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Population-level physical inactivity remains a persistent public health challenge, yet many low-threshold activity innovations fail to achieve institutional integration within health and sports governance systems. Emerging sports often diffuse rapidly through grassroots participation without coordinated governance, standardized participation metrics, or aligned facility planning. This institutional gap limits sustained preventative health impact. Using pickleball as a comparative policy case, this study analyzed how governance mechanisms enabled scalable integration in the United States and assessed their transferability within China’s state-led system. Using national participation reports, policy documents, and secondary literature, the analysis identified four defining features of the US model: association-led governance with formal monitoring, a dual-track facility strategy combining retrofitting with selective new construction, community-embedded participation across age cohorts and social settings, and a multi-level competition system linked to the health, tourism, and education sectors. By contrast, diffusion in China is constrained by the absence of unified governance, lack of participation and facility data, insufficient spatial provisions, low public awareness, and weak cross-sector coordination. Based on these contrasts, the study proposes a localization framework that prioritizes phased institutionalization, data-driven planning, low-cost spatial adaptation, educational and community embedding, and incremental integration into public health and tourism programs. The findings suggest that international experience is transferable when functional mechanisms, rather than institutional forms, are adapted to domestic governance conditions. The study provides policy-relevant guidance for incorporating emerging sports into China’s national fitness and population-health strategies, with implications for other emerging sports in state-led governance systems.