Differential Moderation by Aerobic and Muscle-Strengthening Physical Activity of the Violence Victimization-Suicidal Ideation Association in Korean Adolescents.

PURPOSE: Violence victimization is a known risk factor for adolescent suicidal ideation, yet moderating factors remain poorly understood. This study examined whether aerobic and muscle-strengthening physical activity (PA) differentially moderated the violence victimization-suicidal ideation association. METHODS: Four waves of the Korea Youth Risk Behavior Survey (KYRBS 2021-2024; n = 214,218) were analyzed using complex sample logistic regression. Aerobic PA (0-7 days/week) and muscle-strengthening PA (0-5+ days/week) were modeled continuously, with linear and quadratic terms to test interactions with violence victimization, adjusting for psychosocial and sociodemographic covariates. Sex- and SES-stratified analyses and formal three-way interaction tests were conducted. RESULTS: Overall, 13.3% reported suicidal ideation, versus 38.9% among violence-victimized adolescents (OR = 3.43). Aerobic PA showed a non-monotonic interaction with violence: odds of suicidal ideation were elevated at 1-3 days/week (ORs 1.4-1.8) but attenuated at ≥ 4 days/week, a pattern nominally strongest among males. Muscle-strengthening PA showed elevated odds at higher frequencies (≥ 3 days/week; ORs 1.4-1.9) rather than low frequencies, though this association was not statistically significant in continuous models. DISCUSSION: Both PA types showed frequency-dependent, nonlinear associations inconsistent with single-threshold framing. Findings are associational and hypothesis-generating, requiring prospective confirmation.