Experiences of Implementing a Culturally Adapted Lifestyle-Integrated Functional Exercise Programme (CLiFE) Among Chinese Older Adults Living in the UK: A Qualitative Study

Falls are a quiet but powerful force that can steal independence from older adults, turning a simple misstep into a life-altering injury. For decades, doctors and scientists have known that building strength and balance is the best defense against these accidents. Yet, a stubborn problem remains: most exercise programs ask people to set aside specific times to work out, like going to a gym or following a strict routine. For many older people, especially those navigating life in a new country, finding the time, energy, or motivation to stick to a separate schedule is incredibly difficult. The idea of "lifestyle-integrated" exercise emerged to solve this by suggesting a different path: instead of stopping to exercise, weave the movements into the things you already do every day, like walking to the kitchen or standing up from a chair. This approach aims to make movement a natural part of life rather than a chore. However, for these ideas to work, they must fit the culture, language, and daily reality of the people using them.

Researchers at the University of Manchester decided to test how this concept works for Chinese older adults living in the United Kingdom. They took an existing program called aLiFE, which had been adapted for general use, and created a specific Chinese version known as CLiFE. This new program was translated and tweaked to respect cultural preferences, but the researchers wanted to go beyond just checking if people could do the exercises. They wanted to understand the actual experience of living with the program. To find out, they invited fifteen Chinese older adults, with an average age of seventy-four, who had just finished a four-week trial of the program. The researchers sat down with each person for an hour-long conversation, speaking in their native Cantonese, to hear how the program felt in their real lives.

The conversations revealed that the participants found the program generally positive, but the way they used it varied significantly. Half of the people interviewed successfully wove the exercises into their daily tasks, such as practicing balance while mowing the lawn or walking in a straight line while carrying groceries. For them, the program worked exactly as intended, turning mundane moments into opportunities for strength. However, the other half preferred a different approach. They found it safer and easier to remember to do the exercises if they set aside a specific time, like right after washing their face in the morning, to practice several movements together. Some participants felt that trying to balance while doing other tasks was too risky, fearing they might get distracted and fall. Others found that complex movements, which required remembering a specific sequence of steps, were too difficult to recall while distracted by daily chores.

Safety and familiarity were the two most powerful guides for the participants. They gravitated toward simple, known movements that felt natural, such as standing on their toes or stepping over objects. Many recognized these motions from traditional practices like Tai Chi, which made them feel comfortable and confident. Conversely, they were hesitant about anything that felt dangerous or unnatural for their age. Movements that involved jumping were almost universally rejected; the participants felt that jumping was something for children, not for older adults, and worried about the impact on their joints or backs. Similarly, exercises that required closing their eyes or standing on one leg were often avoided because the participants felt unstable or afraid of hitting furniture in their homes. The environment mattered too; one woman explained that she no longer walked alone in certain city areas because she felt unsafe, highlighting that the fear of falling extended beyond the exercises themselves to their daily surroundings.

How the program was taught played a crucial role in whether people felt they could do it. The participants valued the group sessions where a trainer spoke to them in Chinese. This language connection removed barriers to understanding and allowed them to ask questions without fear. They also appreciated the social aspect, noting that the chance to chat with others and make friends was often just as important as the exercise itself. Watching a trainer demonstrate the moves and seeing other people practice alongside them provided a sense of reassurance that a video on a computer screen could not match. Many participants admitted they struggled to remember the exercises once they got home, and they felt that more frequent, shorter sessions would help them retain the information. For those with limited reading skills, the picture-based manuals were far more useful than the written instructions, though some still found the complex movements hard to visualize from pictures alone.

The researchers also looked at how the participants tracked their progress using a small logbook. At the start of the program, this book served as a helpful reminder and a source of motivation, acting like an external nudge to keep them on track. However, as the exercises became a habit, the logbook lost its appeal. For some, it felt like an unnecessary burden, especially when they were trying to remember to tick off activities that happened briefly throughout the day. Others found it difficult to write down exactly how many times they did an exercise when it was mixed into their routine. The study suggests that while recording is useful at the beginning, it may need to be simplified or adapted for long-term use, perhaps by using more pictures or making the book smaller and easier to carry.

The findings paint a clear picture of what works and what does not when bringing exercise into the daily lives of older adults from a specific cultural background. The program was feasible and well-received, but the ideal method of integration was not the same for everyone. While the original idea was to mix exercises into every task, the study showed that for many, a dedicated time slot was safer and more sustainable. The research also highlighted that cultural adaptation is not just about translation; it requires a deep understanding of what feels safe, familiar, and appropriate for the community. The participants' willingness to modify the difficulty of the exercises on their own showed that they were engaged, but the struggle with complex movements suggested that some activities might need to be simpler or taught differently. Ultimately, the study confirms that when exercise programs are designed with respect for language, culture, and individual safety concerns, older adults are eager to participate, but the path to making those exercises a permanent part of life requires flexibility and ongoing support.