This study examined leisure activities and facility perceptions among middle-aged adults (50~64 years) in Seoul and Gunsan, South Korea amid rapid population aging and regional disparities. A survey of 348 participants revealed significant regional differences. Gunsan residents showed lower leisure participation frequency and higher dependence on private facilities than Seoul residents who primarily used public facilities. Gunsan residents reported significantly lower satisfaction with leisure facilities across all dimensions including usability, accessibility, and program diversity. Regression analysis revealed that leisure facility service satisfaction was the most influential factor affecting overall leisure satisfaction in both regions. However, regional differences emerged in other factors. Health status significantly influenced leisure satisfaction in Gunsan, while life satisfaction played a more prominent role in Seoul. This study also found that customized programs based on personal preferences and facility design aesthetics had varying impacts on leisure satisfaction in the two regions. These findings highlight the need for region-specific leisure policies that address unique characteristics and needs of middle-aged populations in different geographical contexts. Results of this study suggest that non-metropolitan areas require targeted improvements in public leisure infrastructure, service quality enhancement, and development of diverse, preference-based programs to reduce regional disparities in leisure opportunities. This research contributes to our understanding of how regional inequalities in leisure environments can affect the quality of life among middle-aged adults, providing empirical evidence for developing tailored leisure policies in an aging society.