Background

In 2017, the Chinese government launched the ‘Healthy China’ policy, with the aim of providing comprehensive health services through all stages of life for Chinese citizens. This implied the need to intensify efforts in health education and promotion ensuring that Chinese people receive effective health services at every stage of their life cycle. However, China has the largest elderly population in the world and generally has lower levels of health literacy, exacerbated by significant urban‒rural disparities.1 Additionally, the migration of the population from rural areas to urban areas, combined with the ageing of the remaining population, is placing increasingly heavy burdens on the social economy. According to statistics, by the end of 2022, there were 14.41 million health workers in China, with fewer than 9.5% working in rural clinics; however, these rural workers needed to provide health services for nearly 35% of China’s population. The significant urban‒rural healthcare disparity restricts the access that elderly people in rural China have to services related to the ‘exercise promotes health’ strategy. Thus, strengthening rural health services to improve the physical health of the rural elderly is key to advancing the realisation of the ‘Healthy China’ policy as well as the ‘Transforming our World: The 2030 Agenda for Sustainable Development’ strategy.

Challenges

Exercise can prevent and treat chronic diseases such as cardiovascular diseases and osteoarthritis, which are common among elderly people in rural areas.2 To further explore the practical application and socioeconomic benefits of an ‘exercise promotes health’ strategy in underdeveloped rural areas, we conducted a door-to-door survey on the exercise status and medical expenses of elderly people living in these regions. The results showed that there is a general lack of guidance and services for physical activity and exercise rehabilitation in underdeveloped rural areas, leading to low levels of awareness and poor compliance with exercise instruction and participation among elderly people. Additionally, due to limited economic resources in rural areas, equipment for the rehabilitation of elderly people is lacking. Coupled with a dearth of professional guidance from physical therapists, the disabled population often experiences slow recovery times, poor prognoses and a resultant lower quality of life.

Exercise for health promotion

Scientific exercise, as an effective means of promoting health, refers to evidence-based exercise routines that have been scientifically validated to optimise bodily functions and both prevent and treat diseases.3 The ‘exercise prescription’ based on personalised guidance from physicians is gradually gaining recognition and widespread promotion in China.4 5 Against this backdrop, in 2021, approximately 50 medical and rehabilitation therapy students from Jiangxi Medical College of Nanchang University formed the ‘Dawn of Health Home’ team. This team aimed to provide sports activities and exercise rehabilitation guidance to underdeveloped rural areas in China, striving to improve the health of every household. Under the guidance of professional physicians and physical therapists, we regularly conduct assistance activities in rural areas during winter and summer vacations, as well as on weekends. We developed personalised exercise plans for elderly people in underdeveloped rural areas, such as providing various forms of sports activity guidance and auxiliary equipment to improve exercise effects. Currently, we have provided services to approximately 1000 elderly people, particularly disabled elderly people, in 5 economically underdeveloped rural areas in China (figure 1).

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Figure 1

"Dawn of Health Home" Team members conducting health education and consultation services at the nursing home, with a focus on "Exercise for Health Promotion".

For elderly people living in rural areas, team members shared traditional Chinese fitness methods, such as tai chi and the Five-Animal Exercise (Wuqinxi). Tai chi is known for its slow, flowing movements and stress-reducing benefits, helping to enhance cardiopulmonary function, lower blood pressure and strengthen lower limb muscles.6 The Five-Animal Exercise, which imitates the movements of the tiger, deer, bear, monkey and bird, can reduce pain levels, improve the level of physical function and enhance knee stability in elderly people.7 Considering the limited understanding of professional medical knowledge among rural elderly people, we used popular and engaging educational videos to help them understand the benefits of these sports activities. Additionally, we demonstrated the importance of the Five-Animal Exercise and tai chi using drama, aiming to help rural elderly people maintain a healthy state while enjoying these beneficial physical activities.

Using technology

In addition, rural elderly individuals with disabilities were provided with team-developed exercise rehabilitation equipment under the guidance of professional physiotherapists and instructed on how to use this equipment. We used intelligent lower limb exoskeletons to assist patients in dealing with functional deficits caused by neuromuscular diseases or limb loss. These exoskeletons can simulate and enhance the body’s natural movements. We used such devices to help patients reduce their pain level, increase their level of participation in daily activities, accelerate their rehabilitation process and thereby improve their quality of life.8 In addition, we used fitness mirrors equipped with posture recognition, intelligent error correction and exercise guidance features to help disabled individuals achieve better rehabilitation outcomes and return to participation in normal daily activities.

The impact on the community

Through our services related to the ‘exercise promotes health’ strategy, elderly individuals who were previously in suboptimal health have actively engaged in scientific exercise, resulting in significant improvements in their physical condition. Many of the previously disabled individuals have either transitioned to a mild disability or nearly fully recovered. These individuals have regained the ability to work and re-engage in productive work; they have also reduced their expenditure on medical and nursing care. Such improvements collectively help foster the socioeconomic development of underdeveloped rural areas, taking solid steps towards realising the vision of a healthy countryside and contributing to the broader ‘Healthy China’ initiative.

Sustainability and reproducibility elements

While providing services, team members enhanced their knowledge of medicine and cultivated deep medical humanistic care. After completing their undergraduate studies, some members chose to remain in rural areas while others continued their studies at medical schools across China, spreading the spirit of service nationwide. The team’s efforts have been repeatedly featured in mainstream Chinese media, and our project experience has been acknowledged by experts at academic forums organised by the Chinese Medical Association. In the future, we plan to strengthen collaborations with more medical schools, charitable organisations and other entities to expand our team’s size and service scope. We aim to enable more residents in underdeveloped rural areas to equally access scientific-exercise-based rehabilitation and professional sports activity guidance, thereby promoting sustainable development.