What Urban Older Adults Actually Need: A Kano-Model Map for Community Physical Fitness Services

Table of Contents

1. Key Highlights
2. Introduction
3. Why a differentiated approach matters: variations in need and consequence
4. Applying the Kano model to older-adult fitness services: what it reveals
5. How the study was conducted: sample, groups and service items
6. What healthy older adults prioritize
7. What older adults with chronic diseases need most
8. What care-dependent older adults require
9. The needs map: monitoring, early warning, intervention, feedback
10. Translating priorities into an implementation roadmap
11. Workforce, technology and financing considerations
12. Policy alignment and scaling: connecting to national and municipal goals
13. Limitations and avenues for further research
14. Practical checklist for community providers
15. Final reflections
16. FAQ

Key Highlights

• Older adults in urban communities express differentiated, hierarchical demands for physical-fitness services: healthy seniors prioritize monitoring and interpretive information; those with chronic disease emphasize continuous professional guidance and reassessment; care-dependent seniors need robust care coordination and family-centered rehabilitation.
• The Kano model applied to 1,688 urban older adults reveals which service elements are must-be (absence causes strong dissatisfaction), one-dimensional (satisfaction rises with provision), attractive (delight factors), indifferent, or reverse—enabling community providers to set realistic priorities and allocate scarce resources effectively.

Introduction

Cities are where the majority of ageing populations now live and where day-to-day health support systems must function. For older adults, preserving mobility, balance and functional independence depends less on single clinical interventions than on a steady sequence of monitoring, early warning, targeted exercise, follow-up and feedback. Yet not all service components contribute equally to older adults’ sense of wellbeing. Treating a community fitness program as a single bundle risks misdirecting scarce staff time and budget.

A recent multi-city study used the Kano model to classify the demand attributes of physical fitness promotion services among urban older adults. By surveying 1,688 people across Shanghai, Zhengzhou and Chengdu and grouping respondents as healthy, chronic-disease, or care-dependent, the study mapped which services are baseline expectations, which drive satisfaction when improved, and which create extra perceived value. That classification offers operational guidance for community planners, health managers and front-line providers who must decide what to deliver first, what to refine, and what to add later.

This article synthesizes the study’s findings, explains what they mean for everyday service design, and translates them into concrete steps community actors can adopt to improve outcomes for older residents. Practical examples and implementation options illustrate how a data-driven hierarchy of needs can reshape local programs without demanding disproportionate new resources.

Why the Kano model matters and how its results reflect different older-adult profiles appear first. The article then presents the priority services for each subgroup, analyzes satisfaction and dissatisfaction drivers, and proposes a compact needs map—organized around monitoring, early warning, intervention and feedback—that community operators can act on. The final sections translate evidence into operational recommendations and answer frequently asked questions.

Why a differentiated approach matters: variations in need and consequence

Physical fitness promotion is not a one-size-fits-all service. The study makes two points that should shape planning.

First, aging manifests along multiple dimensions—disease burden, mobility, balance, functional independence—and these change the value older adults place on specific services. For example, a quarterly fitness assessment is indispensable for someone managing chronic heart or respiratory disease; the same person may regard diverse testing venues or family involvement as desirable but not essential. Conversely, a healthy, active older adult may highly value attractive services such as scientific exercise guidance and diversified testing venues because they enhance the exercise experience.

Second, missing baseline elements produces disproportionate harm. Must-be attributes do not generate delight when provided, but their absence causes strong dissatisfaction and erodes trust. For providers, failing to deliver these elements can reduce program uptake and undermine the perceived credibility of the entire service package. This creates both health and programmatic risk: older people who lose confidence are less likely to remain engaged in preventive activities, making declines in function likelier and more costly later.

Recognizing heterogeneity prevents “equity through uniformity,” where the same service mix is offered to all. A tiered strategy—guarantee the basics for everyone, optimize the core for target groups, and selectively introduce value-added features—makes scarce resources go further and improves measurable outcomes.

Applying the Kano model to older-adult fitness services: what it reveals

The Kano model distinguishes how service elements affect satisfaction through paired functional/non-functional scenarios. Respondents indicate how they would feel if a service were present and how they would feel if it were absent. Responses are mapped into categories:

• Must-be: basic expectations. Presence does not raise satisfaction markedly; absence causes strong dissatisfaction.
• One-dimensional: satisfaction rises in proportion to the level of provision.
• Attractive: exceed expectations; create delight, but absence does not cause dissatisfaction.
• Indifferent: provision or absence has limited impact on satisfaction.
• Reverse: provision may reduce satisfaction for some groups.

This study adapted the Kano response format into a satisfaction–dissatisfaction scale to match the comprehension needs of older respondents. It complemented attribute classification with numerical satisfaction and dissatisfaction coefficients. A composite sensitivity score (S) quantified how strongly each item influenced satisfaction when present and dissatisfaction when absent: higher S indicates a stronger combined effect.

Applied to community physical fitness services, the model reveals which items are foundation stones and which are optional or experience enhancers. Planners can therefore sequence investment: secure must-be items first; optimize one-dimensional items next; introduce attractive features when capacity permits.

How the study was conducted: sample, groups and service items

The survey ran May–September 2025 in three Chinese cities—Shanghai (east), Zhengzhou (central) and Chengdu (west). It targeted older adults aged 60+ at community service–related sites: community health centers, day-care centers, physical fitness centers, eldercare institutions, universities for older adults, hospitals and residential communities. The goal was not strict population representativeness but to capture needs among older adults interacting with service systems.

From 1,953 distributed questionnaires, 1,688 valid responses were obtained. Respondents were classified by function-first criteria:

• Healthy older adults (N = 608): no physician-diagnosed chronic disease and no ADL limitations.
• Older adults with chronic diseases (N = 992): self-reported physician-diagnosed chronic disease but no ADL limitation.
• Older adults with care dependency (N = 88): ADL limitation requiring assistance (classified into care-dependent group regardless of chronic disease status).

The questionnaire and item pool were developed through literature review, practical case analysis and two-round Delphi expert consultation. It organized services along a closed-loop structure: monitoring, early warning, intervention and feedback. Sixteen service elements were surveyed, including establishment of personal health records, routine physical fitness assessment, personalized exercise prescriptions, scientific exercise guidance, physical fitness risk alerts and graded feedback, medical follow-up, family rehabilitation training and family involvement.

What healthy older adults prioritize

Major finding: healthy older adults’ needs show a mixed pattern of must-be and one-dimensional attributes, with a handful of attractive elements that enhance participation.

Key must-be items

• Routine physical fitness assessment
• Establishment of personal health records
• Personalized exercise prescription
• Periodic reassessment

These items form the service baseline for healthy seniors. They do not create excitement when present, but their absence undermines confidence and participation. Practically, a healthy older adult expects simple, regular checks and a clear record of performance and guidance.

High-sensitivity drivers (S)

• Physical fitness risk alerts (S = 0.923)
• Interpretation of physical fitness risks (S = 0.910)
• Physical fitness risk grading (S = 0.889)

Although risk alerts and grading were classified as one-dimensional rather than must-be for this group, their combined satisfaction and dissatisfaction coefficients made them the most sensitive items. Healthy older adults value not just measurement, but interpretation: they want to understand what the numbers mean and how to act.

Attractive features

• Scientific exercise guidance (high satisfaction coefficient: 0.698)
• Diverse testing venues
• Healthy lifestyle guidance

These features can substantially raise perceived value once baseline services are in place. Scientific exercise guidance, in particular, can turn regular participants into committed ones by showing them how to exercise effectively and safely.

Reverse and indifferent items

• Family involvement showed reverse characteristics: some healthy seniors prefer autonomy and worry about burdening family.
• Age-friendly testing indicators, medical follow-up and family rehabilitation training were relatively indifferent for this group.

Practical implication For healthy older adults, a community should ensure reliable baseline monitoring and an accessible channel for risk interpretation. Once those are in place, investing in scientific exercise guidance classes, varied testing sites (e.g., fitness corners in community centers) and lifestyle workshops will enhance engagement and retention.

Real-world example A community center might run quarterly fitness assessments and maintain simple personal health records for members. After each assessment, a nurse or exercise specialist explains results in plain language and offers a practical exercise plan. Popular add-ons include supervised tai chi or balance classes led by a certified instructor—an attractive feature that increases continued participation.

What older adults with chronic diseases need most

Major finding: older adults with chronic diseases place greater weight on continuous, professional, and disease-linked services. The structure for this group is more rigid and anchored in must-be items.

Must-be items (strongest concentration)

• Routine physical fitness assessment
• Personalized exercise prescription
• Scientific exercise guidance
• Physical fitness risk alerts
• Periodic reassessment
• Physical fitness risk grading
• Establishment of personal health records
• Interpretation of physical fitness risks

This cluster forms the backbone of risk-management-oriented services. For people managing chronic conditions, gaps in monitoring and guidance can directly affect functional outcomes and disease control; absence of these services produces strong dissatisfaction.

High-sensitivity one-dimensional items

• Healthy lifestyle guidance (S = 0.882)
• Organization of social activities (S = 0.811)

Among this group, lifestyle guidance is both expected and highly influential: it links daily behaviors—diet, sleep, physical activity—with chronic disease trajectories. Social activities also matter because they sustain motivation and adherence.

Attractive items

• Diverse testing venues
• Age-friendly testing indicators
• Medical follow-up
• Family involvement

These are experience-enhancers that improve accessibility and perceived continuity. Medical follow-up, for example, boosts perceived professionalism and security.

Practical implication Communities serving many people with chronic disease should prioritize continuous screening and professional guidance. Integrating monitoring with follow-up and reassessment, and routing data into individual health records, will maintain trust and adherence to exercise prescriptions.

Real-world example A community health center could pair local general practitioners with exercise health specialists to provide joint chronic disease clinics. Each appointment includes fitness assessment, prescription updates and short workout supervision. Results feed into the older adult’s record and trigger a scheduled reassessment or a remote follow-up call if deterioration is detected.

What care-dependent older adults require

Major finding: the care-dependent subgroup displays the highest concentration of must-be attributes; for them, physical fitness promotion is tightly interwoven with everyday care and family support.

Dominant must-be items

• Establishment of personal health records
• Routine physical fitness assessment
• Physical fitness risk alerts and interpretation
• Synchronization of physical fitness risks (sharing information with caregivers)
• Personalized exercise prescription
• Scientific exercise guidance
• Healthy lifestyle guidance
• Medical follow-up
• Periodic reassessment
• Family involvement

Care-dependent older adults depend on a stable, continuous service chain. Their satisfaction and safety depend on coordination between professionals and family caregivers and on frequent reassessment. Family rehabilitation training appears as a key one-dimensional item; families expect practical skills that help them support rehabilitation at home.

High-sensitivity items

• Family rehabilitation training (S = 0.802)
• Family involvement (S = 0.731)
• Medical follow-up (S = 0.726)

These items show strong bidirectional influence on satisfaction: their presence increases satisfaction; their absence causes substantial dissatisfaction. The high sensitivity of family-oriented services underscores the central role family members play in daily care, particularly when mobility is restricted.

Attractive items

• Physical fitness risk grading (for this group it behaves as an attractive attribute): clear, systematic feedback can increase confidence and perceived progress, even if not strictly necessary for survival.

Indifferent items

• Diverse testing venues, age-friendly testing indicators and organization of social activities scored lower in importance, likely because mobility constraints limit participation.

Practical implication For care-dependent older adults, community services should focus on care coordination: robust records, frequent assessment, medical follow-up, and structured support for caregivers. Training family members in basic rehabilitation and safe exercise is a high-impact, cost-effective lever to maintain function and reduce institutional care needs.

Real-world example A home-care program could deploy trained physiotherapists for periodic in-home reassessments and provide structured family training sessions. Simple, illustrated exercise sheets and short video modules enable caregivers to supervise daily practice safely. Local day-care facilities can organize small, supervised activity sessions tailored to mobility level to maintain social contact and basic exercise.

The needs map: monitoring, early warning, intervention, feedback

The study consolidates services into a closed-loop needs map that communities can use as a blueprint. Each stage contains items ranked by attribute and sensitivity.

Monitoring

• Core (must-be across groups): Establishment of personal health records; Routine physical fitness assessment.
• Optimizing features: Diverse testing venues (attractive to healthy and chronic groups); Age-friendly testing indicators (more attractive for chronic disease group).

Operational advice: Use existing community health centers, day-care centers, and fitness hubs to host routine assessments. Integrate lightweight digital records to track trajectories. For care-dependent people, prioritize home-based monitoring.

Early warning

• Core: Physical fitness risk alerts; Interpretation of risk; Risk grading.
• Role by group: For healthy adults these are one-dimensional (important for satisfaction); for chronic and care-dependent groups, these are must-be.

Operational advice: Implement triage-based alerts and clear, graded communications (green/yellow/orange/red), combined with personalized interpretation by professionals. Share critical alerts with designated family members or caregivers with consent.

Intervention

• Core: Personalized exercise prescription; Scientific exercise guidance; Healthy lifestyle guidance.
• Supporting modules: Organization of social activities (key for healthy and chronic groups); Medical follow-up and family rehabilitation training (essential for chronic and care-dependent groups).

Operational advice: After assessment, produce an actionable prescription specifying mode, intensity and safety notes. Offer supervised group classes for the generalized population and targeted one-to-one sessions for chronic or care-dependent clients. Embed family training into intervention plans for care-dependent older adults.

Feedback

• Core: Periodic reassessment (must-be across groups); Family involvement and feedback loops.
• Operational advice: Set quarterly reassessments as baseline, shorten the interval for high-risk clients, and present results in visual formats. Ensure records update in real time and remain accessible to authorized caregivers and providers.

Translating priorities into an implementation roadmap

Communities and service managers can use a pragmatic sequence to act on the findings without waiting for ideal funding.

Phase 1 — Secure the baseline (first 6–12 months)

• Set up standardized routine assessments (quarterly) at accessible sites.
• Create or enhance personal health records for every registered older adult; prioritize data fields related to mobility, balance, chronic disease, ADLs and recent assessments.
• Train staff to deliver clear risk interpretation and graded alerts; create simple communication templates for different literacy levels.

Phase 2 — Build continuity and professional support (6–18 months)

• Introduce personalized exercise prescriptions based on assessment results and risk grading; ensure prescriptions specify frequency, intensity, duration and safety precautions.
• Establish channels for medical follow-up (telehealth calls, GP-exercise specialist coordination).
• Develop family rehabilitation training modules (short workshops, printed materials, videos) and pilot them with families of care-dependent clients.

Phase 3 — Enhance experience and scale selectively (12–36 months)

• Add scientific exercise guidance classes (certified instructors) and diversified testing venues (pop-up screenings).
• Pilot social activity programs that combine physical activity and socialization for healthy and chronic-disease groups (tai chi, walking clubs, dance).
• Use satisfaction/dissatisfaction data and the sensitivity measure to refine priorities and evaluate marginal returns before scaling.

Operational tips

• Use existing community assets: social halls, health stations and volunteer networks.
• Share data across providers with privacy safeguards; integrate records with local primary care where feasible.
• Focus on family-centered approaches for dependent older adults rather than attempting wide-scale facility-based programs.
• Prioritize low-cost, high-impact training for family caregivers (teach 3–5 safe exercises suited to the older adult’s capacity).

Workforce, technology and financing considerations

Workforce

• Exercise health specialists, physiotherapists and trained community workers are key. Where specialist numbers are limited, upskill community nurses and volunteers to deliver basic guidance and family training under professional supervision.
• Multidisciplinary teams—GPs, exercise specialists and community coordinators—deliver better continuity for chronic disease management.

Technology

• Lightweight digital health records and simple dashboards enable risk grading and automated alerting. Prioritize usability and offline options for care-dependent clients.
• Use telehealth for follow-up where mobility or staffing constraints exist; short video demonstrations multiply the reach of family training.

Financing

• Begin with reconfiguring existing budgets toward baseline services; many items (routine assessment, records, basic training) require organizational change more than large capital.
• Pilot public–private partnerships for specialized classes or devices, ensuring that subsidized access remains available to lower-income older adults.
• Demonstrate early outcomes (attendance, adherence, fewer falls or hospital readmissions) to unlock municipal or regional funding for scale-up.

Policy alignment and scaling: connecting to national and municipal goals

Connecting program design to policy frameworks increases sustainability. The study notes alignment with the “Healthy China” strategy’s emphasis on scientific fitness guidance and community-based health promotion. Municipal authorities can incorporate the needs map into broader aging-in-place strategies, prioritizing:

• Integrating community fitness promotion into chronic disease management pathways.
• Training and certifying community exercise specialists.
• Encouraging information-sharing standards for personal health records across community and primary care providers.

Scaling across cities requires adapting the needs map to local resource realities: in high-capacity cities, attractive features can be adopted sooner; in resource-constrained settings, the emphasis should be on securing must-be items and enabling family-centered care.

Limitations and avenues for further research

The authors transparently acknowledge limitations that readers should keep in mind when applying findings:

• Questionnaire format: the Kano items used a satisfaction–dissatisfaction scale, adapted for older respondents. This may alter some classifications compared with classic Kano preference options. Future studies should validate the modified format through cognitive interviews and comparative testing.
• Sampling: respondents were recruited at community service–related sites in three Chinese cities and are not a probability-based sample of all urban older adults. Findings reflect needs among service-contact older adults and may overrepresent those already engaged with services.
• Care-dependent sample size: the care-dependent subgroup was relatively small (N = 88), which can destabilize attribute classification. Results for this group should be seen as exploratory and refined with larger samples.
• Causality and effectiveness: the Kano model maps perceived needs and priorities but does not test whether reallocating resources according to these priorities will improve clinical or functional outcomes. Interventional studies and longitudinal follow-up are needed.

Research priorities

• Longitudinal trials that test whether implementing the priorities improves adherence, functional status and healthcare utilization.
• Comparative studies across more regions and among rural populations.
• Cost-effectiveness analyses of baseline versus attractive investments, particularly family training versus facility-based therapy.

Practical checklist for community providers

A compact checklist to operationalize the study’s priorities:

1. Establish at least quarterly routine fitness assessments for registered older adults.
2. Create or update simple personal health records capturing key fitness indicators and chronic disease status.
3. Implement a graded risk-alert system and train staff to interpret results for lay audiences.
4. Produce personalized exercise prescriptions with clear safety notes and family guidance when needed.
5. Offer scientific exercise guidance (group or one-to-one) prioritized for chronic-disease and care-dependent clients.
6. Design family rehabilitation training modules (short, practice-focused).
7. Schedule periodic reassessments; shorten intervals for high-risk clients.
8. Monitor satisfaction and dissatisfaction signals; use the sensitivity metric to decide where incremental improvements yield greatest benefit.

Final reflections

Older adults’ expectations and sensitivities toward physical fitness promotion services align predictably with their function and dependency. Healthy older adults expect reliable monitoring and value interpretive information and motivation-enhancing activities. Those with chronic disease depend on continuous, professional, risk-aware systems. For care-dependent older adults, family coordination and follow-up constitute the critical backbone of safety and perceived value.

Community programs can improve both fairness and impact by sequencing investments: secure must-be elements for everyone; tailor one-dimensional and attractive services to the groups that benefit most; and empower families as essential partners for care-dependent clients. Practical pilots, embedded measurement and gradual scaling will convert the needs map from a planning tool into sustained improvements in older adults’ function and quality of life.

FAQ

Q: Which service should a community prioritize first if budget and staff are limited? A: Prioritize must-be items: routine physical fitness assessment, establishment of personal health records, personalized exercise prescription and periodic reassessment. These items avert strong dissatisfaction and preserve trust. For communities serving many chronic-disease or care-dependent older adults, ensure scientific exercise guidance and medical follow-up are also included early.

Q: How often should reassessments be conducted? A: Quarterly reassessment is an appropriate baseline for the general older-adult population. For chronic-disease patients or those with functional decline, shorten intervals based on risk grading—every 6–8 weeks for unstable conditions, or as clinically indicated.

Q: How can family members be engaged without overburdening them? A: Use brief, practical family rehabilitation training modules focused on 3–5 safe exercises and clear safety rules. Provide printed or short video materials and set up periodic supervised sessions where professionals observe and coach family caregivers. Recognize family limits and offer respite or professional home visits when capacity is exceeded.

Q: Are technology solutions necessary to implement the needs map? A: They are helpful but not strictly necessary. Simple paper-based records, regular phone calls for follow-up and in-person risk interpretation can be effective. Light-touch technology—mobile forms, simple dashboards, or shared spreadsheets—improves efficiency and scalability where digital literacy and infrastructure permit.

Q: What are low-cost, high-impact interventions that communities can deploy quickly? A: Quarterly group fitness assessments, basic risk interpretation delivered by trained nurses or exercise specialists, distribution of tailored exercise prescriptions, and short family training workshops are low-cost and produce meaningful benefits. Leveraging volunteers and existing community spaces reduces marginal cost.

Q: How should services differ between healthy, chronic-disease and care-dependent older adults? A: Healthy older adults: emphasis on monitoring, clear interpretation, and motivational group activities (scientific guidance, lifestyle workshops). Chronic-disease older adults: emphasize continuous assessment, personalized prescriptions, medical follow-up and lifestyle counseling. Care-dependent older adults: prioritize coordinated care—medical follow-up, family involvement, family rehabilitation training, frequent reassessment and home-adapted interventions.

Q: How can success be monitored after implementing changes? A: Track process measures (number of assessments, completion of personal records, frequency of reassessments), engagement metrics (attendance at classes, adherence to prescriptions), and short-term outcome indicators (self-reported function, fall incidence, readmissions). Use periodic satisfaction and dissatisfaction measures to assess whether changes have reduced sources of negative sentiment.

Q: Does the Kano model tell us which interventions improve health outcomes? A: No. The Kano model identifies perceived attributes and priority. It indicates which services matter most to older adults’ satisfaction and trust, but interventional trials are needed to show which reconfigurations lead to clinical improvements. Start with Kano-guided prioritization and evaluate outcomes prospectively.

Q: Can this needs map be applied outside China? A: The principles—distinguishing must-be from attractive elements and stratifying by functional status—are widely applicable. Local context (health system structure, cultural norms around family caregiving, resource levels) should shape the precise mix and delivery mechanisms.

Q: What are immediate next steps for a community leader reading this? A: Conduct a rapid inventory of current services against the needs map, identify must-be gaps, pilot one targeted improvement (for example, structured reassessments plus risk-interpretation sessions), collect basic process and satisfaction data, and use that feedback to scale or adjust priorities.