Physical Activity in Culturally and Linguistically Diverse Migrant Groups to Western Society

Physical Activity in Culturally andLinguistically Diverse MigrantGroups to Western SocietyA Review of Barriers, Enablers and Experiences

Cristina M. Caperchione,1 Gregory S. Kolt2 and W. Kerry Mummery1

1 Institute for Health and Social Science Research, CQUniversity Australia, Rockhampton, Queensland,

Australia

2 School of Biomedical and Health Sciences, University of Western Sydney, Sydney, New South Wales,

Australia

Abstract A close examination of epidemiological data reveals burdens of diseaseparticular to culturally and linguistically diverse (CALD) migrants, as theseindividuals adjust to both culture and modernization gaps. Despite theincreased risk of hypertension, diabetesmellitus, overweight/obesity and cardio-vascular disease, individuals from CALD groups are less likely to be pro-active in accessing healthcare or undertaking preventative measures to ensureoptimal health outcomes. The purpose of this paper is to review literaturethat outlines the barriers, challenges and enablers of physical activityin CALD groups who have recently migrated to Western society, and toidentify key strategies to increase physical activity participation for theseindividuals. Electronic and manual literature searches were used to identify57 publications that met the inclusion criteria. Findings from the review in-dicate that migration to Western societies has a detrimental effect on thehealth status and health behaviours of CALD groups as they assimilate totheir new surroundings, explore different cultures and customs, and embracea new way of life. In particular, there is evidence that physical inactivity iscommon in migrant CALD groups, and is a key contributing risk factor tochronic disease for these individuals. Challenges and barriers that limitphysical activity participation in CALD groups include: cultural and religiousbeliefs, issues with social relationships, socioeconomic challenges, environ-mental barriers, and perceptions of health and injury. Strategies that mayassist with overcoming these challenges and barriers consist of the need forcultural sensitivity, the provision of education sessions addressing healthbehaviours, encouraging participation of individuals from the same culture,exploration of employment situational variables, and the implementation of‘Health Action Zones’ in CALD communities. This information will informand support the development of culturally appropriate programmes designed topositively influence the physical activity behaviours of individuals from CALDpopulations.

LEADING ARTICLESports Med 2009; 39 (3): 167-177

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Rising levels of immigration have been shapedby changing government policies, allowing for adiverse flow of immigrants from varied origins totraditional countries of immigration. In countriessuch as the US, UK, Canada, Australia and NewZealand, the numbers of foreign-born individualshas approximately doubled over the past 40years, with the largest proportion originatingfrom developing countries.[1] For example, thepopulation of Australia increased by 134 600persons in 2005–6 as a result of net overseas mi-gration, representing 51% of the total annualpopulation growth.[2] Individuals from the UK(24%), New Zealand (9%), Italy (5%), Chinaand Vietnam (4% each), Greece, Germany, thePhilippines and India (approximately 3% each)accounted for the majority of the overseas mi-gration into Australia.[3] Additionally, Australiahas witnessed a rapid increase in migration fromcountries such as Sudan, Afghanistan, Somalia,Bangladesh and Iraq.[4]

A large proportion of migrants to traditionalimmigration countries have been born in coun-tries recently affected by war and political unrest.Many of them have been subject to traumaticevents such as prolonged periods of deprivation,the loss of family and friends in violent circum-stances, or a perilous escape from their home-land.[1,4,5] Under such circumstances, many ofthese culturally and linguistically diverse(CALD) groups, a common term used to describenon-Anglo migrant groups,[6,7] are exemptedfrom meeting certain health requirements thatgovern migration. As a result, many migrantsarrive in the host countries with suboptimal orpoor health, posing a public health challenge.[8]

Close examination of epidemiological datareveals particular burdens of disease in CALDcommunities throughout many traditional im-migration countries.[9-11] It has been suggestedthat migration from a developing to an in-dustrialized/Westernized country has a detri-mental impact on chronic disease risk factors asindividuals from CALD groups adjust to bothculture and modernization gaps.[5,12] Moreover,there is a consensus that among Western coun-tries, significant racial and ethnic disparities existin terms of morbidity and mortality, highlighting

higher rates of risk factors for a number ofchronic diseases in such populations.[13,14] Ofparticular concern is the increased prevalence ofhypertension, diabetes mellitus and overweight/obesity in CALD populations, all of which arepredominant risk factors for cardiovascular dis-ease (CVD).[13] For example, Asianmen in theUKappear to be more prone to coronary heart diseasethan others, and both men and women of SouthAsian origin have 30–40% higher coronary diseasemortality rates than UK-born individuals.[15,16]

Similar findings have been reported in NewZealand, where there is a high prevalence of riskfactors for lifestyle diseases including CVD anddiabetes in older Asian Indians[17] and olderTongan adults[18] living in urban settings com-pared with individuals born in New Zealand.

Despite the increased risk of hypertension, dia-betes, overweight/obesity and CVD, individualsfrom CALD groups are less likely to be proactivein accessing health care or undertaking preven-tative measures to ensure optimal health out-comes.[14,19] Although it has been well documentedthat engaging in preventive measures such as reg-ular physical activity is associated with reducedrisk of CVD and other chronic diseases,[20] it isevident that individuals from CALD backgroundsare less likely than others to participate in suchactivities.[10,17,21,22] For many CALD individualsthere are several constraints on activity partici-pation beyond personal motivation. Languagebarriers, socioeconomic factors, psychologicaltrauma relating to migration and alternativehealth-seeking behaviours are just a few of theconstraints that are likely to have a detrimentalimpact on health in these populations.[14,23,24]

In an attempt to limit these constraints andpositively influence the physical activity behavioursof CALD individuals, it is necessary to carefullyconsider cultural diversity whilst developingand planning health promotion (e.g. physical ac-tivity), resources and programmes. The limitednature of research in this area is evident.[9,25,26] Thechallenge, therefore, is to understand more aboutthe influence of the migration process on thephysical activity behaviours of CALD groups.Such information will support the development ofculturally appropriate programmes designed to

168 Caperchione et al.

ª 2009 Adis Data Information BV. All rights reserved. Sports Med 2009; 39 (3)

positively influence the physical activity behavioursof individuals from CALD populations.[24,27] Thepurpose of this paper is to review literature thatoutlines the barriers, challenges and enablers ofphysical activity for people in CALD groups whohave recently migrated to Western society, and tomake recommendations and propose strategies thatmay positively affect physical activity participationin these populations.

1. Methods

For the purpose of this review, individualsfrom CALD groups refers to individuals fromnon-English-speaking backgrounds (those bornoverseas, those who speak a language other thanEnglish at home, or those who have little profi-ciency in speaking English) and individuals whoidentify with or have a social orientation towardsa non-English speaking culture.[6,7] Indigenouspopulations are not clearly defined by thesevariables and thus were not included in this re-view. Moreover, the physical activity behavioursof indigenous populations differ to those ofCALD groups and are reported elsewhere in theresearch literature.[28-30]

Our search strategy included an exploration ofpublications from a number of electronic data-bases as well as manual searching of referencelists and relevant texts. The electronic databasesused included Scopus, MEDLINE, ProQuest,CINAHL, ScienceDirect, PsycINFO and GoogleScholar. These electronic databases were ex-plored using the search terms ‘physical activity’,‘physical activity barriers’, ‘cultural diversity’,‘acculturation’, ‘immigration’, ‘migration’, ‘cul-tural sensitivity’, ‘ethnic groups’, ‘ethnicity’,‘refugees’ and ‘westernisation’. Specifically, theterms ‘physical activity’ and ‘physical activitybehaviours’ were combined with each of theother terms listed above. These search termswere chosen based on previous research literatureassociated with migration and socioculturalissues. Publications were selected for the reviewif they met the following criteria: (i) must be inthe English language; (ii) must include CALDadults (aged ‡18 years); (iii) must refer to themigration/immigration process; and (iv) must

discuss physical activity behaviours, barriers orenablers.

From the initial search strategy, publicationswere excluded if they did not meet the inclusioncriteria, as determined by the title and abstract.After this initial assessment, 120 publications(i.e. articles, articles from reference lists, relevanttexts) potentially met the criteria. These publica-tions were further screened and a total of 57publications were identified as meeting the in-clusion criteria, and thus included in this review.

2. Results

Findings from the review identified key issuesassociated with the physical activity behavioursof those who belong to CALD groups. These keyissues include, but are not limited to, the migra-tion process and health status of these groups,barriers to physical activity as a risk factor fordisease in these particular groups, and specializedstrategies for increasing physical activity beha-viours in CALD groups. Each of these key issuesis discussed below.

2.1 Migration Process and Health Status ofCulturally and Linguistically Diverse (CALD)Groups

Literature pertaining to the health status ofthese groups at the time of migration is incon-sistent, claiming that while many migrants are ingood physical and mental health when entering anew host country,[8,10,31,32] others are consideredto be in relatively poor health.[5,33-35]

Many researchers have suggested that manymigrants are in good health upon arrival due tothe lifestyle behaviours in which they are tradi-tionally engaged (e.g. work that is physicallydemanding, walking for transport, eating foodshigh in fibre and low in fat) in their country oforigin.[22,36,37] Other researchers have argued thatmigrants, particularly those entering as humani-tarian refugees, are highly likely to be in poorhealth as a consequence of past deprivation andprolonged periods of suboptimal diet while livingin their country of origin.[5,34] Furthermore, thepoor physical health of these humanitarian

Physical Activity in Migrant Groups to Western Society 169


refugees is accompanied by stress, anxiety andoverall poor mental health as a result of beingsubject to traumatic events such as physical andpsychological violation and torture.[26,38-40]

Although the literature is equivocal on the is-sue of health status of migrants entering a newhost country, the literature favours a ‘healthyimmigrant effect’.[8,31,41-44] A ‘healthy immigranteffect’ exists where migrants from non-Westerncountries are in generally very good health onarrival to a Western country; however, this con-dition erodes with increased time since migration,and is associated with what is commonly referredto as ‘acculturation’.[10,45] Evenson et al.[46] de-fined acculturation as changes in cultural pat-terns when groups of individuals from differentcultures come into first-hand continuous contactwith each other.

Acculturation, which is part of the migrationprocess, is often associated with the adoption ofdetrimental Western behaviours such as theconsumption of a high-fat, calorie-dense diet,smoking, alcohol intake and a more sedentarylifestyle.[47-50] The adoption of these behavioursby migrant populations serve as risk factors for anumber of chronic diseases including hyperten-sion, diabetes, cardiovascular disease, obesityand poor mental health.[27,37,51-54] In a recent re-view, Steffen et al.[51] concluded that immigrantsto the US and Europe from Africa, Asia, LatinAmerica and Polynesia have consistently shownhigher blood pressure with increasing levels ofacculturation toWestern society, whilst Nakanishiet al.[55] described the impact of lifestyle Wester-nization on diabetes mellitus in Japanese peoplemigrating to America. Whilst all of these riskfactors are important, for the purpose of thispaper, discussion is limited to physical inactivityas a risk factor of disease. Poor diet/nutrition,smoking and excess alcohol intake have beendiscussed elsewhere.[56-60]

2.2 Barriers to Physical Activity as a Risk Factorfor Disease in CALD Groups

There are a number of contributing factorsinherent in the decreasing levels of physical ac-tivity in CALD groups. Specific to individuals

from CALD groups, the literature has indicatedthat many of these barriers fit into commonthemes such as cultural and religious issues, issuesof social relationships, socioeconomic challenges,environmental barriers and perceptions of healthand injury (see table I).

2.2.1 Cultural and Religious Barriers

Cultural and religious barriers vary amongstdifferent CALD groups, as some are quite genericand common to many individuals, while othersare unique to the individual and require cultural-specific attention.[26] For example, the Muslimcommunity exemplifies the need for culturalsensitivity as many of their religious practices andtraditions have a particular influence on theirphysical activity behaviours. Guerin et al.[61] andRogerson and Emes[26] reported that Muslimmen and women arriving from Arabic-speakingcountries (e.g. Morocco, Mauritania, Algeria,Tunisia, Libya, Sudan, Egypt and Somalia) tra-ditionally pray five times a day and observe themonth of Ramadan. Times of prayer can be aconstraint, as all activity must stop and organiz-ing a time for regular physical activity has to ac-commodate this religious activity. Also, duringthe month of Ramadan, Muslims fast from firstlight until sundown, abstaining from food anddrink. As it is essential that individuals areproperly hydrated and have energy stores toperform physical activity, fasting for Ramadanalso becomes a constraint in terms of maintaininga correct energy balance for these particularCALD groups.

Sex appropriateness was another commoncultural barrier cited in the literature. ManyCALD groups specified that physical activityfor women is not encouraged, as these womenare often expected to spend their time at homelooking after their immediate and extendedfamilies.[24,64] Many individuals of Muslim faithinterpret scriptures of the Quran as prohibitingphysical activity participation for women,[65]

while others allow participation to occur only if itdoes not conflict with their family responsi-bilities, if they engage in female-only programmesthat ensure that men will not see them or be active



Table I. Summary of barriers to physical activity (PA) in culturally and linguistically diverse groups

Study Participant characteristics Barriers to PA

Kolt et al.[18] 24 Tongans living in Auckland, New Zealand

Sex: 12 male, 12 female

Age: 60–79 y

Lack of education about benefits of PA

Lack of motivation

Safety of physical environment

Lack of facilities and transport

Family commitments

Physical and health limitations

Cultural barriers

Kalavar et al.[22] 10 Asian Indian migrants in the US

Sex: five male, five female

Age: 66–79 y

Health problems

Fear of injury

Physical infrastructure

Weather

Incompatibility of PA and old age

Inexperience with PA in the past

Lack of interest and motivation

Lifestyle in the US

Lack of time due to family and domestic

commitments

Not having someone to be active with

Belza et al.[23] 71 migrant adults from seven cultures

(American Indian/Alaskan Native, African

American, Filipino, Chinese, Latino,

Korean, Vietnamese)


Age: 52–85 y

Lack of motivation associated with low

self-esteem to be PA

Feeling disconnected and culturally isolated

Weather

Neighbourhood safety, crime

Programme costs

Lack of access and transport

Family and work obligations

Not having someone to be active with

Lack of culture-specific activities

Lawton et al.[24] 32 South Asian migrants living in the UK

(23 Pakistani, 9 Indian)


Age: 40–79 y

Lack of time due to family obligations

Unfamiliarity of neighbourhood

Fear and shame

Lack of culturally sensitive facilities

Weather

Religious fatalism

Negative perceptions of PA and disease

Rogerson and Emes[26] Qualitative review paper

Example of Muslim migrants

Sex: not reported

Age: older adults

Lack of affordable transport

Lack of access to programmes

Use of technical language used delivery

activity instructions

Poor health/painWeather

Cultural insensitivity

Barnes and Almasy[36] 31 adult migrants living in the US

(11 Bosnians, 10 Cubans, 10 Iranians)

Sex: 50/50 male/female

Age: 19–71 y

All spoke first language at home

90.3% were married

58% employed in low paying jobs

Lack of access to PA facilities

Unfamiliarity with the physical environment

Neighbourhood safety

Evenson et al.[46] 671 Latin migrant women living in US

Age: 20–50 y

Poor English language levels

Low household income

Low levels of employment

Language barriers

Religious fatalism

Lack of transportation due to not having

a drivers license

Continued next page



with them, and if they are appropriately dressedat all times.[5,24,53,61]

Language acculturation can also be a barrierto physical activity, as many individuals migratewith an inability to read or write in their ownlanguage. This problem is exacerbated with theneed to become literate in the language of thehost country.[23,50] In two recent studies lookingat physical activity programmes for refugee So-mali women in New Zealand, participants foundit difficult to follow activity instructions from aninstructor or from programme manuals, eventhough interpreters were made available as muchas possible.[53,61]

Although subtle, religious fatalism has alsobeen recognized as a common cultural andreligious barrier to physical activity for someCALD groups. In a study of South Asianmigrants living in Britain, Lawton et al.[24] re-ported that fatalistic notions of health, illness anddeath that were pre-ordained by Allah/God actedas a barrier, as participants did not perceive thatphysical activity could help reduce the risk ofdisease or death, but rather they believed thattheir religious fate was in the hands of Allah/God.Evenson et al.[46] reported a similar tendency in

Latin migrants in North Carolina, who believethat prayer alone can help them stay healthy, thattheir health is in God’s hands and their future isout of their control; therefore, they see no need toengage in preventive health measures such asphysical activity.

2.2.2 Social Relationships

The literature suggests the lack of social sup-port and the prevalence of isolation is highamongst individuals from CALD groups and hasa detrimental effect on their physical activitybehaviours.[33,35,50] Belza et al.[23] examinedthe physical activity behaviours of individualsfrommultiple cultures (including Korean, Latino,Filipino and Vietnamese migrants), and reporteda common theme in which migrants from thesemultiple cultures expressed feelings of isolation.Amesty,[62] who investigated barriers to physicalactivity in Hispanic migrants living in the US,found that migration to a different country, se-paration from family and friends, and loss of so-cial capital had a profound influence on theirphysical activity behaviours.

Table I. Contd

Study Participant characteristics Barriers to PA

Guerin et al.[61] 27 Somali women living in Hamilton, New Zealand

Age: 17–67 y

75% had children

Majority unemployed and on government benefit plans

Lack of childcare

Cultural/religious insensitivity

Lack of transport

Safety

Language barriers

Lack of financial stability

Amesty[62] Qualitative review paper

Hispanics living in inner city Philadelphia, PA, USA

Lack of knowledge of benefits of PA

associated with low education levels

Not having someone to exercise with

Cultural/social isolationSafety and crime

Lack of access to PA facilities

Poor health

Hayes et al.[63] 653 South Asian migrants living in UK

(Indian, Pakistani, Bangladeshi)

Sex: 320 men, 333 female

Age: 25–75 y

Low socioeconomic status

Cultural attitudes and values

Perceptions of illness associated with being PA

Modesty and avoidance of mixed sex activity

Fear of racism

Lack of finances

Lack of transport



2.2.3 Socioeconomic Challenges

Socioeconomic factors, such as low educationand literacy levels, poverty status and lack of ac-cess in general, play an adverse role in the physi-cal activity behaviour of migrants from CALDgroups.[18,27,48,63] For example, it has been pro-posed that migrants and refugees coming toWestern countries as a consequence of economichardships, war and displacement are usuallyquite poor and as a result are forced to move toresidential areas that are deteriorating, and intohouses that have been worn out and abandonedby others.[62] As a consequence, incidence of dis-ease tends to rise, education and literacy levels areminimal and there is a lack of general resources(particularly with transportation), all of whichaffect participation in physical activity.[26,33,35]

2.2.4 Environmental Barriers

Safety was most often recognized as a majorbarrier to physical activity participation amongstwomen from CALD groups. Amesty[62] andEyler et al.[66] stated that areas of high crime andviolence found in low socioeconomic neighbour-hoods where CALD migrants commonly residedwas a reason why many women were not active.Lawton et al.[24] also suggested that women fromCALD groups are fearful of being physically ac-tive due to lack of familiarity with their localneighbourhood, leaving them feeling vulnerablewhen they leave their house, which is com-pounded by their difficulties with communicatingin English.

A change in climate may also act as a barrier tophysical activity, significantly affecting migrantswho originally arrive from countries with verywarm and dry climates to countries with variedweather and climate conditions.[26] For example,migrants from Vietnam living in the Seattlearea reported the cold weather as being veryproblematic when attempting to exercise, as theyperceived that the cold weather made it hardfor them to breathe.[23] Additionally, Asian In-dians living in New Jersey viewed snow as abarrier to activity because of a fear of falling andsubsequent injury.[22]

2.2.5 Perceptions of Health and Injury

Another commonly reported barrier to activ-ity was migrants’ perceptions of ill health andinjury associated with being physically ac-tive.[26,63] Rather than seeing sweating, increasedheart rate and breathlessness as ‘normal’ by-products of physical activity, individuals ofPakistani and Indian origin who recently mi-grated to the UK perceived these as illness statesand something to be avoided.[24] Kalavar et al.[22]

also noted concerns of injury from falling andoverexertion while participating in physicalactivities for Asian Indian adults.

2.3 Strategies for Increasing Physical ActivityLevels in CALD Groups

The research literature has proposed a numberof strategies that may assist with overcoming thechallenges and barriers faced by many CALDmigrants. One particular approach highlightedby many was the need for cultural sensitivity onthe part of the health professional.[31,53,67] It isimperative that health professionals who workwith CALD groups acknowledge cultural di-versity, display a caring attitude, and place theindividual at the centre of programme develop-ment in an attempt to respond to their specificneeds and deliver a programme that encouragesparticipation and respects the culture of the par-ticipant.[26,68] For example, Guerin et al.[61] sug-gested that adapting activity times to workaround prayer and Ramadan and blocking win-dows in a manner so that men are not able to seeMuslim women perform activities are just a fewresponses to cultural competence. Furthermore,culture-specific tailoring of physical activitymessages, resources (social and environmentalstructures), and programmes must also be con-sidered for accommodating the specific needs ofthe different CALD groups.

The beliefs and perceptions of the benefits ofphysical activity on disease vary amongst manyCALD migrants. While some acknowledge theinfluence that physical activity has on the risk ofdisease, others hold fatalistic beliefs and do notfully understand the benefits of engaging inhealthy behaviours such as physical activity.[46,54]



Providing detailed yet simple education sessionsthat utilize tools such as curriculum-based booksand DVDs (nutrition and physical activity in-formation), as well as interpreters, has been sug-gested as a strategy to assist CALD groups withlearning about the benefits of preventive healthmeasures.[5,33] Additionally, health professionalsshould consider partnering these sessions withlearning centres/organizations who teach Englishto these migrants.[23]

Consistently, the literature has addressed theimportance of social support and social networksto migrant groups when they first arrive to theirnew host country.[5,22,46] Designing programmesthat promote and encourage the participation ofindividuals from the same culture will providemigrants with the support of others who are fa-miliar with their culture-specific traditions andcustoms, who have had similar migration ex-periences, and who are also moving through theacculturation process.[5,36]

Investigation of other mediums for physicalactivity, such as occupational physical activity,is also supported by the literature.[31,69] Wolinet al.[50] found that leisure time physical activitywas low in a multiethnic group of working classmigrants, but reported that these individuals weremore likely to do active work and thus they maybe meeting activity recommendations throughnon-leisure, occupational activity. Future re-search should explore employment situationalvariables for promoting physical activity in mi-grant groups, as many of them are employed inlabour-intensive jobs.[45]

In addition to the above considerations andstrategies, there is a general consensus that theprovision of resources, in particular childcareand transportation, are essential strategies toovercoming the barriers of physical activityparticipation in CALD migrant groups.[5,26,61]

Childcare is one of the most cited reasons for notattending community centre classes and fitnesscentres,[61] and the implementation of a child-minding scheme within the community has beenidentified as a particularly effective strategy toassist CALD women to attend exercise classes.[61]

Furthermore, the identification of existing schemesand respite programmes that are in place to assist

new migrants with childcare and other factorssuch as food shopping and transportation hasalso been highlighted.[27,70]

In addition to providing transportationthrough community services, the literature de-scribes an alternative strategy for overcomingtransportation barriers. Guerin et al.[61] describedthe notion of bringing the programmes to theCALD groups. As most migrants reside in thesame geographic area in their new host coun-try,[62] developing programmes in these areas,which the participants can walk to, would help toalleviate transportation difficulties. The furtherdevelopment of ‘health action zones’, which havebeen introduced in the UK, provides economicalresources to deprived communities, allowingthese communities to offer healthcare and healthresources to migrants without having to leavetheir residential areas.[33]

3. Conclusions and Future Directions

The literature has suggested that the migrationto Western societies has a detrimental effect onthe health status and health behaviours of CALDgroups as they assimilate to their new surround-ings, explore different cultures and customs, andembrace a new way of life. In particular, there isevidence that physical inactivity is common inmigrant CALD groups, and is a key contributingrisk factor to chronic disease for these in-dividuals.[10,17,71] Clearly, there are particularbarriers and challenges associated with the de-creased physical activity levels, yet research hasalso recognized possible strategies for over-coming these barriers and challenges.[8,23,26,62]

Despite the significance of this literature, thereare a number of gaps that do exist and should beconsidered when undertaking further researchwith migrant CALD groups.

Although it appears that migration from anon-Western society to a Western society has aneffect on the health status and activity levels ofthese migrant CALD groups, few studies havedirectly examined the association between thestages of the migration process and its effect onthe physical activity behaviours of CALD popu-lations. In particular, a search of the literature



failed to identify any studies addressing the ac-tivity levels of CALD populations in their coun-try of origin and how this may or may not affecttheir level of physical activity once they havemigrated to their new host country. Given thatthe migration process and the cultural changesassociated with it appear to influence health sta-tus and preventative health behaviours, the as-sessment of this process and the cultural changesassociated with it may be worthy areas for futureresearch.

Another limitation is that the majority of theliterature has been cross-sectional in nature.Limited data are available on how migration toWestern society influences the health status andphysical activity behaviours of CALD popula-tions over time, making it difficult to infercausation. Future studies would benefit fromcontrolled intervention trials and longitudinaldesigns that carefully assess the prevalence oflifestyle disease risk factors associated with themigration process and the effects that physicalactivity has on the incidence of these risk factorsand/or chronic disease.

There may also be some measurement issuesassociated with assessing the physical activityperceptions and behaviours of migrant CALDgroups. CALD groups represent a variety of na-tionalities and ethno-cultural groups, and assuch, the meanings and perceptions of physicalactivity, and physical activity measures used inresearch, are likely to vary. In consideration ofthis, valid and reliable instruments for assessingphysical activity must be specifically developedand tested to suit each cultural group. Further-more, given that many of these cultures do notread or write in their own language or in theEnglish language, alternative delivery modesof self-report physical activity need to be devel-oped and tested. Objective measures of physicalactivity should be considered in these groups tohelp overcome some of these barriers.

Keeping in mind that perceptions of physicalactivity do differ between cultures, it is necessarythat the research examines the educational com-ponents of health promotion programmes, pay-ing close attention to the exchange of informationpertaining to the physiological and psychological

benefits of physical activity. The educationalcomponent should occur in the initial stages ofthe migration process and should address thelifestyle behaviour changes (e.g. physical activityand diet) resulting from cultural changes, and thedirect effect that these behaviours have onchronic disease.

Lastly, the bulk of the literature is based ondata from the US, with some studies also origi-nating in the UK. Although this research hasmade a valuable contribution to the literaturepertaining to the lifestyle behaviours of migrantCALD groups, further research needs to beundertaken with CALD populations who havemigrated to other Western societies such asAustralia and New Zealand. As there may bedifferences when migrating to these differentWestern societies, it would be important to seesome comparative literature describing thesedifferent experiences.

Acknowledgements

This research was funded by a research grant from theOffice for Women, Department of Families, CommunityServices and Indigenous Affairs made to CM Caperchioneand KWMummery. The authors have no conflicts of interestthat are directly relevant to the contents of this article.

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Correspondence: Dr Cristina M. Caperchione, Institute forHealth and Social Science Research, CQUniversityAustralia, Bruce Highway, Rockhampton, QLD 4702,Australia.E-mail: [email protected]



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Physical Activity in Culturally and Linguistically Diverse Migrant Groups to Western Society