OBJECTIVES: The aim of this study is to assess how the moderate activities in the Kidney Disease Quality of Life Questionnaire (KDQoL), namely, ‘vacuuming, bowling and golf’ are adapted to suit various cultures. METHODS: Linguistic Validation was carried out on a total 60 language pairs spanning 41 countries (covering 11 language families) and went through cognitive debriefing whereby adaptations were confirmed or discussed in more detail. We assessed if changes were made for each language pair and calculated what percentage of languages necessitated an adaptation based on the cultural norms. Based on this data, we then evaluated the activities that were considered more culturally appropriate for the target culture. RESULTS: An overview of the language families that deemed an adaptation necessary, the types of activities that were substituted, and how this has enhanced the conceptual equivalency of the translation was created. The source activities were culturally adapted into a range of equivalent moderate activities judged relevant to the target population. Golf was a particularly troublesome term as many cultures considered this a niche sport and was therefore not fully understood as a moderate activity by the general public. Out of the 60 translations, changes were necessary in 60% of cases for the activities to relate to their culture. 5% used ‘gathering berries and mushrooms’ as an equivalent, 17% adapted golf as variants of walking such as ‘forest walking’, 5% changed ‘bowling’ to ‘Tai-chi’ and ‘vacuuming’ was changed to ‘sweeping’ for 11% of languages. CONCLUSIONS: To enable understanding and relatability to the moderate activities given in the questionnaire, it was essential to adapt the activity to one that would be familiar to the target culture. The range of alternative activities that replaced the original source terms demonstrates that in order to achieve conceptual equivalence, cultural adaptation is often vital to the translation process.