Background: Physical activity has benefits for older adults in residential care, including autonomy, socialisation, reduced anxiety, and improved functional mobility, balance, and quality of life. Despite this evidence, activity levels remain low in this setting.
Methods: Prospectively registered (CRD42018104818) mixed-methods systematic review underpinned by the Social Ecological Model. Five databases were searched from inception. Primary studies were included with quantitative and/or qualitative data on barriers or facilitators to physical activity for older adults in residential care (65+ years) from the perspective of residents, family, staff, or other stakeholders. Two independent reviewers screened citations and appraised studies. Data were synthesised using a convergent integrated approach, with quantitative data ‘qualitised’ for thematic synthesis.
Results: 7980 titles and abstracts and 74 full-text articles were screened, with 51 studies included. Residents accounted for 55% of participants (n=38), followed by facility staff (41%, n=23) and family (3%, n=7). Twenty-four barriers and 26 facilitators were identified. Intrapersonal factors were the most common barriers (n=44) (dependence, negative emotions, poor health, negative attitudes, lack of previous exposure, safety, limitations) and facilitators (n=43) (purpose, independence, positive attitudes, self-awareness, resident capabilities, experience, avoiding sitting and benefits of being active). Policy factors were the least common barriers (n=5) and facilitators (n=1).
Conclusion: The most common barriers and facilitators to physical activity were identified as intrapersonal, describing constructs occurring within residents, most commonly from the residents’ perspectives. The identified barriers and facilitators may inform the development of targeted interventions, co-designed with relevant stakeholders, to increase physical activity engagement in this setting.