Asian American Women’ Experiences and Perceptions of Physical Activity: A Systematic Review of the Qualitative Evidence

Subtheme 1.1: Culturally Specific Practices of PA

PA is widely recognized for its role in enhancing overall well-being, including mental and physical health, as well as spirituality in Asian Americans. Traditional leisure-time PA practices vary across cultural contexts, often involving light-to-moderate-intensity movements and integrating cognitive engagement through meditative or spiritual elements.^25,26,32 For example, Tai Chi and Yuanji dance are more prominent in East Asian cultures, particularly Chinese, while Yoga and folk dance are more commonly associated with South Asian cultures. These practices incorporate breath control, various postures, and mindful awareness of the body to cultivate a calmer, more focused state of being.^30,31 They are recognized for their contributions to improving balance, muscular strength, flexibility, motor coordination, and cognitive focus. Interestingly, religious practices such as praying are often considered a form of exercise in South Asian American communities. ³² These practices involve many physical postures, including bowing, kneeling, and prostrating, along with cognitive engagement. Additionally, the frequent act of praying and commuting to places of worship further reinforces its association with PA. ³² Another common form of PA is walking, which is valued not only for its health benefits but also for its role in enhancing social connections. Engaging in conversations during walks is considered essential, as it is seen as a way to reduce stress, strengthen friendships, and enhance familial bonds. ²⁸ Despite these traditional practices, leisure-time PA has not historically been a normative aspect of most Asian cultures.^28,31-34 PA is often embedded in daily routines rather than structured as a separate, intentional activity.

Subtheme 1.2: Impact of Traditional Gender Roles and Family-Centered Cultural Values on PA

Culture-related societal norms and perceived expectations shape Asian American women’s perceptions and participation in PA, acting as both a barrier and a facilitator. Traditional gender roles often limit Asian American women’s engagement in leisure-time PA. From childhood to midlife, many women recall a lack of encouragement to participate in leisure-time PA, as they are directed to focus on acquiring domestic skills or academic achievement.^30,31,33-35 These societal expectations reinforce obligations such as cooking, caregiving, and household responsibilities, which take precedence over leisure-time PA.^31,34 Consequently, women who equate PA with exercise often view daily chores and caregiving tasks as sufficient exercise, further reducing the perceived need for dedicated leisure-time PA.^31-34 The internalization of those societal expectations further reinforces the low priority of leisure-time PA across life stages.^29,34

In addition, a deeply ingrained family-first mindset in Asian cultures often prioritizes the family over individual well-being, leaving little time or energy for leisure-time PA.^{25,30,31,33-35} Activities that foster social connections and family harmony are highly valued, often leading to family-centered engagements or social events taking precedence over individual PA when scheduling conflicts arise. In this context, family endorsement is often essential for PA. For example, older Chinese American women cite caregiving responsibilities, such as looking after grandchildren, as a barrier that disrupts their ability to maintain consistent PA routines, while South Asian American women reported higher PA levels during young adulthood than, attributing this to having more personal time than in later years. ³¹ When women primarily identify as daughters, wives, mothers, and grandmothers, cultural undervaluation, societal expectations, and familial obligations reinforce the notion that leisure-time PA is an add-on rather than a necessity.

However, the family-oriented value can also motivate PA, especially when it aligns with the desire to support and care for loved ones. For instance, older Chinese Americans engage in PA to maintain independence and promote longevity, allowing them to continue to support their children and avoid becoming a burden.^26,27,30 In this context, PA is not merely an individual pursuit but a way to sustain their ability to care for their loved ones, reinforcing its value within cultural expectations.

Subtheme 1.3: The Role of Social Support in PA Engagement

Emotional, informational, and instrumental support from family, community, and cultural networks significantly enhances PA participation. Family support, particularly from spouses and children, plays a critical role in helping women navigate cultural norms, expectations, and logistical challenges related to PA participation. Women encouraged by their families are more likely to engage in PA, whereas those facing discouragement or disapproval often struggle to maintain consistent activity levels.^25,27,31 Moreover, negative social dynamics, such as dismissive remarks from spouses or a lack of participation in joint activities, can diminish PA engagement.^30,33

Beyond the family context, participating in PA within cultural communities provides additional opportunities for social engagement, contributing to emotional and psychological well-being.^29,30 Shared activities, such as group walks, dance classes, and religious or cultural events, offer a space for interpersonal interaction and mutual support. These experiences facilitate the adaptation of immigrant women to new environments while reinforcing cultural identity and offering essential emotional benefits.^26,29,30,34 Engaging in exercise with peers from similar cultural backgrounds fosters a sense of belonging and strengthens emotional bonds, making PA feel more accessible and enjoyable.^27,30,33,34

Subtheme 1.4: Misconception That Exercise Is Only for Weight Management

Linking PA exclusively to weight management often discourages women from recognizing their need for regular PA. While the general benefits of PA, such as “good for your body,” ³¹ were recognized, many had little knowledge about its role in preventing chronic illnesses.^28,31 The dominant belief that regular PA is only necessary for those who are overweight or obese undermines its broader health-promoting potential.^28,31 This misconception is often intertwined with familial and cultural influences. Many women recalled that, during their youth, their families discouraged leisure-time PA, viewing it as unnecessary unless they were overweight or at risk of obesity.^28,30,31,35 In addition, in South Asian cultures, societal norms often associate a fuller body size with prosperity and social status, which can conflict with Western health definitions of a healthy weight. ³² This perspective may lead to a preference for larger body sizes, influencing individual perceptions of health and beauty.

Subtheme 2.1: Influence of Environmental Changes on PA Engagement

Asian American immigrants described how PA domains shifted from active commuting and occupational labor to more sedentary lifestyles after they migrated to the United States. For instance, many Asian American immigrants previously relied on walking or public transportation for daily travel and engaged in physically active labor (eg, journalists and farmers).^30,34,35 After migration, environmental and cultural changes disrupted the continuation of their PA behaviors. Many women highlighted the stark infrastructural differences between their home countries and the United States.^28,30,34 In their home countries, essential destinations are often within walkable distances, making walking a common mode of travel. In addition, well-established public transportation systems provide a pedestrian-friendly environment that supports daily mobility. In contrast, in the United States, essential services and destinations are often dispersed, and public transit options are limited. This contributes to automobile dependence for commuting, making walking less practical and, at times, unsafe.^30,34 Asian Americans who were previously non-sedentary through non-leisure-time PA may struggle to adopt Western leisure-time PA habits, such as gym workouts or sports. The cultural expectation in the United States to engage in structured leisure-time PA can be unfamiliar and even intimidating, leading to an inactive lifestyle.

Cultural norms present additional challenges, particularly for women from South Asian backgrounds. Those women report that participating in PA in public or open settings is considered culturally inappropriate. Mixed-gender facilities are often viewed as acceptable only for “foreigners” (ie, non-Muslims or subsequent-generation Asian Americans). ³² Even those who attend gyms feel self-conscious wearing traditional clothing, such as hijabs or long tunics, in mainstream fitness environments where Western athletic attire prevails.^31,32 Limited access to culturally appropriate or culturally friendly PA facilities remains a significant barrier due to cultural norms of modesty (eg, gender segregation, privacy).^31,32

Subtheme 2.2: Psychosocial Influence on PA Engagement

The process of migration introduces various adaptation challenges, including language barriers, discrimination, and social isolation.^26,29 The need to familiarize with social norms, bureaucratic systems, and daily interaction courtesies contributes to an increased cognitive load, which can exacerbate psychological distress and feelings of loneliness.^26,29 In response, immigrant women often turn to familiar activities that reinforce their cultural identity as a coping mechanism. Many immigrant women report spending their leisure time engaging in passive or familiar activities, such as watching television in their native language, preparing traditional meals, and socializing within ethnic enclaves. ³⁴ While these activities foster a sense of belonging, they may also reduce engagement in PA. ³⁰ However, when immigrant Asian Americans establish social connections through PA participation with culturally similar peers, they report experiencing psychological benefits, including stress reduction.^27,29,31 These findings suggest that culturally inclusive PA opportunities can enhance both the adaptation process and emotional well-being among these groups.

Subtheme 3.1: Physical Health-Related Barriers to PA

Health conditions, including chronic diseases or acute illnesses, pose barriers to PA. Individuals with chronic pain, fatigue, or physical limitations due to long-term health conditions often struggle in regular PA. A lack of knowledge or guidance on how to participate in PA safely may further exacerbate inactivity. ³¹ Similarly, acute illnesses can temporarily disrupt PA routines, creating setbacks in long-term behavioral maintenance. Physical discomfort associated with PA, including post-exercise soreness or muscle fatigue, can deter individuals from consistent engagement. Korean women, for example, reported that such physical sensations (eg, soreness and exhaustion following exercise) decreased their motivation to sustain PA routines. ³⁰

Subtheme 3.2: Psychological Factors on PA Engagement

Psychological and intrapersonal factors significantly influence PA participation. Many women report that a lack of self-discipline, high stress levels, and a general lack of enjoyment in leisure-time PA serve as major deterrents to engagement.^30,33 These challenges often stem from competing priorities and a lack of intrinsic motivation. Conversely, finding PA enjoyable and recognizing the benefits of regular PA serve as strong motivators for sustained engagement in PA.^29,31 Women who associate regular leisure-time PA with improved physical and mental health and enhanced overall well-being are more likely to maintain an active lifestyle.^27,30,32,33 Furthermore, achieving fitness milestones, such as improved endurance, weight management, or increased confidence, provides a sense of accomplishment that reinforces continued engagement.^30,33

Subtheme 3.3: Healthcare Professionals in PA Promotion

Healthcare professionals are uniquely positioned to influence PA engagement through education and personalized recommendations. Physician referrals and counseling on the health benefits of regular PA have been associated with higher participation rates, particularly among those managing chronic conditions.^31,35 Integrating PA guidance into routine medical consultations may help address misconceptions about exercise safety, provide tailored recommendations, and foster long-term behavioral change.

Subtheme 3.4: Environmental and Safety Concerns as Barriers to PA

Unfavorable weather conditions, such as extreme heat, cold, or heavy rainfall, often deter outdoor PA (eg, walking, jogging, or biking).^27,30,33,35 Seasonal variations in climate could affect consistency, as people may struggle to find accessible indoor alternatives during inclement weather. Safety concerns also present significant obstacles, particularly for women engaging in outdoor PA.^30,33 Fear of crime, harassment, or traffic hazards can discourage walking or exercising in public spaces, especially in neighborhoods with limited pedestrian-friendly infrastructure.^30,33-35