Quasi-experimental studies in the Journal of Korean Biological Nursing Science (2011~2024): an evaluation based on the TREND guidelines.

For the past two decades, the prevalence of physical inactivity has remained persistently high in most countries worldwide, with approximately 80% of adolescents and one-third of adults failing to meet the physical activity guidelines set by the World Health Organization (; ). Research has indicated that physical activity among college students is significantly negatively correlated with negative emotions such as depression and anxiety (), and that a longer duration of Moderate-to-Vigorous Physical Activity (MVPA) is associated with a lower risk of psychological symptoms (). Currently, health problems among the college student population are particularly prominent, characterized by a significant decline in physical fitness and a marked increase in cardiovascular risk burden (), which has become a global public health issue. The university stage, as a critical period of transition from adolescence to adulthood, represents a golden window for the formation and consolidation of healthy behaviors. Participation in exercise during this period not only affects students’ academic performance and mental health during their studies () but also plays an important role in the long-term management of chronic diseases (). However, exercise avoidance behaviors have become increasingly common among college students, and insufficient physical activity has become a widespread global problem, posing a serious health threat. Promoting healthy behaviors-particularly participation in physical activity-among college students has become an urgent practical issue that needs to be addressed. In the field of health behavior promotion, the knowing–doing gap in exercise participation remains a core challenge. Over the past several decades, major frameworks for understanding physical activity have focused on the role of cognitive factors (). Traditional cognitively oriented theories, such as the Health Belief Model and Protection Motivation Theory, place emphasis on how individuals reflect on their thoughts and feelings, overstating an individual’s ability and willingness to make rational decisions aimed at achieving desired goals (). Although these theories have revealed the predictive role of health cognition in behavior, they have difficulty fully explaining why individuals often still fall into action dilemmas despite holding positive health cognitions. The limitations of these theories have gradually come to the forefront, as a marked discrepancy remains between people’s cognitions and behaviors-namely, the “knowing-doing gap.” Fábio contends that existing physical activity guidelines rely too heavily on epidemiological and medical evidence while neglecting the irrational characteristics of human behavior and the crucial role of affective experience-an oversight that may be a reason why global physical activity levels remain persistently low (). It has been suggested by a scholar that although many people rationally know that exercise is beneficial, they affectively experience it as unpleasant, which leads to an inability to persist in exercise. The fundamental reason is that individuals have not developed a good association between physical activity and positive affective attitudes (). Motivational hedonism holds that individuals tend to seek pleasant experiences and avoid unpleasant ones (). However, most people associate exercise with unpleasant feelings (), which hinders their participation in physical activity. With the development of motor cognitive science and exercise psychology, dual-system theories and affective system theories that emphasize the role of affective factors have gradually gained prominence (). Some scholars have found that exercise behavior is not merely the result of purely rational decision-making () but is rooted in bodily experience, interweaving automatic and controlled processes, and represents a complex adaptive performance deeply regulated by affective dynamics. In other words, the generation of exercise behavior is not a simple knowing-doing linear relationship but is jointly influenced by automatic affective evaluation and reflective cognitive processes (), offering a new research perspective for addressing college students’ exercise participation dilemmas. Body image is a multidimensional construct that encompasses an individual’s perceptions, attitudes, affect, and behaviors regarding physical appearance and functioning, and has since been extended to dimensions such as health functioning (). The appreciation boundary defined by positive body image emphasizes the functionality and health of the body beyond mere appearance, whereas the respect boundary emphasizes the individual’s engagement in health-promoting exercise behaviors (). In contrast, body dissatisfaction, as a core manifestation of negative body image, is closely related to poor health, directly affects health-related behaviors, diminishes exercise motivation, and leads to exercise avoidance (). Grounded in the multidimensional conno