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Risk for physical inactivity due to inadequate health literacy among middleaged Japanese adults: a cross-sectional study† Cover

Risk for physical inactivity due to inadequate health literacy among middleaged Japanese adults: a cross-sectional study†

By: Nao Sonoda and  Akiko Morimoto  
Open Access
|Mar 2026

Abstract

Objective

We assessed the risk for physical inactivity due to inadequate health literacy using multivariable analysis in a large middleaged population.

Methods

This cross-sectional mail survey using a self-administered questionnaire was conducted in 2020 and included 33,902 community residents aged 40–64 years from 5 cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) agreed to participate in the survey. After exclusion of those with regular visits to medical institutions and those with missing data, the analysis included 3742 participants. Health literacy was measured by the communicative and critical health literacy (CCHL) scale, and participants were classified into 3 groups (low, medium, and high health literacy groups) by the tertiles of the CCHL scale score. Physical inactivity was defined as not completing at least 150 min of moderate-intensity physical activity throughout the week.

Results

After adjustment for age, gender, education level, occupation, economic status, living alone, and stages of health behavior change, the multivariable-adjusted odds ratios (ORs) for physical inactivity were 1.36 (95% confidence interval [CI]: 1.16–1.59, P < 0.001) in the medium health literacy group and 1.70 (95% CI: 1.36–2.11, P < 0.001) in the low health literacy group compared with the high health literacy group.

Conclusions

This large-scale study provides compelling evidence that those with inadequate health literacy are at higher risk for physical inactivity among middle-aged adults.

DOI: https://doi.org/10.2478/FON-2026-0006 | Journal eISSN: 2544-8994 | Journal ISSN: 2097-5368
Language: English
Page range: 43 - 49
Submitted on: Jan 3, 2025
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Accepted on: Mar 11, 2025
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Published on: Mar 24, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Nao Sonoda, Akiko Morimoto, published by Shanxi Medical Periodical Press
This work is licensed under the Creative Commons Attribution 4.0 License.