Internet use and physical activity among older adults in China: a multi-dimensional analysis with endogeneity mitigation
TL;DR
Internet use is associated with exercise participation among older adults in China primarily through direct mechanisms not captured by the learning or entertainment pathways examined, and digital inclusion policies should be integrated into broader public health strategies for active aging.
Abstract
Background As population aging accelerates globally, promoting physical activity among older adults has emerged as a central public health challenge. Although internet use has been widely promoted as a potential enabler of healthy aging, its net effects on exercise behavior and the underlying mechanisms remain theoretically ambiguous and empirically underexplored, particularly in large developing economies. Methods Using nationally representative microdata from the 2022 China Family Panel Studies (CFPS) covering 6,860 adults aged 60 and above, we examine the association between internet use and three dimensions of exercise behavior: participation, frequency, and intensity. Baseline logistic and OLS regression models are complemented by Karlson–Holm–Breen (KHB) decomposition to assess two hypothesized mediating pathways—learning-oriented health empowerment and entertainment-oriented instant gratification—and by doubly robust treatment-effect estimators (IPWRA and AIPW) to address endogeneity arising from health selection and unobserved confounding. Results Internet use is significantly and positively associated with exercise participation (OR = 1.36, p < 0.01), while its associations with exercise frequency and intensity are heterogeneous. KHB decomposition reveals that neither learning-oriented empowerment (indirect effect: 1.14% of the total) nor entertainment-oriented instant gratification (3.49%) serves as a statistically significant mediating pathway. Doubly robust estimates confirm a meaningful positive association (IPWRA ATET: +14.9 percentage points; AIPW ATE: +11.0 percentage points). Results are stable across alternative variable definitions, estimation methods, and subsample analyses. Conclusion Internet use is associated with exercise participation among older adults in China primarily through direct mechanisms not captured by the learning or entertainment pathways examined. These findings suggest that digital inclusion policies should be integrated into broader public health strategies for active aging, with emphasis on enabling purposeful online engagement rather than passive digital consumption.