The 4-Circles Tool 2.0-A Tool to Prepare Older Patients for Shared Decision Making: A Developmental and Feasibility Study.

Sustainable Development Goal 3.4 (SDG 3.4), established by the United Nations, aims to reduce premature mortality from non-communicable diseases (NCDs) by one-third and promote mental health and wellbeing by 2030 (). Within this global public health framework, there is growing emphasis on the development of low-cost, scalable, and accessible health interventions. Among these, mind–body practices have attracted increasing scholarly and policy attention due to their demonstrated benefits in chronic disease prevention, psychological stress reduction, and overall improvement of quality of life (). Compared to conventional pharmaceutical and medical treatments, these practices offer lower entry barriers and greater adaptability, making them a promising avenue for advancing the SDG 3.4 agenda. Yoga, in particular, has gained global prominence, with an estimated 300 million practitioners worldwide. It is widely integrated into chronic disease management, mental health promotion, and community wellness programs (). In contrast, traditional Chinese mind–body practices—such as Tai Chi, Wuqinxi (Five Animal Frolics), and Baduanjin—though comparable in their theoretical foundations and health benefits, remain underutilized both domestically and globally. This disparity reflects a cultural asymmetry in dissemination capacity and highlights the urgency of incorporating indigenous health resources into public health promotion strategies. As China advances its Healthy China 2030 agenda, understanding and addressing the dissemination gap of traditional practices like Wuqinxi becomes increasingly essential. This study focuses on Wuqinxi, a representative form of traditional Chinese mind–body exercise with a documented history spanning more than 1,800 years. Originating in Bozhou, Anhui Province during the Eastern Han Dynasty, Wuqinxi was developed by the renowned physician Hua Tuo and embodies not only distinctive cultural characteristics rooted in Traditional Chinese Medicine (TCM) but also the holistic philosophy of “Dao follows nature,” which emphasizes harmony between the human body and the natural world (). It is the world’s first complete set of animal-imitating qigong exercises (). Its movements are inspired by five animals, namely the tiger, deer, bear, monkey, and crane (), and are believed to harmonize the five zang organs (viscera in Traditional Chinese Medicine): the Tiger exercise soothes the liver, the Deer exercise tonifies the kidneys, the Bear exercise regulates the spleen and stomach, the Monkey exercise nourishes the heart, and the rane exercise invigorates the lungs (). Grounded in both somatic and meditative traditions, Wuqinxi emphasizes the coordinated regulation of movement, breathing, and mental focus, reflecting a holistic orientation similar to yoga (, ).