Comment on ‘prevalence and determinants of insufficient physical activity in elderly nursing homes: A cross‐sectional study based on the COM‐B model’

We read with great interest the article recently published by Shi et al. in the Journal of Clinical Nursing entitled 'Prevalence and Determinants of Insufficient Physical Activity in Elderly Nursing Homes: A Cross-sectional Study Based on the COM-B Model'. This study provides valuable insights into the prevalence of insufficient physical activity among nursing home residents in China and its various determinants. The study is well designed, but we would like to provide some perspectives for discussion with the authors. First, we believe that the 6-minute walk test is more suitable for testing the physical condition of the older than the SPPB used in the article: being able to walk at least 4 m without a walking aid. Because the 6-minute walk test can use assistive devices such as crutches: for the older aged 62–97 in the sample of this article, some of them may use assistive devices to walk in their daily lives, which makes walking more stable and reduces the risk of falling. In addition, the cardiac function of the older during exercise can be observed to obtain the amount of activity they can tolerate. The conclusion of the article proposes that these influencing factors provide potential focus points for interventions aimed at increasing the level of physical activity of nursing home residents and ultimately improving health outcomes, which means that effective exercise is needed to improve health, and effective exercise can be judged by monitoring heart rate whether it is of sufficient intensity and whether it can be tolerated (Kitai et al., 2021). Second, the opportunity part of the COM-B model in the article is represented by the availability of physical activity instruction and satisfaction with physical activity facilities. This article did not explore specific aspects of nursing home environmental factors that could be improved. Future research could conduct detailed assessments of the nursing home physical environment to identify specific barriers and facilitators of physical activity. For example, assessing the safety of exercise spaces, the availability of equipment and social support networks could provide feasible interventions to improve the physical activity environment (Yang et al., 2023). Third, this article is too subjective in analysing the impact of traditional Chinese culture such as 'Qing Jing Wu We' on the lack of exercise in the older. It is suggested that future research can be combined with qualitative research such as interviews to gain a deeper understanding of the reasons why the older are sedentary (Song et al., 2019). The dynamic nature of culture and its impact on different generations can also be considered. Blaming traditional culture for lack of exercise may oversimplify cultural dynamics. It is necessary to consider how modern influences and increasingly globalized lifestyles are changing traditional concepts. The intersection of traditional and modern values can provide a more nuanced perspective on behavioural motivational factors, which in turn can inform more culturally adaptive interventions. Finally, the sample size in the article is 69.7% female, and the sample size should be expanded in the future to make the ratio of male and female samples more balanced. In sum, this article not only provides an important contribution to our understanding of physical inactivity among older adults in nursing homes, it also provides opportunities for further discussion and exploration. We look forward to the authors' response and hope for further fruitful discussion on this important topic. Y-J.G. guided this comment, helped select the article and made critical revisions for important intellectual content. S-Y.S. selected the article and drafted the manuscript. All authors have read and approved the final version of the manuscript and agree with the order of presentation by the authors. The authors wish to thank Nantong University for supporting this research and also like to express gratitude to funding programs for supporting this study. This study was supported by the National Social Science Fund of China (21BSH007). The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. No ethical approval is required.