The phased characteristics and countermeasures of physical exercise behavior change of rural older adults in China

Objective Based on the Transtheoretical Model (TTM), this study aims to reveal the characteristics and evolutionary patterns of physical exercise behavior among rural older adults in China across different stages, providing a reference for constructing a stage-specific public sports service supply model. Methods A cross-sectional questionnaire survey was conducted among 1,667 rural older adults in Ningde (Fujian), Shaoyang (Hunan), and Guanghan (Sichuan). Exercise behavior was classified into six stages: Precontemplation, Contemplation, Preparation, Action I (participating but irregularly), Action II (regular but less than six months), and Maintenance. Stage differences in behavioral, cognitive, environmental factors, and service demands were analyzed. Results (1) Exercise frequency and duration increased progressively with stage advancement, but intensity declined in the Maintenance stage; activity choices expanded from low-threshold activities to structured programs. (2) Sports cognition significantly improved during the Preparation→Action I transition, but awareness of the role of exercise in chronic disease prevention remained generally weak with no stage differences. (3) “Safety” and “convenience” were foundational needs across all stages; the importance of “facilities” and “exercise guidance” became prominent during Preparation→Action I; and the role of “sports organizations” strengthened during Action I→Action II. (4) Service demands exhibited a fluctuating pattern: “sports guidance” and “sports organizations” were sensitive during Contemplation and Preparation; demand for “facilities” and “sports leaders” surged during Preparation→Action I; while demands for soft services showed no stage differences. Conclusion Exercise behavior among rural older adults demonstrates significant stage-specific characteristics. Guidance and organizational information should be strengthened in the pre-exercise phases, facility and facilitator support ensured during the initiation phase, and diverse organizations developed during the regularization phase. Concurrently, knowledge dissemination regarding exercise interventions for chronic disease prevention should be maintained throughout all stages to address cognitive gaps.