Interplay Between Sex, Age, BMI, Health-Related Quality of Life, and Coping Strategies in Amateur and Professional Athletes

Walter Sapuppo^1,2,3Davide Giacconi^1,3Antonietta Monda⁴Antonietta Messina⁵Daniele Saccenti¹Claudia Maria Mineo^1,3Maria Casillo⁶Salvatore Allocca⁶Giovanni Michelini^1,7Regina Gregori¹Vincenzo Monda⁸Jacopo Lamanna⁹Mattia Ferro¹Girolamo Di Maio^10*Marcellino Monda⁶Marco La Marra^6*

• ¹Department of Psychology, Sigmund Freud University Wien, Milan, Italy
• ²Studi Cognitivi, Cognitive Psychotherapy School and Research Center, Milan, Italy
• ³INSPIRE Lab, Department of Psychology, Sigmund Freud University Wien, Milan, Italy
• ⁴Department of Human Science and Quality of Life Promotion, San Raffaele Telematic University, Rome, Italy
• ⁵Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
• ⁶Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
• ⁷Department of Disabilities, Fondazione Istituto Ospedaliero di Sospiro, Sospiro, Italy
• ⁸Department of Economics, Law, Cybersecurity, and Sports Sciences, University of Naples “Parthenope”, Naples, Italy
• ⁹Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
• ¹⁰Department of Psychology and Health Sciences, Pegaso Telematic University, Naples, Italy

Background/Objectives: The psychological well-being of athletes has garnered increasing interest due to its strong association with physical performance. While somatic indicators such as Body Mass Index (BMI) are routinely monitored in sports, the role of psychological resources-especially coping strategies-in shaping Health-Related Quality of Life (HRQoL) remains underexplored. This study aimed to investigate the influence of psychological and physical factors on HRQoL among amateur and professional athletes, controlling for sex, age, and BMI.A cross-sectional design was adopted, involving 537 athletes (326 males, 211 females; mean age = 32.44, SD = 13.64), aged 18-76 years. Participants were recruited via online platforms and sports organizations and completed a battery of self-report questionnaires, including the SF-36 to assess HRQoL and the COPE-NVI-25 to evaluate coping strategies. BMI was calculated from selfreported height and weight. Hierarchical multiple regression analyses were performed to assess the relative contributions of demographic, anthropometric, and psychological variables to HRQoL.Results: Demographic variables and BMI explained a limited proportion of the variance in HRQoL. In contrast, coping strategies significantly contributed to HRQoL outcomes, accounting for up to 22.5% of the variance in the global SF-36 score. Positive attitude and social support were associated with better physical and mental health, while avoidance strategies showed consistent negative associations across all HRQoL dimensions. Conclusions: Adaptive coping strategies, particularly positive attitude and social support, play a pivotal role in enhancing athletes' HRQoL, surpassing the influence of BMI, sex, and age. These findings support the development of tailored psychological interventions to foster athlete well-being across competitive levels.