Study on the Association Between Low-Intensity Physical Activity Duration and Falls Among Middle-Aged and Older Adults in China — An Empirical Analysis Based on the CHARLS Database

Study on the Association Between Low-Intensity Physical Activity Duration and Falls Among Middle-Aged and Older Adults in China — An Empirical Analysis Based on the CHARLS Database | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Study on the Association Between Low-Intensity Physical Activity Duration and Falls Among Middle-Aged and Older Adults in China — An Empirical Analysis Based on the CHARLS Database Zhou Jiang, ChengHao Zheng, YanDan Wu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8416360/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The Chinese government attaches great importance to fall prevention among middle-aged and older adults and has incorporated it as an important component of healthy ageing strategies and public health policies. For middle-aged and older populations, low-intensity physical activity is not only relatively safe and easy to maintain but also contributes to enhancing physical function and improving balance ability and reaction speed. Methods This raises an important question regarding the relationship between the duration of low-intensity physical activity and falls among middle-aged and older adults in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) and a binary logistic regression model, this study empirically analyses the factors influencing falls among middle-aged and older adults in China, with a particular focus on whether the duration of low-intensity physical activity can predict falls in this population. Result The findings indicate that: (1) the weekly duration of low-intensity physical activity independently predicts falls among middle-aged and older adults; specifically, compared with those who engaged in low-intensity physical activity for only one day per week, each additional day of activity was associated with a 4.1%–4.4% reduction in fall risk. (2) The daily duration of low-intensity physical activity also independently predicts falls; compared with individuals who exercised for 10–30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day exhibited a 14.6%–17.0% lower risk of falling. (3) In addition to age and low-intensity physical activity duration, age, sex, type of toilet facility, alcohol consumption status, and marital status were also reference factors influencing falls among middle-aged and older adults in China. conclusions Based on these findings, it is recommended to reduce the risk of falls among middle-aged and older adults in China by promoting low-intensity physical activity and developing personalised exercise prescriptions; strengthening the prevention and intervention of osteoporosis among middle-aged and older women; and improving the living environment to reduce environmental risk factors for falls. These measures would contribute to advancing the deep integration of nationwide fitness and population health, fully leveraging the role of physical activity in health promotion, disease prevention, and rehabilitation, and facilitating the development of a healthy ageing society. duration of low-intensity physical activity middle-aged and older adults falls fall prevention Figures Figure 1 Figure 2 1. Introduction A fall is defined as a sudden, unintentional change in position that causes an individual to come to rest on the ground or at a lower level, and is not the result of sudden paralysis, epileptic seizures, or overwhelming external forces[ 1 ]. According to reports from the National Bureau of Statistics of China, a total of 2,324,577 fall incidents occurred between 2019 and 2022, with most falls taking place at home, accounting for 39.41% of all cases[ 2 ]. The National Health Commission of the People’s Republic of China revised and issued Health Literacy of Chinese Citizens—Basic Knowledge and Skills (2024 Edition) , which explicitly emphasizes the importance of fall prevention (Article 21: caring for older adults, preventing falls among older adults, and identifying senile dementia) and encourages older adults to enhance their awareness of fall prevention.China has the largest older population in the world, accounting for approximately one quarter of the global older population[ 3 ], and falls have ranked as the leading cause of medical visits due to unintentional injuries among older adults in China for several consecutive years[ 4 ]. According to data from the World Health Organization (WHO), approximately 684,000 people die from falls each year worldwide, with more than 80% of these deaths occurring in low- and middle-income countries or regions; falls are a common cause of accidental injury-related mortality globally. Falls are also a major contributing factor to disability, functional decline, and even death among older adults[ 5 ].The process of human ageing is universal, pervasive, and inevitable, during which all physiological functions progressively decline, leading to an increased probability of falls with advancing age. As demonstrated by a nationwide survey, approximately 28.7% of older adults self-reported experiencing at least one fall in the past year, among whom 37.5% were hospitalized due to fall-related injuries[ 6 ]. Falls among older adults have been formally recognized as a global issue; however, this problem tends to be overlooked in middle-aged populations[ 7 ].The prevalence of falls among middle-aged individuals ranges from approximately 11.4% to 31.4%, with 35% of these being severe falls requiring hospitalization[ 8 ].Nevertheless, existing fall prevention guidelines primarily target populations aged 60 or 65 years and older. For example, the World Guidelines for Falls Prevention and Management for Older Adults issued by the World Falls Guidelines Working Group, as well as the Technical Guidelines for Fall Interventions among Older Adults published by the Ministry of Health of the People’s Republic of China, mainly focus on individuals aged 60 or 65 years and above. Evidently, early fall prevention has not yet received sufficient attention. Although some studies have emphasized that midlife represents a critical period for fall prevention, individuals aged 45–60 years constitute a substantial proportion of the labor force; therefore, falls in this group may result in non-negligible consequences[ 9 ]. As noted by Mack KA et al. (2013), falls rank as the third leading cause of unintentional injury-related mortality among middle-aged adults. Recent studies further indicate that individuals aged 45–60 years face considerable public health and social challenges[ 10 ]. The health status of middle-aged adults has profound implications for labor force participation and public expenditure, and also serves as a predictor of ageing-related adverse events later in life. Taken together, fall prevention constitutes one of the most critical components of injury and fracture prevention programmes for middle-aged and older adults; however, existing research has predominantly focused on older populations. A large body of evidence indicates that, compared with older adults who are physically inactive or sedentary, those who engage in regular physical activity have a lower risk of falling, suggesting that physical activity serves as a protective factor against falls[ 11 ]. For example, an observational systematic review and meta-analysis reported that exercise interventions could reduce fall rates by 17%[ 12 ]. In addition, a national survey found that only 15.4% of older adults participated in physical exercise, and the vast majority tended to engage in low-intensity physical activities[ 2 ]. Low-intensity physical activity has demonstrated clear benefits for clinically defined high-risk older adults—namely, individuals who have experienced hospitalisation or at least two consecutive days of bed rest within the past month—by significantly reducing their risk of falls. Nevertheless, the effectiveness of low-intensity physical activity in preventing falls among older adults remains controversial. Some scholars argue that low-intensity physical activity may increase the risk of falls among healthy older adults[ 13 ]. One possible explanation is that older adults with higher physical function may require a higher exercise threshold to achieve beneficial effects and therefore may not gain sufficient benefits from small increases in muscle strength. Another potential explanation is that increases in overall physical activity may themselves elevate exposure to fall-related risks.Conversely, other studies suggest that the long-term benefits of regular physical exercise for older adults far outweigh the potential harms[ 14 ]. Epidemiological evidence shows that although the risk of myocardial infarction is higher during exercise than at rest, the overall risk of myocardial infarction among older adults who exercise regularly is approximately 50% lower than that among those who only engage in routine daily activities[ 15 ]. Moreover, these benefits appear to be independent of participants’ age, physical function, or cognitive status[ 16 ]. It should be noted, however, that while physical activity can reduce fall risk, prolonged duration or high-intensity physical activity may substantially increase exposure to hazardous environments, thereby elevating the likelihood of severe falls. Therefore, moderate levels of physical activity are crucial for reducing both falls and fall-related injuries. Although low-intensity physical activity is well suited to middle-aged and older populations and is beneficial for improving muscle strength, gait, and balance, the scientific evidence regarding its effectiveness in reducing falls is complex. In particular, the association between the duration of low-intensity physical activity and fall risk among middle-aged and older adults remains unclear, with a lack of context-specific and evidence-based research in China. Given that midlife represents a critical transitional period into older age, health behaviours during this stage are of great importance for the prevention of chronic diseases and the extension of life expectancy[ 17 ]. Accordingly, this study aims to examine whether the duration of low-intensity physical activity can effectively predict falls among middle-aged and older adults in China. By elucidating the dose–time relationship between physical activity and falls, this study seeks to provide empirical evidence for the development of more scientifically grounded and appropriate exercise intervention strategies for middle-aged and older adults in China. 2. Methods 2.1 Data Sources and Variable Definitions This study uses data from the China Health and Retirement Longitudinal Study (CHARLS) and applies a binary logistic regression model to empirically examine factors influencing falls among middle-aged and older adults in China, with a particular focus on whether the duration of low-intensity physical activity can predict falls in this population. The data were derived from the fifth wave of the China Health and Retirement Longitudinal Study (CHARLS), which is currently the most recent and nationally representative survey of middle-aged and older adults in China. CHARLS, released by the National School of Development at Peking University, is a longitudinal survey representative of the Chinese mainland population aged 45 years and above. The survey collects multidimensional information covering socioeconomic status and health conditions to meet the needs of ageing-related research. All waves of CHARLS have received ethical approval from the Biomedical Ethics Committee of Peking University. The ethical approval number for the fieldwork of the fifth-wave household survey is IRB00001052-11015. This study obtained 20,180 observations from the 2020 CHARLS dataset through the official CHARLS website( http://charls.pku.edu.cn/ ). First, 785 cases with unrecorded registration information or loss to follow-up were excluded, along with 950 cases that did not report fall status. Subsequently, cases that failed to report responses to the following items were excluded: “DA033: How many days per week do you usually engage in low-intensity physical activity for at least 10 minutes?”, “DA034: How much time per day do you spend on a certain low-intensity physical activity?”, “DA035: How much time per day do you spend on a certain low-intensity physical activity?”, “DA036: How much time per day do you spend on a certain low-intensity physical activity?”, and “DA037: Is this activity undertaken for work, leisure activities, physical exercise, or other purposes?”. Finally, cases with missing values in sex (BA001), marital status (BA011), living alone status in the past half year (BA018), housing type (I004), type of residence area (BA008), purpose of physical activity (DA037), alcohol consumption status (DA051), and type of toilet facility (I013) were excluded. It should be noted that some cases had overlapping missing values across multiple variables; therefore, these cases were excluded simultaneously. After handling missing values and outliers in key variables, a final analytical sample of 9,337 valid observations was retained. Figure 2 . The dependent variable was falls. The survey question was: “Since the last interview, have you fallen?” In this study, “no fall” was coded as 0, and “having fallen” was coded as 1. The independent variables included low-intensity physical activity and demographic characteristics. With respect to low-intensity physical activity, weekly duration was measured as the number of days per week with at least 10 minutes of physical activity (responses ranged from 1 to 7 days); daily duration was defined as the total minutes of low-intensity physical activity per day, categorized as 10–30 minutes (coded as 1) or 30 minutes to 2 hours (coded as 2); and the purpose of low-intensity physical activity included work-related activity (coded as 1), leisure or entertainment (coded as 2), physical exercise (coded as 3), or other purposes (coded as 4). Demographic characteristics included age (in years) and sex (male coded as 1, female coded as 2). Control variables encompassed the physical living environment and individual and family life factors. The physical living environment included the administrative type of residential area, categorized as city or town center (coded as 1), urban–rural or town–village fringe areas (coded as 2), rural areas (coded as 3), and special areas (coded as 4); housing type, including single-story houses (coded as 1), general apartment buildings (coded as 2), and detached houses (coded as 3); and toilet type, including squatting toilets (coded as 1) and sitting toilets (coded as 2). Individual and family life factors included alcohol consumption, assessed by the question: “In the past year, did you drink alcohol, including beer, wine, rice wine, yellow wine, spirits, or medicinal liquor? How frequently did you drink?” with three response categories. In this study, “drinking alcohol more than once per month” was coded as 0; “drinking alcohol less than once per month” was coded as 1; and “not drinking any alcohol” was coded as 2. Marital status was assessed by the question: “What is your current marital status?” with six response options. Specifically, “never married” was coded as 0; “married and living with spouse” as 1; “married but temporarily not living with spouse due to work or other reasons” as 2; “separated and no longer living together as spouses” as 3; “divorced” as 4; and “widowed” as 5. 2.2Descriptive analysis Among the 9,337 samples included in this study (Age, Min = 45 years, Max = 108 years; M = 61.86 years; SD = 9.750), there were 4,463 men and 4,874 women. A total of 1,598 individuals reported having experienced a fall (625 men and 973 women), accounting for 17.1% of the overall sample, as detailed in Table 1 . The distribution of falls among middle-aged and older adults by age and sex is presented in Table 1 . Table 1 Basic characteristics of the study population(n = 9337) Number of individuals without falls (percentage) Number of participants with falls(percentage) Number of participants Sex Male 3838(86.0%) 625(14.0%) 4463(100.0%) Female 3901(80.0%) 973(20.0%) 4874(100.0%) Age Group 45–64 years 4931(86.2%) 790(13.8) 5721(100.0%) 65 years and above 2808(77.9%) 808(22.1%) 3616(100.0%) Weekly Duration of Low-Intensity Physical Activity 1 day 160(73.4%) 58(26.6%) 218(100.0%) 2 days 445(80.9%) 105(19.1%) 550(100.0%) 3 days 767(83.2%) 165(17.7%) 932(100.0%) 4 days 481(82.4%) 103(17.6%) 584(100.0%) 5 days 617(84.8%) 111(15.2%) 728(100.0%) 6 days 168(87.0%) 25(13.0%) 193(100.0%) 7 days 5101(83.2%) 1031(16.8%) 6132(100.0%) Daily Duration of Low-Intensity Physical Activity Less than 30 minutes 1422(79.8%) 361(20.2%) 1783(100.0%) More than 30 minutes (less than 2 hours) 6317(83.6%) 1237(16.4%) 7554(100.0%) Purpose of Low-Intensity Physical Activity Work-related 1568(83.5%) 309(16.5%) 1877(100.0%) Recreation 940(82.4%) 201(17.6%) 1141(100.0%) Exercise 4560(83.2%) 920(16.8%) 5480(100.0%) Exercise 671(80.0%) 168(20.0%) 839(100.0%) Type of Residential Area Urban or town central area 2340(84.2%) 439(15.8%) 2779(100.0%) Urban–rural or town–village transitional area 1080(86.3%) 172(13.7%) 1252(100.0%) Rural 4302(81.4%) 985(18.6%) 5287(100.0%) Special area 14(100.0%) 0(0.0%) 14(100.0%) Type of Housing Single-story house 2603(81.4%) 594(18.6%) 3197(100.0%) Regular multi-story building 2472(84.9%) 441(15.1%) 2913(100.0%) Detached house 2664(82.6%) 563(17.4%) 3227(100.0%) Type of Toilet Squat 4411(81.6%) 997(18.4%) 5408(100.0%) Sit 3328(84.7%) 601(15.3%) 3929(100.0%) Alcohol Consumption in the Past Year Do not drink 4782(82.3%) 1028(17.7%) 5810(100.0%) Drink,more than once per month 2174(84.2%) 409(15.8%) 2583(100.0%) Drink, less than once per month 783(82.9%) 161(17.1%) 944(100.0%) Current Marital Status Never married 32(72.7%) 12(27.3%) 44(100.0%) Married and living with spouse 5941(84.5%) 1086(15.5%) 7027(100.0%) Married but temporarily not living with spouse due to work or other reasons 656(83.0%) 134(17.0%) 790(100.0%) Separated, no longer living with spouse 30(76.9%) 9(23.1%) 39(100.0%) Divorced 118(76.6%) 36(23.4%) 154(100.0%) Widowed 962(75.0%) 321(25.0%) 1283(100.0%) 3. Model Results and Analysis 3.1 Univariate Screening Using Binary Logistic Regression Regarding variable selection for logistic regression, when numerous risk factors are involved, univariate analysis can be adopted for preliminary screening; however, appropriate adjustment of the significance level and consideration of professional judgment should be combined when selecting variables for multivariable analysis[ 18 ]. Independent variables that are not statistically significant in univariate analysis should not be arbitrarily excluded, in order to avoid omitting important risk factors. Commonly used univariate analysis methods include the chi-square test, t test, analysis of variance, and rank-sum test. When the number of variables is large or the sample size is limited, univariate analysis can be used to screen independent variables, after which only variables with significant effects are retained for multivariable regression analysis.The results of the independent-samples t test showed that age (t=-10.963, df = 9335, p < 0.001;) and the weekly duration of low-intensity physical activity (t = 2.611, df = 9335, p = 0.009) were statistically significant. The chi-square test results indicated that sex (χ 2 = 58.319, df = 1, p < 0.001), daily duration of low-intensity physical activity (χ 2= 15.240, df = 1, p < 0.001), type of toilet facility (χ 2 = 15.808, df = 1, p < 0.001), type of residential area (χ 2 = 24.933, df = 3, p < 0.001), housing type (χ 2 = 13.104, df = 2, p = 0.001), and marital status (χ 2 = 78.613, df = 5, p < 0.001) were significantly associated with falls. In contrast, alcohol consumption in the past year (χ 2 = 4.360, df = 2, p = 0.113) and the purpose of low-intensity physical activity (χ 2 = 6.182, df = 3, p = 0.103) were not statistically significant.To avoid omission of important variables, the significance level for differences can be appropriately relaxed to 0.10, 0.15, or even 0.20 (Wu Zhenqiang, Wang Yang, & Li Wei, 2014). The results showed that although “alcohol consumption in the past year” (p = 0.113) and “purpose of low-intensity physical activity” (p = 0.103) were not statistically significant, both p values were below 0.15. Therefore, to prevent omission of important factors related to falls among middle-aged and older adults, all explanatory variables were retained in this study. 2.2Multicollinearity diagnosis For multicollinearity diagnostics in the logistic regression model, this study employed the variance inflation factor (VIF), which is the reciprocal of tolerance (TOL). Generally, a VIF ≥ 5 or VIF ≥ 10 indicates serious multicollinearity among independent variables[ 19 ]. In addition, a VIF = 1 indicates that an independent variable is completely uncorrelated with other independent variables, whereas 1 < VIF < 5 suggests a certain degree of correlation that is typically considered acceptable. Multicollinearity diagnostics were conducted for all explanatory variables in this study, with categorical variables transformed into dummy variables. The results showed that the VIF values for all variables were below 5, indicating that there was no serious multicollinearity among the factors included in the model. 3.3 Results of Binary Logistic Regression This study primarily examines whether the duration of low-intensity physical activity can predict falls among middle-aged and older adults in China. The main analytical variables included the weekly duration of low-intensity physical activity and the daily duration of low-intensity physical activity, while the secondary factor was the purpose of low-intensity physical activity. Demographic variables included age and sex. Control variables comprised type of toilet, type of residential area, type of housing, alcohol consumption status, and marital status. Table 2 reports the results of the binary logistic regression analyses examining the effects of the above variables on falls among middle-aged and older adults.Model 1 examined the predictive effects of age, sex, weekly duration of low-intensity physical activity, daily duration of low-intensity physical activity, and purpose of low-intensity physical activity on falls among middle-aged and older adults. The results indicated that all the above variables showed statistically significant differences at the 0.05 level. Specifically, age was identified as a risk factor, with each additional year of age associated with a 3.2% increase in fall risk (p < 0.001). In terms of sex, the risk of falling among women was 1.565 times that among men (p < 0.001). The weekly duration of low-intensity physical activity was a protective factor, such that each additional day of activity (compared with only one day per week) was associated with a 4.4% reduction in fall risk (p = 0.002). The daily duration of low-intensity physical activity was also a protective factor; compared with individuals who exercised for 10–30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day exhibited a 17.0% lower risk of falling (p = 0.006). The purpose of low-intensity physical activity did not predict falls among middle-aged and older adults (p = 0.159).Based on Model 1, Model 2 further controlled for type of residential area, type of housing, and type of toilet. The results showed that age remained a risk factor, with each additional year of age associated with a 3.1% increase in fall risk (p < 0.001). The odds ratio for sex was consistent with that in Model 1, indicating that women had a 1.565 times higher risk of falling than men (p < 0.001). Each additional day of low-intensity physical activity per week (compared with only one day) was associated with a 4.2% reduction in fall risk (p = 0.004). Compared with individuals who exercised for 10–30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day had a 15.2% lower risk of falling (p = 0.016). Regarding toilet type, middle-aged and older adults using sit toilets had a 15.2% lower risk of falling compared with those using squat toilets (p = 0.011). The purpose of low-intensity physical activity, type of residential area, and type of housing did not significantly predict falls among middle-aged and older adults (p > 0.05).Model 3 further controlled for alcohol consumption and marital status on the basis of Model 2. The results of Model 3 showed that each additional year of age was associated with a 3.0% increase in fall risk (3.2% in Model 1 and 3.1% in Model 2). The risk of falling among women was 1.661 times that among men (1.565 times in both Model 1 and Model 2). Each additional day of low-intensity physical activity per week (compared with only one day) was associated with a 4.1% reduction in fall risk (4.4% in Model 1 and 4.2% in Model 2). Compared with individuals who exercised for 10–30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day exhibited a 14.6% lower risk of falling (17.0% in Model 1 and 15.2% in Model 2). Middle-aged and older adults using sit toilets had a 13.7% lower risk of falling compared with those using squat toilets (15.2% in Model 2). Drinking alcohol more than once per month was identified as a risk factor; compared with non-drinkers, middle-aged and older adults who drank alcohol more than once per month had a 21.5% higher risk of falling. Middle-aged and older adults who were married and living with their spouse had a 55.5% lower risk of falling compared with those who had never married (p = 0.020). In Model 3, the purpose of low-intensity physical activity, type of residential area, and type of housing did not significantly predict falls among middle-aged and older adults (p > 0.05). The Hosmer–Lemeshow test results for the three models were as follows: Model 1 (χ 2 = 6.093, df = 8, p = 0.637); Model 2 (χ 2 = 7.398, df = 8, p = 0.494) and Model 3 (χ 2 = 6.719, df = 8, p = 0.567). As the p-values of the Hosmer–Lemeshow tests for all three models were greater than 0.05, the null hypothesis was accepted, indicating that all three models demonstrated a good fit to the observed data. Table 2 Regression results of factors influencing falls among middle-aged and older adults (binary logistic model) Fall Model 1 Fall Model 2 Fall Model 3 Variables (VIF) OR(95% CI) p OR(95% CI) p OR(95% CI) p Age (1.250) 1.032(1.026–1.038) < 0.001** 1.031(1.025 ~ 1.037) < 0.001** 1.030(1.024 ~ 1.037) < 0.001 Sex (1.312) < 0.001** Male Ref Ref Ref Female 1.565(1.400 ~ 1.749) < 0.001** 1.565(1.400 ~ 1.750) < 0.001** 1.661(1.462 ~ 1.887) < 0.001** Weekly Duration of Low-Intensity Physical Activity (1.023) 0.956(0928 ~ 0.984) 0.002** 0.958(0.931 ~ 0.987) 0.004** 0.959(0.931 ~ 0.987) 0.005** Daily Duration of Low-Intensity Physical Activity (1.072) 0.830(0.727 ~ 0.949) 0.006** 0.848(0.742 ~ 0.970) 0.016* 0.854(0.747 ~ 0.977) 0.022* Purpose of Low-Intensity Physical Activity 0.159 0.321 Livelihood-related Ref Ref Ref Recreation (1.444) 0.910(0.745 ~ 1.111) 0.355 0.932(0.763 ~ 1.139) 0.493 0.930(0.761 ~ 1.137) 0.478 Physical exercise (1.744) 0.864(0.747 ~ 0.999) 0.049 0.908(0.783 ~ 1.053) 0.200 0.917(0.790 ~ 1.064) 0.252 Other purposes (1.375) 0.994(0.803 ~ 1.232) 0.960 1.054(0.849 ~ 1.308) 0.636 1.055(0.849 ~ 1.311) 0.628 Type of Residential Area 0.105 Urban or town central area Ref Ref Urban–rural or town–village transitional area (1.417) 0.838(0.684 ~ 1.027) 0.088 0.850(0.693 ~ 1.043) 0.119 Rural (2.342) 1.056(0.891 ~ 1.252) 0.528 1.082(0.912 ~ 1.283) 0.368 Special area (1.009) - - - Type of Housing 0.799 Single-story house Ref Ref Regular multi-story building (2.481) 0.938(0.777 ~ 1.132) 0.504 0.928(0.769 ~ 1.121) 0.440 Detached house (1.357) 0.980(0.860 ~ 1.116) 0.758 0.979(0.859 ~ 1.117) 0.756 Type of Toilet 0.011* Squat Ref Ref Sit (1.281) 0.848(0.747 ~ 0.962) 0.011* 0.863(0.760 ~ 0.980) 0.023* Alcohol Consumption 0.017* Do not drink Ref Drink more than once per month (1.324) 0.008** 1.215(1.053 ~ 1.402) 0.008** Drink less than once per month (1.085) 0.104 1.170(0.968 ~ 1.414) 0.104 Marital Status < 0.001** Never married (Ref) Ref Married and living with spouse (1.050) 0.020* 0.445(0.226 ~ 0.878) 0.020 Married but temporarily not living with spouse due to work or other reasons (1.003) 0.104 0.559(0.277 ~ 1.128) 0.104 Separated, no longer living with spouse (1.011) 0.599 0.762(0.277 ~ 2.097) 0.599 Divorced (1.197) 0.585 0.805(0.370 ~ 1.753) 0.585 Widowed (1.007) 0.093 0.551(0.276 ~ 1.103) 0.093 Note: ∗∗、∗ indicate statistical significance at the 1% and 5% levels,respectively. “-”indicates that the sample size was too small, resulting in extreme values without statistical significance;therefore,these results are not reported. 4. Discussion Falls are a common geriatric syndrome. Falls among middle-aged and older adults are mostly not accidental events but are associated with complex risk factors. For example, age-related loss of muscle mass leading to frailty or restricted mobility, declines in depth perception that interfere with visual judgment, changes in the inner ear causing dizziness and loss of balance, insufficient cerebral perfusion due to orthostatic hypotension, and side effects of certain medications may all contribute to falls[ 20 ]. In addition, the occurrence of falls is closely related to demographic characteristics and exercise habits, further increasing the complexity of falls among middle-aged and older adults. According to the results of this study, first, at the level of demographic characteristics, both age and sex independently affect falls among middle-aged and older adults. Age is a risk factor for falls, with fall risk increasing as age increases, which is consistent with the findings of Peel, Nancye May[ 21 ]. For Chinese middle-aged and older adults, each one-year increase in age is associated with a 3%–3.2% increase in fall risk. The age-related increase in fall risk may be attributable to age-related adverse conditions, such as physical frailty, impairments in balance, cognition, and vision, medication use, acute illnesses, and environmental factors. In particular, individuals with a history of falls are at a higher risk of recurrent falls. Female middle-aged and older adults are more likely to experience falls than males, with fall risk being 1.565–1.661 times higher among women. This may be because women in middle and later life are more prone to osteoporosis [ 20 ], highlighting the need for more targeted preventive strategies for this group. For example, supplementation with vitamin D and calcium may be more effective in reducing falls among middle-aged and older women [ 22 ]. However, some studies [ 23 ], based on 35 randomized controlled trials involving 58,937 older adults, have shown that daily supplementation with 800–1000 IU of vitamin D can significantly reduce fall incidence by 15%, regardless of sex composition or living arrangements. The mechanism by which vitamin D reduces falls may be explained by its role in regulating calcium homeostasis and improving muscle strength and balance, thereby reducing fall risk. Overall, developing multidimensional preventive measures that integrate demographic characteristics, physiological changes, and nutritional interventions is of great importance for reducing fall risk among middle-aged and older adults. Second, regarding the time characteristics of low-intensity physical activity, both the number of exercise days per week and the duration of daily exercise (protective factors) independently influence falls among middle-aged and older adults. Compared with those who engaged in low-intensity physical activity for only one day per week, each additional day of activity (at least 10 minutes per day) was associated with a 4.1%–4.4% reduction in fall risk. This finding is highly consistent with the study by Peeters et al. [ 24 ], which reported that each additional 100 units of physical activity (e.g., 30 minutes of walking) reduced fall risk among older adults by approximately 4%. Compared with individuals who exercised for 10–30 minutes per day, those who engaged in low-intensity physical activity for 30 minutes to 2 hours per day experienced a 14.6%–17.0% lower risk of falls. These results indicate that increasing the duration of low-intensity physical activity can significantly reduce the probability of falls among middle-aged and older adults. For example, engaging in at least 50 hours of low-intensity physical activity over a three-month period (approximately 33 minutes per day) can reduce fall risk among older adults, and this conclusion is also applicable to middle-aged populations [ 8 ]. Regular physical activity has potential health-regulating effects for middle-aged and older adults, similar to pharmacological interventions for patients with chronic diseases. Therefore, fall prevention among middle-aged and older adults in China requires appropriate exercise prescriptions, particularly low-intensity physical activity programs tailored to individual needs. Third, the motivational characteristics (purpose) of low-intensity physical activity were not predictive of falls among middle-aged and older adults in China. Whether the purpose of exercise was to enhance physical fitness or for other reasons, exercise motivation did not directly predict fall occurrence. This may be because falls are unstable and uncontrollable events that are not determined by individuals’ subjective intentions or the will of others. Thus, although exercise motivation may influence the level of physical activity participation, it does not directly determine fall risk. As falls result from the combined effects of multiple factors [ 25 ], fall prevention requires comprehensive consideration and multifaceted interventions. Finally, after incorporating physical living environment variables, including type of residential area, housing type, and type of toilet facility, age, sex, and low-intensity physical activity duration remained significant predictors of falls among middle-aged and older adults. Further inclusion of personal and family life characteristics (including alcohol consumption and marital status) showed that the predictive effects of age, sex, and low-intensity physical activity duration on falls remained largely unchanged. At the same time, type of toilet facility, alcohol consumption, and marital status were also found to influence falls among middle-aged and older adults to some extent. In summary, preventing falls among middle-aged and older adults requires an integrated consideration of demographic characteristics, physiological changes, nutritional interventions, and exercise habits. Independent influencing factors such as age, sex, and low-intensity physical activity duration provide a scientific basis for developing personalized fall prevention strategies. 5. Conclusions and Recommendations 5.1 Conclusions (1) The weekly duration of low-intensity physical activity can independently predict falls among middle-aged and older adults. Specifically, compared with those who engaged in low-intensity physical activity for only one day per week, each additional day of activity is associated with a 4.1%–4.4% reduction in fall risk. (2) The daily duration of low-intensity physical activity can also independently predict falls among middle-aged and older adults. Compared with individuals who exercised for 10–30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day experienced a 14.6%–17.0% lower risk of falling. (3) In addition to age and the duration of low-intensity physical activity, age, sex, type of toilet facility, alcohol consumption status, and marital status are also relevant factors influencing falls among middle-aged and older adults in China. 5.2 Recommendations (1) With fall prevention as the primary objective, safe, affordable, and effective low-intensity physical activity should be widely promoted. The National Health Commission should further strengthen health education to enhance fall-prevention awareness among middle-aged and older adults. Adhering to the principles of gradual progression, exercising within one’s capacity, long-term adherence, and safety first, low-intensity activities such as ultra-slow jogging, Tai Chi, and the Twelve Zodiac Health Qigong should be actively promoted and popularized to reduce fall risk. Specific guidance on low-intensity physical activity could be incorporated into Health Literacy of Chinese Citizens—Basic Knowledge and Skills , encouraging middle-aged and older adults to engage in low-intensity physical activity at least 3–5 days per week, with each session lasting 30 minutes to 2 hours according to individual conditions. In this process, technology-enabled approaches may also be adopted to support safe and scientific exercise among older adults. For example, wearable devices (e.g., smart bands, health apps) can be used to monitor physical activity levels, provide real-time feedback and reminders, and help older adults manage exercise duration and intensity more effectively. Overall, exercise-based interventions play a crucial role in the complex system of fall prevention among middle-aged and older adults, although large-scale implementation and effective execution remain challenging. (2) Improve the living environment and reduce environmental risk factors for falls. In terms of health screening, osteoporosis screening and prevention should be strengthened for middle-aged and older women, especially postmenopausal women. Regular bone mineral density testing is recommended at community health service centers, along with guidance on vitamin D and calcium supplementation. Regarding nutritional interventions, national efforts should be intensified to promote awareness of vitamin D and calcium supplementation, encouraging adequate intake through diet and supplements. Communities can organize nutrition education sessions to disseminate knowledge on osteoporosis prevention. In terms of exercise interventions, tailored balance training and core stability programs should be designed for middle-aged and older women to enhance muscle strength and balance and thereby reduce fall risk. (3) Improve the living environment and reduce environmental risk factors for falls. The government should promote age-friendly home modifications for older adults, particularly in rural areas and urban–rural transitional regions. It is recommended that provisions on housing safety for older adults be incorporated into the Law on the Protection of the Rights and Interests of Older Persons , encouraging households to install non-slip flooring, handrails, and sit-down toilets to reduce environmental fall risks. Of particular importance is the promotion of sit-down toilets, especially in rural areas. Government subsidy policies could encourage households to replace squat toilets with sit-down toilets for older adults, thereby reducing the risk of falls during toileting. (4) Strengthen health education and enhance fall-prevention awareness among middle-aged and older adults. The National Health Commission should intensify health education on fall prevention for middle-aged and older adults through multiple channels, including television, radio, and social media, to disseminate relevant knowledge and skills. Communities can regularly organize fall-prevention lectures, inviting experts to explain how posture management, nutrition, and environmental modifications can help prevent falls. In addition, family members should be encouraged to participate in the health management of older adults by helping them identify and avoid fall risks. Family members should regularly assess the safety of the living environment to ensure adequate protection. Moreover, necessary psychological support and interventions should not be overlooked. Falls not only affect physical health but may also have negative psychological impacts on middle-aged and older adults. Communities should provide psychological counseling services to help older adults overcome fear of falling and enhance confidence and independence. (5) Enhance health management related to alcohol consumption and marital status. With regard to alcohol consumption, health management should be strengthened for middle-aged and older adults, particularly those who drink more than once per month. Communities can disseminate information through health lectures and educational materials on the association between excessive alcohol consumption and increased fall risk, encouraging moderation or abstinence. In terms of marital support, for widowed or older adults living alone, communities should provide greater social support, such as organizing social activities and offering psychological counseling, to reduce loneliness and depressive symptoms and thereby lower fall risk. Declarations Acknowledgement We would like to thank the anonymous peer reviewers for their insightful comments that helped improve this paper Authors' contributions Zhou Jiang: proposed the primary research objectives and was responsible for the conception and design of the study, study implementation, manuscript drafting, overall accountability for the article, and supervision. Chenghao Zheng: conducted data collection and organization, statistical analyses, preparation and presentation of figures and tables, manuscript revision, and overall review of the paper. YanDan Wu:Reviewed the manuscript, clarified the research logic, and revised the paper. Funding Statement This work was supported by a grant from Research on the Construction of a High-Quality Development System for Public Sports Services for Persons with Disabilities and Its Practice in China [grant number 24BTY045 ] Data availability All data analyzed during this study are included in this article [and its supplementary information files]. Ethics approval and consent to participate Not applicable Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Cao L, Tong G, Yang G, et al. Multidimensional risk factors influencing falls among older adults. China Sport Sci Technol. 2012;48(03):96–9. CHEN SIYI, et al. Epidemiological Characteristics of Falls from the National Injury Surveillance System—China, 2019–2022[J]. China CDC Wkly. 2024;6(49):1283–8. GUSTAVSSON J, NILSON F, BONANDER C, et al. Compliant sports floors and fall-related injuries: evidence from a residential care setting and updated meta-analysis for all patient care settings[J]. Inj Prev. 2023;4(29):283–9. Yuan Y, Li H. Inequality in falls among older adults in China under the Healthy China initiative: An empirical analysis based on three waves of CHARLS data. Popul Dev. 2020;26(4):72–85. Song B, Liu C, Lü S. The role of moderate physical exercise in reducing fall incidence and improving cognitive function among older adults. Chin J Gerontol. 2020;40(4):807–10. BERGEN GWEN. Falls and fall injuries among adults aged ≥ 65 years—United States, 2014. MMWR Morb Mortal Wkly Rep, 2016, 65. ADAMS MICHAEL, et al. Effects of physical activity interventions on strength, balance and falls in middle-aged adults: a systematic review and meta-analysis[J]. Sports Medicine-Open. 2023;9(1):61. CABAN-MARTINEZ ALBERTOJ, et al. Leisure-time physical activity, falls, and fall injuries in middle-aged adults[J]. Am J Prev Med. 2015;49(6):888–901. SOCIAS-MORALES CM, CHAUMONT MENÉNDEZ CK, MARSH SM. Fatal work-related falls in the United States, 2003–2014. Am J Ind Med. 2018;61(3):204–15. BROWN RT, COVINSKY KE. Moving prevention of functional impairment upstream: is middle age an ideal time for intervention?[J]. Womens Midlife Health. 2020;6(4):1–9. MAO MIN, et al. The effect of Tai Chi lower extremity exercise on the balance control of older adults in assistant living communities. BMC Complement Med Ther. 2024;24(1):112. SHERRINGTON CATHERINE, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008;56(12):2234–43. GARDNER MM, ROBERTSON MC, CAMPBELL AJ. Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials.Brit. J Sport Med. 2000;34:7–17. YANG ZHEN et al. Physical activity, sedentary behaviour, and cognitive function among older adults: A bibliometric analysis from 2004 to 2024. Ageing Res Rev (2024): 102283. IZQUIERDO MIKEL, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines. J Nutr Health Aging. 2021;25(7):824–53. Wu YM, Yang Y, Luo SL. Interpretation of the International Physical Activity Guidelines for Older Adults: An Expert Consensus[J]. Nurs Res. 2022;36(10):1701–5. FORD AMYE. LEIF A. FORD.2016. Middle Adulthood: Physical and Cognitive Development. Human Growth and Development Across the Lifespan: Applications for Counselors,: 443–474. Xu RF. An empirical analysis of variable selection and regression method choice in logistic regression [J]. Chin J Evidence-Based Med. 2016;16(11):1360–4. Zhou F, Zhao FL, Wei XM, et al. Multicollinearity diagnostics in logistic regression models and their application in medicine [J]. J Gansu Univ Chin Med. 2014;31(01):90–3. EASTELL R, O’NEILL TW, Hofbauer LC, Langdahl B, Reid IR, Gold DT, et al. Postmenopausal osteoporosis. Nat Rev Dis Primers. 2016;2(1):16069. PEEL. Epidemiology of falls in older age. Can J Aging/La Revue canadienne du vieillissement. 2011;30(1):7–19. LARSEN ERIKROJ, LEIF MOSEKILDE, AND ANDERS FOLDSPANG. Vitamin D and calcium supplementation prevents severe falls in elderly community-dwelling women: a pragmatic population-based 3-year intervention study. Aging Clin Exp Res. 2005;17:125–32. TAN LONG, RUIQIAN HE, AND XIAOXUE ZHENG. Effect of vitamin D, calcium, or combined supplementation on fall prevention: a systematic review and updated network meta-analysis. BMC Geriatr. 2024;24(1):390. PEETERS GMEE, et al. Is there a U-shaped association between physical activity and falling in older persons? Osteoporos Int. 2010;21:1189–95. JIANG YUESHUAI, et al. The association between sedentary behavior and falls in older adults: A systematic review and meta-analysis. Front public health. 2022;10:1019551. Additional Declarations No competing interests reported. Supplementary Files Dataavailability.rar Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8416360","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":563752719,"identity":"91b23674-dfa2-42bf-93e3-793e7a75cae7","order_by":0,"name":"Zhou Jiang","email":"","orcid":"","institution":"Shandong University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Zhou","middleName":"","lastName":"Jiang","suffix":""},{"id":563752720,"identity":"4a7a66aa-9995-41f4-9a5d-0963204504f7","order_by":1,"name":"ChengHao 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09:12:43","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":64093,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2. Fall status among middle-aged and older adults across different age groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8416360/v1/41443549258637ba5c96acfb.jpeg"},{"id":99794293,"identity":"680e2fdd-a292-46b8-8966-cc4e0f3f33f4","added_by":"auto","created_at":"2026-01-08 13:34:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1710402,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8416360/v1/3757db18-e723-4962-b873-5dec0e9bab8f.pdf"},{"id":98860773,"identity":"74bbe386-ac90-4913-a51e-708d092f0186","added_by":"auto","created_at":"2025-12-23 09:12:44","extension":"rar","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18602290,"visible":true,"origin":"","legend":"","description":"","filename":"Dataavailability.rar","url":"https://assets-eu.researchsquare.com/files/rs-8416360/v1/cb16441d553bba41c9c0c1af.rar"}],"financialInterests":"No competing interests reported.","formattedTitle":"Study on the Association Between Low-Intensity Physical Activity Duration and Falls Among Middle-Aged and Older Adults in China — An Empirical Analysis Based on the CHARLS Database","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eA fall is defined as a sudden, unintentional change in position that causes an individual to come to rest on the ground or at a lower level, and is not the result of sudden paralysis, epileptic seizures, or overwhelming external forces[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to reports from the National Bureau of Statistics of China, a total of 2,324,577 fall incidents occurred between 2019 and 2022, with most falls taking place at home, accounting for 39.41% of all cases[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The National Health Commission of the People\u0026rsquo;s Republic of China revised and issued \u003cem\u003eHealth Literacy of Chinese Citizens\u0026mdash;Basic Knowledge and Skills (2024 Edition)\u003c/em\u003e, which explicitly emphasizes the importance of fall prevention (Article 21: caring for older adults, preventing falls among older adults, and identifying senile dementia) and encourages older adults to enhance their awareness of fall prevention.China has the largest older population in the world, accounting for approximately one quarter of the global older population[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and falls have ranked as the leading cause of medical visits due to unintentional injuries among older adults in China for several consecutive years[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. According to data from the World Health Organization (WHO), approximately 684,000 people die from falls each year worldwide, with more than 80% of these deaths occurring in low- and middle-income countries or regions; falls are a common cause of accidental injury-related mortality globally. Falls are also a major contributing factor to disability, functional decline, and even death among older adults[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].The process of human ageing is universal, pervasive, and inevitable, during which all physiological functions progressively decline, leading to an increased probability of falls with advancing age. As demonstrated by a nationwide survey, approximately 28.7% of older adults self-reported experiencing at least one fall in the past year, among whom 37.5% were hospitalized due to fall-related injuries[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Falls among older adults have been formally recognized as a global issue; however, this problem tends to be overlooked in middle-aged populations[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].The prevalence of falls among middle-aged individuals ranges from approximately 11.4% to 31.4%, with 35% of these being severe falls requiring hospitalization[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].Nevertheless, existing fall prevention guidelines primarily target populations aged 60 or 65 years and older. For example, \u003cem\u003ethe World Guidelines for Falls Prevention and Management for Older Adults\u003c/em\u003e issued by the World Falls Guidelines Working Group, as well as \u003cem\u003ethe Technical Guidelines for Fall Interventions among Older Adults\u003c/em\u003e published by the Ministry of Health of the People\u0026rsquo;s Republic of China, mainly focus on individuals aged 60 or 65 years and above. Evidently, early fall prevention has not yet received sufficient attention. Although some studies have emphasized that midlife represents a critical period for fall prevention, individuals aged 45\u0026ndash;60 years constitute a substantial proportion of the labor force; therefore, falls in this group may result in non-negligible consequences[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As noted by Mack KA et al. (2013), falls rank as the third leading cause of unintentional injury-related mortality among middle-aged adults. Recent studies further indicate that individuals aged 45\u0026ndash;60 years face considerable public health and social challenges[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The health status of middle-aged adults has profound implications for labor force participation and public expenditure, and also serves as a predictor of ageing-related adverse events later in life.\u003c/p\u003e \u003cp\u003eTaken together, fall prevention constitutes one of the most critical components of injury and fracture prevention programmes for middle-aged and older adults; however, existing research has predominantly focused on older populations. A large body of evidence indicates that, compared with older adults who are physically inactive or sedentary, those who engage in regular physical activity have a lower risk of falling, suggesting that physical activity serves as a protective factor against falls[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. For example, an observational systematic review and meta-analysis reported that exercise interventions could reduce fall rates by 17%[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, a national survey found that only 15.4% of older adults participated in physical exercise, and the vast majority tended to engage in low-intensity physical activities[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Low-intensity physical activity has demonstrated clear benefits for clinically defined high-risk older adults\u0026mdash;namely, individuals who have experienced hospitalisation or at least two consecutive days of bed rest within the past month\u0026mdash;by significantly reducing their risk of falls. Nevertheless, the effectiveness of low-intensity physical activity in preventing falls among older adults remains controversial. Some scholars argue that low-intensity physical activity may increase the risk of falls among healthy older adults[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. One possible explanation is that older adults with higher physical function may require a higher exercise threshold to achieve beneficial effects and therefore may not gain sufficient benefits from small increases in muscle strength. Another potential explanation is that increases in overall physical activity may themselves elevate exposure to fall-related risks.Conversely, other studies suggest that the long-term benefits of regular physical exercise for older adults far outweigh the potential harms[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Epidemiological evidence shows that although the risk of myocardial infarction is higher during exercise than at rest, the overall risk of myocardial infarction among older adults who exercise regularly is approximately 50% lower than that among those who only engage in routine daily activities[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, these benefits appear to be independent of participants\u0026rsquo; age, physical function, or cognitive status[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. It should be noted, however, that while physical activity can reduce fall risk, prolonged duration or high-intensity physical activity may substantially increase exposure to hazardous environments, thereby elevating the likelihood of severe falls. Therefore, moderate levels of physical activity are crucial for reducing both falls and fall-related injuries. Although low-intensity physical activity is well suited to middle-aged and older populations and is beneficial for improving muscle strength, gait, and balance, the scientific evidence regarding its effectiveness in reducing falls is complex. In particular, the association between the duration of low-intensity physical activity and fall risk among middle-aged and older adults remains unclear, with a lack of context-specific and evidence-based research in China. Given that midlife represents a critical transitional period into older age, health behaviours during this stage are of great importance for the prevention of chronic diseases and the extension of life expectancy[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Accordingly, this study aims to examine whether the duration of low-intensity physical activity can effectively predict falls among middle-aged and older adults in China. By elucidating the dose\u0026ndash;time relationship between physical activity and falls, this study seeks to provide empirical evidence for the development of more scientifically grounded and appropriate exercise intervention strategies for middle-aged and older adults in China.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data Sources and Variable Definitions\u003c/h2\u003e \u003cp\u003eThis study uses data from the China Health and Retirement Longitudinal Study (CHARLS) and applies a binary logistic regression model to empirically examine factors influencing falls among middle-aged and older adults in China, with a particular focus on whether the duration of low-intensity physical activity can predict falls in this population. The data were derived from the fifth wave of the China Health and Retirement Longitudinal Study (CHARLS), which is currently the most recent and nationally representative survey of middle-aged and older adults in China. CHARLS, released by the National School of Development at Peking University, is a longitudinal survey representative of the Chinese mainland population aged 45 years and above. The survey collects multidimensional information covering socioeconomic status and health conditions to meet the needs of ageing-related research. All waves of CHARLS have received ethical approval from the Biomedical Ethics Committee of Peking University. The ethical approval number for the fieldwork of the fifth-wave household survey is IRB00001052-11015. This study obtained 20,180 observations from the 2020 CHARLS dataset through the official CHARLS website(\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://charls.pku.edu.cn/\u003c/span\u003e\u003cspan address=\"http://charls.pku.edu.cn/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). First, 785 cases with unrecorded registration information or loss to follow-up were excluded, along with 950 cases that did not report fall status. Subsequently, cases that failed to report responses to the following items were excluded: \u0026ldquo;DA033: How many days per week do you usually engage in low-intensity physical activity for at least 10 minutes?\u0026rdquo;, \u0026ldquo;DA034: How much time per day do you spend on a certain low-intensity physical activity?\u0026rdquo;, \u0026ldquo;DA035: How much time per day do you spend on a certain low-intensity physical activity?\u0026rdquo;, \u0026ldquo;DA036: How much time per day do you spend on a certain low-intensity physical activity?\u0026rdquo;, and \u0026ldquo;DA037: Is this activity undertaken for work, leisure activities, physical exercise, or other purposes?\u0026rdquo;. Finally, cases with missing values in sex (BA001), marital status (BA011), living alone status in the past half year (BA018), housing type (I004), type of residence area (BA008), purpose of physical activity (DA037), alcohol consumption status (DA051), and type of toilet facility (I013) were excluded. It should be noted that some cases had overlapping missing values across multiple variables; therefore, these cases were excluded simultaneously. After handling missing values and outliers in key variables, a final analytical sample of 9,337 valid observations was retained. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe dependent variable was falls. The survey question was: \u0026ldquo;Since the last interview, have you fallen?\u0026rdquo; In this study, \u0026ldquo;no fall\u0026rdquo; was coded as 0, and \u0026ldquo;having fallen\u0026rdquo; was coded as 1. The independent variables included low-intensity physical activity and demographic characteristics. With respect to low-intensity physical activity, weekly duration was measured as the number of days per week with at least 10 minutes of physical activity (responses ranged from 1 to 7 days); daily duration was defined as the total minutes of low-intensity physical activity per day, categorized as 10\u0026ndash;30 minutes (coded as 1) or 30 minutes to 2 hours (coded as 2); and the purpose of low-intensity physical activity included work-related activity (coded as 1), leisure or entertainment (coded as 2), physical exercise (coded as 3), or other purposes (coded as 4). Demographic characteristics included age (in years) and sex (male coded as 1, female coded as 2). Control variables encompassed the physical living environment and individual and family life factors. The physical living environment included the administrative type of residential area, categorized as city or town center (coded as 1), urban\u0026ndash;rural or town\u0026ndash;village fringe areas (coded as 2), rural areas (coded as 3), and special areas (coded as 4); housing type, including single-story houses (coded as 1), general apartment buildings (coded as 2), and detached houses (coded as 3); and toilet type, including squatting toilets (coded as 1) and sitting toilets (coded as 2). Individual and family life factors included alcohol consumption, assessed by the question: \u0026ldquo;In the past year, did you drink alcohol, including beer, wine, rice wine, yellow wine, spirits, or medicinal liquor? How frequently did you drink?\u0026rdquo; with three response categories. In this study, \u0026ldquo;drinking alcohol more than once per month\u0026rdquo; was coded as 0; \u0026ldquo;drinking alcohol less than once per month\u0026rdquo; was coded as 1; and \u0026ldquo;not drinking any alcohol\u0026rdquo; was coded as 2. Marital status was assessed by the question: \u0026ldquo;What is your current marital status?\u0026rdquo; with six response options. Specifically, \u0026ldquo;never married\u0026rdquo; was coded as 0; \u0026ldquo;married and living with spouse\u0026rdquo; as 1; \u0026ldquo;married but temporarily not living with spouse due to work or other reasons\u0026rdquo; as 2; \u0026ldquo;separated and no longer living together as spouses\u0026rdquo; as 3; \u0026ldquo;divorced\u0026rdquo; as 4; and \u0026ldquo;widowed\u0026rdquo; as 5.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2Descriptive analysis\u003c/h2\u003e \u003cp\u003eAmong the 9,337 samples included in this study (Age, Min\u0026thinsp;=\u0026thinsp;45 years, Max\u0026thinsp;=\u0026thinsp;108 years; M\u0026thinsp;=\u0026thinsp;61.86 years; SD\u0026thinsp;=\u0026thinsp;9.750), there were 4,463 men and 4,874 women. A total of 1,598 individuals reported having experienced a fall (625 men and 973 women), accounting for 17.1% of the overall sample, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The distribution of falls among middle-aged and older adults by age and sex is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics of the study population(n\u0026thinsp;=\u0026thinsp;9337)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of individuals without falls (percentage)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eNumber of participants with falls(percentage)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNumber of participants\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3838(86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e625(14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4463(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3901(80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e973(20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4874(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;64 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4931(86.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e790(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5721(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65 years and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2808(77.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e808(22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3616(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeekly Duration of Low-Intensity Physical Activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e160(73.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(26.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e218(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e445(80.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105(19.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e550(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e767(83.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165(17.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e932(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e481(82.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103(17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e584(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e617(84.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e728(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e168(87.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(13.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e193(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5101(83.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1031(16.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6132(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDaily Duration of Low-Intensity Physical Activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 30 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1422(79.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e361(20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1783(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 30 minutes\u003c/p\u003e \u003cp\u003e(less than 2 hours)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6317(83.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1237(16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7554(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePurpose of Low-Intensity Physical Activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork-related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1568(83.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e309(16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1877(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecreation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e940(82.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e201(17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1141(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4560(83.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e920(16.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5480(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e671(80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e168(20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e839(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Residential Area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban or town central area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2340(84.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e439(15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2779(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u0026ndash;rural or town\u0026ndash;village transitional area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1080(86.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e172(13.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1252(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4302(81.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e985(18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5287(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecial area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e14(100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Housing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle-story house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2603(81.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e594(18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3197(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular multi-story building\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2472(84.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e441(15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2913(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetached house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2664(82.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e563(17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3227(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Toilet\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSquat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4411(81.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e997(18.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5408(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3328(84.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e601(15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3929(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol Consumption\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ein the Past Year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not drink\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4782(82.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1028(17.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5810(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink,more than once per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2174(84.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e409(15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2583(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink, less than once per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e783(82.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e161(17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e944(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent Marital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e32(72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried and living with spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5941(84.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1086(15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7027(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried but temporarily not living with spouse due to work or other reasons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e656(83.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134(17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e790(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparated, no longer living with spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30(76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e118(76.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(23.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e154(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e962(75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e321(25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1283(100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Model Results and Analysis","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Univariate Screening Using Binary Logistic Regression\u003c/h2\u003e \u003cp\u003eRegarding variable selection for logistic regression, when numerous risk factors are involved, univariate analysis can be adopted for preliminary screening; however, appropriate adjustment of the significance level and consideration of professional judgment should be combined when selecting variables for multivariable analysis[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Independent variables that are not statistically significant in univariate analysis should not be arbitrarily excluded, in order to avoid omitting important risk factors. Commonly used univariate analysis methods include the chi-square test, t test, analysis of variance, and rank-sum test. When the number of variables is large or the sample size is limited, univariate analysis can be used to screen independent variables, after which only variables with significant effects are retained for multivariable regression analysis.The results of the independent-samples t test showed that age (t=-10.963, df\u0026thinsp;=\u0026thinsp;9335, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001;) and the weekly duration of low-intensity physical activity (t\u0026thinsp;=\u0026thinsp;2.611, df\u0026thinsp;=\u0026thinsp;9335, p\u0026thinsp;=\u0026thinsp;0.009) were statistically significant. The chi-square test results indicated that sex (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;58.319, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), daily duration of low-intensity physical activity (χ\u003csup\u003e2=\u003c/sup\u003e15.240, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), type of toilet facility (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;15.808, df\u0026thinsp;=\u0026thinsp;1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), type of residential area (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;24.933, df\u0026thinsp;=\u0026thinsp;3, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), housing type (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;13.104, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.001), and marital status (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;78.613, df\u0026thinsp;=\u0026thinsp;5, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with falls. In contrast, alcohol consumption in the past year (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.360, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.113) and the purpose of low-intensity physical activity (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.182, df\u0026thinsp;=\u0026thinsp;3, p\u0026thinsp;=\u0026thinsp;0.103) were not statistically significant.To avoid omission of important variables, the significance level for differences can be appropriately relaxed to 0.10, 0.15, or even 0.20 (Wu Zhenqiang, Wang Yang, \u0026amp; Li Wei, 2014). The results showed that although \u0026ldquo;alcohol consumption in the past year\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.113) and \u0026ldquo;purpose of low-intensity physical activity\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.103) were not statistically significant, both p values were below 0.15. Therefore, to prevent omission of important factors related to falls among middle-aged and older adults, all explanatory variables were retained in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.2Multicollinearity diagnosis\u003c/h2\u003e \u003cp\u003eFor multicollinearity diagnostics in the logistic regression model, this study employed the variance inflation factor (VIF), which is the reciprocal of tolerance (TOL). Generally, a VIF\u0026thinsp;\u0026ge;\u0026thinsp;5 or VIF\u0026thinsp;\u0026ge;\u0026thinsp;10 indicates serious multicollinearity among independent variables[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, a VIF\u0026thinsp;=\u0026thinsp;1 indicates that an independent variable is completely uncorrelated with other independent variables, whereas 1\u0026thinsp;\u0026lt;\u0026thinsp;VIF\u0026thinsp;\u0026lt;\u0026thinsp;5 suggests a certain degree of correlation that is typically considered acceptable. Multicollinearity diagnostics were conducted for all explanatory variables in this study, with categorical variables transformed into dummy variables. The results showed that the VIF values for all variables were below 5, indicating that there was no serious multicollinearity among the factors included in the model.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Results of Binary Logistic Regression\u003c/h2\u003e \u003cp\u003eThis study primarily examines whether the duration of low-intensity physical activity can predict falls among middle-aged and older adults in China. The main analytical variables included the weekly duration of low-intensity physical activity and the daily duration of low-intensity physical activity, while the secondary factor was the purpose of low-intensity physical activity. Demographic variables included age and sex. Control variables comprised type of toilet, type of residential area, type of housing, alcohol consumption status, and marital status. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reports the results of the binary logistic regression analyses examining the effects of the above variables on falls among middle-aged and older adults.Model 1 examined the predictive effects of age, sex, weekly duration of low-intensity physical activity, daily duration of low-intensity physical activity, and purpose of low-intensity physical activity on falls among middle-aged and older adults. The results indicated that all the above variables showed statistically significant differences at the 0.05 level. Specifically, age was identified as a risk factor, with each additional year of age associated with a 3.2% increase in fall risk (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In terms of sex, the risk of falling among women was 1.565 times that among men (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The weekly duration of low-intensity physical activity was a protective factor, such that each additional day of activity (compared with only one day per week) was associated with a 4.4% reduction in fall risk (p\u0026thinsp;=\u0026thinsp;0.002). The daily duration of low-intensity physical activity was also a protective factor; compared with individuals who exercised for 10\u0026ndash;30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day exhibited a 17.0% lower risk of falling (p\u0026thinsp;=\u0026thinsp;0.006). The purpose of low-intensity physical activity did not predict falls among middle-aged and older adults (p\u0026thinsp;=\u0026thinsp;0.159).Based on Model 1, Model 2 further controlled for type of residential area, type of housing, and type of toilet. The results showed that age remained a risk factor, with each additional year of age associated with a 3.1% increase in fall risk (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The odds ratio for sex was consistent with that in Model 1, indicating that women had a 1.565 times higher risk of falling than men (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Each additional day of low-intensity physical activity per week (compared with only one day) was associated with a 4.2% reduction in fall risk (p\u0026thinsp;=\u0026thinsp;0.004). Compared with individuals who exercised for 10\u0026ndash;30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day had a 15.2% lower risk of falling (p\u0026thinsp;=\u0026thinsp;0.016). Regarding toilet type, middle-aged and older adults using sit toilets had a 15.2% lower risk of falling compared with those using squat toilets (p\u0026thinsp;=\u0026thinsp;0.011). The purpose of low-intensity physical activity, type of residential area, and type of housing did not significantly predict falls among middle-aged and older adults (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).Model 3 further controlled for alcohol consumption and marital status on the basis of Model 2. The results of Model 3 showed that each additional year of age was associated with a 3.0% increase in fall risk (3.2% in Model 1 and 3.1% in Model 2). The risk of falling among women was 1.661 times that among men (1.565 times in both Model 1 and Model 2). Each additional day of low-intensity physical activity per week (compared with only one day) was associated with a 4.1% reduction in fall risk (4.4% in Model 1 and 4.2% in Model 2). Compared with individuals who exercised for 10\u0026ndash;30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day exhibited a 14.6% lower risk of falling (17.0% in Model 1 and 15.2% in Model 2). Middle-aged and older adults using sit toilets had a 13.7% lower risk of falling compared with those using squat toilets (15.2% in Model 2). Drinking alcohol more than once per month was identified as a risk factor; compared with non-drinkers, middle-aged and older adults who drank alcohol more than once per month had a 21.5% higher risk of falling. Middle-aged and older adults who were married and living with their spouse had a 55.5% lower risk of falling compared with those who had never married (p\u0026thinsp;=\u0026thinsp;0.020). In Model 3, the purpose of low-intensity physical activity, type of residential area, and type of housing did not significantly predict falls among middle-aged and older adults (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe Hosmer\u0026ndash;Lemeshow test results for the three models were as follows: Model 1 (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.093, df\u0026thinsp;=\u0026thinsp;8, p\u0026thinsp;=\u0026thinsp;0.637); Model 2 (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.398, df\u0026thinsp;=\u0026thinsp;8, p\u0026thinsp;=\u0026thinsp;0.494) and Model 3 (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.719, df\u0026thinsp;=\u0026thinsp;8, p\u0026thinsp;=\u0026thinsp;0.567). As the p-values of the Hosmer\u0026ndash;Lemeshow tests for all three models were greater than 0.05, the null hypothesis was accepted, indicating that all three models demonstrated a good fit to the observed data.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression results of factors influencing falls among middle-aged and older adults (binary logistic model)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFall Model 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFall Model 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eFall Model 3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e (VIF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (1.250)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.032(1.026\u0026ndash;1.038)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.031(1.025\u0026thinsp;~\u0026thinsp;1.037)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.030(1.024\u0026thinsp;~\u0026thinsp;1.037)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e (1.312)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.565(1.400\u0026thinsp;~\u0026thinsp;1.749)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.565(1.400\u0026thinsp;~\u0026thinsp;1.750)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.661(1.462\u0026thinsp;~\u0026thinsp;1.887)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeekly Duration of Low-Intensity Physical Activity\u003c/b\u003e (1.023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.956(0928\u0026thinsp;~\u0026thinsp;0.984)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.958(0.931\u0026thinsp;~\u0026thinsp;0.987)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.959(0.931\u0026thinsp;~\u0026thinsp;0.987)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDaily Duration of Low-Intensity Physical Activity\u003c/b\u003e (1.072)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.830(0.727\u0026thinsp;~\u0026thinsp;0.949)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.006**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.848(0.742\u0026thinsp;~\u0026thinsp;0.970)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.854(0.747\u0026thinsp;~\u0026thinsp;0.977)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.022*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePurpose of Low-Intensity Physical Activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLivelihood-related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecreation (1.444)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.910(0.745\u0026thinsp;~\u0026thinsp;1.111)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.932(0.763\u0026thinsp;~\u0026thinsp;1.139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.930(0.761\u0026thinsp;~\u0026thinsp;1.137)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.478\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical exercise (1.744)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.864(0.747\u0026thinsp;~\u0026thinsp;0.999)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.908(0.783\u0026thinsp;~\u0026thinsp;1.053)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.917(0.790\u0026thinsp;~\u0026thinsp;1.064)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther purposes (1.375)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.994(0.803\u0026thinsp;~\u0026thinsp;1.232)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.054(0.849\u0026thinsp;~\u0026thinsp;1.308)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.055(0.849\u0026thinsp;~\u0026thinsp;1.311)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Residential Area\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban or town central area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u0026ndash;rural or town\u0026ndash;village transitional area (1.417)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.838(0.684\u0026thinsp;~\u0026thinsp;1.027)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.850(0.693\u0026thinsp;~\u0026thinsp;1.043)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural (2.342)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.056(0.891\u0026thinsp;~\u0026thinsp;1.252)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.082(0.912\u0026thinsp;~\u0026thinsp;1.283)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecial area (1.009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Housing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle-story house\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular multi-story building (2.481)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.938(0.777\u0026thinsp;~\u0026thinsp;1.132)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.928(0.769\u0026thinsp;~\u0026thinsp;1.121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.440\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDetached house (1.357)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.980(0.860\u0026thinsp;~\u0026thinsp;1.116)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.979(0.859\u0026thinsp;~\u0026thinsp;1.117)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.756\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Toilet\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSquat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSit (1.281)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.848(0.747\u0026thinsp;~\u0026thinsp;0.962)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.863(0.760\u0026thinsp;~\u0026thinsp;0.980)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.023*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol Consumption\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.017*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not drink\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink more than once per month (1.324)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.215(1.053\u0026thinsp;~\u0026thinsp;1.402)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.008**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrink less than once per month (1.085)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.170(0.968\u0026thinsp;~\u0026thinsp;1.414)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married (Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried and living with spouse (1.050)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.020*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.445(0.226\u0026thinsp;~\u0026thinsp;0.878)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried but temporarily not living with spouse due to work or other reasons (1.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.559(0.277\u0026thinsp;~\u0026thinsp;1.128)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparated, no longer living with spouse (1.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.762(0.277\u0026thinsp;~\u0026thinsp;2.097)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced (1.197)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.805(0.370\u0026thinsp;~\u0026thinsp;1.753)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed (1.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.551(0.276\u0026thinsp;~\u0026thinsp;1.103)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: \u0026lowast;\u0026lowast;、\u0026lowast; indicate statistical significance at the 1% and 5% levels,respectively.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026ldquo;-\u0026rdquo;indicates that the sample size was too small, resulting in extreme values without statistical significance;therefore,these results are not reported.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eFalls are a common geriatric syndrome. Falls among middle-aged and older adults are mostly not accidental events but are associated with complex risk factors. For example, age-related loss of muscle mass leading to frailty or restricted mobility, declines in depth perception that interfere with visual judgment, changes in the inner ear causing dizziness and loss of balance, insufficient cerebral perfusion due to orthostatic hypotension, and side effects of certain medications may all contribute to falls[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In addition, the occurrence of falls is closely related to demographic characteristics and exercise habits, further increasing the complexity of falls among middle-aged and older adults. According to the results of this study, first, at the level of demographic characteristics, both age and sex independently affect falls among middle-aged and older adults. Age is a risk factor for falls, with fall risk increasing as age increases, which is consistent with the findings of Peel, Nancye May[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. For Chinese middle-aged and older adults, each one-year increase in age is associated with a 3%\u0026ndash;3.2% increase in fall risk. The age-related increase in fall risk may be attributable to age-related adverse conditions, such as physical frailty, impairments in balance, cognition, and vision, medication use, acute illnesses, and environmental factors. In particular, individuals with a history of falls are at a higher risk of recurrent falls. Female middle-aged and older adults are more likely to experience falls than males, with fall risk being 1.565\u0026ndash;1.661 times higher among women. This may be because women in middle and later life are more prone to osteoporosis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], highlighting the need for more targeted preventive strategies for this group. For example, supplementation with vitamin D and calcium may be more effective in reducing falls among middle-aged and older women [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, some studies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], based on 35 randomized controlled trials involving 58,937 older adults, have shown that daily supplementation with 800\u0026ndash;1000 IU of vitamin D can significantly reduce fall incidence by 15%, regardless of sex composition or living arrangements. The mechanism by which vitamin D reduces falls may be explained by its role in regulating calcium homeostasis and improving muscle strength and balance, thereby reducing fall risk. Overall, developing multidimensional preventive measures that integrate demographic characteristics, physiological changes, and nutritional interventions is of great importance for reducing fall risk among middle-aged and older adults.\u003c/p\u003e \u003cp\u003eSecond, regarding the time characteristics of low-intensity physical activity, both the number of exercise days per week and the duration of daily exercise (protective factors) independently influence falls among middle-aged and older adults. Compared with those who engaged in low-intensity physical activity for only one day per week, each additional day of activity (at least 10 minutes per day) was associated with a 4.1%\u0026ndash;4.4% reduction in fall risk. This finding is highly consistent with the study by Peeters et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], which reported that each additional 100 units of physical activity (e.g., 30 minutes of walking) reduced fall risk among older adults by approximately 4%. Compared with individuals who exercised for 10\u0026ndash;30 minutes per day, those who engaged in low-intensity physical activity for 30 minutes to 2 hours per day experienced a 14.6%\u0026ndash;17.0% lower risk of falls. These results indicate that increasing the duration of low-intensity physical activity can significantly reduce the probability of falls among middle-aged and older adults. For example, engaging in at least 50 hours of low-intensity physical activity over a three-month period (approximately 33 minutes per day) can reduce fall risk among older adults, and this conclusion is also applicable to middle-aged populations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Regular physical activity has potential health-regulating effects for middle-aged and older adults, similar to pharmacological interventions for patients with chronic diseases. Therefore, fall prevention among middle-aged and older adults in China requires appropriate exercise prescriptions, particularly low-intensity physical activity programs tailored to individual needs.\u003c/p\u003e \u003cp\u003eThird, the motivational characteristics (purpose) of low-intensity physical activity were not predictive of falls among middle-aged and older adults in China. Whether the purpose of exercise was to enhance physical fitness or for other reasons, exercise motivation did not directly predict fall occurrence. This may be because falls are unstable and uncontrollable events that are not determined by individuals\u0026rsquo; subjective intentions or the will of others. Thus, although exercise motivation may influence the level of physical activity participation, it does not directly determine fall risk. As falls result from the combined effects of multiple factors [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], fall prevention requires comprehensive consideration and multifaceted interventions.\u003c/p\u003e \u003cp\u003eFinally, after incorporating physical living environment variables, including type of residential area, housing type, and type of toilet facility, age, sex, and low-intensity physical activity duration remained significant predictors of falls among middle-aged and older adults. Further inclusion of personal and family life characteristics (including alcohol consumption and marital status) showed that the predictive effects of age, sex, and low-intensity physical activity duration on falls remained largely unchanged. At the same time, type of toilet facility, alcohol consumption, and marital status were also found to influence falls among middle-aged and older adults to some extent. In summary, preventing falls among middle-aged and older adults requires an integrated consideration of demographic characteristics, physiological changes, nutritional interventions, and exercise habits. Independent influencing factors such as age, sex, and low-intensity physical activity duration provide a scientific basis for developing personalized fall prevention strategies.\u003c/p\u003e"},{"header":"5. Conclusions and Recommendations","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e5.1 Conclusions\u003c/h2\u003e \u003cp\u003e(1) The weekly duration of low-intensity physical activity can independently predict falls among middle-aged and older adults. Specifically, compared with those who engaged in low-intensity physical activity for only one day per week, each additional day of activity is associated with a 4.1%\u0026ndash;4.4% reduction in fall risk.\u003c/p\u003e \u003cp\u003e(2) The daily duration of low-intensity physical activity can also independently predict falls among middle-aged and older adults. Compared with individuals who exercised for 10\u0026ndash;30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day experienced a 14.6%\u0026ndash;17.0% lower risk of falling.\u003c/p\u003e \u003cp\u003e(3) In addition to age and the duration of low-intensity physical activity, age, sex, type of toilet facility, alcohol consumption status, and marital status are also relevant factors influencing falls among middle-aged and older adults in China.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e5.2 Recommendations\u003c/h2\u003e \u003cp\u003e(1) With fall prevention as the primary objective, safe, affordable, and effective low-intensity physical activity should be widely promoted. The National Health Commission should further strengthen health education to enhance fall-prevention awareness among middle-aged and older adults. Adhering to the principles of gradual progression, exercising within one\u0026rsquo;s capacity, long-term adherence, and safety first, low-intensity activities such as ultra-slow jogging, Tai Chi, and the Twelve Zodiac Health Qigong should be actively promoted and popularized to reduce fall risk. Specific guidance on low-intensity physical activity could be incorporated into \u003cem\u003eHealth Literacy of Chinese Citizens\u0026mdash;Basic Knowledge and Skills\u003c/em\u003e, encouraging middle-aged and older adults to engage in low-intensity physical activity at least 3\u0026ndash;5 days per week, with each session lasting 30 minutes to 2 hours according to individual conditions. In this process, technology-enabled approaches may also be adopted to support safe and scientific exercise among older adults. For example, wearable devices (e.g., smart bands, health apps) can be used to monitor physical activity levels, provide real-time feedback and reminders, and help older adults manage exercise duration and intensity more effectively. Overall, exercise-based interventions play a crucial role in the complex system of fall prevention among middle-aged and older adults, although large-scale implementation and effective execution remain challenging.\u003c/p\u003e \u003cp\u003e(2) Improve the living environment and reduce environmental risk factors for falls. In terms of health screening, osteoporosis screening and prevention should be strengthened for middle-aged and older women, especially postmenopausal women. Regular bone mineral density testing is recommended at community health service centers, along with guidance on vitamin D and calcium supplementation. Regarding nutritional interventions, national efforts should be intensified to promote awareness of vitamin D and calcium supplementation, encouraging adequate intake through diet and supplements. Communities can organize nutrition education sessions to disseminate knowledge on osteoporosis prevention. In terms of exercise interventions, tailored balance training and core stability programs should be designed for middle-aged and older women to enhance muscle strength and balance and thereby reduce fall risk.\u003c/p\u003e \u003cp\u003e(3) Improve the living environment and reduce environmental risk factors for falls. The government should promote age-friendly home modifications for older adults, particularly in rural areas and urban\u0026ndash;rural transitional regions. It is recommended that provisions on housing safety for older adults be incorporated into the Law on the \u003cem\u003eProtection of the Rights and Interests of Older Persons\u003c/em\u003e, encouraging households to install non-slip flooring, handrails, and sit-down toilets to reduce environmental fall risks. Of particular importance is the promotion of sit-down toilets, especially in rural areas. Government subsidy policies could encourage households to replace squat toilets with sit-down toilets for older adults, thereby reducing the risk of falls during toileting.\u003c/p\u003e \u003cp\u003e(4) Strengthen health education and enhance fall-prevention awareness among middle-aged and older adults. The National Health Commission should intensify health education on fall prevention for middle-aged and older adults through multiple channels, including television, radio, and social media, to disseminate relevant knowledge and skills. Communities can regularly organize fall-prevention lectures, inviting experts to explain how posture management, nutrition, and environmental modifications can help prevent falls. In addition, family members should be encouraged to participate in the health management of older adults by helping them identify and avoid fall risks. Family members should regularly assess the safety of the living environment to ensure adequate protection. Moreover, necessary psychological support and interventions should not be overlooked. Falls not only affect physical health but may also have negative psychological impacts on middle-aged and older adults. Communities should provide psychological counseling services to help older adults overcome fear of falling and enhance confidence and independence.\u003c/p\u003e \u003cp\u003e(5) Enhance health management related to alcohol consumption and marital status. With regard to alcohol consumption, health management should be strengthened for middle-aged and older adults, particularly those who drink more than once per month. Communities can disseminate information through health lectures and educational materials on the association between excessive alcohol consumption and increased fall risk, encouraging moderation or abstinence. In terms of marital support, for widowed or older adults living alone, communities should provide greater social support, such as organizing social activities and offering psychological counseling, to reduce loneliness and depressive symptoms and thereby lower fall risk.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the anonymous peer reviewers for their insightful comments that helped improve this paper\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhou Jiang: proposed the primary research objectives and was responsible for the conception and design of the study, study implementation, manuscript drafting, overall accountability for the article, and supervision.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChenghao Zheng: conducted data collection and organization, statistical analyses, preparation and presentation of figures and tables, manuscript revision, and overall review of the paper.\u003c/p\u003e\n\u003cp\u003eYanDan Wu:Reviewed the manuscript, clarified the research logic, and revised the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by a grant from Research on the Construction of a High-Quality Development System for Public Sports Services for Persons with Disabilities and Its Practice in China [grant number 24BTY045 ]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data analyzed during this study are included in this article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCao L, Tong G, Yang G, et al. 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Am J Prev Med. 2015;49(6):888\u0026ndash;901.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSOCIAS-MORALES CM, CHAUMONT MEN\u0026Eacute;NDEZ CK, MARSH SM. Fatal work-related falls in the United States, 2003\u0026ndash;2014. Am J Ind Med. 2018;61(3):204\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBROWN RT, COVINSKY KE. Moving prevention of functional impairment upstream: is middle age an ideal time for intervention?[J]. Womens Midlife Health. 2020;6(4):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMAO MIN, et al. The effect of Tai Chi lower extremity exercise on the balance control of older adults in assistant living communities. BMC Complement Med Ther. 2024;24(1):112.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHERRINGTON CATHERINE, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008;56(12):2234\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGARDNER MM, ROBERTSON MC, CAMPBELL AJ. Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials.Brit. J Sport Med. 2000;34:7\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYANG ZHEN et al. Physical activity, sedentary behaviour, and cognitive function among older adults: A bibliometric analysis from 2004 to 2024. Ageing Res Rev (2024): 102283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIZQUIERDO MIKEL, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines. J Nutr Health Aging. 2021;25(7):824\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu YM, Yang Y, Luo SL. Interpretation of the International Physical Activity Guidelines for Older Adults: An Expert Consensus[J]. Nurs Res. 2022;36(10):1701\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFORD AMYE. LEIF A. FORD.2016. Middle Adulthood: Physical and Cognitive Development. Human Growth and Development Across the Lifespan: Applications for Counselors,: 443\u0026ndash;474.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu RF. An empirical analysis of variable selection and regression method choice in logistic regression [J]. Chin J Evidence-Based Med. 2016;16(11):1360\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou F, Zhao FL, Wei XM, et al. Multicollinearity diagnostics in logistic regression models and their application in medicine [J]. J Gansu Univ Chin Med. 2014;31(01):90\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEASTELL R, O\u0026rsquo;NEILL TW, Hofbauer LC, Langdahl B, Reid IR, Gold DT, et al. Postmenopausal osteoporosis. Nat Rev Dis Primers. 2016;2(1):16069.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePEEL. Epidemiology of falls in older age. Can J Aging/La Revue canadienne du vieillissement. 2011;30(1):7\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLARSEN ERIKROJ, LEIF MOSEKILDE, AND ANDERS FOLDSPANG. Vitamin D and calcium supplementation prevents severe falls in elderly community-dwelling women: a pragmatic population-based 3-year intervention study. Aging Clin Exp Res. 2005;17:125\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTAN LONG, RUIQIAN HE, AND XIAOXUE ZHENG. Effect of vitamin D, calcium, or combined supplementation on fall prevention: a systematic review and updated network meta-analysis. BMC Geriatr. 2024;24(1):390.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePEETERS GMEE, et al. Is there a U-shaped association between physical activity and falling in older persons? Osteoporos Int. 2010;21:1189\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJIANG YUESHUAI, et al. The association between sedentary behavior and falls in older adults: A systematic review and meta-analysis. Front public health. 2022;10:1019551.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"duration of low-intensity physical activity, middle-aged and older adults, falls, fall prevention","lastPublishedDoi":"10.21203/rs.3.rs-8416360/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8416360/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Chinese government attaches great importance to fall prevention among middle-aged and older adults and has incorporated it as an important component of healthy ageing strategies and public health policies. For middle-aged and older populations, low-intensity physical activity is not only relatively safe and easy to maintain but also contributes to enhancing physical function and improving balance ability and reaction speed.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis raises an important question regarding the relationship between the duration of low-intensity physical activity and falls among middle-aged and older adults in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) and a binary logistic regression model, this study empirically analyses the factors influencing falls among middle-aged and older adults in China, with a particular focus on whether the duration of low-intensity physical activity can predict falls in this population.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThe findings indicate that: (1) the weekly duration of low-intensity physical activity independently predicts falls among middle-aged and older adults; specifically, compared with those who engaged in low-intensity physical activity for only one day per week, each additional day of activity was associated with a 4.1%\u0026ndash;4.4% reduction in fall risk. (2) The daily duration of low-intensity physical activity also independently predicts falls; compared with individuals who exercised for 10\u0026ndash;30 minutes per day, those who engaged in 30 minutes to 2 hours of low-intensity physical activity per day exhibited a 14.6%\u0026ndash;17.0% lower risk of falling. (3) In addition to age and low-intensity physical activity duration, age, sex, type of toilet facility, alcohol consumption status, and marital status were also reference factors influencing falls among middle-aged and older adults in China.\u003c/p\u003e\u003ch2\u003econclusions\u003c/h2\u003e \u003cp\u003eBased on these findings, it is recommended to reduce the risk of falls among middle-aged and older adults in China by promoting low-intensity physical activity and developing personalised exercise prescriptions; strengthening the prevention and intervention of osteoporosis among middle-aged and older women; and improving the living environment to reduce environmental risk factors for falls. These measures would contribute to advancing the deep integration of nationwide fitness and population health, fully leveraging the role of physical activity in health promotion, disease prevention, and rehabilitation, and facilitating the development of a healthy ageing society.\u003c/p\u003e","manuscriptTitle":"Study on the Association Between Low-Intensity Physical Activity Duration and Falls Among Middle-Aged and Older Adults in China — An Empirical Analysis Based on the CHARLS Database","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-23 09:12:38","doi":"10.21203/rs.3.rs-8416360/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc7ea662-0bd7-4423-9a6d-0c84eebbd572","owner":[],"postedDate":"December 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-06T10:10:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-23 09:12:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8416360","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8416360","identity":"rs-8416360","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}