Chronic Illness and the Structural Integration of Physical Literacy, Physical Activity, and Body Composition in Older Women

Chronic non-communicable diseases are highly prevalent in older women and are associated with unfavorable changes in body composition (BC). Physical literacy (PL) and physical activity (PA) are key determinants of healthy aging but it remains unclear whether chronic illness modifies not only their levels but also the structural relationships among PL, PA, and BC. This study aimed to examine differences in PL, PA, and BC between older women with- and without-chronic-illness and to compare the structural organization of associations among these variables in two observed groups. The sample included 60 women aged 66.1±9.6 years, categorized in two groups, those with- (n=36) and without-chronic-illness (n=24). PL, and PA were assessed using the validated questionnaires (Perceived Physical Literacy Questionnaire for South Eastern Europe, and Nordic Physical Activity Questionnaire – short version), and BC via bioelectrical impedance analysis. Between-group differences were examined using Welch’s t-tests with Cohen’s d effect size (ES). Pearson correlations were calculated separately by group, and Fisher’s z-tests with FDR correction were applied (91 comparisons). Correlation networks (|r|≥0.25) were constructed to assess cross-domain integration. Women with chronic illness demonstrated lower PL-competence (moderate ES) and higher PL-confidence and PL-knowledge, as well as higher moderate-to-vigorous PA (all moderate ES). No significant differences were observed in BMI, fat mass, skeletal muscle mass, or visceral fat. Prior to correction, PA showed stronger negative associations with fat mass (r=−0.54 vs. 0.11) and visceral fat (r=−0.55 vs. 0.04) in women without-, compared to women with-chronic-illness. Network analysis indicated reduced cross-domain integration between PA and BC in the chronic-illness group. Chronic illness in older women appears to modify the structural relationships among PL, PA, and BC rather than uniformly reducing their levels. The attenuated coupling between PA and BC suggests partial behavioral–physiological decoupling in the presence of chronic disease.