical practice participation had a significant positive direct effect on VRQOL ($\beta = 0.404$, $p < .001$), accounting for 68.36% of the total effect.
• Total Indirect Effect: The combined indirect pathways were significant ($\beta = 0.187$, $p < .001$), accounting for 31.64% of the total effect, indicating partial mediation.
• Specific Pathways:
  1. Via Exercise Self-Efficacy: TPP $\rightarrow$ Self-Efficacy $\rightarrow$ VRQOL ($\beta = 0.088$, 14.89% of total effect).
  2. Via Visual Function Anomalies: TPP $\rightarrow$ Visual Anomalies $\rightarrow$ VRQOL ($\beta = 0.065$, 11.00% of total effect).
  3. Serial Mediation: TPP $\rightarrow$ Self-Efficacy $\rightarrow$ Visual Anomalies $\rightarrow$ VRQOL ($\beta = 0.034$, 5.75% of total effect).
• Correlations: All hypothesized correlations were significant. TPP was positively correlated with self-efficacy and VRQOL, and negatively correlated with visual function anomalies.

5. Significance and Implications

• Theoretical: The findings support a multi-pathway model where behavioral engagement (TPP) enhances psychological resources (self-efficacy), which in turn mitigates functional symptoms (visual anomalies), ultimately improving perceived quality of life. This validates the role of self-efficacy as a bridge between physical activity and specific health outcomes.
• Practical/Intervention:
  • School Health Promotion: Traditional physical practices (e.g., morning exercises, club activities) are identified as low-cost, scalable interventions for improving adolescent visual well-being.
  • Dual-Focus Strategy: Interventions should target both psychological resources (building exercise confidence through mastery experiences) and symptom management (monitoring visual fatigue).
  • Policy: The study suggests that integrating structured mind-body exercises into school curricula can serve as a preventative strategy against the decline in vision-related quality of life associated with academic and digital demands.

Conclusion: The study concludes that traditional physical practice participation is a robust predictor of better vision-related quality of life in adolescents, operating through both direct mechanisms and a serial mediation pathway involving exercise self-efficacy and the reduction of visual function anomalies.