Chinese elderly are undergoing unoptimistic PA condition and mental health status. Advocating fitness for all and promoting elderly health have become important topics in current China. In this study, we found that elderly people in rural areas had significantly poorer PA-related KABs than those in urban areas, especially for PA-related behaviors. PA-related KABs were associated with the elderly’s mental health.
This study reported the proportion of 76.7% for knowing about the benefits of physical activity, 44.3% for knowing about appropriate exercise intensity, and 75.4% for knowing about healthy weight. The results were generally consistent with previous studies [21–23]. Almost 90% of the participants hold positive attitude towards physical activity, which is much higher than Doyle et al. [11] reported in Emirati university students. Knowledge and attitudes are the basis of behaviors. PA-related knowledge and attitudes may affect individuals’ choice of PA-related behavior [24]. Future health education is needed to help elderly people acquire PA-related knowledge and hold positive attitudes towards PA.
This study included three PA-related behaviors, including walking & Tai Chi, ball games, and body building. We found that 45.0% of the elderly individuals reported preferring walking & Tai. Only 12.1% and 12.9% of the participants reported preferring ball games and body building. Yang et al. [25] also reported apparent differences in types of exercises among community residents in China. People were mainly engaged in traditional leisure activities and the participation of competitive sports was relatively low. Nakagawa et al. [26] found that more frequent vigorous- and moderate-intensity PA rather than walking (considered low to moderate intensity) was associated with better cognitive and mental health measures. Thus, behavioral interventions focused on vigorous- and moderate-intensity PA might make more sense in Chinese elderly population.
Comparison analysis indicated that elderly residents in rural areas had significantly poorer PA-related KABs than those in urban areas, especially for PA-related behaviors. The result is in line with Deng et al.’s [27] study in middle-aged and older Chinese adults. Bu et al. [28] and Li et al. [29] also mentioned the substantial rural-urban disparities in PA among Chinese residents. However, contrary findings were reported in several studies from the United States [30, 31], South African [32], and India [33]. This inconsistency might be related to different national conditions. In China, there is an obvious urban-rural dualistic structure in PA-related KABs, which might be due to the difference in accessibility for sports resources and awareness for activity participation between urban and rural regions [34]. Thus, policy interventions are warranted to improve the accessibility and affordability of local exercise facilities in rural areas as a way to reduce urban-rural disparities in PA.
The results of regression analysis showed that PA-related KABs were associated with higher mental health in Chinese elderly, except for the knowledge on appropriate exercise intensity and healthy weight. Previous studies have confirmed this finding that PA-related behaviors had positive correlation with the elderly’s mental health [35–37]. According to the KAB theory, individuals who have better knowledge and hold positive attitude are more likely to adopt healthy behaviors [10]. Campos et al. [24] also reported that PA-related knowledge can be a protective factor against sedentariness and physical inactivity. Thus, behavioral intervention related to PA might be taken as an important supplementary measure for mental health promotion of the elderly, and the role of PA-related knowledge and attitudes should not be ignored. Moreover, previous studies suggested that different types of physical activity had variant impacts on mental health [26, 38, 39]. Thus, personalized behavioral guidance regarding PA for elderly people might make sense in mental health promotion.
Chinese government implemented “Fitness-for-all Campaign”, “Elderly Health Promotion Action”, and “Mental Health Promotion Action” as part of the “Healthy China Action (2019–2030)” [9]. Improving physical activity and mental health of the elderly is not an easy task in China. From the KAB theory perspective, this study reinforced the importance of creating good conditions for PA-related health resources, especially in rural areas. Our findings also indicate the possibility that PA-related interventions and programs could help improve the elderly’s mental health. Such interventions and programs should be target three physical activity dimensions: knowledge, attitudes, and behaviors.
Several potential limitations should be mentioned regarding this study. Firstly, limited by the data structure and content of the CHNS database, we only selected several variables to evaluate PA-related knowledge and behaviors. Future studies are needed to comprehensively assess PA-related KABs. Secondly, all variables included in this study were obtained through participants’ self-report, thus are likely to cause measurement errors. Thirdly, the cross-sectional nature of this study may be considered a weakness, as no causal inferences can be drawn from the results. Despite these limitations, this study is the first to explore the association between PA-related knowledge, attitudes, behaviors, and mental health of elderly people from the perspective of KAB theory. The result might be a valuable reference for the implementation of the current “Fitness-for-all Campaign” and “Elderly Health Promotion Action”, as well as for further relevant research.