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Abstract Background Regular physical activity is beneficial for both physical and mental health. However, studies on physical activity levels among middle-aged and elderly individuals in China are relatively scarce, and the health benefits of different activity levels remain unclear. Objective Using cross-sectional data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), this study describes the prevalence of chronic diseases and examines their association with physical activity (PA). Methods Participants self-reported the presence of fifteen chronic health conditions: Hypertension, Dyslipidemia, Diabetes, Cancer or Malignant tumor, Chronic lung diseases, Liver disease, Heart attack, Stroke, Kidney disease, Stomach or other Digestive diseases, Emotional, Nervous, or Psychiatric problems, Memory-related diseases (such as dementia, brain atrophy), Parkinson’s disease, Arthritis or Rheumatism, and Asthma. Total physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Multivariate logistic regression was used to estimate the association between chronic diseases and PA. Results In China, more than a quarter of middle-aged and elderly individuals do not meet physical activity guidelines, with only about a third achieving high activity levels. Compared to those with low PA, individuals with moderate PA had a reduced risk of 4 chronic diseases (Stroke, Emotional and Mental problems, Memory-related diseases, Asthma), while those with high PA had a reduced risk of 10 chronic diseases (Hypertension, Dyslipidemia, Diabetes, Cancer, Heart attack, Stroke, Emotional, Nervous, or Psychiatric problems, Memory-related diseases such as dementia and brain atrophy, Parkinson’s disease, Asthma). Conclusion Higher physical activity levels are associated with lower risks of chronic diseases. Governments and organizations should encourage individuals to achieve higher activity levels (> 3000 MET-min/week), not merely meet physical activity guidelines (≥ 600 MET-min/week).
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