Physical inactivity is an established risk factor for non-communicable diseases such as hypertension, diabetes, cardiovascular diseases, cancer, and chronic obstructive pulmonary disease (COPD) (1–4). Eliminating physical inactivity would enhance global population life expectancy by 0.68 years (5). Physical inactivity also leads to higher health care costs (6). Despite such negative effects of physical inactivity, a large proportion of Chinese adults do not engage in leisure-time physical activity. According to the findings of the China Health and Nutrition Survey, the age-standardized leisure-time physical activity rate of Chinese adults increased from 7.13% in 2000 to 11.79% in 2011, but then dropped to 7.33% in 2015 (7).

Other studies have found that leisure-time physical activity is associated with reduced risk of all-cause, cardiovascular, type 2 diabetes, and cancer mortality (8, 9), and regular exercise is essential for both physical and mental well-being (10). The World Health Organization 2020 guidelines on physical activity and sedentary behavior recommended regular aerobic exercise for all age groups (11). The most recent national fitness plan (2021–2025), which was announced in August 2021, highlighted the benefits of regular leisure-time physical activity in promoting population health and quality of life (12).

Existing Chinese studies mostly described regular exercise rates in a single year, rather than analyzing changes in trends in regular exercise rates (13, 14). Previous studies have assessed trends in regular exercise rates in Western countries, but definitions of regular exercise rates are not uniform across countries (15, 16). The population in China differs from that in developed countries in terms of the importance of healthy lifestyles, the availability of infrastructure facilities, and the hosting of sports events, but the trends in the rate of regular exercise in the Chinese population may be useful to other developing countries in implementing physical activity programs. Chinese population is changing from a developing country to a developed country. The shift in physical activity is large. For example, the level of leisure-time physical activity showed an increasing trend and the consumption of physical exercise increased (17). As such, the study of trends in physical activity in Chinese population has implications for other developing countries. In addition, “The Health China 2030 Plan Outline” (18) and “Medium- and long-term planning for the prevention and treatment of chronic diseases in China (2017–2025)” (19) propose to increase the proportion of regular physical activity to reduce the burden of chronic diseases. Regular exercise rate and socioeconomic status interact with each other (20). Individuals with higher socioeconomic status are more likely to be exercise, and individuals with lower socioeconomic status are more often engaged in heavy workloads, longer work hours, and more night work, with less time and energy for physical activity (21). Regular exercise leads to more efficient learning, resulting in higher education level, higher income, and higher socioeconomic status (22). In addition, few previous studies have examined the association between regular exercise rates and socioeconomic factors. Investigating the association between regular exercise and socioeconomic status can help develop physical activity promotion interventions that target specific socioeconomic status groups.

A total of 33,448 individuals (mean age, 54.05 years [standard deviation, 14.62 years]; 18,544 [55.4%] female) were included in this analysis. A significant difference was found in population distribution across the four survey rounds. Participants were primarily urban residents (59.0%) and residents without chronic disease at baseline (64.2%). A total of 46.3% of the sample had a secondary school degree and 45.8% undertook non-manual work. The percentages of participants with higher household income (≥￥60,000) and obesity increased between 2010 and 2018 (Table 1).

From 2010 to 2018, the overall weighted rate of regular exercise increased by 9.17% from 12.28% (95% CI: 9.11–15.45%) to 21.47% (95% CI: 17.26–25.69%) (P for trend = 0.009). Trends in the overall group and for each gender, residence, and baseline self-reported chronic disease groups remained similar. Among the different age groups, the rate of regular exercise was highest among adults aged ≥60 years in 2010, while the rate among adults aged ≥60 years in 2018 was the lowest. The rate of regular exercise increased with higher education and household income. Regular exercise rates were highest among overweight adults and lowest among underweight adults. The rate of regular exercise among retirees decreased from 33.79% (95% CI: 28.61–38.97%) in 2010 to 29.78% (95% CI: 24.21–35.36%) in 2018. In each year, however, retirees still had the highest rate of regular exercise among all occupations (Figure 1; Supplementary Table S1).

Various sociodemographic factors were positively associated with the rate of regular exercise. After multivariable adjustment, a significantly higher estimated regular exercise rate was observed among participants aged 45– < 60 years, those residing in urban areas, individuals with a college degree or higher, participants who were retired, individuals with annual household income ≥￥60,000, overweight participants, those with self-reported chronic diseases at baseline, ever drinkers, and residents of south Jiangsu Province. Compared with participants in the 18– < 45 years old age group, those who were 45– < 60 years old had a 24% higher regular exercise rate (OR: 1.24, 95% CI: 1.14–1.34). Compared with rural residents, the OR for the regular exercise rate for urban residents was 1.43 (95% CI: 1.32–1.54). The rate of regular exercise was higher in participants who were retired than in participants with agriculture-related jobs (OR: 2.94, 95% CI: 2.61–3.30). Relative to participants with a household income <¥30,000, the OR for those in the ¥30,000– < ¥60,000 was 1.20 (95% CI: 1.10–1.32). Further, participants with higher education and higher BMI tended to exercise more regularly (P for trend <0.001). Self-reported chronic disease at baseline was associated with a 24% higher regular exercise rate (OR: 1.24, 95% CI: 1.16–1.33) (Table 2). The rate of regular exercise was 20% higher among those who had consumed alcohol in the previous 30 days relative to those who had never consumed alcohol (OR = 1.20, 95% CI: 1.11–1.29). The association between sociodemographic factors and regular exercise according to each survey was similar to that of the overall survey (Supplementary Table S2). We observed that rural participants with college degrees or higher had higher rates of regular exercise than rural participants without formal education (OR = 4.90, 95% CI: 3.79–6.30; P_interaction = 0.001). We did not observe an interaction between smoking and BMI (Supplementary Figures S1, S2).

Using provincially representative data from the CDRFS in Jiangsu, China, from 2010 to 2018, we analyzed the weighted rate of regular exercise, estimated its trend over time, and examined associations of regular exercise with demographic factors. Our analysis showed that the regular exercise rate of adults in Jiangsu Province was 16.02% in 2013, which was higher than the national average level (15.0%) (29). Provinces with similar GDP to Jiangsu Province, e.g., Shandong Province (19.8%) (14), had a higher rate of regular exercise than Jiangsu Province. Provinces with lower GDP than Jiangsu Province, e.g., Gansu Province (13.95%) (13), had a lower rate of regular exercise than Jiangsu Province. Therefore, we speculate that the economy is one of the factors affecting the regular exercise rate. This part needs to be further explored. These findings demonstrate that health policies relevant to Jiangsu Province need to be developed and targeted measures implemented to increase the rate of regular exercise. Additionally, our research demonstrates that the regular exercise rate in Jiangsu Province increased by 9.17% from 2010 to 2018. A study in Beijing found that the regular exercise rate in the city increased by 8.14% from 2008 to 2017 (31, 32). Nevertheless, data reported from Iran and Madrid indicated that the trends in leisure-time physical activity declined, possibly due to increased sedentary time and obesity rates (33, 34).

The rate of regular exercise among retirees generally showed a downward trend over time; however, the rate of regular exercise among retirees was still relatively high compared to that of participants in the other occupation groups, and retirement was positively associated with regular exercise. The decline in the regular exercise rate among retirees could be attributed to the fact that China is transforming into an aging nation and the older adult population is growing rapidly (35). The aging of society makes it more likely that retirees continue working, resulting in a lack of time for leisure-time physical activity (36). Additionally, the increase in older adults taking care of their grandchildren in China has led to a decrease in the time they spend on exercise (37). The average retirement age is 60. Compared with non-retirees under 45 years old, retired people have less stress from study, work, and life and take more exercise (38). We observed a much higher rate of regular exercise in urban than in rural areas, as well as significant increases in regular exercise rates in both areas, consistent with a previous study (39). The disparity between areas may primarily be attributable to the fact that rural areas are less likely to have facilities associated with leisure-time physical activity, such as parks and green spaces (40). Additionally, residents in urban areas have higher incomes and are increasingly concerned about quality of life, and thus exercise more frequently (41).

Positive associations of regular exercise with educational and income levels were observed in our study, consistent with other studies showing that education and income are positive influences on leisure-time physical activity (20, 42). Some previous studies (43, 44) have reported an inverse relationship between BMI and leisure-time physical activity, which contradicts our findings. In our study, overweight adults had the highest regular exercise rate. The possible reasons for these different findings might be that Jiangsu Province implemented “The Outline of the National Fitness Program 2001–2010” to improve fitness publicity for people with overweight and obesity (45). The number of people who consciously participate in exercise increased, with running, square dancing, climbing mountains, and fitness becoming fashionable. Further, individuals with overweight and obesity have greater motivation to take part in physical activity with the aim of weight management and improving their appearance (46, 47). In addition, being overweight may not mean obesity, but may be an increase in muscle mass from exercise (48). Exercise increases muscle mass, and muscle is denser than fat, so people with more muscle mass at the same weight may have a higher BMI (49). Follow-up studies should focus on indicators of both waist circumference and visceral fat.

Multivariable logistic regression analyses suggested that lack of regular exercise was more severe among individuals who were younger, lived in a rural area, had a lower education level, participated in agriculture-related work, and had a lower income. In summary, people in socially/economically disadvantaged positions were more likely to have a low regular exercise rate. In a recent Swedish study, economic stress was associated with low leisure-time physical activity and the strength of the association increased sharply with higher levels of economic stress (50). Therefore, targeted interventions for the abovementioned groups should be created, to encourage them to take more exercise (11).

This study provides data support for the government to develop physical activity policies. The government can launch educational campaigns and awareness programs to promote the benefits of regular exercise and encourage citizens to adopt a more active lifestyle. The government can also improve infrastructure and recreational exercise facilities to encourage citizens to be physically active. Society can support community sports organizations by providing funding, resources, and infrastructure to enable citizens to participate in organized sports activities. Individuals can develop regular exercise habits by raising their awareness of exercise. The strengths of our study include the large sample size, with a representative population and the use of a validated measure of physical activity (51). Our study has some potential limitations. First, the surveys were not conducted annually, which could have allowed for a more detailed and quantitative analysis of the trend. Second, all sociodemographic characteristics and physical activity data were based on self-reported information, which is likely to have introduced bias. Third, the study had a cross-sectional design; hence the causality of relationships between sociodemographic factors and regular exercise could not be determined. However, this study has four different time points, and the time interval can reflect the trend of change.

Our study showed a significant increase in the overall rate of regular exercise in adults in Jiangsu Province over the 8 year period from 2010 to 2018; however, the rate decreased among retired participants. Being older, living in urban areas, having a higher education level, engaging in non-agriculture-related work, having a higher income, having a higher BMI, having a chronic disease at baseline, former smoking, and ever drinking were all positively associated with regular exercise from 2010 to 2018. Interventions targeted at population subgroups with low regular exercise rates, or those showing decreasing trends in regular exercise, are warranted.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The protocol for the 2015 chronic disease and risk factor surveillance survey was approved by the ethics review committee of the Chinese Center for Disease Control and Prevention (CDC), and all other surveys were approved by the ethical committee of National Center for Chronic and Noncommunicable Disease Control and Prevention (NCNCD), China CDC. The patients/participants provided their written informed consent to participate in this study.

JS and JY designed the research. JY performed the data analyses and drafted the manuscript. JS revised the data analysis. JS, YQ, RT, JY, and SL conducted field investigations and data collection. SL, JZ, and MW revised the manuscript critically for important intellectual content. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.