Skip to main content
PLOS One logoLink to PLOS One
. 2026 Jul 23;21(7):e0353105. doi: 10.1371/journal.pone.0353105

The anxious society’s fertility problem: The promoting effect of physical exercise on mental health—An empirical analysis using CGSS data

Jincao Zhai 1, Dingwu Liu 1, Mingze Gao 1, Chunli Han 2,*
Editor: Wanli Zang3
PMCID: PMC13395366  PMID: 42490655

Abstract

The declining willingness to have children is significantly influenced by underlying psychological constraints that cannot be ignored. Providing psychological health support and interventions for the reproductive-age population is crucial for enhancing fertility intentions. Based on data from the 2021 China General Social Survey, this research explores the association between the psychological benefits of physical exercise on individuals’ willingness to bear children. The results indicate a positive correlation between engagement in physical exercise and individual fertility intentions. Specifically, a one-unit higher in level of physical exercise is associated with a 0.099-unit higher level of fertility willingness. Mechanistically, participation in physical exercise is associated with psychological well-being (β = 0.0133, P < 0.001) and social engagement(β = 0.011, P < 0.001),these factors are, in turn, associated with higher fertility intentions. Heterogeneity analysis reveals that the positive association between physical exercise and fertility intentions is more pronounced among single individuals with higher educational attainment and income levels (β = 0.092, β = 0.109, β = 0.095; P < 0.001),suggesting potential implications for addressing the “fertility-income paradox.”.

1. Introduction

Low fertility rates have become a global demographic phenomenon [1].The fertility rates in the United States, Japan, South Korea, Singapore, and certain developed European nations continue to decline, reflecting a widespread issue of low fertility. In recent years, China’s total fertility rate has consistently remained below the internationally recognized threshold of 1.5, significantly below the replacement level, thereby facing the risk of falling into a “low fertility trap [2].” A declining fertility rate triggers issues of population decline and aging, impacting demographic stability and structural balance, th-ereby affecting the sustainable development of future society [3].Addressing the challenge of declining fertility rates and effectively enhancing reproductive levels to promote balanced population development has become an urgent societal issue.

Traditional economic perspectives often attribute declining fertility rates or fertility intentions to high economic costs and the lack of social support systems. However, increasing empirical evidence indicates that purely rational economic models are insufficient to fully explain the complex reproductive decision-making behaviors of individuals. Particularly, they struggle to account for the conflicting sentiments prevalent among women of reproductive age, such as the desire to have children versus the reluctance or fear of childbirth [4].This theoretical shift has prompted scholars to focus on deeper psychological motivations [5].An empirical study on depression and fertility intentions found that individuals exhibiting depressive symptoms often experience emotional distress and negative affect, with diminished perceptions of partner support and family well-being. Consequently, their reproductive intentions are 2.3% lower compared to those without depressive symptoms. This indicates a positive correlation between mental health status and fertility intentions [6].Research in the field of psychology indicates that excessive psychological stress in individuals can trigger intense self-denigration, subsequently diminishing fertility confidence. Providing timely mental health support and emotional assistance to reproductive-age populations can improve their fertility intentions [7].However, existing research predominantly focuses on how to stimulate fertility through external policy interventions such as extending parental leave and increasing childcare subsidies, while paying less attention to how improving individuals’ mental health can foster positive shifts in reproductive attitudes. This bias somewhat diminishes the efficacy of economic levers and constrains the overall effectiveness of fertility promotion policies.

Sports activities are regarded as an efficient and sustainable form of positive psychological intervention,which is associated with mental health.Empirical studies consistently demonstrate that regular physical exercise is associated with higher levels of psychological resilience,life satisfaction, and subjective well-being across multiple dimensions, including physiological regulation, emotional optimization, and behavioral adaptation, while also effectively fostering the development of a positive mindset [8].From this perspective, participatation in physical exercise may may be positively associated with fertility intentions, and may correlate with the establishment of a positive and healthy reproductive mindset.Existing research has examined the relationship between these factors, indicating that participation in sports and leisure activities can fulfill fundamental psychological needs, enhance physical health, and improve psychological well-being, thereby promoting an increase in reproductive intention [9, 10]. Although existing research has addressed the positive psychological correlates of physical exercise with respect to fertility intentions, there remains scope for further in-depth exploration. Existing studies have neither paid sufficient attention to the contextual link between social anxiety, reproductive loss tendencies and subsequent fertility avoidance, nor systematically clarified the antecedent mechanisms and internal pathways linking physical exercise to fertility intentions from a psychological perspective. Relevant theoretical relationships remain to be further explored and clarified.Based on data from the 2021 China General Social Survey (CGSS), this study conducts an in-depth analysis of the complex psychological dilemmas associated with low fertility intentions under an anxiety-inducing social environment.It aims to explore the potential correlation between positive psychological experiences derived from physical exercise and individual fertility intentions.

2. Literature review and research hypotheses

2.1. The influence of psychological factors on fertility intentions

Psychologist Daniel Kahneman highlights that individual judgment and decision-making are often embedded within complex cognitive schemas [11]. Fertility intention is a psychological representation whereby individuals evaluate their own reproductive,nurturing,and educational capacities.It is not only a product of objective conditions but also the outcome of complex psychological constructs and cognitive reconfigurations, likely influenced by individual psychological traits and tendencies [12].The TDIB reproductive sequence model developed by Miller et al. suggests that individual psychological traits are critical variables for predicting and explaining fertility intentions [13].Fertility anxiety is a specific manifestation of psychological factors influencing reproductive intentions.It refers to the emotional states or experiences,such as worry, tension, and unease that individuals of reproductive age exhibit regarding fertility decisions and related issues [14].Existing studies have fund that such negative emotions not only associated with individuals’ fertility intentions but also potentially reduce reduce them by inducing excessive perception of fertility risks and negative attentional bias, which could in turn affect subjective well-being and life satisfaction [15].

Fertility anxiety is closely linked to the prevailing anxiety traits in contemporary society. Against the backdrop of an era characterized by transition and transformation, the rapid flux of social environments, growing economic downward pressure, intensified career competition, educational involution, and climate and environmental challenges,may jointly contribute to various structural social dilemmas. These factors not only affect people’s daily behavioral choices but also deeply penetrate into individual psychology, tending to foster widespread feelings of anxiety and uncertainty. Various forms of “anxiety syndromes,” such as employment anxiety,education anxiety,and pension anxiety, have emerged accordingly [16]. Fertility anxiety arises within this context and, as its influence expands, has become a latent risk constraining societal reproductive potential and long-term balanced demographic development.Thus, at its root, low fertility intentions can be viewed as a manifestation of generalized social anxiety projected onto the domain of reproduction [17]. Relevant studies on the formation of low fertility rates also indicate that internalized social anxiety, as a subjective psychological barrier, is closely correlated with individuals’ low fertility intentions. For example, River et al. found that women under long-term economic pressure, work-family conflict and future uncertainty are more likely to suffer from anxiety, depression and other negative emotions. Such persistent emotional distress and mental fatigue tend to be correlated with low intrinsic motivation for childbearing and parenting, and may reduce their willingness to have more children [18]. Similarly, Luo Rong et,al. indicated that the extended commuting time resulting from the spatial separation of workplaces and residences in modern society exacerbates psychological stress and tension among residents, causing substantial harm to both physical and mental health. In the context of fertility, this harm manifests as increased concerns about childbearing, delayed childbirth, or fewer children [19].

Under the backdrop of social transformation, chronic anxiety and persistent tension have become prevalent in the mental and psychological states of modern society. The widespread popularity of terms such as “lying flat,” “involution,” “Buddha-like mentality,” and “beast-of-burden workers”serves as vivid manifestations ofthis phenomenon.Such widespread anxious emotions are closely associated with people’s fertility cognition and decision-making, and may lead to certain psychological predicaments.When it comes to childbearing issues, many people are liable to have worries about potential burdens, such as the economic cost of raising children, insufficient family care support and children’s educational pressure.This kind of emotional experience tends to weaken people’s fertility confidence and inner childbearing motivation, and may make people ignore the unique values of parenting such as emotional companionship and spiritual satisfaction.Individuals tend to form inner perceptions such as fear of childbearing and insufficient preparation for parenthood.They are also inclined to agree with views concerning parenting hardships, which may deepen their worries about reproduction and gradually form a self-strengthening psychological tendency.In the social media era, widespread discussions about elite parenting and parenting burnout [20] may further intensify such anxious feelings. These emotional states, combined with actual economic burdens, are closely associated with the downward trend of fertility intentions.

While socioeconomic structural issues represent the core cause of low fertility intentions, the resulting psychological challenges should not be overlooked as a contributing factor. According to the 2023 Blue Book on Mental Health in China, the risk of depression among Chinese adults stands at 10. 16%, while the risk of anxiety disorders reaches 15.8%. Among those who self-rated their mental health as “relatively poor,” the risk of depression was as high as 45. 1%, highlighting the pronounced mental health challenges faced by the population during this period of social transformation [21]. Therefore, it is essential to pay closer attention to the public’s psychological state and mental well-being, and to develop systematic intervention strategies aimed at improving mental health and enhancing psychological welfare. Such efforts are crucial for helping individuals establish a more objective and positive cognitive framework toward parenting.

2.2. Research on the relationship between physical exercise and fertility intentions

2.2.1. The association between physical exercise and fertility intentions.

The multifaceted social functions of sports have long been a focus of academic research. Situating the diverse benefits of sports within complex social contexts, relevant studies have revealed that physical exercise is associated with individuals’ subjective perceptions of themselves and the world around them. For instance, empirical evidence indicates that engagement in sports activities is associated with higher life satisfaction, a greater willingness among elderly adults to delay retirement, and lower suicidal ideation among university students [22, 23, 24]. Embodied cognition theory posits that the ways in which the body moves, along with its sensory and motor experiences, shape how we perceive and interpret the world [24]. As an activity fundamentally based on physical movement, sport encompasses diverse bodily practices that may form an embodied foundation for cognitive development, potentially influencing the formation and expansion of schemas related to perception, sensation, thought, and volition [25]. The benefits of physical exercise for psychological and mental well-being may further contribute to holistic human development. Fertility intentions, which essentially reflect the cognitive and attitudinal dispositions of individuals or couples toward childbearing within a given period, are not formed through abstract mental processes alone [26]. Rather, they may be perceived and considered through concrete, practical bodily experiences, rooted in the temporal and spatial dimensions of bodily existence [27].

Based on this reasoning, Hypothesis 1: There is a positive association between physical exercise and individuals’ fertility intentions.

2.2.2. The mediating role of mental health.

Existing research on the relationship between physical exercise and individual cognitive regulation has predominantly focused on its associated benefits in alleviating anxiety, reducing stress, and improving mental health. Representative theoretical frameworks supporting this view include the stress adaptation hypothesis, the HPA axis regulation hypothesis, and the self-efficacy hypothesis. For instance, a study by Guo Kai et al. indicated that physical exercise is associated with fewer negative perceptions of physiological aging among older adults, alongside improved mood disturbances, fewer depressive symptoms, and greater optimism and a proactive mindset, which together relate to a positive self-perception characterized as “defying aging” [28]. As one of the most cost-effective psychological interventions, physical exercise may be related to reduced generalized anxiety affecting fertility-related cognition and decision-making, potentially through lower work and life stress and better mental health, thereby showing a positive association with individual fertility intentions.

At the physiological level, regular physical exercise is associated with optimized stress-regulatory function of the HPA axis, lower excessive amygdala activation, and higher secretion of neurotransmitters such as endorphins and serotonin. These physiological correlates may relate to a higher threshold for anxiety perception, making individuals less prone to excessive panic when confronted with external stressors, which may provide a stable physiological foundation for rational fertility decisions [6]. At the psychological level, engagement in sports is associated with positive psychological traits such as self-esteem, self-confidence, and optimism, as well as enriched emotional experiences including a sense of achievement, happiness, and self-efficacy. These positive emotional states are correlated with broader cognitive scope and greater cognitive flexibility, and they may equip individuals with greater resilience and confidence when confronting uncertainties associated with future parenting [29]. At the social level, the abilities developed through sports practice,such as emotion regulation, stress modulation, and pressure release,may translate into psychological resilience when coping with social pressures. This may relate to a stronger overall sense of control over work and life, enabling individuals to adopt more adaptive cognitive regulation strategies in the face of parenting challenges [30].

Based on this rationale, Hypothesis 2: Physical exercise is positively associated with fertility intentions through its relationship with reduced anxiety, lower stress, and better mental health, suggesting that mental health may play a mediating role in this association.

2.2.3. The Mediating role of social interaction.

Existing studies have confirmed that individual fertility intentions are subject to social influence, which encompasses both behavioral and attitudinal effects from others [31]. For instance, Bernardi’s research demonstrated that social interactions across different spheres,including friends, acquaintances, colleagues, siblings, or neighbors are associated with individuals’ childbearing decisions and behaviors [32]. Social interaction provides individuals with valuable emotional support and parenting-related resources, which may serve as important buffers against fertility-related anxiety, stress, isolation, and uncertainty.

On one hand, when facing stress, effective communication and self-disclosure with relatives and friends may offer emotional support such as understanding, empathy, and comfort, which could be associated with lower psychological anxiety and stronger intrinsic motivation for childbearing [33, 34]. On the other hand, stable social interactions may also help expand individuals’ learning opportunities and resource acquisition channels, thus relating to greater problem-solving capacities, higher confidence, and a stronger sense of control in coping with parenting challenges [33]. As highlighted by Gong Xi et al., frequent interactions among social actors—based on kinship, familial ties, professional relations, and friendships—can generate social capital that provides multidimensional support, including firsthand information on childbearing, emotional comfort, and caregiving assistance, thereby showing associations with both fertility intentions and the timing of childbirth [35].

Physical exercise is widely regarded as being associated with closer interpersonal relationships, higher trust, and greater well-being, and has been described as a “bond of human communication” [36]. In analyzing the social functions of sports, Putnam argued that physical exercise is associated with a broader scope of interpersonal contact, higher social trust, and greater social capital. He further noted that social interactions initiated through sports often occur in a relatively relaxed and informal setting, where individuals tend to be more open and cheerful, making it easier to establish positive connections with others [37]. Huang Qian et al. systematically examined the welfare effects of physical exercise, pointing out that physical exercise is associated with a platform and opportunities for social interaction, broader access to informal resources such as information and support, and a better understanding of others’ choices and trade-offs, thereby relating to more informed decision-making [38].

Based on this reasoning, Hypothesis 3: Physical exercise is positively associated with fertility intentions through its association with greater interpersonal social interactions and more diverse channels for stress relief and resource acquisition.

3. Methods

3.1. Data

This study utilized data from the 2021 China General Social Survey (CGSS) to examine the relationship between physical exercise and fertility intentions. The initial CGSS sample comprised 8,148 observations. In accordance with the definition of the reproductive-age population (i.e., individuals aged 15–49 years), and given that all CGSS respondents are aged 18 years or older, we restricted the analytical sample to respondents aged 18–49 years by excluding those older than 49 years. We then sequentially excluded observations with missing values on the dependent variable, independent variable, mediating variables, and all control variables. In addition, univariate outliers falling outside the range of mean ± 3 standard deviations were removed. Following these systematic screening procedures, a final valid sample of 3,185 observations was retained for subsequent empirical analysis.

3.2. Variable definitions

3.2.1. Dependent variable.

In line with established research practices, this study employs the “ideal number of children” to measure fertility intention [26]. Specifically, the variable is operationalized using the response to survey item A37.1: “If there were no policy restrictions, how many children would you like to have?” The CGSS specially sets the presupposition of “in the absence of policy restrictions,” which to a certain extent eliminates the interference of external policy constraints and helps capture individuals’ genuine fertility preferences.

3.2.2. Independent variable.

The independent variable in this study is physical exercise. This variable is measured using the response to survey item A30.9: “How often have you participated in physical exercise in your free time over the past 12 months?” As the original coding represented a negative indicator (higher values corresponding to lower participation frequency), the responses were reversely coded as 5, 4, 3, 2, and 1 to ensure intuitive interpretation, without altering the fundamental nature or relational structure of the data.This ordinal variable is treated as a continuous variable in the main analysis, which conforms to the standard practice in quantitative social science research. This widely accepted and valid compromise facilitates the adoption of more interpretable parametric statistical models such as linear regression [39].

3.2.3. Mediating variables.

The mediating variables include mental health and social interaction.Mental health was measured using the item: “Over the past four weeks, how often have you felt depressed or downhearted?” Responses were scored such that higher values indicate better mental health status.Social interaction was operationalized based on established measurement approaches in the literature and the structure of the CGSS questionnaire. It was constructed using two items assessing the frequency of social and recreational activities with “neighbors” and with “other friends.” A composite score was generated by averaging the responses to these two items, with higher values reflecting a greater frequency of social interaction.

3.2.4. Control variables.

In addition to the above variables, fertility intentions are also affected by other confounding factors. Therefore, control variables are included in the model to improve estimation accuracy. Referring to factors proven to influence fertility intentions and physical activity in existing studies, control variables are selected from three dimensions: demographic characteristics, economic level and social security status, including gender, ethnicity, religious belief, marital status, educational attainment and social security participation. The specific definition and coding of all variables are shown in Table 1.

Table 1. Variable definition and descriptive statistical analysis.
Variable Type Variable Name Variable Definition
Dependent Variable Fertility Intention Intended number of children (0 or more)
Independent Variable physical Exercise Daily = 5, Several times a week = 4, Several times a month  = 3, Several times a year or less = 2, Never = 1
Mediating Variables Mental Health 1 = Always, 2 = Often, 3 = Sometimes, 4 = Rarely, 5 = Never




Social Interaction
Almost daily = 7, 1–2 times per week = 6, Several times per month  = 5, About once per month = 4, Several times per year = 3, Once a year or less = 2, Never = 1
Demographic Characteristics Gender Male = 1, Female = 0
Ethnicity Ethnic minority = 1, Han Chinese = 0
Religious Affiliation No religious affiliation = 1, Has religious affiliation = 0
Educational Level Primary school or below = 1, Junior high school = 2,

High school or vocational school = 3, College or above = 4
Marital Status Married (first marriage with spouse, separated but not divorced,

remarried with spouse) = 1, Single (divorced, widowed, cohabitin g, never married) = 0
Household Economic

Characteristics
Family Economic Status Far below and below average = 1, Average = 2, Above and farabove average = 3
Social Attitudes Social Security Participates in at least one social security program = 1,

No parti cipation in any social security program = 0

4. Results

Table 2 presents the descriptive statistics of all variables. The results show that the mean ideal number of children is 1.83, with a median of 2, indicating that the majority of the reproductive-age population prefers to have two children. The mean value for physical exercise is 2.98, with a median of 3, suggesting that most residents engage in physical exercise several times per month. This frequency remains somewhat below the recommended levels outlined in the Physical Activity Guidelines for Chinese Adults (2021), which advise adults to accumulate 2–5 hours of moderate-intensity aerobic activity per week and engage in muscle-strengthening activities on at least two days [40]. Additionally, the mean score for mental health is 4.28, reflecting a generally favorable mental health status among respondents. The mode for social interaction is 6, and the median is 8, indicating a relatively low frequency of interaction with relatives, friends, and neighbors. In the era of intelligent media, social behaviors are increasingly characterized by fatigue and virtualization, with social alienation becoming a more prominent phenomenon [41].

Table 2. Descriptive statistical analysis of each variable.

Variable Mean Std. Dev. Mode Median
Fertility Intention 1.83 1.09 2 2
physical exercise 2.98 1.38 4 3
Mental Health 4.28 4.65 5 4
Social Interaction 7.89 3.01 6 8
Gender 0.43 0.49 0 0
Ethnicity 0.08 0.27 0 0
Religious Affiliation 0.93 0.24 1 1
Educational Level 2.90 1.06 4 3
Marital Status 0.63 0.48 1 1
Family Economic Status 1.74 0.60 2 2
Social Security 0.97 0.17 1 1

Table 3 presents the results of the overall regression analysis.Four regression models were constructed with fertility intention as the dependent variable, physical exercise, mental health, and social interaction as independent variables, while controlling for individual characteristics, family economic status, and social factors. Model 1 serves as the baseline model. Models 2 to 4 were built upon Model 1 by sequentially adding mental health, social interaction, and physical exercise.The regression results in Table 3 indicate that the coefficients for physical exercise are consistently positive (p < 0.001), regardless of whether it is included individually or simultaneously with other variables.This demonstrates a significant positive association between physical exercise and individual fertility intentions, supporting Hypothesis H1.

Table 3. Physical activity and fertility intention baseline regression.

Variable Model 1 Model 2 Model 3 Model 4
physical exercise 0.099***

(0.01)
0.085***

(0.009)
0.086***

(0.009)
0.074***

(0.009)
Mental Health 0.218**

(0.009)
0.21***

(0.008)
Social Interaction 0.045***

(0.004)
0.038***

(0.004)
Gender 0.04

(0.027)
0.4

(0.025)
0.033

(0.026)
0.017

(0.024)
Ethnicity 0. 173***

(0.05)
0. 144**

(0.047)
0. 172***

(0.049)
0. 147**

(0.045)
Religious Affiliation −0. 172**

(0.056)
−0. 179***

(0.053)
−0. 175**

(0.055)
−0. 167**

(0.051)
Educational Level −0.087**

(0.015)
−0.066***

(0.013)
−0.089**

(0.015)
−0.083***

(0.013)
Marital Status 0.307***

(0.03)
0.249***

(0.028)
0.305***

(0.029)
0.245***

(0.027)
Family Economic

Status
0.018

(0.022)
0.023

(0.021)
0.002

(0.022)
0.002

(0.02)
Social Security −0. 12

(0.016)
−0.019

(0. 15)
−0.017

(0.015)
−0.021

(0.014)
Constant 1.763

(0.136)
1.259

(0.129)
1.506

(0.136)
0.822

(0.128)
N 3185 3185 3185 3185
R 2 0. 112 0.271 0. 142 0.174

Note: ***P < 0.01, **P < 0.05. The same notation applies throughout.

Table 4 shows the mediating effect test results of mental health and social interaction. The empirical results reveal that physical exercise is significantly positively correlated with fertility intentions (β = 0.756, p < 0.001). Mental health (β = 0.2126, p < 0.001) and social interaction (β = 0.02384, p < 0.001) are also positively associated with fertility intentions. In addition, physical exercise is positively linked to mental health (β = 0.0627, p < 0.05) and social interaction (β = 0.287, p < 0.001). In light of the above regression coefficients, it can be inferred that mental health and social interaction exhibit significant mediating associations between physical exercise and fertility intentions, which supports Hypotheses 2 and 3.

Table 4. Regression model analysis of the mediating effect of social interaction and mental health.

Variable Mental Health Social Interaction Fertility Intention
Gender 0.078

(0.51)
0.172

(0.108)
0.017

(0.024)
Ethnicity 0.2

(0.052)
0.067

(0.203)
0.134**

(0.044)
Religious Affiliation 0.034

(0.11)
0.069

(0.223)
−0.183**

(0.05)
Educational Level −0.158***

(0.027)
−0.093

(0.056)
−0.078***

(0.012)
Marital Status 0.329***

(0.057)
0.047

(0.121)
0.238***

(0.027)
Family Economic

Status
−0.01

(0.043)
0.423***

(0.091)
−0.004

(0.02)
Social Security 0.018

(0.03)
0.132

(0.063)
−0.014

(0.0139)
physical exercise 0.063**

(0.018)
0.288***

(0.039)
0.074***

(0.009)
Mental Health 0.213***

(0.008)
Social Interaction 0.038***

(0.004)
Constant 3.467 5.591 0.767
R 2 0.192 0.162 0.294
N 3185 3185 3185

Table 5 reports the mediation effect sizes and confidence intervals for mental health and social interaction.The results indicated a significant total effect of physical exercise on fertility intentions, with an effect size of 0.0984 and a confidence interval excluding zero. The direct effect of physical exercise on fertility intentions was also significant, with an effect size of 0.0741, accounting for 75.3% of the total effect. Furthermore, the total indirect effect was significant (effect size = 0.0244,CI excluding zero).Significant mediating effects were observed through two pathways: the path through mental health (physical exercise→mental health→fertility intentions) with an indirect effect of 0.0133, representing 13.5% of the total effect; and the path through social interaction (physical exercise→social interaction→fertility intentions) with an indirect effect of 0.011, accounting for 11.3% of the total effect.

Table 5. Bootstrap analysis of the significance test of the mediating effect and its effect size.

Effect Path Effect Size SE LLCL ULCL Proportion
Total Effect 0.0984 0.0096 0.0796 0.1172 100%
Direct Effect Direct Path 0.0741 0.0086 0.0571 0.091 75.3%
Total Indirect Effect 0.0244 0.0047 0.0155 0.0338 24.8%
Specific Indirect Effects Path 1 0.0133 0.0041 0.0055 0.0214 13.5%
Path 2 0.011 0.002 0.0072 0.0155 11.3%

Table 6 presents the results of the robustness checks.First, the dependent variable was replaced with the intention to have at least one child. Respondents who indicated zero as their ideal number of children were coded as “no fertility intention = 0,” while those reporting one or more children were coded as “having fertility intention = 1.” Accordingly, the regression model was changed to a binary logistic model. The results, presented in Column (1) of Table 6, show that the significance and direction of the coefficients remain largely consistent with the baseline regression, supporting the robustness of the original findings.Second, the independent variable was redefined. Respondents reporting daily, several times per week, or several times per month were recoded as “engaged in sports = 1”, while those reporting several times a year or never were coded as “not engaged in sports = 0”. As shown in Column (2) of Table 6, the correlation between physical exercise and fertility intentions remains statistically consistent, further verifying the reliability of the baseline results.

Table 6. Robustness test.

Variable Replacing Explained Variable

(1)
Replacing Explanatory Variable

(2)
Fertility Intention Fertility Intention
physical exercise 0.13***

(0.063)
0.176***

(0.025)
Mental Health 0.051***

(0.003)
0.215***

(0.008)
Social Interaction 0.007**

(0.001)
0.039***

(0.004)
Control Variables Controlled Controlled
N 3185 3185
R2 0.173 0.286

To further examine the differential effects of physical exercise on fertility intentions across population subgroups, this study conducted grouped regression analyses. As the original dataset contained multiple categories for educational level and family economic status—which are less suitable for grouped regression—these variables were recoded into binary dummy variables. Educational level was categorized as low (secondary education or below =0) and high (college or above =1). Similarly, family economic status was divided into two groups: average or below (=0) and above average (=1). All other variables remained unchanged in specification.

Table 7 presents the results of the heterogeneity analysis.The results reveal significant heterogeneity in the correlation between physical exercise and fertility intentions across family economic status, educational level, and marital status.Specifically, in terms of educational heterogeneity, the correlation magnitude of physical exercise exhibits a clear educational gradient. The coefficient in the high-education group (0.092) is significantly larger than that in the low-education group (0.056), indicating that the positive association between physical exercise and fertility intentions tends to be stronger among people with higher educational attainment.Regarding economic heterogeneity,the regression coefficient increases progressively from 0.069 in the low-income group to 0.109 in the high-income group (p < 0.01), suggesting that this positive correlational trend is more evident among groups with better economic conditions.Such group differences may be associated with varied access to sports resources and different exercise participation frequency across economic groups.Concerning marital status heterogeneity, the correlation strength between physical exercise and fertility intentions varies significantly between married and unmarried individuals.Overall, this linkage appears relatively more evident among unmarried respondents.

Table 7. Comparison of differences in education, economics and. marital status between physical exercise.

Variable (1)

Low Education
(2)

High Education
(3)

Average or Below
(4)

Above Average
(5)

Married
(6)

Unmarried
physical exercise 0.056***

(0.011)
0.092***

(0.016)
0.069***

(0.009)
0. 109***

(0.029)
0.06***

(0.01)
0.095***

(0.017)
Control Variables Controlled Controlled Controlled Controlled Controlled Controlled
N 1895 1290 2855 275 1996 1134
R 2 0.245 0.303 0.29 0.337 0.215 0.305

5. Discussion

Research findings indicate a significant positive correlation between physical exercise and individual fertility intentions, a conclusion that aligns with existing study results.Shus as,Zhang Haifeng from the perspective of the intrinsic value of outdoor leisure activities, argue that such activities can promote individuals’ physiological, psychological, and social relationships, as well as their interaction with the environment, which may in turn foster a positive mental state and be associated with residents’ willingness to have additional children [10]. Based on the Second Demographic Transition theory and leisure theory, Deng Weiquan posit that physical exercise fulfills self-oriented needs. When individuals actively engage in sports and achieve need satisfaction, they are more likely to perceive their current environment as suitable for childbearing,which could be related to stronger fertility intentions [9]. Previous studies suggest that sports involvement not only satisfies self-oriented needs but also improves marital and family relationships, creating a psychological and familial environment conducive to childbearing decisions, thereby enhancing individual fertility intentions [42]. Against this backdrop, in situations where external conditions for childbearing are difficult to improve fundamentally in the short term, physical exercise may be seen as a potential psychological empowerment factor that is correlated with “intentional childbearing” and may be associated with internal support for positive fertility decisions.

Although the findings of this study are generally consistent with existing conclusions, the initial linear regression results indicated a weak correlation between the two (r =0.099). Possible reasons for this outcome include:

  • (1) Observation suggests that most respondents in this sample take physical exercise only several times a month or several times a year, reflecting an overall low level of exercise frequency. At such low participation levels, the psychological benefits brought by physical activity may fail to be fully manifested, which could be one factor associated with the weak linkage with fertility intentions. In line with the dose-response relationship of exercise, it is speculated that only sustained and regular physical exercise might help accumulate psychological benefits to a certain level, which is likely to be linked to a more obvious tendency in fertility willingness [42].

  • (2) Through an in-depth exploration of the “sports and fertility” nexus, we have identified a potential non-linear relationship between physical exercise and fertility intentions. According to the crowding-out effect theory, engagement in sports requires investments of time and financial resources, which may be indirectly associated with a reduction in the temporal and economic resources available for childbearing and childrearing.This resource shift could be related to relatively lower fertility intentions [43]. But from the perspective of Maslow’s hierarchy of needs, sports participation, as a higher-level need, might serve as an indicator that individuals have already established a certain temporal or material foundation.Simultaneously, considering the functional aspects of sports, regular physical exercise helps alleviate stress, improve emotional states, and enhance self-efficacy, thereby exerting positive influences on individual fertility intentions to some extent. Consequently, the linear model employed in the study may have failed to capture the nonlinear trajectory between physical exercise and fertility intentions, resulting in the observed weak correlation.

  • (3) Furthermore, random measurement errors inherent in the data collection process, along with the potential influence of other confounding variables, may have collectively contributed to the observed phenomenon.

Physical exercise may be associated with individuals’ fertility intentions, and this association could be partly related to psychological well-being. Social psychology research suggests that the decision to bear children may be partially linked to the possession of greater psychological capital and more resilient psychological traits at both mental and social levels [13]. Individuals with abundant psychological resources possess broader cognitive scope, typically maintaining more positive perceptions of their parenting capabilities while experiencing deeper fulfillment throughout childbearing and childrearing processes. As a component of healthy living, physical exercise is known to be beneficial for maintaining and enhancing physical health. Similarly, its observed associations with anxiety alleviation, stress reduction, and the cultivation of positive psychological attributes may also be relevant to fertility intentions. Through consistent physical exercise, individuals may effectively release occupational and daily pressures and alleviate accumulated psychological burdens, while potentially developing resilient qualities such as self-confidence, optimism, and psychological resilience. These psychological characteristics may correlate with stronger confidence in managing parenting challenges, and could be related to more positive expectations toward future childrearing experiences, which might in turn show associations with fertility intentions.

Physical exercise directly and indirectly enhances individuals’ fertility intentions through the facilitation of social interactions.Existing studies indicate that both offline face-to-face interaction and online virtual social engagement could to some extent correlate with individuals’ childbearing willingness [44]. However, as indicated by earlier analysis, current interactions with relatives and friends mostly occur only several times a year, reflecting clearly insufficient depth and quality of social engagement.In the digital era,public social behavior is characterized by fast-food-style,lightweight,and fragmented interactions [41]. While such shallow social interactions help maintain personal boundaries, they may widen interpersonal gaps, weaken mutual trust, and make it difficult for people to obtain emotional comfort and practical support related to childbearing through daily social contacts. As a spontaneous platform for offline socialization, physical exercise can partly offset the deficiencies of prevailing superficial social modes. When taking part in sports activities together, individuals get chances to interact with diverse groups, perceive others’ perceptions and practical choices regarding childbearing and parenting, and thereby develop diversified understandings of fertility behaviors. Additionally, the relaxed atmosphere of sports activities encourages casual discussions on parenting issues, making it easier for people to gain emotional resonance and practical life experience. Previous research has noted that the pleasant environment of sports activities is conducive to people expanding their social circles and establishing steady interpersonal bonds [45]. Furthermore,the positive interactive experiences and unintentional resource accumulation built through sports activities enhance individuals’ sense of trust and satisfaction with society and their own living environment thereby reducing anxiety and unease caused by environmental uncertainties and infusing more confidence into fertility decisions [28]. The relaxed communicative atmosphere and informal social bonds formed by physical exercise may be linked to individuals’ sense of acceptance and belonging in daily life, which is in turn correlated with lower psychological pressure arising from environmental uncertainty. Such states may further connect with a more rational and calm mindset when making fertility-related decisions, and present a certain positive correlation with increased fertility intentions.

The association between physical exercise and fertility intentions is more pronounced among highly educated, high-income, and unmarried individuals. Conventional studies often suggest a negative relationship between socioeconomic development and fertility intentions—for instance, higher education and income levels typically predict lower fertility intentions, a contradiction known as the “income-fertility paradox” [46]. However,our findings indicate that physical exercise is more strongly associated with fertility intentions specifically within this demographic, suggesting that physical exercise may help mitigate this paradoxical phenomenon.Highly educated, high-income unmarried individuals often face multiple stressors. These stressors are not limited to basic material and security needs but may also extend to societal expectations, work-life balance pressures, and aspirations for self-actualization. The accumulation of such stressors is closely linked to internal conflict and persistent psychological exhaustion among this group. For this demographic, enhancing fertility intentions may depend less on financial subsidies and more on supportive, healthy lifestyle interventions. Physical exercise can be regarded as an effective means of alleviating stress and promoting physical and mental well-being. Through regular exercise, this population may be able to release accumulated work and life pressures, reduce feelings of social isolation, loneliness, and anxiety associated with sedentary, office-centered routines, and gain a sense of achievement, self-efficacy, and happiness. Meanwhile, these positive psychological enhancements may contribute to an improved sense of control over and satisfaction with life, which might, in turn, enable them to approach childbearing from a more rational and forward-looking perspective.

6. Recommendations、limitations and future directions

6.1. Recommendations

This study indicates that while socioeconomic factors are widely regarded as primary constraints on fertility intentions, a deeper examination of the decision-making logic behind childbearing suggests that psychological barriers, such as anxiety and a diminished sense of meaning, may also represent significant, yet often overlooked, factors associated with low fertility rates. Therefore,enhancing fertility levels may require not only economic and institutional support,but also responsive interventions that address the psychological and emotional needs of reproductive-age individuals in an increasingly uncertain social environment.As an potential psychological intervention,physical exercise may be linked to the systematic renewal of psychological energy and may help individuals accumulate the psychological capital that could be relevant to childbearing decisions.It may therefore be worthwhile to recognize the health benefits derived from sports engagement and to consider integrating them into public health service frameworks. Establishing a well-developed system for promoting sports participation might be associated with positive psychological readiness and intrinsic motivation for childbearing, which could, in turn, relate to long-term balanced population development. Based on the findings, the following recommendations are proposed:

  • (1)Expand the provision of public fitness services to ensure broader access to the benefits of sports development. This includes continuing to develop sports parks, community sports venues, outdoor fitness trails, and other infrastructure. Emphasis should also be placed on upgrading these spaces with intelligent, diverse, and user-friendly features—such as installing smart fitness equipment and parent-child activity zones—to significantly enhance the accessibility and convenience of physical exercise and enable more people to enjoy the physical and mental health benefits of regular exercise.

  • (2)Incorporate sports activity as a complementary approach within supportive fertility services. At the community level, full-cycle health promotion courses should be offered, with tailored exercise programs designed for the pre-pregnancy, pregnancy, and postpartum stages. Through scientifically guided physical activity management, these programs can help prevent and alleviate common psychological issues such as prenatal anxiety and postpartum depression, thus enhancing improving psychological resilience throughout the childbearing process.

  • (3)Develop a national workplace sports strategy to address mental health challenges among employees.The psychological pressures observed among highly educated, high-income, unmarried individuals reflect broader mental health issues within the working population. To this end, a scientifically informed workplace sports development strategy should be established, positioning physical activity as a cornerstone of healthy living for employees. Policy measures may include supporting public and private organizations in outsourcing sports services, establishing employee sports clubs, purchasing fitness equipment, and organizing diverse sports events to reduce barriers to participation. Additionally, providing fitness subsidies or vouchers targeted at employees can lower the financial cost of sports engagement, stimulate interest and enthusiasm for exercise, and help encourage proactive health management and holistic well-being.

6.2. Limitations and future directions

Despite the valuable findings, several limitations warrant consideration. The cross-sectional design restricts definitive conclusions regarding causal relationships among variables. Longitudinal studies are required to explore the sustained impact of physical exercise on fertility intentions.The indicator of ideal number of children adopted in this study cannot fully reflect the intensity of fertility intentions. Future studies can adopt multi-dimensional indicators including desired number of children and fertility preference to achieve more accurate effect evaluation. This study does not distinguish the differential effects caused by different participation levels, exercise types and exercise environments. Future studies can conduct more in-depth microscopic analyses to achieve a more comprehensive and objective effect evaluation. In addition, the measurement dimensions of mental health are relatively single, and multi-dimensional measurement tools can be adopted in future research to more comprehensively assess individual mental health status.

Data Availability

The data is available at China General Social Survey, 2021 CGSS: http://cgss.ruc.edu.cn/.

Funding Statement

The author(s) received no specific funding for this work.

References

Decision Letter 0

Wanli Zang

11 May 2026

-->PONE-D-25-64152-->-->The Anxious Society's Fertility ProblemThe Promoting Effect of Physical Exercise on Mental Health—An Empirical Analysis Using CGSS Data-->-->PLOS One

Dear Dr. Han,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jun 25 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:-->

  • A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only  the individual author can complete the verification step; PLOS staff cannot  verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Wanli Zang, Ph.D.

Guest Editor

PLOS One

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager.

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: No

Reviewer #2: Yes

**********

-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

**********

-->3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

Reviewer #2: Yes

**********

-->4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

**********

-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: This study addresses a timely and socially relevant question: the potential association between physical exercise and fertility intentions among Chinese adults. The use of a large population-based dataset is an important strength, as is the inclusion of mental health and social interaction as potential explanatory mechanisms.

However, there are several important methodological limitations that should be addressed before the manuscript can be considered for publication.

First, the study uses a cross-sectional design, which prevents any causal inference. In several sections, the authors suggest that physical exercise increases fertility intentions, improves mental health, or reduces fertility-related anxiety. However, with cross-sectional data, only associations can be identified. Therefore, the authors should replace causal language with more cautious terms such as “is associated with” or “may be associated with.”

Second, the dependent variable used (“ideal number of children”) may not adequately represent actual fertility intentions. This measure may reflect normative or cultural preferences rather than concrete reproductive plans.

Third, the measurement of physical exercise is limited to participation frequency, without information on intensity, duration, modality, or weekly volume. Similarly, mental health was assessed using only a single question related to feelings of sadness or depression, which may not adequately capture the complexity of this construct.

In addition, several potentially important confounding variables appear to be missing from the models, including current number of children, health status, employment conditions, urban versus rural residence, and working hours. The omission of these variables may introduce residual confounding.

The mediation analyses should also be interpreted cautiously because all variables were measured at the same time. Therefore, the temporal order necessary to support mediation cannot be established.

Finally, the manuscript contains problems related to language, repetition, and English fluency. Professional language editing is strongly recommended to improve clarity, conciseness, and coherence.

Overall, the study has merit and potential, but it requires substantial revision to better align the interpretation of the findings with the limitations of the design and data.

Reviewer #2: Dear Authors,Thank you for the opportunity to review your manuscript titled: *The Anxious Society's Fertility Problem: The Promoting Effect of Physical Exercise on Mental Health—An Empirical Analysis Using CGSS Data*. This study attempts to introduce “physical exercise participation” as a health behavior into the explanatory framework of the psychological mechanisms underlying low fertility intentions, thereby addressing the limitations of previous studies that have focused solely on economic and policy perspectives. The topic has significant practical relevance and demonstrates theoretical innovation. The data are reliable and the methodology is generally sound. However, in its current version, the manuscript has several issues related to theoretical development, data transparency, presentation of results, and language expression.Theoretical Development and Mechanism Elaboration1. This study uses physical exercise participation as an explanatory variable to explore its effect on fertility intentions, but there are issues concerning logic and causal identification. Physical exercise participation represents a healthy lifestyle. It may be that a healthy lifestyle (characterized by positivity, optimism, and regularity) enhances fertility intentions, rather than physical exercise participation directly promoting fertility intentions. It is recommended that the authors more objectively explain the role of physical exercise participation in the theoretical development section, positioning it as a “supportive” or “psychological buffering” factor.2. The articulation of how the proposed mechanisms—mental health and social interaction—specifically alleviate “fertility loss anxiety” remains relatively abstract. The specific psychological pathways from “physical exercise participation → mental health → fertility intentions” and “physical exercise participation → social interaction → fertility intentions” need further refinement.Data Transparency1. The authors report substantial sample loss (from 8,148 to 3,085), but state only that cases with missing data were deleted, without providing specific deletion criteria. This lack of transparency regarding data processing undermines the validity of the sample.2. The variable for physical exercise participation is ordinal but is treated as continuous in the analysis without justification. The authors should provide supplementary explanation for this treatment.Presentation of Results1. Please check the standard deviations and means of the variables in Table 2 and keep a consistent number of decimal places (e.g., two) to facilitate readability.

2

**********

-->6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #1: No

Reviewer #2: Yes: zhouxiao

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

--> -->

Attachment

Submitted filename: Additional reviewer comments.docx

pone.0353105.s001.docx (12.8KB, docx)
PLoS One. 2026 Jul 23;21(7):e0353105. doi: 10.1371/journal.pone.0353105.r002

Author response to Decision Letter 1


25 May 2026

Dear Reviewers

Thank you very much for your thorough review and for pointing out the shortcomings in our work. Your comments have been incredibly helpful and have played a key role in improving the quality of our manuscript. We have carefully considered all of your suggestions and have revised the manuscript accordingly. To facilitate your review, all changes in the revised manuscript have been marked in red. Below are our responses to each of your comments.

Reviewer1

�1�The study adopts a cross-sectional design and uses more prudent terms to avoid any causal inference.

Based on your comments, we recognize that some statements in the original manuscript implied causal inferences, which cannot be validated by a cross-sectional study. Accordingly, we have revised the abstract, introduction, literature review (hypothesis formulation) and discussion sections, and adopted more prudent wording to interpret the research findings objectively and accurately.

Specifically, causal-oriented terms such as influence, impact, effect have been replaced with neutral and weakly inferential expressions including correlation, association, magnitude and correlation strength. The phrase be attributed to is revised to may be closely related to.In terms of sentence expression, "Physical exercise can significantly boost individual fertility willingness" is revised to "Physical exercise is positively correlated with individual fertility willingness". "Physical exercise can effectively promote social interaction and improve mental health" is adjusted to "The study shows that physical exercise is closely linked with positive social interaction and sound mental state".In addition, we have added relevant content to research limitations, stating that causal relationships cannot be confirmed by cross-sectional design, and future studies can adopt longitudinal or experimental designs for further analysis, ensuring the scientificity and rigor of the research. All specific revisions are highlighted in red in the paper for your reference.

�2�The ideal number of children may not adequately reflect actual fertility intentions.

Thank you for pointing out this key methodological issue. We fully agree that the "ideal number of children," as a measure of fertility intentions, has certain limitations. We have acknowledged and explicitly discussed this limitation in Section 6.2 "Limitations and future directions," noting that "future research could adopt multidimensional measures of fertility intentions to improve construct validity." We would like to explain that this indicator was selected based on data availability and common academic practices. In existing literature, especially studies using data from the Chinese General Social Survey, ideal number of children is one of the most widely adopted indicators to measure fertility intention (doi:10.3390/ijerph18094784).

Besides, robustness tests have been conducted in this study. The results presented in Table 6 verify the consistency of the core correlation that physical exercise is positively associated with ideal number of children, which mitigates potential bias caused by the single measurement indicator. All supplementary contents are marked in red for your review.

�3�The measurement indicators for physical exercise and mental health were single dimensional and failed to reflect the complexity of the constructs.

We fully agree with your comment that a single indicator cannot reflect multi-dimensional complex concepts. We have comprehensively discussed and explicitly acknowledged the limitations of the measurement tools for physical exercise and mental health in Section 6.2 Limitations and Future Directions. We also noted that future research should adopt multi-dimensional measurement instruments to more comprehensively assess their correlation.

Similar to the selection of the ideal number of children indicator, the indicators for physical exercise and mental health were chosen based on data availability and prevailing research conventions. Though the current measurements fail to cover all connotations, they fit the research design requirements, ensure data comparability with similar studies, and the analytical results are of valid reference value.

�4�Explanation of confounding variables

Thank you for pointing out this important issue. We fully agree that unmeasured confounders such as current number of children, health status, and employment conditions may indeed act as confounding factors influencing the association between physical exercise and the primary outcome variable. In response, we would like to provide the following explanation:In the 2021 Chinese General Social Survey (CGSS) questionnaire, information on current number of children, employment conditions, and urban/rural residence was not collected. Additionally, the measurement scale for working hours was inconsistent with the measurement of our core variables, making it impossible to include these factors in the analysis.The control variables included in this study were selected based on established studies in the literature that have examined factors influencing fertility intentions and physical exercise. These variables were determined across three dimensions—demographic characteristics, economic status, and social security—to cover the main pathways of potential confounding as comprehensively as possible, thereby reducing the risk of bias due to omitted variables.To highlight the adequacy and rationality of the selected control variables, we have revised the discussion in the control variables section to explicitly state that our selection followed multiple mature studies in the field, demonstrating the systematic and standardized nature of the selection process. The specific revisions are as follows:In addition to the above variables, fertility intentions are also affected by other confounding factors. Therefore, control variables are included in the model to improve estimation accuracy. Referring to factors proven to influence fertility intentions and physical activity in existing studies, control variables are selected from three dimensions: demographic characteristics, economic level and social security status, including gender, ethnicity, religious belief, marital status, educational attainment and social security participation. The specific definition and coding of all variables are shown in Table 1.

�5�Cautious interpretation of the mediation analysis

We fully agree with the valuable suggestion made by the reviewer. All variables in this study were measured cross-sectionally at a single time point, which makes it impossible to establish the temporal order necessary for determining mediation effects. Accordingly, we have revised the manuscript accordingly. We have removed language that implied overly strong causal inferences and have adopted more rigorous wording when interpreting the results of the mediation analysis. The interpretation now focuses primarily on the indirect associations revealed by the study, without drawing definitive causal mediation conclusions, and only objectively describes the associative relationships among the variables.Given the extent of the revisions, it is not feasible to present them all here. All changes have been highlighted in red in the manuscript for your convenience.

Reviewer2

�1�Objectively explain that physical exercise is an auxiliary rather than a determining factor

Thank you for your highly constructive comments. We fully agree with your assessment. This study used physical exercise as an explanatory variable to explore its association with fertility intentions, and we acknowledge that there are indeed limitations in terms of causal identification and logical interpretation. We recognize that physical exercise is essentially an external behavioral manifestation of a healthy lifestyle. Rather than physical exercise itself directly determining fertility choices, it is the underlying healthy lifestyle—characterized by an optimistic outlook and regular daily routines—that serves as the core internal factor driving fertility intentions.In response to your suggestions, we have thoroughly revised the theoretical framework of the manuscript, including the Introduction, Literature Review (hypothesis development), Results interpretation, and Discussion sections. We have toned down the wording that implies a determining role of physical exercise and have redefined it as an auxiliary influencing factor and a psychological buffer. The revised text focuses on elucidating its indirect pathways in shaping fertility intentions—such as alleviating psychological stress, improving physical and mental states, and enhancing personal cognitive attitudes—while objectively describing the associative relationships between variables. We have carefully distinguished between behavioral manifestations and underlying internal mechanisms, thereby avoiding absolute causal inferences.

All specific revisions have been highlighted in red in the manuscript for your ease of review.

�2�Further refinement of the two pathways

Thank you for your insightful and constructive comments. We agree with the reviewer that the original description of the pathways was somewhat general and failed to elaborate on the chained mediating psychological transmission process. We have now thoroughly revised the relevant content and refined the internal logic of the two core pathways.

First pathway: Physical exercise may alleviate long‑term work and life stress, regulate negative emotions, reduce fertility‑related loss anxiety, and improve an individual's psychological state, thereby subtly influencing fertility intentions.

Second pathway: Physical exercise creates relaxed offline social interaction opportunities, helping individuals expand social connections, gain more emotional and informational support, alleviate concerns about the uncertainties of childbearing, and thus indirectly influence fertility decisions.

The manuscript now step by step clarifies the progressive psychological mechanisms of "physical exercise → mental health → fertility intentions" and "physical exercise → social interaction → fertility intentions." We have supplemented the logical connections within each step to make the transmission process clear and specific, while maintaining objective wording and avoiding any absolute causal claims.All specific revisions have been highlighted in red in the manuscript for your ease of review.

�3�Transparency of the sample selection process

To enhance the methodological rigor and transparency, we have rephrased the data processing procedure. Specifically, we have provided a detailed, step-by-step description of the complete sample selection process and the specific exclusion criteria. This includes clearly specifying the age range restrictions, the rules for excluding cases with missing values on each variable, and the criterion for identifying outliers (values beyond ±3 standard deviations). The complete data processing flow is now fully presented, which effectively improves the transparency of the data processing and ensures the rationality and validity of the final analytical sample. The specific revisions are as follows:This study employed data from the 2021 China General Social Survey (CGSS), consisting of 8,148 original observations. In line with the definition of the reproductive-age population, namely the age range of 15 to 49 years, and given that all respondents in the CGSS are aged 18 years and above, individuals older than 49 years were excluded, and the sample was restricted to respondents aged 18 to 49 years. Afterwards, observations with missing values in dependent variables, independent variables, mediating variables and all control variables were excluded stepwise. Furthermore, univariate outliers lying outside the range of mean ±3 standard deviations were eliminated. Following the above systematic screening procedures, a final valid sample of 3,185 observations was retained for subsequent empirical analysis.

�4�Ordinal variables were treated as continuous variables

Thank you for pointing out this issue. In this study, physical exercise is an ordinal categorical variable, and it was treated as a continuous variable in the analysis. The rationale for this approach is as follows: the variable's categories are ordered with an increasing gradient, and the differences between adjacent levels are relatively uniform, which aligns with the common academic practice of approximating ordinal variables as continuous. Moreover, previous studies on similar topics have generally adopted this approach, as it facilitates a straightforward exploration of linear associations among variables.Following your suggestion, we have added a justification for this analytical approach along with supporting references in the manuscript. The specific additions are as follows:This ordinal variable is treated as a continuous variable in the main analysis, which conforms to the standard practice in quantitative social science research. This widely accepted and valid compromise facilitates the adoption of more interpretable parametric statistical models such as linear regression�Frankfort-Nachmias et al., 2020�.

�5�Results presentation

Thank you for pointing out this issue. Following your suggestion, we have standardized the presentation of means and standard deviations for all variables in Table 2, uniformly rounding all values to two decimal places. The table has been reformatted to facilitate easy reading and comparison. In addition, we have thoroughly reviewed the data format of all other tables throughout the manuscript and simultaneously calibrated the corresponding result descriptions to ensure consistent standards of data presentation across the entire paper.

The above are the corresponding revisions made in response to the expert's suggestions. If any of the revisions are inappropriate, or if there are other aspects that require further modification, we sincerely welcome your further comments. It is our great honor to communicate with you. Once again, thank you for your time and valuable suggestions. We look forward to hearing from you.

Sincerely,

The author of PONE-D-25-64152

Attachment

Submitted filename: 1Response to Reviewers.docx

pone.0353105.s003.docx (18.5KB, docx)

Decision Letter 1

Wanli Zang

19 Jun 2026

The Anxious Society's Fertility ProblemThe Promoting Effect of Physical Exercise on Mental Health—An Empirical Analysis Using CGSS Data

PONE-D-25-64152R1

Dear Dr. Han,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Wanli Zang, Ph.D.

Guest Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

Reviewer #2: Yes

**********

-->3. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

**********

-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

Reviewer #2: Yes

**********

-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

**********

-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: Thank you to the authors for the careful revision of the manuscript.

The authors have adequately addressed the major concerns raised during the previous round of review. In particular, the interpretation of the findings has been substantially improved through the replacement of causal language with associative language, which is more appropriate for a cross-sectional study design.

The methodological procedures are now described more clearly, including sample selection criteria, variable definitions, robustness analyses, and study limitations. The authors have also explicitly acknowledged the limitations inherent to the cross-sectional design and have appropriately discussed the implications of their findings.

The statistical analyses are appropriate for the stated objectives, and the conclusions are generally supported by the data presented. Ethical considerations and data availability have also been adequately addressed.

Although some minor language and stylistic issues remain, they do not affect the overall clarity of the manuscript or the validity of the scientific findings.

Overall, I believe that the manuscript meets the standards of methodological rigor, transparency, and scientific soundness required by PLOS ONE and is suitable for publication.

Reviewer #2: (No Response)

**********

-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #1: Yes: Carla Christina Ade Caldas

Reviewer #2: No

**********

Acceptance letter

Wanli Zang

PONE-D-25-64152R1

PLOS One

Dear Dr. Han,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Wanli Zang

Guest Editor

PLOS One

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    Attachment

    Submitted filename: Additional reviewer comments.docx

    pone.0353105.s001.docx (12.8KB, docx)
    Attachment

    Submitted filename: 1Response to Reviewers.docx

    pone.0353105.s003.docx (18.5KB, docx)

    Data Availability Statement

    The data is available at China General Social Survey, 2021 CGSS: http://cgss.ruc.edu.cn/.


    Articles from PLOS One are provided here courtesy of PLOS

    RESOURCES