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Background: While previous studies have shown that regular physical activity can delay the onset of certain chronic diseases; less is known about the changes in physical activity practices following chronic disease diagnoses. China is experiencing a rapid aging transition, with physical activity an important routine in many older people's lives. This study utilizes the Health Belief Model to better understand the bidirectional relationships and bipolar effects between physical activity and chronic disease burden in Huainan City, a mid-sized city in China., Methods: Longitudinal health survey data (2010-2015) from annual clinic visits for 3198 older people were obtained from a local hospital, representing 97% of the older population in three contiguous neighborhoods in Huainan City. The chronic diseases studied included obesity, hypertension, diabetes, hyperlipidemia, cardiovascular diseases, liver and biliary system diseases, and poor kidney function. Multilevel logistic regression was used to examine differences in physical activity levels across socio-demographic groups. Cox proportional hazards models were used to examine the impacts of physical activity practice levels on chronic disease onsets. Logistic regression was used to estimate the effects of chronic disease diagnosis on physical activity practice levels., Results: The prevalence of chronic diseases increased with increasing age, among men, and those with a lower education. Older people who were physically active experienced a later onset of chronic disease compared to their sedentary counterparts, particularly for obesity and diabetes. Following diagnosis of a chronic disease, physically active older people were more likely to increase their physical activity levels, while sedentary older people were less likely to initiate physical activity, demonstrating bipolar health trajectory effects., Conclusions: Health disparities among older people may widen as the sedentary experience earlier onsets of chronic diseases and worse health trajectories, compared to physically active people. Future health education communication and programmatic interventions should focus on sedentary and less healthy older populations to encourage healthy aging. These lessons from China may be applied to other countries also experiencing an increasing aging population.