Abstract Physical activity is associated with healthy aging and prevention of non-communicable diseases; however, older people in Northern Thailand encounter numerous obstacles. This study explored both these barriers and enablers from the perspectives of various stakeholders, to guide for locally tailored strategies to improve participation. Two study groups of participants were interviewed using qualitative technique of focus group discussions (FGDs): in the first group were public health officials, 99 local government personnel and community health workers and in the second were 93 older adults, family members, and VHVs. A total of 20 FGDs took place in 10 sub-districts of Chiang Mai, Phayao, Chiang Rai, and Lamphun. The thematic analysis followed Braun and Clarke’s framework. Findings showed that barriers existed at individual, interpersonal, environmental and systemic levels. Physical pain, fear of getting hurt, and mental resistance was reported among the older bunch. Socio-cultural beliefs associating ageing to rest, weak infrastructure, and irregularities in program implementation also act as barriers to participate. Institutional problems were a lack of grown capacity, poor inter-agencies coordination, untrained staff. Support from VHVs, group-based activities in familiar environments, and culturally relevant routines were the facilitators. Interventions to encourage PA in older adults of North Thailand should be participatory, culturally based, and community owned. The empowerment of local capacity and the improvement of intersectoral cooperation as well as age-friendly design of public spaces and inclusive communication are essential.

Keywords: Barriers, Challenges, Exercise, Older adults

Graphical Abstract:

Citation:  Wungrath, J., Chautrakarn, S., Tonloungkat, S., Chernbumroong, S., Boonprasit, K., Yanawong, K., Thasuwanain, T., and Wicha, S. 2026. Barriers to exercise among older adults in northern Thailand: Insights from public health and community stakeholders. Natural and Life Sciences Communications. 25(1): e2026017.

INTRODUCTION

The ageing population is emerging as a defining demographic trend of the 21^st century, reshaping priorities in global health. Data from the United Nations (2023) indicate that more than 1 billion people were aged 60 and above by 2021 a figure expected to rise to 2.1 billion by 2050. This shift brings notable health and socio-economic challenges, especially in lower-income countries where medical systems are already under pressure. According to the World Health Organization (2020), promoting healthy ageing involves preserving autonomy, functional ability, and daily participation factors closely tied to regular physical movement. Physical activity not only helps prevent chronic illnesses such as heart disease, diabetes, and osteoporosis but also supports cognitive sharpness and emotional well-being in older age (WHO, 2022; Indrakumar and Silva, 2024).

While the advantages of staying physically active are widely recognized, inactivity continues to rise quietly across the globe. According to the World Health Organization (2024), nearly one in three adults fall short of the recommended 150 minutes of moderate activity per week putting close to 1.8 billion people at greater risk of developing chronic diseases. Older adults are the least active group, often hindered by declining physical abilities, unsupportive surroundings, and social beliefs that discourage movement in old age (Kilgour et al., 2024). These behaviors are shaped not just by individual habits but also by deeper cultural and societal structures that influence how ageing is perceived and lived.

In the Asia-Pacific region, countries experiencing rapid demographic change are facing a new set of public health challenges. Thailand offers a clear example. According to the National Economic and Social Development Council (NESDC, 2024), over 13 million people in Thailand about one-fifth of the population are now aged 60 or older. This shift marks Thailand as an ageing society, with projections suggesting that by 2037, seniors could make up one-third of the population (United Nations Thailand, 2020). Alongside this shift is a noticeable rise in chronic illness and age-related disability. Recent national surveys highlight high rates of hypertension, diabetes, and musculoskeletal issues among the elderly (Siripanumas et al., 2023).

Although Thailand has included physical activity in national health planning for more than twenty years, many older people remain inactive. Research from 2012 to 2019 showed that under 30% of elderly Thais met the recommended levels of moderate or vigorous exercise (Katewongsa et al., 2021). The problem tends to be more visible in rural areas particularly in the North and Northeast where poor infrastructure and geographic challenges make physical activity harder to maintain (Chanwikrai et al., 2022). While efforts like the “Active Ageing Thailand” campaign and local wellness clubs have been introduced, getting older adults to participate regularly has been difficult (WHO, 2023). The reasons go beyond individual health. Many face limited access to appropriate facilities, weak continuity in program support, and long-standing cultural beliefs that associate old age with slowing down rather than staying physically engaged (Ethisan et al., 2017).

In the northern region of Thailand, encouraging older adults to stay active is no easy task. Many villages are spread out over mountainous areas, which makes transportation and infrastructure a challenge. Most health outreach here depends on Village Health Volunteers (VHVs), who serve as the main link to the community. Seniors in this part of the country often say they deal with persistent joint pain, fear of falling, and a general lack of drive to join exercise activities especially when getting to those activities is already tough (Aung et al., 2021). Physical barriers don’t help either. Uneven walking paths, unsafe or unshaded areas, and worn-down communal spaces all make regular movement difficult. There’s also a cultural side to the problem. In some households, Buddhist teachings and a deep respect for age can discourage older people from seeing physical exertion as necessary or appropriate (Choi and Lee, 2020). Local health staff have pointed out that coordination between agencies is often patchy, funding is limited, and VHVs don’t always receive the training they need to run safe and attractive programs for the elderly (Wungrath and Mongkol, 2020).

Previous studies in Thailand explored the levels of physical activities among older adults. However, most of these relied on quantitative approaches and followed an individualistic emphasis focused on motivational factors or health literacy (Ethisan et al., 2017; Chamnankit et al., 2020). This mostly neglects the greater community and systemic contexts framing exercise behaviors. The experiences of public-health actors, local authorities, and community stakeholders also playing an important role in the design and implementation of exercise programs remain ill understood. Recent global evidence has suggested that the success of physical-activity interventions for older adults requires cultural relevance, social connectedness, and community engagement (Boulton et al., 2018; Mogamisi, 2022; Guan et al., 2023). In this respect, the present study qualitatively investigates how older adults, Village Health Volunteers, and public-health practitioners perceive and manage physical exercise within the context of their communities in Northern Thailand. This study aims to obtain insight into the interlinkages between personal beliefs, cultural norms, environmental conditions, and structural constraints from which it would be possible to support the development of sustainable, age-friendly, and culturally responsive physical-activity programs that support active and healthy aging.

MATERIALS AND METHODS

Study design    

The study used qualitative research design with focus group discussions (FGDs) as the primary data collection method. The chosen design allowed for in-depth exploration of complex and context-dependent phenomena, such as perceptions, experiences and systemic challenges surrounding exercise behaviors among older adults. Conducting FGDs enabled participants to speak about common and different perspectives, whilst researchers collected information on group dynamics, sociocultural norms, and group problem framing. This method is best for research that includes community-based intervention and health behavior research.

Participants and setting

Participants were recruited using purposive sampling from ten subdistricts located across four upper Northern provinces of Thailand: Chiang Mai, Phayao, Chiang Rai, and Lamphun. Each province contributed two to three selected subdistricts, ensuring that at least two distinct communities from each province were 

Group 1: ninety-nine public health professionals and allied personnel, including local government unit staff, subdistrict health promoting hospitals (SHPHs), and community health development agency staff.

Group 2: ninety-three community-based stakeholders who are elderly aged 60 and above, informal caregivers (for instance, family members), and Village Health Volunteers (VHVs).

The sites selected encompassed a well-balanced mixture of urban, peri-urban and rural communities. The selection criteria focus on geographic diversity, socioeconomic variation and different degrees of community health infrastructure. Participants were eligible to participate if they had direct experience in either elderly care services or personal experience around exercise and aging-related health conditions.

Specifically, participants were included if they (1) were aged 60 years or above, or were public health officers, caregivers, or Village Health Volunteers (VHVs) with direct experience in elderly care or exercise-related programs; and (2) had lived or worked in the study area for at least one year. Those who were unable to communicate effectively, cognitively impaired, or unwilling to participate were excluded.

Data collection procedures

The data collection was conducted from February 2025 until March 2025; In all, 20 FGDs were held, 10 in each group keeping the discussion environment separate to prevent hierarchical bias and role-influenced answers. All sessions lasted between 2.5 and 3 hours, conducted by a team of trained moderators and note-takers.

An interview guide was created based on a literature review and expert consultation. Topics included perceptions of physical activity, perceived barriers and facilitators, support system, availability of infrastructure, cultural influences, and suggestions for program improvement. It was pilot tested in the previous year at an external, non-study site to refine question ordering and clarity. All FGDs were conducted in Thai, audio-recorded (with consent from participants) and supplemented by field notes. Below is an overview of the thematic coverage of the interview guide questions:

Group 1: Public health professionals and allied personnel

-   What are some current policies or practices related to engaging older adults in physical activity in your community?

-   What do you think are the barriers that stop older people from exercising regularly?

-   How does your organization work with the health promotion and elderly care of others (e.g., local government, VHVs)?

-   Which support or resources would help to better provide physical activity programs for older adults?

-   Is there any cultural or societal IPV that affects older adults in their approach to exercise?

Group 2: Elderly individuals, caregivers, and VHVs

-   What does exercise mean to you and how much do you move?

-   What supports or challenges your ability to exercise regularly?

-   Do older adults in your community have places or programs they can attend to exercise?

-   How do your own family or neighbors support (or not support) your physical activity?

-   What would make getting into exercise activities easier or more fun for you?

These guiding questions helped facilitate discussion and ensured consistent thematic exploration across sites while allowing flexibility to probe emerging ideas and context-specific issues.

Data analysis

Thematic analysis was undertaken manually by the research team, generating verbatim transcripts. The analytical process adhered to Braun and Clarke’s six-phase framework of: musty brand with the data, creation of initial codes, identification themes, themes review, themes definition and naming, and final report Additionally. An inductive and deductive approach was taken to generate emergent themes, while ensuring the themes remained grounded within the study’s theoretical framework.

For increased rigor, intercoder reliability was achieved through dual coding by two independent researchers with discussions to reach consensus. Data for the triangulation cross-group comparisons were applied, and member-checking with selected participants confirmed interpretations. An audit trail was kept throughout to promote transparency and replicability.

Trustworthiness

Several methods consistent with qualitative research rigor were used to establish trustworthiness in the study. Credibility was established through long-term immersion with the populations studied, triangulation of data sources (adults over 60, caregivers, VHVs, and public health stakeholders), and checks with informants from whom the data were drawn to confirm interpretations. Transferability was accomplished by offering comprehensive information on the context of the study settings and participant selection in different provinces. Reliability was achieved via transparent audit trail and independent dual coding with consensus discussions. Confirmability was facilitated by keeping reflexive notes and (re)focussing findings on participants’ narratives and not the researcher’s subjectivity.

Ethical considerations

Ethical approval for this study was obtained from the Research Ethics Committee of the Faculty of Public Health of Chiang Mai University (Ref. No. 03/2568). Participants received both oral and written descriptions of the research purpose, procedures, confidentiality, and the fact that participation is voluntary. Informed written consent was obtained before participation. Anonymity was preserved by assigning participants with codes, and audio files and transcripts were kept in encrypted folders accessible to the research team only.

RESULTS

The findings of this study are reported in two main sections according to the two groups of participants: (1) public health practitioners and allied personnel; and (2) community-based stakeholders: elderly individuals, caregivers and Village Health Volunteers (VHVs). The individual sections offer a thematic analysis emerging from the focus group discussions organized according to the core domains explored closer in the interview guide. This framework will enable us to comprehensively explore the multifarious barriers and needs and contextualize the promotion and management of physical activity among older people in Northern Thailand. The results will explore both systemic and experiential factors that may influence exercise behaviours across this population.

Public health professionals and allied personnel

Current policies and practices

Participants reported that national policies underscore the importance of active aging and promoting healthy lifestyles among seniors, but that community-level implementation is both limited in scope and sustainable. Elderly exercise data programs are mostly pilot and ad hoc without institutionalized continuity and integration into subdistrict health plans. Many commented on the lack of standard operating procedures, or monitoring mechanisms, for programs for elderly physical activity.

Some health officials say community health promotion is more disease prevention campaigns than the fundamentals of regular physical activity, particularly among the older population, is a priority. In addition, exercise initiatives may be heavily dependent on either local leaders or local volunteers without a central authority offering standardized support.

“We try to offer exercise as part of our elderly clubs, but it really depends on who is available and whether we have budgeted for it in that month.” It’s not something we can guarantee every week.” (Public Health Officer, Chiang Rai)

Observed barriers

Important structural barriers involved insufficient human resources in health centres, excessive workload of the VHVs and inadequacy of conducive environment for physical activity. Rural land and limited options for physical activity in places such as community parks or centers were highlighted. Additionally, psychological resistance among elderly individuals, such as fear of injury or lack of confidence, can be barriers to engaging in physical activity.

Staff described how, even where resources do exist, take-up is low because of a failure to reach out, lack of sustained communication, or competing responsibilities among the over 60s. Chronic illness, emotional vulnerability, and absence of structured follow-up contribute to the abandonment of physical activity programs.

“Some of the elders have diabetes, arthritis or are recovering from strokes. “They’re afraid to even stretch, much less participate in a group exercise class.” (Subdistrict Health Promoting Hospital Nurse, Phayao)

“With only two staff members for five villages, it is impossible to conduct proper sessions. We are forced to only prioritize the very sick.” (Health Officer, Lamphun)

Inter-organizational coordination

Most respondents described fragmented collaboration between the sectors. Kenzie tree and local service agencies’ sparked duplication, divergence, inconsistent efforts from civil society. Coordination was based much more on personal relationships than on formal interagency structures.

Several respondents cautioned that while formal networks existed on paper, joint planning was rare. As a result, the response paid little attention to synchronized workplans and performance indicators, resulting in poor efforts to coordinate interventions.

“There’s no regular meeting or shared calendar for us to align goals or timelines. It’s informal and reactive.” (Local Government Officer, Lamphun)

“Sometimes the municipality does something without informing the health team. We discover it when it’s too late to do anything in support.” (VHV Supervisor, Chiang Mai)

Needed support and resources

Stretching interventions in this population could be facilitated by structured training programs around geriatric exercise, mobile teams, dispensing home-based interventions, simple exercise apparatus, and flexible funding mechanisms, as highlighted by a number of respondents in this study. VHVs' training was reported to be outdated or inadequate, and access to age-specific program designs was lacking for health workers.

Moreover, it was reported that the lack of culturally tailored media or visuals tools in older populations, especially low literacy and language barriers, remained a barrier.

“We need training not only when it comes to physical activities but how to safely motivate and monitor elders.” (Health Educator, Chiang Rai)

“There are elders who cannot take themselves out of the house. If we had kits or mobile vans with guided routines, at least they could move safely from home.” (Local Health Officer, Phayao)

Cultural and societal beliefs

Public health workers said many elders have attitudes that equate aging with passivity and strength with youth. Some elders feared being judged or ridiculed while exercising in public spaces.

The idea that exercise was too strenuous for one’s age, especially among older men, was widespread. Some professionals attributed this to the influence of Buddhist tenets that promote uprightness and detachment, which some elders interpret as advising against strenuous physical activity.

“They say, ‘I’m old. My time for making a move has gone.’ Man shifts the focus to compassion, as in, “It’s difficult to change minds when internal culture says rest equates to respect.” (Community Health Worker, Chiang Rai)

“Some older men feel that exercise is for women or for the young. It’s a mindset challenge.” (VHV Coordinator, Lamphun)

Community-based stakeholders

Meanings and patterns of exercise

Among the older participants, “exercise” meant very different things to different people, shaped by personal history, physical condition and cultural interpretation. For many, physical motivators were framed within activities of daily living framed in mundane activities of daily living that included sweeping, gardening, walking to the temple, monks, or feeding chickens that were perceived sufficient for maintaining movement. For some, “exercise” meant formal gym-based activities or sports geared toward young people, which seemed irrelevant or intimidating.

With a few notable exceptions, participants indicated that they preferred familiar, low-intensity activities and those that didn’t require special clothing, equipment, or other unfamiliar techniques. A few had experiences with group exercises, such as temple-based aerobics or sessions led by VHVs, but most reported participating infrequently due to health constraints, transportation challenges, and lack of incentive.

“I do my sweeping and watering of the garden — that’s my exercise. That’s enough for me — I don’t want to do anything risky.” (Elderly woman aged 69, Phayao)

“I used to attend aerobic classes at the temple, but now I don’t feel stable on my feet.” (Elderly man aged 67, Chiang Mai)

Barriers and facilitators

The most commonly reported barrier was health-related constraints. Commonly reported chronic conditions included knee osteoarthritis, high blood pressure, vertigo and fatigue, which greatly decreased participants’ mobility and self-confidence. Many were concerned about falling, particularly unsupervised. They also raised psychological barriers, such as embarrassment or feelings of inadequacy in a group setting.

But when exercise was embedded in a social situation — particularly one involving peers or acquaintances — participation increased. Support from VHVs, neighbors or family members was another key motivator. Those who had been through structured sessions noted the necessity of clear guidance, slow pacing and inclusive, nonjudgmental atmospheres.

“My knees are painful every time I get up. It’s a big deal for me to walk around.” (Elderly man aged 63, Lamphun)

“When the village volunteers come and do it along with us, I feel brave enough to join.” (Elderly woman aged 67, Chiang Rai)

I want to go, but I don’t have the right clothes. “Others look neat and ready — I feel like a fish out of water.” (Woman aged 66, Chiang Mai)

Access to community programs

Physical activity opportunities were unevenly structured or community based. Aside from some sporadic programs based on health campaigns or religious occasions, other communities had no structured activities whatsoever. A common complaint was scheduling: Many sessions took place early in the morning, clashing with caregiving responsibilities, housework or religious rituals.

There was also basic infrastructure. Participants bemoaned the absence of adequate spaces, stating that unshaded, rough, or slick ground discouraged participation — particularly among people with walking aids. Transport difficulties exacerbated the inaccessibility of these areas for those living in the remote hamlets.

“They sometimes plan activities, but it’s too far away, or at a time when I have to cook for my husband and feed him.” (Caregiver aged 54, Chiang Mai)

“There’s not a proper place here. We work out on concrete, outdoors, in the sun. That’s why people don’t go.” (Elderly woman aged 69, Phayao)

“I walk to the market; that’s my only opportunity to move. But organized activities? Too far, and nobody to take me.” (62 years old, Chiang Rai, Elderly man)

Family and community support

The effects of family influence on exercise behavior were mixed. In particular, some participants benefited from emotional and logistical support from children or grandchildren, who urged them to move or provided resources such as links to YouTube videos or music that facilitated home-based exercise. Others mentioned they felt discouraged from being active for fear of injury or the perception that elders should rest.

The VHVs were repeatedly described as trusted, approachable staff who minimized the gap between elderly and formal health promotion. Just being there, supporting us mitigated the feelings of isolation and built confidence.”

“My daughter fears I’ll fall and she tells me not to go outside. She has good intentions, but it makes me feel useless.” (Elderly woman aged 71, Chiang Rai)

“My grandson puts on YouTube videos of Thai exercise for me. That’s how I begin to move again.” (Elderly man aged 68, Chiang Rai)

“If the VHV summons me, I’ll go. “I feel safe because they take care of me.” (Elderly woman aged 65, Lamphun)

Suggestions for improvement

Participants in the discussion had various suggestions for making exercise more attractive and sustainable. Some of these key recommendations highlighted the importance of regular and predictable schedules, transport, and ensuring activities were age-appropriate and culturally relevant. Participants also proposed incorporating music, local dance forms, or religious spaces (e.g., temple compounds) in exercise practices.

 Elders also preferred to have community members or VHVs lead the sessions, rather than an outside trainer. Some ideas also included providing refreshments or small incentives. Importantly, many expressed the need for emotional support and encouragement as the most vital aspect of continued engagement.

“We don’t need fancy gyms. Just music, shade and an instructor who smiles while they teach us.” (VHV aged 51, Phayao)

“If the village can rent a songthaew (local transport) once a week, then we can all go together and exercise.” (Elderly woman aged 67, Lamphun)

“If you do check on me, I won’t feel so lazy. I just need to be reassured that I’m still part of something.” (Elderly man aged 70, Chiang Mai).

DISCUSSION

This study highlights the complex interplay of physical, psychological, social, and structural barriers restricting elderly participation in exercise in Northern Thailand. Chronic non-communicable diseases (NCDs) were particularly osteoarthritis, diabetes and hypertension were consistently mentioned as significant barriers to movement with fear of injury or exacerbation of symptoms expressed by many of the participants. Such musings were more than just about their pain; what worried them was the loss of independence, agency, and security when trying something new, novel, or unknown. These results are consistent with earlier work, including that of Savvakis et al. (2024), focusing on the association between physical frailty, fall risk, and physical inactivity among older adults (Chamnankit et al., 2020). Moreover, the WHO (2015) stated that worldwide, more than 20–30% of older adults have reduced mobility from chronic conditions, corroborating this study’s data.

Psychological barriers like embarrassment and low self-confidence, along with beliefs that older age mandates passiveness were also strong deterrents (Peng et al., 2023). Such sentiments were often echoed by family members and peers, discouraging activity due to safety concerns, fostering a protectionism that ironically decreased functional independence. These trends are consistent with those of Cunningham et al. (2020), whose synthesis from the meta-ethnographic approach found that cultural background, especially in collectivist societies, can strongly influence participation in health behaviors. Subjects in the study, especially older men, considered public exercise to be potentially shameful or unbecoming. Thus, this aligns with a cultural lens emerging in data (Choi and Lee, 2020) that suggest modesty norms and gender roles inhibit older men from group exercise, and as a setting factor limiting elderly men’s participation in athletic spectacle to more mixed-gender environments.

And these challenges are compounded by even more environmental and infrastructural constraints. Many reported barriers to participation in community programs stemming from uneven terrain, no shaded spaces, poor maintenance of public walkways, and limited transportation (Aung et al., 2021). Some rural villages also did not have a dedicated space for group activities; even where such spaces did exist, timing conflicts with other events, weather conditions, or inadequate lighting impeded accessibility. These environmental barriers have been well documented in previous research, such as a rural, Australia-based study by Burton et al. (2017), which highlighted the disproportionate effect of geographic isolation and lack of age-friendly infrastructure on the ability of rural elders to exercise. Similarly, Ruchi and Kumar (2024) in their study conducted in Noida, has shown that closeness to green areas and safe walking paths has a significantly positive association to the physical activity of older individuals in cases where the settings are elder-friendly (Khamjing et al., 2025).

This discrepancy between the policy goals at the national level and the execution at the local level was highlighted from the views of public health professionals on a systemic level. Although strategic frameworks, such as Thailand’s National Elderly Plan, exist, frontline workers described variable funding, fragile intersectoral coordination and no dedicated personnel (Chunharas, 2002). A number of programs relied extensively on ad hoc financing from local administrative organization (LAO), without sufficient technical guidance or accountability. This resonates with the worries expressed by Knodel et al. (2015), who cautioned that the gap is widening between Thai policy rhetoric and rural implementation capacity of a portion of Thailand’s aging-care system. Moreover, like findings and debates emerging from work on rural health service delivery (Yuan et al., 2024) within the context of countries such as Myanmar, reliance on unsustainably low-resourced volunteer networks (such as VHVs) without investment in structured capacity-building undermines the long-term effectiveness and sustainability of the interventions(s).

Crucially, the study also revealed a battery of facilitators and windows of opportunity. Older participants were willing to exercise when it was led by trusted representatives of the community, in culturally familiar formats with social incentives. The best type of workout for them was low-impact group-based movement, gentle dance, or sports practices integrated into their daily routines including walking to the temple. The role of VHVs turned out to be critical—not only in mobilizing participation, but also in ensuring continuity and providing emotional support. These insights correspond with the notion of community health workers as health brokers and social connectors discussed in Perry et al. (2014). The social dimension of exercise, especially peer motivation, small group accountability and sense of being a member, have been long promoted in the literature as a protective factor against dropout and isolation (Boulton et al., 2018).

This highlights the importance of culturally embedded, contextually appropriate and structurally supported interventions. Interventions that incorporate local customs whether they are stretching on temple grounds, walking and sharing stories, or performing folk dances that older adults prefer are not only practicable but probably more sustainable because they respect elders’ values and preferences (Mogamisi, 2022). The findings also argue for more low-tech, age-friendly innovations such as Thai-language exercise videos broadcast over village radio, posted in SHPH waiting areas or played on smartphone for home-based participation. These methods are inspired in part by successful strategies in similar settings: for example, community radio-based exercise campaigns in rural India (Guan et al., 2023).

Constantly fostering exercise in older adults in Northern Thailand requires a paradigmatic change of heart: a shift from top-down mandates to participatory, bottom-up co-design.; How to do that is to interweave policy, place based knowledge and trusted networks with roads that are realistic enough that stretch the seam from intention to action. The on-the-ground experiences of the elderly, caregivers and frontline health workers highlighted in this study can serve as a powerful roadmap to guide the design of inclusive, scalable and human-centered interventions in similar socio-cultural landscapes (Wungrath and Mongkol, 2020).

CONCLUSION

This study provides a multi-faceted view of the exercise barriers faced by older adults living in four Northern provinces in Thailand. Results show participation was limited by the intersections of physical barriers, psychological resistance, cultural beliefs, environmental constraints and systemic resource gaps. On one hand, facilitators including the unique legitimacy of the role of VHVs, community ties and routine established through cultural familiarity create an opportunity for effective intervention. As such, these findings underscore the need for community-informed, flexible, and locally embedded strategies that are aligned with the lived realities of older adults. To scale up sustainable physical activity in older adults, future interventions should focus on participatory approaches, building local capacity and promoting intersectoral collaboration. Positioning exercise as a cultural value and socially supported aspect of life, not a clinical recommendation, will be the most critical vehicle for supporting healthy aging in Thailand and similar settings.

LIMITATIONS AND FUTURE RESEARCH

Despite them, this study was able to provide some insights, but it does come with several limitations. First, the findings derived from qualitative data collected from purposively sampled subdistricts in four provinces do not represent all parts of Thailand. Local contexts, resources, and sociocultural factors may differ widely beyond the study sites. Second, the use of focus group discussions may have potentially prevented individual perspectives from being shared, particularly on sensitive topics such as fear, self-doubt or stigma. Influence of dominant voices or group norms on some of the speakers.

The study also excluded people who are not connected with comprehensive community health services or networks like VHV as it focused on older people. As a result, views of the elderly who are more isolated, homebound or marginalized may be underrepresented. Finally, although the study covered multisectoral perspectives, higher-level policymakers, and funding bodies were not represented.

Further research is needed to examine the long-term effects of exercise promotion initiatives in community contexts, particularly sustainability and the health benefits of initiatives. By including behavioral data and complementing it with in-depth interviews, mixed-methods studies could provide a richer understanding of respondents’ motivations and barriers. There is also a need to investigate the role of emerging technologies, including mobile health applications and remote coaching, in supporting elderly physical activity in the rural context. Comparative studies in other regions of Thailand or Southeast Asia would provide complementary evidence and inform scalable, culturally sensitive interventions.

RECOMMENDATIONS

From what the study revealed, here are four practical ideas to help get older adults moving more:

1.  Keep the training for village health volunteers and local health staff fresh. Run regular refresher sessions so they feel confident teaching exercises that are safe and appropriate for older folks. Also, equip them with better ways to encourage and engage seniors.

2.  Make exercise locations senior friendly and nearby. Think shaded walkways, smooth even surfaces, multi purpose spaces near temples or health centers — places seniors can reach easily and feel safe using.

3.  Design activity programs that match the local culture and daily habits. Try group workouts with traditional music, folk dancing, or hold sessions at the temple. That familiarity helps make the activities feel natural, not forced.

4.  Bring together different sectors to make this work. Local governments, public health teams, and community groups should join forces — plan together, fund the work, and keep it going so the benefit lasts.

DECLARATION OF GENERATIVE AI IN SCIENTIFIC WRITING

The authors confirm that Generative AI tools (such as ChatGPT or GPT-5) were utilized only to enhance the linguistic quality of the manuscript (grammar, spelling, and clarity). No AI was involved in generating original content, scientific data, or analytical interpretations.

ACKNOWLEDGEMENTS

The authors sincerely thank all participants, including older adults, Village Health Volunteers, and public health personnel across Chiang Mai, Chiang Rai, Phayao, and Lamphun provinces. We also acknowledge the support from the Faculty of Public Health, Chiang Mai University; College of Arts, Media and Technology, Chiang Mai University; Faculty of Education, Chiang Mai University; Health Promotion Center Region 1 Chiang Mai, Department of Health; Faculty of Public Health, Chiang Rai Rajabhat University; and the School of Applied Digital Technology, Mae Fah Luang University.

AUTHOR CONTRIBUTIONS

JW conceived the study, led the design of the study, engaged in data collection, performed the main analysis, and helped to draft the manuscript. SC and ST participated in literatures collection, data analysis and manuscript revisions. SCB contributed to the methodology and supported the qualitative coding. Field coordination and engagement of stakeholders were supported by KB. KY participated in the interpretation of the results and policy context analysis. TT contributed in data transcribing and quality control. SW oversaw the implementation and conduct of the study, manuscript critical review and revision, and intellectual content critical review and revision. All authors read and approved the final manuscript.

CONFLICT OF INTEREST

The authors declare that they hold no competing interests.

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