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

Exercise frequency and duration increased progressively with stage advancement, but intensity declined in the Maintenance stage.

• Study used a cross-sectional questionnaire survey among 1,667 rural older adults across three regions in China: Ningde (Fujian), Shaoyang (Hunan), and Guanghan (Sichuan).
• Exercise behavior was classified into six stages based on the Transtheoretical Model (TTM): Precontemplation, Contemplation, Preparation, Action I (participating but irregularly), Action II (regular but less than six months), and Maintenance.
• Activity choices expanded from low-threshold activities to structured programs as stage advanced.
• The decline in intensity at the Maintenance stage represents a notable deviation from the otherwise progressive pattern.

Sports cognition significantly improved during the Preparation to Action I transition, but awareness of exercise's role in chronic disease prevention remained generally weak with no stage differences.

• The Preparation→Action I transition was identified as a critical inflection point for cognitive change.
• Despite overall improvements in sports cognition across stages, awareness of exercise's role in chronic disease prevention did not differ significantly across any of the six stages.
• The authors recommend that knowledge dissemination regarding exercise interventions for chronic disease prevention should be maintained throughout all stages to address these cognitive gaps.

'Safety' and 'convenience' were foundational service needs across all stages of exercise behavior change.

• These two needs were identified as consistent priorities regardless of which of the six TTM stages the older adult was in.
• The importance of 'facilities' and 'exercise guidance' became prominent specifically during the Preparation→Action I transition.
• The role of 'sports organizations' strengthened during the Action I→Action II transition.
• This pattern suggests that foundational environmental needs remain constant while instrumental and social support needs become more prominent in later stages.

Service demands exhibited a fluctuating pattern across stages, with different services being sensitive at different stage transitions.

• 'Sports guidance' and 'sports organizations' were sensitive (high demand) during the Contemplation and Preparation stages.
• Demand for 'facilities' and 'sports leaders' surged during the Preparation→Action I transition.
• Demands for soft services showed no stage differences across the six behavioral stages.
• The fluctuating rather than monotonically increasing pattern of service demand across stages is a key finding for stage-matched intervention design.

The study applied a six-stage extension of the Transtheoretical Model to classify rural older adult exercise behavior in China.

• The standard TTM was extended by splitting the Action stage into Action I (participating but irregularly) and Action II (regular but less than six months), yielding six total stages.
• Sample consisted of 1,667 rural older adults recruited from three geographically distinct regions: Ningde (Fujian), Shaoyang (Hunan), and Guanghan (Sichuan).
• A cross-sectional questionnaire design was used to analyze stage differences in behavioral, cognitive, environmental factors, and service demands.
• The study aimed to provide a reference for constructing a stage-specific public sports service supply model.