Objective  To investigate how health-promoting lifestyle affecting on the fatigue of suboptimal health (FSH) among middle school teachers.

  Methods  A cross-sectional survey was conducted among 8 111 middle school teachers randomly selected in three districts of Guangzhou city. The participants were asked to complete the Health-Promoting Lifestyle Profile (HPLP-II) and Sub-Health Measurement Scale V1.0 (SHMS V1.0) while taking routine physical examination between April and May 2013. Health status and fatigue of the participants were assessed based on physical examination reports and SHMS V1.0 and lifestyle was evaluated with HPLP-II.

  Results  Among the 8 111 participants, 1 586 reported fatigue status and the prevalence rate of fatigue was 19.55%. Of the participants reporting fatigue status, 31.72% (503) and 65.89% (1 045) were categorized as suboptimal health-related and disease-related fatigue, much higher than the ratio (2.39%, 38) of fatigue under normal health. Regression analyses revealed a significant association between suboptimal health-related fatigue and healthy lifestyle (P < 0.05). After adjusting for demographic variables, the participants with poor lifestyle were approximately 70 times (odds ratio OR: 69.63, 95% confidence interval 95% CI: 26.80 – 180.87) more likely to have FSH, while those with general and suboptimal lifestyle were about 16 times (OR: 15.87, 95% CI: 8.43 – 29.89) and 2 times (OR: 2.05, 95% CI: 1.07 – 3.93) more likely to have FSH compared to the participants with excellent health-promoting lifestyle. Further regression analyses demonstrated that the participants with poor, general and suboptimal status of six dimensional lifestyle defined in HPLP-II were also at higher risk of FSH (P < 0.05 for all), especially for those with unhealthy status for the dimensions of stress management, interpersonal relationship, and spiritual growth.

  Conclusions  Un-healthy lifestyles are significantly related to an increased risk of fatigue of suboptimal health among middle school teachers.