Unveiling the chain mediation model of sleep quality and fatigue in linking subjective exercise experience to depression in adolescent

Xiaoyu Li; Qian Yang; Ziyang Qi; Changhao Ma; Shenghua Qi; Wenliang Ji

doi:10.1371/journal.pone.0333460

Peer Review History

Original SubmissionSeptember 19, 2025
21 Jan 2026 Decision Letter - Tanja Grubić Kezele, Editor Dear Dr. Ji, 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 Mar 07 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.. 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. 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The reviewers' comments can be found below. [Note: HTML markup is below. Please do not edit.] Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: 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 ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: The primary theoretical contribution of this study lies in proposing and validating a dual-mediation pathway model demonstrating how subjective movement experiences influence depressive symptoms in adolescents. The findings hold significant practical implications for the prevention and intervention of adolescent depression. However, the study has significant limitations: its cross-sectional design prevents establishing causal relationships or temporal sequences between variables. While the research identified an association between subjective exercise experiences and depressive symptoms, it cannot determine whether subjective exercise experiences influence depressive symptoms, depressive symptoms affect subjective exercise experiences, or if a bidirectional relationship exists. Second, the sample comprised 538 Chinese high school students, yet the study did not specify the sampling method or sampling frame, making it impossible to assess the representativeness of the sample. Additionally, cultural backgrounds, educational systems, and lifestyles among Chinese adolescents may differ from those in other countries, potentially limiting the generalizability of the findings. Third, the use of self-administered questionnaires for assessment may introduce social desirability bias and recall bias. Particularly when assessing subjective exercise experiences, individual cognitive biases may compromise reporting accuracy. Finally, while the study proposes a dual-mediation pathway model, other crucial mediating variables—such as self-efficacy, social support, and coping strategies—may have been omitted. Furthermore, potential interactions and moderating effects among variables remain under-explored in this complex relationship. Based on this, it is recommended that corresponding modifications be made! ****** what does this mean? ). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our Privacy Policy .--> Reviewer #1: Yes: Hong Wang.Hong Wang. ******** [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. https://doi.org/10.1371/journal.pone.0333460.r001
Revision 1
2 Feb 2026 Author Response 1.The study has significant limitations: its cross-sectional design prevents establishing causal relationships or temporal sequences between variables. While the research identified an association between subjective exercise experiences and depressive symptoms, it cannot determine whether subjective exercise experiences influence depressive symptoms, depressive symptoms affect subjective exercise experiences, or if a bidirectional relationship exists. Response: Thank you for your important suggestions. We fully agree with your opinion and have supplemented and revised the content of the manuscript according to your suggestions. Firstly, since the present study adopted a cross-sectional design, it can only identify the associations among subjective exercise experience, sleep quality, fatigue, and depressive symptoms based on the observed data. Although the proposed chain mediation model revealed significant relationships among these variables, causal inference and temporal ordering cannot be definitively established. Secondly, through correlation analysis and structural equation modeling, significant direct and indirect paths were observed between subjective exercise experience and depressive symptoms via sleep quality and fatigue. The results showed that adolescents with more positive subjective exercise experiences tended to report better sleep quality, lower levels of fatigue, and fewer depressive symptoms. These findings indicate a consistent and theoretically meaningful pattern of associations, suggesting that subjective exercise experience is closely related to adolescents’ emotional health. Finally, the identified chain mediation pathway—subjective exercise experience → sleep quality→fatigue→depressive symptoms—aligns well with existing theoretical frameworks and empirical evidence in the literature. From the perspective of the research theme, these findings suggest that interventions emphasizing positive exercise experiences, particularly those that contribute to improvements in sleep quality and reductions in fatigue, may have the potential to alleviate depressive symptoms among adolescents. Nevertheless, we acknowledge that longitudinal or experimental studies are required in future research to further verify the causal direction and stability of these relationships. We have added a dedicated section on Limitations and Future Directions at the end of the conclusion. In this section, we explicitly note that the cross-sectional design prevents us from establishing causal relationships and acknowledge the potential reverse effects of depressive symptoms on subjective exercise experience and sleep quality. We also suggest that future studies employ longitudinal designs or cross-lagged panel models to address this issue and validate the causal direction of these relationships. 2. The sample comprised 538 Chinese high school students, yet the study did not specify the sampling method or sampling frame, making it impossible to assess the representativeness of the sample. Additionally, cultural backgrounds, educational systems, and lifestyles among Chinese adolescents may differ from those in other countries, potentially limiting the generalizability of the findings. Response: Thank you for your suggestion. Based on your suggestion, we have made the following explanations. Firstly, the original submission lacked sufficient details regarding the sampling procedure. We adopted a stratified cluster random sampling method. In the section "2.1 Participants and procedure", we have supplemented a detailed description of the sampling framework. Thank you for this thoughtful comment. We fully agree that differences in cultural background, educational systems, and lifestyles among Chinese adolescents may limit the generalizability of the findings. We acknowledge this as an important consideration when interpreting the results, and we will explicitly address this issue in future studies by extending the proposed model to samples from different cultural and educational contexts. 3. The use of self-administered questionnaires for assessment may introduce social desirability bias and recall bias. Particularly when assessing subjective exercise experiences, individual cognitive biases may compromise reporting accuracy. Response: Thank you for this valuable comment. We acknowledge that the use of self-administered questionnaires may introduce potential sources of bias, such as social desirability bias and recall bias, particularly when assessing subjective exercise experiences. Nevertheless, we would like to note that self-report questionnaires remain the most widely used and methodologically feasible approach for assessing psychological constructs such as subjective exercise experience, fatigue, sleep quality, and depressive symptoms. The instruments adopted in the present study have been extensively validated and applied in prior research, demonstrating acceptable reliability and construct validity across adolescent populations. Moreover, subjective exercise experience is inherently perceptual and experiential in nature, making self-report measures an appropriate and commonly accepted method for capturing individual evaluations. At the same time, we recognize the limitations associated with this assessment approach. Accordingly, we have acknowledged this issue as a methodological limitation and suggest that future studies may benefit from incorporating multi-method assessment strategies, such as objective physical activity indicators, sleep monitoring, or informant-based reports, to further reduce potential reporting bias and enhance measurement accuracy. 4.While the study proposes a dual-mediation pathway model, other crucial mediating variables—such as self-efficacy, social support, and coping strategies—may have been omitted. Furthermore, potential interactions and moderating effects among variables remain under-explored in this complex relationship. Response: We would like to express our sincere gratitude for your valuable comments and suggestions on our manuscript. Firstly, this is a very insightful and valuable suggestion. We fully agree that the mechanisms underlying adolescent depression are highly complex, and that a single mediation model is unlikely to capture all relevant psychological, social, and contextual factors involved in this process. Secondly, in the present study, we intentionally focused on a theoretically grounded and parsimonious chain mediation model involving subjective exercise experience, sleep quality, and fatigue, with the aim of clearly testing a core behavioral–physiological–emotional pathway. To ensure model stability, interpretability, and statistical robustness—particularly given the cross-sectional design—other potentially important variables such as self-efficacy, social support, and coping strategies were not included in the current analysis. Thirdly, following the reviewer’s suggestion, we have explicitly acknowledged these potentially omitted variables in the Limitations and Future Directions section of the revised manuscript. We now propose that future studies extend the present model by incorporating self-efficacy, social support, and coping strategies as additional mediators or moderators, and by examining possible interaction effects among individual and environmental factors. Such extensions may help construct a more comprehensive and ecologically valid theoretical framework for understanding how subjective exercise experience influences depressive symptoms in adolescents. Attachments Attachment Submitted filename: Response to Reviewer.docx https://doi.org/10.1371/journal.pone.0333460.r002
3 Mar 2026 Decision Letter - Tanja Grubić Kezele, Editor Unveiling the Chain Mediation Model of Sleep Quality and Fatigue in Linking Subjective Exercise Experience to Depression in Adolescent PONE-D-25-44933R1 Dear Dr. Ji, 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 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, Tanja Grubić Kezele, Ph.D., M.D. Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0333460.r003
Formally Accepted
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