Cultural Adaptation and Feasibility Testing of Adapted Lifestyle-integrated Functional Exercise Programme for Chinese Older Adults in the UK: A Mixed-Methods Study
This mixed-methods study demonstrates that the culturally adapted Chinese version of the Lifestyle-integrated Functional Exercise (CLiFE) programme is feasible, acceptable, and safe for Chinese older adults living in the UK, warranting further refinement and larger-scale evaluation.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Falls are a quiet but serious threat to older adults, often leading to injury, a loss of independence, and a reduced quality of life. While exercise is known to be one of the best ways to prevent these accidents, many people struggle to keep up with a traditional gym routine or a strict set of movements. The challenge is not just doing the exercise once, but making it a natural part of daily life so that it happens automatically, without needing constant willpower. Researchers have developed a method called "lifestyle-integrated" exercise, which weaves balance and strength tasks into ordinary activities like walking to the kitchen or standing up from a chair. However, what works well in one culture does not always translate directly to another. For older adults from different backgrounds, language barriers, different ideas about how to learn, and varying levels of comfort with physical activity can make a standard program feel confusing or inaccessible.
In the United Kingdom, a team of researchers set out to see if they could adapt this lifestyle-based exercise program specifically for Chinese older adults living in Manchester. They wanted to know if the program could be reshaped to fit the cultural preferences and practical needs of this community, and if it could be done safely and effectively. The goal was not just to translate words, but to change the way the program was taught and recorded, ensuring it felt right for the people using it.
The researchers began by listening closely to the community. They held a workshop with seven older Chinese adults to discuss a draft version of the program. The participants offered clear, practical feedback that led to significant changes. They felt the original instructions were too heavy with text and scientific language, so the team simplified the manual, replacing dense paragraphs with plain language and clear pictures. The participants also expressed a strong preference for learning together in a group rather than receiving one-on-one instruction at home, valuing the chance to learn from one another. Finally, they found the paperwork required to track their progress to be burdensome. In response, the researchers removed complex planning sheets and replaced handwriting with simple box-ticking on a single combined form. These adjustments ensured the program was not just understood, but welcomed.
Following these changes, the team launched a four-week trial with fifteen participants. The group met for two long teaching sessions where they practiced the new exercises, which included tasks like standing on one leg, walking in a straight line, and sitting down and standing up. The participants were given the simplified manual and the easy-to-use tracking sheet to use at home. The results of this trial were encouraging. Every single person who signed up attended both teaching sessions and completed the final check-in, showing that the group format and the adapted materials kept them engaged. Most participants, twelve out of the fifteen, were able to complete their weekly tracking sheets, and of those, ten followed the program exactly as intended. No one reported any injuries or safety issues during the four weeks.
The participants also shared how they felt about the program. They rated it as acceptable and helpful, and their tracking sheets suggested that the exercises were becoming automatic parts of their daily routines. They particularly enjoyed the simpler activities, like standing with their feet one in front of the other or sitting and standing, which felt safe and easy to fit into their day. However, the study also revealed a gentle limitation. While the participants were happy to do the exercises, they were hesitant to make them harder or more challenging, often worrying about losing their balance. Because they stuck to the safer, easier versions of the movements, their physical strength and balance scores did not change much by the end of the four weeks. This suggests that while the program is excellent for getting people started and building a habit, it may need extra support to help them gradually take on more difficult challenges.
This study demonstrates that a falls prevention program can be successfully adapted for a specific cultural group by paying attention to how people learn, how they prefer to interact, and what makes them feel safe. The researchers found that by simplifying the materials, moving to a group setting, and reducing the burden of paperwork, they could create a program that Chinese older adults in the UK were willing to try and stick with. The findings suggest that the next step is to refine the program further, perhaps by adding more support to help participants feel confident enough to increase the difficulty of their exercises over time. For now, the work proves that with the right cultural adjustments, lifestyle exercise can become a natural and safe part of daily life for older adults from diverse backgrounds.
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