Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients-the WALK-Copenhagen project (WALK-Cph)

BACKGROUND

Mobility interventions can prevent functional decline among older patients, but implementation of such interventions may be complicated by barriers in the clinical setting. The WALK-Copenhagen project (WALK-Cph) is aimed at promoting a 24-h mobility among older medical patients during hospitalization. The WALK-Cph intervention was co-designed by researchers and stakeholders to tailor the intervention to the clinical context. The aim of this study was to investigate the feasibility and implementation fidelity of the WALK-Cph intervention before evaluating clinical effectiveness in a randomized controlled trial (ClinicalTrials.gov NCT03825497).

METHODS

The WALK-Cph intervention consisted of six components: a welcome folder explaining the importance of in-hospital activity, a WALK-plan prescribing up to three daily walking sessions during and after hospitalization, a WALK-path in the hallway that patients were motivated to use daily, exercise posters in the hallways and bedrooms, self-service on beverages and clothes, and discharge with a WALK-plan. The present study reports on phase 2 of WALK-Cph and consists of a feasibility and a fidelity component. The study was conducted at the two WALK-Cph intervention departments after the initiation of the WALK-Cph intervention. A cohort of older medical patients (+65) was recruited for the feasibility study to assess recruitment and data collection procedures and the method for assessment of activity. Simultaneously, implementation fidelity was assessed by observing clinical practice and intervention delivery at the intervention departments.

RESULTS

A feasibility cohort of 48 patients was included. Inclusion was considered feasible with recruitment rates between 62% and 70% of all eligible patients. Also, data collection was conducted without obstacles, and all patients accepted to wear activity monitors. The fidelity observations showed that three of the six intervention components were partially implemented as planned whereas three components were not implemented as planned.

CONCLUSION

The WALK-Cph intervention was found feasible, and although the intervention was not implemented with fidelity, the level of fidelity was considered sufficient to continue with further testing of the WALK-Cph intervention in a large-scale trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03825497 (retrospectively registered). Protocol PubMed ID (PMID): 29523569.

Is Promotion of Mobility in Older Patients Hospitalized for Medical Illness a Physician's Job?-An Interview Study with Physicians in Denmark

: The aim of this study was to identify the most common barriers and facilitators physicians perceive regarding their role in the promotion of mobility in older adults hospitalized for medical illness as part of on an intervention to promote mobility. Twelve physicians at two medical departments were interviewed face-to-face using semi-structed interviews based on the Theoretical Domains Framework. The physicians' perceived barriers to promoting mobility were: the patients being too ill, the department's interior does not fit with mobility, a culture of bedrest, mobility not being part their job, lack of time and resources and unwillingness to accept an extra workload. The facilitators for encouraging mobility were enhanced cross-professional cooperation focusing on mobility, physician encouragement of mobility and patient independence in e.g., picking up beverages and clothes. The identified barriers and facilitators reflected both individual and social influences on physicians' behaviors to achieve increased mobility in hospitalized older medical patients and suggest that targeting multiple levels is necessary to influence physicians' propensity to promote mobility.

Ageism in the Fitness and Health Industry: A Review of the Literature

This review aims to understand how age-related stereotypes against older adults' physical capabilities influence their ability to engage in regular physical activity. The authors wanted to know how people construe ageism in the fitness and health arena, how ageism manifests in this field, and how ageism influences older adults' learning and practicing physical activity. Data was extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Twenty-two empirical studies met the selection criteria. The findings revealed that the attributes of ageism fell into either self-imposed or other-directed ageism categories and manifested as implicit or explicit ageism. The study also identified the following four themes: (a) perceptions of aging and exercise, (b) exercise motivation, (c) opportunities for older adults, and (d) ambiguous positionality as older exercisers. The research provides evidence for the existence of ageism against older exercisers. Further research considering the implication of ageism within the exercising industry is necessary.

Changes in Exercise Patterns in Menopausal Women at Low-Intermediate Risk for Cardiovascular Disease: A Prospective Survey Study

INTRODUCTION

We aim to describe changes in exercise habits and barriers to physical activity over 5 years in menopausal women at low-intermediate risk for cardiovascular disease.

MATERIALS AND METHODS

Women in the Stress Echocardiography in Menopausal Women at Risk for Coronary Artery Disease trial were prospectively enrolled in a multisite study from 2004 to 2007. Inclusion criteria were as follows: peri- and postmenopausal women with symptoms and/or risk factors for cardiovascular disease resulting in referral for stress echocardiography. A questionnaire, which assessed details of medical history, physical activity, and body mass index (BMI), was administered at baseline and 5 years.

RESULTS

216 menopausal women (62.5% hypertensive, 15.3% diabetic, 52.3% prior or current smokers) were studied. At baseline, age was 54.9 ± 4.8 years, BMI was 30.7 ± 6.4 kg/m², and Framingham risk score was 4.05% ± 3.76%. One hundred women (46.3%) were obese, 79 (36.6%) overweight, and 37 (17.1%) had a normal BMI. Women changed their self-reported aerobic exercise patterns in similar patterns regardless of their BMI at baseline. There was low participation in strength training among all women. Mean BMI decreased by 0.12 kg/m² in obese women and increased by 1.63 kg/m² in normal BMI women at 5 years (p < 0.0001).

CONCLUSION

These data suggest that women can increase their level of physical activity regardless of BMI and that overweight or obese status is not a barrier to initiating an aerobic, nonaerobic, or strength training exercise routine.

Körperliche Aktivität bei multimorbiden Patienten

Große Teile insbesondere der älteren Bevölkerung leiden an Multimorbidität. In der Therapie zahlreicher Erkrankungen spielt körperliche Aktivität eine anerkannte Rolle. Eine wesentliche Aufgabe in der Vermittlung körperlicher Aktivität an multimorbide Patienten kommt dem Hausarzt zu. Zur Gestaltung und Umsetzung von Aktivitätsprogrammen auf Grundlage einer umfassenden Gesundheitsbeurteilung bedarf es allerdings der engen Kooperation mit spezialisierten Berufsgruppen.

Physician counseling of older adults about physical activity: the importance of context

PURPOSE

Physicians are encouraged to discuss physical activity with their older adult patients. Studies of physician-initiated counseling have yielded inconsistent results, perhaps because older adults' perceptions and concerns about such counseling have not been addressed. The objective of the present work was therefore to explore such perceptions and their implications.

DESIGN

Qualitative study, using a grounded theory approach. Data were collected using both focus groups and semistructured interviews.

SETTING

Data were collected in several settings, including a fitness center and physicians' offices.

SUBJECTS

In a first sample, 56 adults aged 65 and older participated in one of six focus group sessions examining physical activity and exercise. Subsequently, 16 older adults participated in one of two focus groups comprising a second, validation sample. Individual semistructured interviews were conducted with a sample of five physicians.

METHODS

Data collection and analysis took place concurrently. Transcripts were analyzed using the constant comparative method. Recruitment, data collection, and analysis were informed by grounded theory.

RESULTS

Inactive older adults experiencing a health problem were more receptive than their healthy counterparts to receiving physical activity counseling from their physicians. Those who were receptive appeared to find such an intervention useful in leading to behavior change.

CONCLUSION

This study suggests that physicians' efforts in physical activity counseling may have the best impact when provided in the context of a health problem.

Physical activity is medicine for older adults

There is evidence from high quality studies to strongly support the positive association between increased levels of physical activity, exercise participation and improved health in older adults. Worldwide, around 3.2 million deaths per year are being attributed to inactivity. In industrialised countries where people are living longer lives, the levels of chronic health conditions are increasing and the levels of physical activity are declining. Key factors in improving health are exercising at a moderate-to-vigorous level for at least 5 days per week and including both aerobic and strengthening exercises. Few older adults achieve the level of physical activity or exercise that accompanies health improvements. A challenge for health professionals is to increase physical activity and exercise participation in older adults. Some success in this has been reported when physicians have given specific, detailed and localised information to their patients, but more high quality research is needed to continue to address this issue of non-participation in physical activity and exercise of a high enough level to ensure health benefits.

Associations among physician advice, physical activity, and socio-demographic groups in older Spanish adults

This study examined the relationship between medical advice to engage in physical activity with type of demand required by physical activity and demographic variables. A cross-sectional study was developed, featuring a questionnaire on physicians' advice, and type of demand. The questionnaire was completed by a probability and nationwide sample of older adults in Spain (n = 933, M = 74.1, range 65-93), randomly selected using multistage sampling. More physically active older adults have, more often than the less active, received physicians' advice to engage in physical activity. There is a significant relationship between medical advice and type of demand (p < .01) and age (p < .05). However, no relationship was found between physician medical advice and gender, social class, or income. Physicians can effectively promote physical activity among sedentary older adults through appropriate advice. Consequently, health authorities should promote physicians' advising older patients to pursue physical activity.

Motivators, barriers, and beliefs regarding physical activity in an older adult population

BACKGROUND AND PURPOSE

Regular physical activity (PA) plays an important role in improving and maintaining one's health, especially as one ages. Although many older Americans are aware of the benefits of regular PA, the majority do not participate in regular PA that meets recommended guidelines. The purpose of this study was to gain insight into the motivators, barriers, and beliefs regarding PA of independent-living older adults with easy access to fitness facilities.

METHODS

In this qualitative design, focus group interviews were used to explore the individual perceptions of physically active and inactive older adults regarding PA and exercise. Thirty-one older adults, over age 60 participated in focus group discussions regarding PA beliefs and behaviors. Groups were homogenous based on current PA behaviors. Demographic information was collected. Discussions were audiotaped and transcribed verbatim and deidentified. Two researchers independently coded for emergent themes. Interrater reliability was established (κ = 0.89). Peer review was used to further ensure trustworthiness and credibility.

RESULTS

No significant differences were noted in age, body mass index, or educational levels between the physically active and inactive groups. Differences in perceptions were noted between the groups regarding the construct of PA, barriers to participation in regular PA, and the components of an ideal PA program. Physically inactive persons had much lower fitness expectations of a physically active older adult, more perceived barriers to regular PA, and required individual tailoring of a PA program if they were going to participate. In addition, inactive persons were intimidated by the fitness facilities and concerned about slowing others down in a group exercise setting. Both groups shared similar motivators to participate in PA, such as maintaining health and socialization; however, inactive persons also described PA as needing to be purposeful and fun.

DISCUSSION AND CONCLUSION

Physically inactive persons perceived themselves to be physically active, as their perception of PA was grounded in a social context. Although both groups shared some barriers to regular PA participation, physically active individuals developed strategies to overcome them. Issues relating to self-efficacy and stages of change need to be explored to address the individual perceptions and needs of inactive older adults if initiation or long-term adherence to a PA program is to be achieved.

Effects of an exercise programme for chronically ill and mobility-restricted elderly with structured support by the general practitioner's practice (HOMEfit) - study protocol of a randomised controlled trial

BACKGROUND

Exercise programmes can be administered successfully as therapeutic agents to patients with a number of chronic diseases and help to improve physical functioning in older adults. Usually, such programmes target either healthy and mobile community-dwelling seniors or elderly individuals living in nursing institutions or special residences. Chronically ill or mobility-restricted individuals, however, are difficult to reach when they live in their own homes.A pilot study has shown good feasibility of a home-based exercise programme that is delivered to this target group through cooperation between general practitioners and exercise therapists. A logical next step involves evaluation of the effects of the programme.

METHODS/DESIGN

The study is designed as a randomised controlled trial. We plan to recruit 210 patients (≥ 70 years) in about 15 general practices.The experimental intervention (duration 12 weeks)-a multidimensional home-based exercise programme-is delivered to the participant by an exercise therapist in counselling sessions at the general practitioner's practice and on the telephone. It is based on methods and strategies for facilitating behaviour change according to the Health Action Process Approach (HAPA). The control intervention-baseline physical activities-differs from the experimental intervention with regard to content of the counselling sessions as well as to content and frequency of the promoted activities.Primary outcome is functional lower body strength measured by the "chair-rise" test. Secondary outcomes are: physical function (battery of motor tests), physical activity (step count), health-related quality of life (SF-8), fall-related self-efficacy (FES-I), and exercise self-efficacy (SSA-Scale).The hypothesis that there will be differences between the two groups (experimental/control) with respect to post-interventional chair-rise time will be tested using an ANCOVA with chair-rise time at baseline, treatment group, and study centre effects as explanatory variables. Analysis of the data will be undertaken using the principle of intention-to-treat.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN17727272.

The role of health professionals in promoting the uptake of fall prevention interventions: a qualitative study of older people's views

BACKGROUND

uptake of and adherence to fall prevention interventions is often poor and we know little about older people's perceptions of and beliefs about fall prevention interventions and how these affect uptake.

OBJECTIVE

to explore older people's perceptions of the facilitators and barriers to participation in fall prevention interventions in the UK.

METHODS

we undertook a qualitative study with older people who had taken part in or declined to participate in fall prevention interventions using semi-structured interviews (n = 65), and 17 focus groups (n = 122) with older people (including 32 Asian and 30 Chinese older people). This took place in community settings in four geographical areas of the South of England. The mean age of participants was 75 years (range 60-95). Data analysis used a constant comparative method.

RESULTS

older people reported that health professionals and their response to reported falls played a major role in referral to and uptake of interventions, both facilitating and hindering uptake. Health professionals frequently failed to refer people to fall prevention interventions following reports of falls and fall-related injuries.

CONCLUSIONS

consideration should be given to inclusion of opportunistic and routine questioning of older people about recent falls by practitioners in primary care settings. Referrals should be made to appropriate services and interventions for those who have experienced a fall to prevent further injuries or fracture.

Back from the brink: ageing, exercise and health in a small gym

This paper discusses findings from a qualitative study which explored older adults' experiences of becoming regular exercisers in a gym triggered by health problems and their interactions with their younger gym instructors. A key question which the study sought to address was whether becoming embedded in the sub-field of exercise challenged traditional discourses of ageing (age habitus). While these older gym users reported significant benefits (greater health capital, expanded social networks and a return to active life after illness), they nevertheless were engaged in a complex and ambiguous negotiation of attitudes to bodily ageing and meanings of fitness and competence. In contrast, the instructors subscribed to a model of physical activity oriented towards physical capital as greater fitness. The paper suggests that these positions manifest competing understandings about what constitutes appropriate and desirable physical capital in later life. Budgetary constraints, beliefs about physical ability, professional expectations and the persistence of the discourse of decline prevent this gap from being easily bridged and allow alternative notions of ageing physicality to colonise the sub-field of exercise. The paper concludes that there is a need to develop ways of breaking down barriers in communication to overcome divergent understandings of what constitutes legitimate physical capital as we get older.

General practitioner advice on physical activity: analyses in a cohort of older primary health care patients (getABI)

Background

Although the benefits of physical activity for health and functioning are recognized to extend throughout life, the physical activity level of most older people is insufficient with respect to current guidelines. The primary health care setting may offer an opportunity to influence and to support older people to become physically active on a regular basis. Currently, there is a lack of data concerning general practitioner (GP) advice on physical activity in Germany. Therefore, the aim of this study was to evaluate the rate and characteristics of older patients receiving advice on physical activity from their GP.

Methods

This is a cross-sectional study using data collected at 7 years of follow-up of a prospective cohort study (German epidemiological trial on ankle brachial index, getABI). 6,880 unselected patients aged 65 years and above in the primary health care setting in Germany were followed up since October 2001. During the 7-year follow-up telephone interview, 1,937 patients were asked whether their GP had advised them to get regular physical activity within the preceding 12 months. The interview also included questions on socio-demographic and lifestyle variables, medical conditions, and physical activity. Logistic regression analysis (unadjusted and adjusted for all covariables) was used to examine factors associated with receiving advice. Analyses comprised only complete cases with regard to the analysed variables. Results are expressed as odds ratios (ORs) with 95% confidence intervals (95% CI).

Results

Of the 1,627 analysed patients (median age 77; range 72-93 years; 52.5% women), 534 (32.8%) stated that they had been advised to get regular physical activity. In the adjusted model, those more likely to receive GP advice on physical activity were men (OR [95% CI] 1.34 [1.06-1.70]), patients suffering from pain (1.43 [1.13-1.81]), coronary heart disease and/or myocardial infarction (1.56 [1.21-2.01]), diabetes mellitus (1.79 [1.39-2.30]) or arthritis (1.37 [1.08-1.73]), and patients taking a high (> 5) number of medications (1.41 [1.11-1.80]).

Conclusions

The study revealed a relatively low rate of older primary health care patients receiving GP advice on physical activity. GPs appeared to focus their advice on patients with chronic medical conditions. However, there are likely to be many more patients who would benefit from advice.

The influence of primary health care professionals in encouraging exercise and physical activity uptake among White and South Asian older adults: experiences of young older adults

OBJECTIVE

To explore the influence of primary health care professionals in increasing exercise and physical activity among 60-70-year-old White and South Asian community dwellers.

METHOD

Fifteen focus groups and 40 in-depth interviews with community dwelling White and South Asian 60-70-year olds. The sample was selected to include people with very different experiences of participation and non-participation in exercise and physical activity. Data were analysed using framework analysis.

RESULTS

Primary health care professionals' advice and support was found to be a motivator to the initiation of exercise and physical activity. However, this was usually in relation to advice on weight reduction, cardiac conditions and mobility issues, but not generally to improve or increase activity levels. An underlying attitude of genuine interest and empathy was valued and shaped decisions about initiating and/or increasing activity levels.

CONCLUSION

Primary health care professionals should be encouraged to show interest and empathy with older people about the positive benefits of exercise and physical activity to them individually. This advice needs to be tailored to the older adult's symptoms.

PRACTICE IMPLICATIONS

Primary health care professionals need to be able to provide specific advice as to the quantity (frequency, duration, intensity and type) of exercise or physical activity to undertake. Practitioners need to listen to their patients' needs, show empathy and avoid ageism during consultations.

The influence of fitness on insulin resistance in obese children

An increasingly pervasive environment of reduced activity and easy access to high caloric food is leading to an epidemic of poor cardiovascular fitness, obesity, insulin resistance and type 2 diabetes (T2DM) in children. Studies have shown that insulin resistance (IR) to be an independent predictor for morbidity as well as mortality. These serve as a strong stimulus for public health strategies to improve fitness in children and adolescents. Methods to assess IR, improve IR and understand complications are increasingly important in children.

Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner's surgery: study protocol of a single arm trial preparing an RCT [ISRCTN58562962]

Background

Physical activity programmes can help to prevent functional decline in the elderly. Until now, such programmes use to target either on healthy community-dwelling seniors or on elderly living in special residences or care institutions. Sedentary or frail people, however, are difficult to reach when they live in their own homes. The general practitioner's (GP) practice offers a unique opportunity to acquire these people for participation in activity programmes. We conceptualised a multidimensional home-based exercise programme that shall be delivered to the target group through cooperation between GPs and exercise therapists. In order to prepare a randomised controlled trial (RCT), a feasibility study is being conducted.

Methods

The study is designed as a single arm interventional trial. We plan to recruit 90 patients aged 70 years and above through their GPs. The intervention lasts 12 weeks and consists of physical activity counselling, a home-exercise programme, and exercise consultations provided by an exercise therapist in the GP's practice and via telephone. The exercise programme consists of two main components: 1. a combination of home-exercises to improve strength, flexibility and balance, 2. walking for exercise to improve aerobic capacity. Primary outcome measures are: appraisal by GP, undesirable events, drop-outs, adherence. Secondary outcome measures are: effects (a. motor tests: timed-up-and-go, chair rising, grip strength, tandem stand, tandem walk, sit-and-reach; b. telephone interview: PRISCUS-Physical Activity Questionnaire, Short Form-8 Health Survey, three month recall of frequency of falls, Falls Efficacy Scale), appraisal by participant, exercise performance, focus group discussion. Data analyses will focus on: 1. decision-making concerning the conduction of a RCT, 2. estimation of the effects of the programme, detection of shortcomings and identification of subgroups with contrary results, 3. feedback to participants and to GPs.

Conclusion

A new cooperation between GPs and exercise therapists to approach community-dwelling seniors and to deliver a home-exercise programme is object of research with regard to feasibility and acceptance. In case of success, an RCT should examine the effects of the programme. A future implementation within primary medical care may take advantage from the flexibility of the programme.

Trial registration

Current Controlled Trials ISRCTN58562962.

A proposal for a new screening paradigm and tool called Exercise Assessment and Screening for You (EASY)

The Exercise Assessment and Screening for You (EASY) is a tool developed to help older individuals, their health care providers, and exercise professionals identify different types of exercise and physical activity regimens that can be tailored to meet the existing health conditions, illnesses, or disabilities of older adults. The EASY tool includes 6 screening questions that were developed based on an expert roundtable and follow-up panel activities. The philosophy behind the EASY is that screening should be a dynamic process in which participants learn to appreciate the importance of engaging in regular exercise, attending to health changes, recognizing a full range of signs and symptoms that might indicate potentially harmful events, and becoming familiar with simple safety tips for initiating and progressively increasing physical activity patterns. Representing a paradigm shift from traditional screening approaches that focus on potential risks of exercising, this tool emphasizes the benefits of exercise and physical activity for all individuals.

Motivational factors and physician advice for physical activity in older urban adults

This study aimed to ascertain by means of a new scale older adults' motives for engaging in physical activity, in a probability and representative sample of an older urban population. The sample size was 630 older adults, ranging from 65 to 94 years in age, randomly selected using multistage sampling. The participants completed a 17-item questionnaire, as well as answering questions on demographic variables, type of demand for physical activity, and physician's recommendation. A principal-component analysis was performed. The relationships among the four factors (physical health, social relationships, competence, and physician's advice) show a clearly motivational structure. Significant relationships have also been found between physician's recommendation and type of demand. The findings suggest that programs promoting physical activity in older adults should have different characteristics from those aimed at general adult populations.

Prevention and Treatment of Frailty in the Postmenopausal Woman

Frailty is a complex subject, and all aspects of frailty are intertwined. This article identifies and discusses the individual aspects of frailty. These aspects, including sarcopenia, nutrition, obesity, relative strength, inflammatory markers, osteopenia and osteoporosis, aerobic capacity, absolute strength, balance, and prevention of frailty, must be reunited, albeit in varying combinations, if the effects of frailty on women are to be understood and treated. This article does not exhaust the topic, but covers what the authors consider to be the major issues.

The role of physician counseling in improving adherence to physical activity among the general population

The regular practice of physical activity at appropriate levels ensures various benefits for the individual over the short, medium and long terms. It is therefore important in health promotion. On the other hand, sedentary behavior has reached alarming levels among the general population, which qualifies it as a serious health problem of endemic proportions. The present review describes public health problems consequent to sedentary behavior and the importance of physician counseling for change their patients behavior and making them more physically active on a regular basis. Models and behavioral theories are presented to facilitate physicians understanding of how to approach patients during clinical practice. We also describe programs conducted in many countries based on physician counseling for reducing sedentary behavior, and we present many tools used to quantify and qualify patients attitudes towards becoming more physically active. Through understanding the barriers faced by patients, we suggest methodologies that will enable physicians to use physical activity promotion appropriately. We hope that this will provide support for physicians in conducting physical activity counseling, as a means for improving the health of the population.

Pilot study comparing physical and psychological responses in medical qigong and walking

Identifying alternative exercise modalities in an effort to stimulate and promote participation in physical activity, especially among older adults, is a critical health consideration. The purpose of this study was to compare physiological and psychological responses to medical qigong with self-paced brisk walking. Older women (55-79 years) performed 22 min of either qigong or walking on two separate days. During exercise performance, heart rate and ratings of perceived exertion were assessed. Psychological affect, blood pressure, and pulse rate were assessed before and after the exercise bouts. Heart-rate data indicated that both forms of exercise were at a moderate level of intensity. In addition, similar values were found for the physiological and psychological variables as a function of the two forms of exercise. Therefore, it was concluded that this form of medical qigong can be considered a moderate-intensity physical activity that should have both physiological and psychological benefits for older women.

The experiences of older people participating in exercise referral schemes

Exercise referral schemes (ERS) have become a major routeway of promoting physical activity with older adults. However, there is lack of evidence regarding the views of older people and their experience from participating in ERS. The purpose of this study was to offer insights into how physical activity (PA) is situated in notions of successful ageing of people participating in ERS and to highlight points for achieving client-based targets through ERS. Thirteen community-living, retired, older adults (five females) with ages ranging from 63 to 79 who were at various stages in their referral programme were selected from three exercise referral schemes in south west England. The respondents chose to participate in either an individual or a group semi-structured interview. Findings stress that ERS clearly disrupt a lifestyle characterised by growing purposelessness and social isolation, offer older participants better physical and mental function and feelings of accomplishment and success. The participants in this study made a range of personally valued improvements through their involvement in ERS. The success of the programmes relies on the general practitioners' recommendations, the professional help and support from enthusiastic and experienced personnel and the attractiveness of the exercise content which needs to satisfy the multiple needs of the well-being of older adults.