This study in rural Suixi found differences in physical activity and sedentary behaviour by occupation. Farmers had significantly more occupational physical activity compared to their non-farming counterparts, however, they appeared to substitute farming activities with sedentary behaviours (primarily TV viewing) during non-farming seasons. Based on this pattern, one may expect further decreases in occupational physical activity as a result of fewer farming-related occupations, less labour-intensive farm work, and shorter farming seasons. Without compensating forms of physical activity or reduction of TV time, this pattern suggests future increases in overweight/obesity and associated chronic diseases.
The prevalence of LTPA was low in the study sample, which was consistent with findings from previous studies [6, 10, 19]. Correlates of LTPA were explored. After adjusting for other demographic characteristics and environmental variables, those in our study were more likely to participate in LTPA if they were unmarried, living in a smaller household, having sports equipment in the home and if their family, friends, or neighbours participated in LTPA.
The strongest correlate of LTPA was social modelling. During the "member checking" phase of the study, informants strongly agreed with this finding. A woman informant stated, "We are in a very collective society and nobody exercises alone." Other informants confirmed that families, friends, and neighbours in their communities were closely connected (i.e., "The social circle is small here. If one person goes out for a walk, immediately others will notice and probably will follow. They can chat while walking.") Studies in western countries have suggested that seeing other people exercise was associated with individuals' own participation in LTPA, possibly through modelling and prompting [26–28]. In the context of rural China, exercising with others may provide additional and possibly essential social reinforcement. Social support and group activity interventions are effective in Western countries , and they may be even more effective in China, but this remains to be demonstrated.
Another finding was that those who had sports equipment in the home had twice the odds of engaging in LTPA. In a cross-sectional study, such a finding should be interpreted with caution, since it is possible that those who had already been active would be more likely to obtain such equipment. Informants suggested that home equipment was only half of the equation if access to exercise facilities and localities was limited. For example, a young man stated "It is true that I am more active because I have a basketball, but I play in streets where it is not safe. I would have played a lot more if there was a basketball court around." Although the Chinese government has implemented the "Sports for All" program to expand relevant facilities and infrastructure , rural residents still have limited access to such facilities, as demonstrated by one informant's comment, "Sometimes we have to travel for hours to a bigger town for sports. We do not have anything here in our village." In this study sample, adults who were married or who were living in a larger household were less active. This may be a result of related lifestyles and competing priorities of other household activities. An informant said: "We have to travel so far for any activity. If one is married and has children (like me), how can s/he have time for any recreation?"
TV viewing was the major sedentary behaviour. The median TV time was 12 hours per week, and 39% watched TV for 14 hours or more. This is comparable to TV viewing time reported by adults in the US [31, 32]. A woman informant described the "common" lifestyle in her village: "People in my village tend to turn on TV immediately after meals, and then they rest (sitting or lying down) for one hour after lunch, and another hour after dinner." In the current sample, 96% of participants had a TV set in the home, indicating substantial influences from modernisation. Although computers were not as common (23% participants had a computer at home), it is reasonable to postulate that as computer ownership increases, screen time sedentary behaviour may further increase in rural China.
None of the correlates of LTPA was significantly associated with TV time. This finding was similar to a previous study, in which environmental variables that facilitated physical activity were not related to TV time . Furthermore, no association was found between TV time and LTPA in the current sample (Table 2). This suggests that TV viewing may be a behaviour that is independent of physical activity in rural Suixi .
A major strength of the study was using community participation to enhance the design, survey administration and results interpretation. These procedures improved the cultural relevance of research questions, qualitatively validated research findings, and provided interpretations that extended quantitative results. Although a small sample from one county in southern China limits generalizability, and a cross-sectional study cannot establish causality, these findings provide insights to guide future larger-scale and prospective studies that employ objective measures of the environment, physical activity, multiple sedentary behaviours (including sleeping) , and health outcomes. Future studies should assess additional aspects of the built and social environments and explore variables related to sedentary behaviours, especially TV viewing.