Barriers and facilitators to exercise practice in institutionalized older adults: a mixed-methods study
DOI:
https://doi.org/10.47197/retos.v80.118355Keywords:
Barriers to exercise, diabetes, exercise facilitators, institutionalization, older adultsAbstract
Introduction: Institutionalized older adults are among the most vulnerable segments of the population, often engaging in low levels of exercise. Exercise participation may be influenced by perceived barriers and facilitators, however, few studies have explored the impact of these determinants in this population.
Objectives: To identify and characterize the challenges, barriers, and facilitators to exercise participation as perceived by institutionalized older adults with diabetes.
Methodology: This study adopted a convergent mixed-methods design and was conducted in five institutions with 27 participants. Data collection followed a three-phase: administration of a sociodemographic and clinical questionnaire, focus group interviews, and quantitative assessment using the Exercise Benefits and Barriers Scale (EBBS).
Results: The sample included 9 women and 18 men, aged between 72 and 97 years. The main identified barriers were pain, fatigue, and physical limitations, perceived lack of time, and limited access to facilities. Key facilitators included enjoyment, positive emotions, social support, and improved mobility. Participants reported perceived benefits for both physical and mental health, while a major challenge was the limited recognition of exercise as a strategy for managing diabetes.
Conclusion: The management of diabetes in institutionalized older adults requires integrating exercise as a central component. Effective exercise programs in this population should combine educational interventions, appropriate physical environments, qualified healthcare professionals, and a supportive social network. This study contributes to the evidence base by identifying the multidimensional barriers and facilitators of exercise participation in this population, providing guidance for the development of more tailored and effective interventions.
References
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psycho-logy, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Braun, V., & Clarke, V. (2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328–352. https://doi.org/10.1080/14780887.2020.1769238
Che, S., Meng, M., Jiang, Y., Ye, X., & Xie, C. (2022). Perceptions of exercise and exercise instruction in patients with type 2 diabetes mellitus and sarcopenia: A qualitative study. BMC Geriatrics, 22(1), 892. https://doi.org/10.1186/s12877-022-03519-0
Collado-Mateo, D., Lavín-Pérez, A. M., Peñacoba, C., Del Coso, J., Leyton-Román, M., Luque-Casado, A., Gasque, P., Fernández-del-Olmo, M. Á., & Amado-Alonso, D. (2021). Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults: An umbrella review. International Journal of Environmental Research and Public Health, 18(4), 2023. https://doi.org/10.3390/ijerph18042023
Ersin, F., Tülüce, D., & Enzin, F. (2022). Examination of exercise benefit/barrier perceptions of individ-uals with diabetes and affecting factors. African Health Sciences, 22(3), 275–285. https://doi.org/10.4314/ahs.v22i3.29
Forder, J., & Fernandez, J.-L. (2011). Length of stay in care homes. (PSSRU Discussion Paper 2769). Per-sonal Social Services Research Unit. https://researchonline.lse.ac.uk/id/eprint/33895/1/dp2769.pdf
Forster, A., Airlie, J., Birch, K., Cicero, R., Cundill, B., Ellwood, A., Godfrey, M., Graham, L., Green, J., Hul-me, C., Lawton, R., McLellan, V., McMaster, N., & Farrin, A. (2017). Research Exploring Physical Activity in Care Homes (REACH): study protocol for a randomised controlled trial. Trials, 18(1), 182. https://doi.org/10.1186/s13063-017-1921-8
Lindsay Smith, G., Banting, L., Eime, R., O’Sullivan, G., & van Uffelen, J. G. Z. (2017). The association be-tween social support and physical activity in older adults: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 56. https://doi.org/10.1186/s12966-017-0509-8
McLeroy, K. R.; Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promo-tion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
Pelikan, J. M., Ganahl, K., Van den Broucke, S., & Sørensen, K. (2019). Measuring health literacy in Eu-rope: Introducing the European Health Literacy Survey Questionnaire (HLS-EU-Q). In Interna-tional Handbook of Health Literacy (pp. 115–138). Policy Press. https://doi.org/10.51952/9781447344520.ch008
PORDATA. (2023). Índice de envelhecimento e outros indicadores de envelhecimento. https://www.pordata.pt/pt/estatisticas/populacao/populacao-residente/indice-de-envelhecimento-e-outros-indicadores-de
Poveda-López, S., Lillo-Navarro, C., Sánchez-Pérez, A., Gacto-Sánchez, M., & Montilla-Herrador, J. (2023). Older persons’ expressed perceptions on exercise programs in long-term care institu-tions: Influence of professionals and institutions. Patient Education and Counseling, 117, 107985. https://doi.org/10.1016/j.pec.2023.107985
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A. A., Ogurtsova, K., Shaw, J. E., Bright, D., & Williams, R. (2019). Global and regional dia-betes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the Inter-national Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research and Clinical Prac-tice, 157, 107843. https://doi.org/10.1016/j.diabres.2019.107843
Schutzer, K. A., & Graves, B. S. (2004). Barriers and motivations to exercise in older adults. Preventive Medicine, 39(5), 1056–1061. https://doi.org/10.1016/j.ypmed.2004.04.003
Sechrist, K. R., Walker, S. N., & Pender, N. J. (1987). Development and psychometric evaluation of the exercise benefits/barriers scale. Research in Nursing & Health, 10(6), 357–365. https://doi.org/10.1002/nur.4770100603
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
Vilafranca Cartagena, M., Tort-Nasarre, G., & Rubinat Arnaldo, E. (2021). Barriers and facilitators for physical activity in adults with type 2 diabetes mellitus: A scoping review. International Journal of Environmental Research and Public Health, 18(10), 5359. https://doi.org/10.3390/ijerph18105359
Whipple, M. O., Schorr, E. N., Talley, K. M. C., Lindquist, R., Bronas, U. G., & Treat-Jacobson, D. (2019). A mixed methods study of perceived barriers to physical activity, geriatric syndromes, and physi-cal activity levels among older adults with peripheral artery disease and diabetes. Journal of Vascular Nursing, 37(2), 91–105. https://doi.org/10.1016/j.jvn.2019.02.001
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Raquel Sabino, Luís Eva Ferreira, Marlene Rosa

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.