# Changing patterns and associated factors of exercise participation and physical activity levels among middle-aged and older adults from 2011-2020 in China

## TL;DR

Exercise participation among middle-aged and older Chinese adults nearly doubled from 2013 to 2020, but physical inactivity remains high, especially among older and disadvantaged groups.

## Contribution

The study reveals updated national trends in physical activity and identifies vulnerable populations needing targeted interventions.

## Key findings

- Weekly exercise participation increased from 22.6% in 2013 to 43.9% in 2020 among Chinese adults ≥45 years.
- Insufficient physical activity remained stable, with higher prevalence among older adults, rural residents, and low SES groups.
- Job-related physical activity declined but remained a major source of moderate-to-vigorous PA.

## Abstract

Physical inactivity remains a global concern. Understanding population-level physical activity (PA) trends is essential for evidence-based policy-making.

Repeated cross-sectional analysis was conducted using the five waves (2011–2020) of data from the China Health and Retirement Longitudinal Study. PA was assessed by the International Physical Activity Questionnaire. PA sources (job demands, entertainment, exercise, and others) were assessed since 2013. Age- and sex-standardized prevalence was calculated. Log-binomial regression was performed to explore associated factors.

Among Chinese adults ≥ 45 years, weekly exercise participation nearly doubled from 22.6% (2013) to 43.9% (2020). Job-related PA declined but remained the major source of moderate-to-vigorous PA. Insufficient PA prevalence demonstrated slight fluctuations, bottoming at 19.6% in 2018 between 2011 (23.9%) and 2020 (22.2%), with significant reductions in adults ≥ 75 years (-12.7%), females (-5.8%), urban residents (-5.5%), hypertension (-4.1%) or diabetes (-9.7%) groups. By 2020, insufficient PA was more prevalent among adults ≥ 75 years (41%, PR: 2.06, 95% CI: 1.65 to 2.57), individuals with low socioeconomic status (SES) (PR: 1.41, 95% CI: 1.26 to 1.59), rural residents (PR: 1.13, 95% CI: 1.01 to 1.26), and individuals with dyslipidemia (PR:1.12, 95% CI: 1.00 to 1.24).

Our study provides national updated evidence showing exercise participation doubled among middle and older Chinese, yet insufficient PA remained stable over the past decade, which is likely attributable to reductions in job-related PA. In the context of rapid lifestyle and societal changes, future policies and intervention programs need to co-target exercise and varied PA domains and prioritize high-risk populations, including advanced age seniors, rural residents, and low SES groups, to alleviate inequities.

The online version contains supplementary material available at 10.1186/s12966-025-01860-2.