Promoting Physical Activity Among Older People in Long-Term Care Environments

  • Julie Whitney


Residents of long-term care (LTC) are extremely sedentary due to high levels of morbidity, frailty, functional limitation and cognitive impairment as well as barriers created by the environment, attitudes of both staff and residents towards activity and inflexible care routines. Multi-component exercise including resistance training, walking, balance and functional exercise appears to be safe and potentially beneficial in terms of increasing activity levels and maintaining functional ability. Interventions can be delivered either through structured exercise programmes or by integrating more activity into daily routines. Frequent, ongoing and tailored exercise aimed at residents’ preferences is likely to be optimal for adherence and effect.


  1. Alessi, C. A., Yoon, E. J., Schnelle, J. F., Al-Samarrai, N. R., & Cruise, P. A. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: Do sleep and agitation improve? Journal of the American Geriatrics Society, 47(7), 784–791.CrossRefGoogle Scholar
  2. Baert, V., Gorus, E., Guldemont, N., De Coster, S., & Bautmans, I. (2015). Physiotherapists’ perceived motivators and barriers for organizing physical activity for older long-term care facility residents. Journal of the American Medical Directors Association, 16(5), 371–379. Scholar
  3. Baert, V., Gorus, E., Calleeuw, K., De Backer, W., & Bautmans, I. (2016). An administrator’s perspective on the organization of physical activity for older adults in long-term care facilities. Journal of the American Medical Directors Association, 17(1), 75–84. Scholar
  4. Barber, S. E., Forster, A., & Birch, K. M. (2015). Levels and patterns of daily physical activity and sedentary behavior measured objectively in older care home residents in the United Kingdom. Journal of Aging and Physical Activity, 23(1), 133–143. Scholar
  5. Barreto Pde, S., Demougeot, L., Pillard, F., Lapeyre-Mestre, M., & Rolland, Y. (2015). Exercise training for managing behavioral and psychological symptoms in people with dementia: A systematic review and meta-analysis. Ageing Research Reviews, 24(Pt B), 274–285. Scholar
  6. Baum, E. E., Jarjoura, D., Polen, A. E., Faur, D., & Rutecki, G. (2003). Effectiveness of a group exercise program in a long-term care facility: A randomized pilot trial. Journal of the American Medical Directors Association, 4(2), 74–80. Scholar
  7. Benjamin, K., Edwards, N., Guitard, P., Murray, M. A., Caswell, W., & Perrier, M. J. (2011). Factors that influence physical activity in long-term care: Perspectives of residents, staff, and significant others. Canadian Journal on Aging, 30(2), 247–258. Scholar
  8. Bruunsgaard, H., Bjerregaard, E., Schroll, M., & Pedersen, B. K. (2004). Muscle strength after resistance training is inversely correlated with baseline levels of soluble tumor necrosis factor receptors in the oldest old. Journal of the American Geriatrics Society, 52(2), 237–241.CrossRefGoogle Scholar
  9. Buckinx, F., Mouton, A., Reginster, J. Y., Croisier, J. L., Dardenne, N., Beaudart, C., et al. (2017). Relationship between ambulatory physical activity assessed by activity trackers and physical frailty among nursing home residents. Gait & Posture, 54, 56–61. Scholar
  10. Chen, Y.-M., & Li, Y.-P. (2014). Motivators for physical activity among ambulatory nursing home older residents. The Scientific World Journal, 2014, 7. Scholar
  11. Cheng, S. T., Chow, P. K., Song, Y. Q., Yu, E. C., Chan, A. C., Lee, T. M., et al. (2014). Mental and physical activities delay cognitive decline in older persons with dementia. American Journal of Geriatric Psychiatry, 22(1), 63–74. Scholar
  12. Cheung, K. K. W., Au, K. Y., Lam, W. W. S., & Jones, A. Y. M. (2008). Effects of a structured exercise programme on functional balance in visually impaired elderly living in a residential setting. Hong Kong Physiotherapy Journal, 26(1), 45–50. Scholar
  13. Choi, J. H., Moon, J. S., & Song, R. (2005). Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults. Journal of Advanced Nursing, 51(2), 150–157. Scholar
  14. Cichocki, M., Quehenberger, V., Zeiler, M., Adamcik, T., Manousek, M., Stamm, T., et al. (2015). Effectiveness of a low-threshold physical activity intervention in residential aged care – Results of a randomized controlled trial. Clinical Interventions in Aging, 10, 885–895. Scholar
  15. Crocker, T., Forster, A., Young, J., Brown, L., Ozer, S., Smith, J., et al. (2013). Physical rehabilitation for older people in long-term care. Cochrane Database of Systematic Reviews, 2, CD004294. Scholar
  16. da Silva Borges, E. G., de Souza Vale, R. G., Cader, S. A., Leal, S., Miguel, F., Pernambuco, C. S., et al. (2014). Postural balance and falls in elderly nursing home residents enrolled in a ballroom dancing program. Archives of Gerontology and Geriatrics, 59(2), 312–316. Scholar
  17. Damush, T. M., & Damush, J. G., Jr. (1999). The effects of strength training on strength and health-related quality of life in older adult women. Gerontologist, 39(6), 705–710.CrossRefGoogle Scholar
  18. de Bruin, E. D., & Murer, K. (2007). Effect of additional functional exercises on balance in elderly people. Clinical Rehabilitation, 21(2), 112–121. Scholar
  19. de Souto Barreto, P., Morley, J. E., Chodzko-Zajko, W., Pitkala, K. H., Weening-Djiksterhuis, E., Rodriguez-Manas, L., et al. (2016). Recommendations on physical activity and exercise for older adults living in long-term care facilities: A taskforce report. Journal of the American Medical Directors Association, 17(5), 381–392. Scholar
  20. den Ouden, M., Kuk, N. O., Zwakhalen, S. M. G., Bleijlevens, M. H. C., Meijers, J. M. M., & Hamers, J. P. H. (2017). The role of nursing staff in the activities of daily living of nursing home residents. Geriatric Nursing, 38(3), 225–230. Scholar
  21. Dorner, T., Kranz, A., Zettl-Wiedner, K., Ludwig, C., Rieder, A., & Gisinger, C. (2007). The effect of structured strength and balance training on cognitive function in frail, cognitive impaired elderly long-term care residents. Aging Clinical and Experimental Research, 19(5), 400–405.CrossRefGoogle Scholar
  22. Faber, M. J., Bosscher, R. J., Chin, A. P. M. J., & van Wieringen, P. C. (2006). Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Archives of Physical and Medical Rehabilitation, 87(7), 885–896. Scholar
  23. Fiatarone, M. A., O’Neill, E. F., Ryan, N. D., Clements, K. M., Solares, G. R., Nelson, M. E., et al. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine, 330(25), 1769–1775. Scholar
  24. Fien, S., Henwood, T., Climstein, M., & Keogh, J. W. (2016). Feasibility and benefits of group-based exercise in residential aged care adults: A pilot study for the GrACE programme. PeerJ, 4, e2018. Scholar
  25. Frändin, K., Grönstedt, H., Helbostad, J. L., Bergland, A., Andresen, M., Puggaard, L., et al. (2016). Long-term effects of individually tailored physical training and activity on physical function, well-being and cognition in Scandinavian nursing home residents: A randomized controlled trial. Gerontology, 62(6), 571–580.CrossRefGoogle Scholar
  26. Franzke, B., Halper, B., Hofmann, M., Oesen, S., Pierson, B., Cremer, A., et al. (2015). The effect of six months of elastic band resistance training, nutritional supplementation or cognitive training on chromosomal damage in institutionalized elderly. Experimental Gerontology, 65, 16–22. Scholar
  27. Galik, E., Resnick, B., Hammersla, M., & Brightwater, J. (2014). Optimizing function and physical activity among nursing home residents with dementia: Testing the impact of function-focused care. Gerontologist, 54(6), 930–943. Scholar
  28. Gordon, A. L., Franklin, M., Bradshaw, L., Logan, P., Elliott, R., & Gladman, J. R. (2014). Health status of UK care home residents: A cohort study. Age and Ageing, 43(1), 97–103. Scholar
  29. Grönstedt, H., Frändin, K., Bergland, A., Helbostad, J. L., Granbo, R., Puggaard, L., et al. (2013). Effects of individually tailored physical and daily activities in nursing home residents on activities of daily living, physical performance and physical activity level: A randomized controlled trial. Gerontology, 59(3), 220–229.CrossRefGoogle Scholar
  30. Heyn, P., Abreu, B. C., & Ottenbacher, K. J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 85(10), 1694–1704.CrossRefGoogle Scholar
  31. Hinrichs, T., Bucker, B., Wilm, S., Klaassen-Mielke, R., Brach, M., Platen, P., et al. (2015). Adverse events in mobility-limited and chronically ill elderly adults participating in an exercise intervention study supported by general practitioner practices. Journal of the American Geriatrics Society, 63(2), 258–269. Scholar
  32. Kerse, N., Peri, K., Robinson, E., Wilkinson, T., von Randow, M., Kiata, L., et al. (2008). Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial. BMJ, 337, a1445. Scholar
  33. Koeneman, M. A., Chorus, A., Hopman-Rock, M., & Chinapaw, M. J. M. (2017). A novel method to promote physical activity among older adults in residential care: An exploratory field study on implicit social norms. BMC Geriatrics, 17, 8. Scholar
  34. Lach, H. W., & Parsons, J. L. (2013). Impact of fear of falling in long term care: An integrative review. Journal of the American Medical Directors Association, 14(8), 573–577. Scholar
  35. Lazowski, D. A., Ecclestone, N. A., Myers, A. M., Paterson, D. H., Tudor-Locke, C., Fitzgerald, C., et al. (1999). A randomized outcome evaluation of group exercise programs in long-term care institutions. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54(12), M621–M628.CrossRefGoogle Scholar
  36. Lee, L. Y., Lee, D. T., & Woo, J. (2009). Tai Chi and health-related quality of life in nursing home residents. Journal of Nursing Scholarship, 41(1), 35–43. Scholar
  37. MacRae, P. G., Asplund, L. A., Schnelle, J. F., Ouslander, J. G., Abrahamse, A., & Morris, C. (1996). A walking program for nursing home residents: Effects on walk endurance, physical activity, mobility, and quality of life. Journal of the American Geriatrics Society, 44(2), 175–180. Scholar
  38. McMurdo, M. E., & Rennie, L. (1993). A controlled trial of exercise by residents of old people’s homes. Age and Ageing, 22(1), 11–15.CrossRefGoogle Scholar
  39. Meuleman, J. R., Brechue, W. F., Kubilis, P. S., & Lowenthal, D. T. (2000). Exercise training in the debilitated aged: Strength and functional outcomes. Archives of Physical and Medical Rehabilitation, 81(3), 312–318.CrossRefGoogle Scholar
  40. Mouton, A., Gillet, N., Mouton, F., Van Kann, D., Bruyère, O., Cloes, M., & Buckinx, F. (2017). Effects of a giant exercising board game intervention on ambulatory physical activity among nursing home residents: A preliminary study. Clinical Interventions in Aging, 12, 847–858. Scholar
  41. Mulrow, C. D., Gerety, M. B., Kanten, D., Cornell, J. E., DeNino, L. A., Chiodo, L., et al. (1994). A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA, 271(7), 519–524.CrossRefGoogle Scholar
  42. Nordin, S., McKee, K., Wallinder, M., von Koch, L., Wijk, H., & Elf, M. (2016). The physical environment, activity and interaction in residential care facilities for older people: A comparative case study. Scandinavian Journal of Caring Sciences.
  43. Ouslander, J. G., Griffiths, P., McConnell, E., Riolo, L., & Schnelle, J. (2005). Functional incidental training: Applicability and feasibility in the veterans affairs nursing home patient population. Journal of the American Medical Directors Association, 6(2), 121–127. Scholar
  44. Peri, K., Kerse, N., Robinson, E., Parsons, M., Parsons, J., & Latham, N. (2008). Does functionally based activity make a difference to health status and mobility? A randomised controlled trial in residential care facilities (The Promoting Independent Living Study; PILS). Age and Ageing, 37(1), 57–63. Scholar
  45. Phillips, L., & Flesner, M. (2013). Perspectives and experiences related to physical activity of elders in long-term-care settings. Journal of Aging and Physical Activity, 21(1), 33–50. Scholar
  46. Resnick, B., Gruber-Baldini, A. L., Zimmerman, S., Galik, E., Pretzer-Aboff, I., Russ, K., et al. (2009). Nursing home resident outcomes from the Res-Care intervention. Journal of the American Geriatrics Society, 57(7), 1156–1165. Scholar
  47. Rolland, Y., Pillard, F., Klapouszczak, A., Reynish, E., Thomas, D., Andrieu, S., et al. (2007). Exercise program for nursing home residents with Alzheimer’s disease: A 1-year randomized, controlled trial. Journal of the American Geriatrics Society, 55(2), 158–165. Scholar
  48. Rosendahl, E., Lindelof, N., Littbrand, H., Yifter-Lindgren, E., Lundin-Olsson, L., Haglin, L., et al. (2006). High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: A randomised controlled trial. The Australian Journal of Physiotherapy, 52(2), 105–113.CrossRefGoogle Scholar
  49. Sackley, C., Wade, D. T., Mant, D., Atkinson, J. C., Yudkin, P., Cardoso, K., et al. (2006). Cluster randomized pilot controlled trial of an occupational therapy intervention for residents with stroke in UK care homes. Stroke, 37(9), 2336–2341. Scholar
  50. Schnelle, J. F., Alessi, C. A., Simmons, S. F., Al-Samarrai, N. R., Beck, J. C., & Ouslander, J. G. (2002). Translating clinical research into practice: A randomized controlled trial of exercise and incontinence care with nursing home residents. Journal of the American Geriatrics Society, 50(9), 1476–1483.CrossRefGoogle Scholar
  51. Schoenfelder, D. P., & Rubenstein, L. M. (2004). An exercise program to improve fall-related outcomes in elderly nursing home residents. Applied Nursing Research, 17(1), 21–31.CrossRefGoogle Scholar
  52. Senior, H. E., Henwood, T. R., Beller, E. M., Mitchell, G. K., & Keogh, J. W. L. (2015). Prevalence and risk factors of sarcopenia among adults living in nursing homes. Maturitas, 82(4), 418–423. Scholar
  53. Shakeel, S., Newhouse, I., Malik, A., & Heckman, G. (2015). Identifying feasible physical activity programs for long-term care homes in the Ontario context. Canadian Geriatrics Journal, 18(2), 73–104. Scholar
  54. Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., et al. (2016). Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. British Journal of Sports Medicine.
  55. Telenius, E. W., Engedal, K., & Bergland, A. (2015). Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: An assessor blinded randomized controlled trial. PLoS One, 10(5), e0126102. Scholar
  56. Theou, O., Stathokostas, L., Roland, K. P., Jakobi, J. M., Patterson, C., Vandervoort, A. A., & Jones, G. R. (2011). The effectiveness of exercise interventions for the management of frailty: A systematic review. Journal of Aging Research, 2011, 19. CrossRefGoogle Scholar
  57. Tudor-Locke, C., Hart, T. L., & Washington, T. L. (2009). Expected values for pedometer-determined physical activity in older populations. International Journal of Behavioral Nutrition and Physical Activity, 6(1), 59. Scholar
  58. Underwood, M., Lamb, S. E., Eldridge, S., Sheehan, B., Slowther, A. M., Spencer, A., et al. (2013). Exercise for depression in elderly residents of care homes: A cluster-randomised controlled trial. Lancet, 382(9886), 41–49. Scholar
  59. US Department of Health and Human Services. (2017). What is long term care. Retrieved from
  60. Vankova, H., Holmerova, I., Machacova, K., Volicer, L., Veleta, P., & Celko, A. M. (2014). The effect of dance on depressive symptoms in nursing home residents. Journal of the American Medical Directors Association, 15(8), 582–587. Scholar
  61. Weeks, L., Profit, S., Campbell, B., Graham, H., Chircop, A., & Sheppard-LeMoine, D. (2008). Participation in physical activity: Influences reported by seniors in the community and in long-term care facilities. Journal of Gerontological Nursing, 34(7), 36–43. Scholar
  62. Whitney, J., Close, J., Lord, S., & Jackson, S. (2011). Do carers accurately estimate activity in care home residents? Age and Ageing, 40(Suppl 1), i53.Google Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Julie Whitney
    • 1
  1. 1.Clinical Age Research UnitKing’s College Hospital, Cheyne WingLondonUK

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