Introduction: This study applies the Social Ecological Model to examine multilevel determinants of physical activity among community-dwelling older adults within the context of China’s sports-medical integration strategy. Methods: A cross-sectional field survey was conducted among 252 older adults in Xianyang. Hierarchical multiple linear regression was employed to evaluate the predictive effects of variables across four ecological levels on physical activity. Results: The model explained 67.3% variance in older adults’ physical activity (R 2 =0.673; p< 0.01). At the microsystem level, self-efficacy was the dominant predictor (β=0.365) and physical deterioration was the major inhibiting factor. At the mesosystem level, peer support positively predicted physical activity, whereas family burdens hindered regular exercise engagement. At the exosystem level, 66.1% of participants lacked accessible indoor sports venues. At the macrosystem level, an obvious disconnect existed between policy perception and real-world exercise practices. Discussion: Older adults’ physical activity was jointly constrained by interactive individual, social and environmental barriers, accompanied by a prominent cognition-behavior gap. Under sports-medical integration, public health interventions should transform from passive medical treatment to targeted proactive health promotion by enhancing self-efficacy, optimizing peer social support networks, and improving the practical accessibility of sports facilities. Keywords: social ecological model, proactive health, sports-medical integration, older adults, physical activity
Chen et al. (Fri,) studied this question.