J Exerc Sci Fit Vol 5 No 2 2007 95

Original Article
THE CONCEPT OF WELLNESS FROM THE
PERSPECTIVE OF CHINESE CULTURE
Hong Ren
1
, Wen-Hua Xing
1
, Frank H. Fu
2
1
Beijing Sport University, Beijing, CHINA
2
Dr. Stephen Hui Research Centre for Physical Recreation and Wellness,
Hong Kong Baptist University, Hong Kong SAR, CHINA
The present study proposes a model to better understand the concept of wellness from the Chinese perspec-
tive. Subjects were Chinese adults (3049 years old) living in Beijing. Data were collected and analyzed to
establish content validity and to formulate a primary model on various stresses from the environment
through focus group interviews with specialists, professionals and the general public. The proposed model of
homeostasis was then revised and refined, including three major environmental factors: natural, sociocul-
tural and psychophysiological. It was suggested that to have a better understanding of the concept of well-
ness from the Chinese perspective, the component of homeostasis should be included and considered.
Keywords: environment, health, homeostasis, physical fitness
Introduction
Wellness is an area that has been investigated by many
scholars. It can be defined as an active life-long process
of becoming aware of and making choices to achieve
optimal health and a more successful and balanced exis-
tence. Health is an essential component of wellness and
represents a state of complete physical, mental and
social wellbeing, and not merely the absence of disease
or infirmity (Bok 2004; Hales 1997; Edlin & Golanty
1985). Wellness is multidimensional, and has been
divided into six interrelated dimensions by researchers
(Corbin et al. 2001; Hales 1997; Greenberg et al. 1995):
physical, emotional, spiritual, intellectual, social and
environmental. The present study focuses on the impact
of social and environmental factors on wellness in the
Chinese population.
Various assessment methods and tools on wellness
were designed in different countries based on cultural,
economic and social characteristics. It was suggested
that some of them are useful references but are not
applicable to Chinese. In the Chinese culture, it is
believed that there is a close linkage between man and
the universehealth can be attained when the balance
with nature and the body is achieved such as in homeo-
stasis (Xu 2003; Yao & Qiu 2001; Zhu 2000). In order
to enjoy the state of homeostasis, one has to adapt
successfully to environmental changes. Thus, it would
be desirable to understand the process and factors in
achieving and maintaining homeostasis.
As the Chinese economy is developing rapidly in
recent years, the desire to achieve wellness by the
general public has also increased. In China, many
researchers have focused on physical fitness because its
components can be measured by equipment available
Corresponding Author
Hong Ren, Beijing Sport University, 48 Xinxi Road, Haidian
District, Beijing, CHINA.
Tel: (86) (0)1 6298 9585
Fax: (86) (0)1 6298 9585
E-mail: renhong5939@sina.com
in the market (Heyward 2002; The People Physical
Education Department of General Administration of
Sport 2002; Research Section of the Physical Fitness and
Health of Chinese Students 1996, 1993, 1987). However,
wellness is not only influenced by morphologic, physi-
ologic and kinesiologic factors, but also by social, envi-
ronmental and pathologic factors. By focusing on the
latter three factors, we can add to our knowledge on the
wellness of the individual and supplement the existing
physical fitness test in China. Thus, a more complete
assessment of wellness from the Chinese perspective
can be achieved.
In coping with stress from daily life, it is important
that we maintain equilibrium by adapting and thereby
achieving homeostasis. Homeostasis refers to the ability
or tendency of an organism or cell to maintain internal
equilibrium by adjusting its physiologic processes
(American Heritage Dictionary 2000; Selye 1956). If we
can assess the ability to achieve homeostasis through
a questionnaire, we would be able to evaluate health
more comprehensively and conveniently. The main
purposes of this study were to investigate these three
factors of homeostasis (social, environmental, patho-
physiological) and to develop a model for their evalua-
tion. It is believed that together with the components of
physical fitness and health, the component of homeosta-
sis is essential in promoting the concept of wellness in
the Chinese community.
Methods
Relationship of stress, adaptation and homeostasis
Stress is a systemic integration response of the body to
physical, emotional, social, occupational and natural
environmental demands. There are biological stressors
(toxins, heat, cold), sociological stressors (unemploy-
ment), philosophical stressors (deciding on life purpose),
and psychological stressors (depression). Each has the
potential to result in a stressful reaction (American
Heritage Dictionary 2000; Selye 1956). Stress has posi-
tive and negative effects on the body. Long-term and
extreme stresses or lack of proper adjustments will lead
to illness (Selye 1956). Adaptation is a process or ability
to adjust oneself to meet the implications of stressors.
In Selyes Stress Theory, the second stage of the General
Adaptation Syndrome occurs when the body contin-
ues to resist and adapt to the stressor. Adaptation refers
to the ability to change internal characteristics and
lifestyles in accordance with the external environmental
changes (Selye 1956). Adaptation is the morphological
and physiological adaptability to the external environ-
ment (Van Wanger, n.d.). Most of the physical or mental
exertions, infections, and other stressors that act upon
us produce changes corresponding only to the second
stage, then we get used to them and achieve a state of
homeostasis (Selye 1956). Homeostasis refers to the
ability or tendency of an organism or cell to maintain
equilibrium by adjusting its physiological processes
(American Heritage Dictionary 2000).
Definition of homeostasis
In the present study, we defined homeostasis as the
human ability to maintain a balance between the body
and the internal and external environments. Operative
definition of homeostasis is defined as the ability to
keep the balance between the body and the surround-
ing natural, social and physiological environments
in order to maintain optimal health (Z. Zhang 2001;
H. Zhang 2000).
Homeostasis is the maintenance of a constant envi-
ronment. Our living environment includes: natural fac-
tors such as temperature, relative humidity and partial
pressure of oxygen (Chen & Yu 1993); pathophysiologi-
cal factors such as viruses, bacteria, biorhythm and
aging (Roger & Tonks 2003); and sociological factors
such as human relationships, work and family places
(Z. Zhang 2001; H. Zhang 2000). So environment is
divided into three sections in our operative definition
of homeostasis: natural environment, social environ-
ment and physiological environment. Such a defini-
tion provides in-depth research possibilities for the
structuraldimensional research of homeostasis.
The proposed relationship between wellness and
homeostasis, physical fitness and health is presented
in Figure 1.
Subject selection
The results of several large samples of physical fitness
tests in China indicate that the physical fitness level of
adults aged 4044 years decrease significantly com-
pared with other age groups. One reason might be due
96 J Exerc Sci Fit Vol 5 No 2 2007
to the normal decline of body function with age. Another
reason might be due to their exposure to more stress
compared to youth and the elderly. Stress can come
from several sources: workcareer, work task, relation-
ships with colleagues, aspiration; familysupporting
family (children, parents), family planning; socialtraffic,
laws and regulations, ethics, tradition, modernization;
change in natural environment; and physicalfatigue
from working long hours, no exercise. The different
types of living environment can be categorized into:
family; work place; other social venues (vehicle, shop-
ping mall, restaurant, and so on). The present study
focused on middle-aged adults living in Beijing and
investigated the factors that influence their homeosta-
sis and adaptation.
Theoretical model of homeostasis
Initial theoretical model of homeostasis
The purpose of the present study was to assess the
dimensions of homeostasis, but not the process of adap-
tation. Based on the operative definition of homeostasis
and adults daily environment, a six-factor model was
proposed (Figure 2). The proposed model was then
tested for content validity through three focus group
interviews, with the objective of developing a model to
better understand the component of homeostasis in
the context of wellness.
One-to-one semi-structured interviews with specialists:
A qualitative study involving one-to-one semi-structured
interviews was conducted with 12 specialists with the
initial theoretical model (A) of homeostasis. The purposes
of this interview were to: (1) assess the receptiveness of
the homeostasis theoretical model; (2) collect input on
the factors provided; and (3) collect suggestions and views
regarding the initial homeostasis theoretical model (A).
Semi-structured interviews with professionals: Another
qualitative study involving semi-structured interviews
(with open questionnaire) was conducted with 39 pro-
fessionals on the initial homeostasis theoretical model
(A). All subjects were physical fitness-related researchers
and experts. The purposes of this interview were to
assess the modified homeostasis theoretical model (A)
with a more knowledgeable sample and to improve
upon it, leading to the formulation of a more compre-
hensive model (B).
Semi-structured interviews with the general public:
This last phase involved interviewing 225 subjects
(120 males, 105 females) recruited from the general
public through questionnaires on the modified theoret-
ical model (B). The purposes of this interview were to:
(1) further refine the homeostasis theoretical model; and
(2) enhance the content validity of the proposed model.
Understanding of environmental factors
Subjects were required to indicate their personal under-
standing of the natural, sociocultural and pathophysiolog-
ical environments. The Theoretical Model of Homeostasis
(B) has the following categories as detailed below.
Natural environment: Climate was subdivided into
temperature, relative humidity and sunlight. Geological
positions were subdivided into altitude and latitude.
Pollution includes air pollution, water pollution and noise
pollution. Other categories not thus classified were
referred to as others.
Sociocultural environment: Family environment
included the familys economic conditions, relationships
between family members and the health conditions of
family members. Working and learning environments
were subdivided into work and study behaviors and
relationships in the workplace and place of study. Other
social factors referred to the relationships with neigh-
bors, other social members, and other social behaviors.
Pathophysiological environment: Illnesses and recu-
peration were subdivided into vulnerability to illnesses,
J Exerc Sci Fit Vol 5 No 2 2007 97
H. Ren et al.
Homeostasis
(adaptability to environment)
Wellness
Physical fitness
Health
(longevity, no disease)
Fig. 1 Relationship between wellness, physical fitness and
health.
Natural environment
Social
environment
Major events
Resistance
to illness
Family Work
Homeostasis
Fig. 2 A theoretical model of homeostasis (A).
illnessrecovery condition, attitude to illnesses and
knowledge about illnesses. Daily habits were divided
into sports and exercise, sanitation habits and life rules.
Tolerance of starvation and thirst, and durability in
resisting fatigue including not getting tired easily and
fast recovery were also evaluated.
Results
One-to-one semi-structured interviews
The common opinions of specialists were: (1) there was
a need to develop the homeostasis theoretical model
and to do research on the basic tools of assessing human
homeostasis; and (2) the initial theoretical model of
homeostasis involved environments of adult life. This
should be adjusted because the six dimensions pro-
posed were not categorized similarly.
Semi-structured interviews with professionals
The majority (79.5%) of subjects regarded the theoreti-
cal model to have covered all environments of adults
and was logical. The others regarded the model as not
reasonable because six dimensions were not of the same
level category. The revised homeostasis theoretical
model based on the interviews is presented in Figure 3.
Semi-structured interviews with the
general public
In assessing the consistency of the recoding tests, the
correlations between the two numberings are pre-
sented in Table 1. It was remarkable that the correla-
tions of two numbers were above 0.95, indicating that
the coding data were reliable.
In the interview, subjects (N=225) were free to pro-
vide any answers about the natural environment factor,
and 471 valid words were suggested. Some subjects
classified natural environment as mountain, river, lake,
sea, desert, garden, and grassland etc., and all these
answers were put into the natural environment category.
In categorizing environmental factors that influenced
homeostasis, individual adaptations to environmental
changes were considered. The inability to adapt may
pose a threat to human health.
Climate has a close relationship with geological posi-
tion; therefore, geological position was put into the same
category as climate. An adults life is mostly occupied
with family life, work and study. The environment of
family, work and study may influence an individuals
health to a certain degree. Thus, the environment of
family, work and study were listed among the natural
environment. In all the answers, there were no refer-
ences to natural disaster, and it was likely that the
thought of disaster or natural disaster was beyond the
normal life of urban dwellers. Thus, natural disaster
was deleted from the list. Environmental factors influ-
encing homeostasis can be divided into three cate-
gories: climate, pollution and environment of life, work
and study. The aforementioned three categories cov-
ered 75.61% of the glossary of words provided by the
subjects (Table 2).
98 J Exerc Sci Fit Vol 5 No 2 2007
Sociocultural
Family
Study or work
Other social factors
Pathophysiological
Illnesses and recuperation
Habits
Tolerance to starvation and thirst
Durability of resisting fatigue
Homeostasis
Natural environment
Climate
Geographical position
Pollution
Others
Fig. 3 A theoretical model of homeostasis (B).
Table 1. The consistency of recoding tests
Environmental factor Correlation coefficient p (two-tailed)
Natural 0.98 < 0.01
Sociocultural 0.96 < 0.01
Pathophysiological 0.95 < 0.01
Subjects offered 452 valid words for the sociocultu-
ral environment factor; 20.8% of the words collected
were about human relations without defining precisely
what kind of relationship it was. Therefore, it was
deemed that this embodied all the human relations in
all categories. This investigation proved that the previous
categorization and present investigation on sociocultural
environment overlapped with each other, with 98.22%
being covered in the previous categorization (Table 3).
Subjects offered 488 valid words on the pathophys-
iological environment factor. However, some of the
words such as: being healthy, having strong immune
system and strong adaptation ability were too broad
and unclear and could not be included in the subdivi-
sions of pathophysiological environment. There were no
responses on the adaptation of physiological stresses
in the interview, so there were no answers like adapta-
tion to thirst and fatigue; 45.9% of it has been covered
in the previous categorization (Table 4).
Discussion
The revised theoretical model
Further analyses of feedback from theoretical model
of homeostasis (B) suggested the following:
1. One research area on stress was the adaptation to
cold and warm temperature, lack of oxygen, and
pollution. They were grouped into one category
and served as an aspect of homeostasis.
2. Family was an essential segment in an adults life,
and the majority of people aged 3050 years have
their own families. Working for the sake of their
families has become the main stressor of adults,
but they have to bear the responsibility of their el-
ders as well. Much research has been conducted on
J Exerc Sci Fit Vol 5 No 2 2007 99
H. Ren et al.
Table 3. The sociocultural category
%
Family 22.79
Economical 10.99
Relationship 6.87
Health 4.93
Work and study 26.99
Work relationship 19.91
Study relationship 6.64
Other 0.44
Other social factors 27.65
Neighborhood 2.65
Other relationships 11.73
Ethnic relationships 13.27
Relationships 20.80
Others 1.78
Table 4. The pathophysiological environment category
%
Vulnerability to illnesses 12.47
Lower incidence 9.63
No incidence 2.05
No incidence of serious illness 0.82
Recovered from illness easily 4.31
Daily habits 11.07
Sanitation habits 1.44
Life rules 3.07
Exercises 6.56
Coping with illness 18.03
Optimism 12.50
Knowledge about illness 2.87
Support of family and friends 2.66
Healthy and full of vigor 22.77
Immunity from disease 11.89
Mental health 15.98
Adaptation ability 3.48
Table 2. The natural environment category
%
Climate 22.30
Temperature 10.56
Humidity 7.49
Sunlight 4.25
Pollution 31.86
Air 13.38
Water 10.62
Other 7.86
Family, work and study 16.35
Geographical position 5.10
Natural sight 17.62
Traffic 2.97
Food 3.17
Others 0.63
the relationship between life events and stressors
concerned with families.
3. People aged 3050 years were usually in the work-
force. Stressors from work task, career development,
relationship with colleagues and boss were signifi-
cant. Many people studied part-time in order to
advance their career and thus earn more money.
This would also increase the level of stress from
work, work tasks, relationship with colleagues, and
aspiration.
4. Other social factors were inclusive of all the social
factors except family and work, such as traffic jams
(which made people feel anxious), rigid rules and
traditional moral standards (which made some
people feel frustrated), and the impact of modern-
ization on lifestyle.
5. Illnesses and recuperation referred to people who
became ill easily and who needed time to recover
(such as sick leave).
6. Psychological reactions might arise when people
faced environmental changes. They were closely
related with an individuals personalities. Thus, psy-
chological factors might influence an individuals
adaptation to environmental changes; therefore, there
were individual differences in homeostasis state.
Psychological reactions occurred during adaptation
processes, influenced the homeostasis level of the
individual, and affected their cognition and behaviors.
The same stressor would pose different levels of pres-
sure and result in different psychological reactions
and different adaptability. The present study focused
on the homeostasis state, the results of adaptation
and the assessment of homeostasis, rather than
discussed the psychological factors influencing the
process of adaptation.
Limitations of the interview
In the semi-structured interviews with the general pub-
lic, the questions used in this open questionnaire
investigation might not include the ability of adapta-
tion from seasonal influences and biorhythms in the
body. This ability might be important in maintaining
homeostasis.
Summary
The analysis and discussion of the results of the inter-
views support the feasibility and legitimacy of the pre-
vious theoretical model of homeostasis on the one
hand, and complement the weaknesses of the original
three indexes model of wellness on the other hand.
Considering the close relationships between work/study
environment and the social environment, work/study
environment was grouped under sociocultural environ-
ment, and the revised theoretical model of homeostasis
is presented in Figure 4. In Chinese culture, it is suggested
that attaining harmony with the internal and external
environments is a prerequisite to wellness. Since its
introduction by Dr. Halbert Dunn in 1961, the term
wellness has been widely accepted and refined in
Western culture. By including the component of adap-
tation and homeostasis in addition to physical fitness
and health components, a better understanding of the
100 J Exerc Sci Fit Vol 5 No 2 2007
FamilyEconomic, relationship, health, environment
Study or workPressure, relationship, environment
Other social factorsNeighborhood, behavior, others
Sociocultural
Homeostasis
Natural environment
Climate
Pollution
Illness and recuperation
Habits
Tolerance to starvation and thirst
Biorhythms
Coping with illness
Durability of resisting fatigue
Pathophysiological
Fig. 4 The proposed theoretical model of homeostasis.
concept of wellness in the Chinese community might
be achieved.
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