A qualitative study of exercise behavior by the assisted living resident over the age of 65 in a midwestern retirement community: The role of barriers and facilitators

The purpose of this study was to examine individual perspectives on barriers and facilitators that contribute to exercise behavior by assisted living residents over the age of 65, residing at a Midwestern retirement community. Among older adults, the assisted living resident population is a unique segment of people who face a greater risk of physical function loss, as well as declining independence — both of which contribute to the need for higher levels of care. These circumstances can significantly impact the quality of life of the resident, as well as their family members. In addition, healthcare costs on both a personal and national level are affected, and the need for additional professional staff by the assisted living facility increases dramatically. However, exercise greatly contributes to health and wellbeing and can delay the loss of physical function. This research was an exploratory qualitative design using the Health Belief Model as a guide for developing cue questions presented to two focus groups - one of non-exercising assisted living residents and the other of exercising assisted living residents. Each of the questions asked was related to a component of the Health Belief Model: Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The responses of the focus groups provided barriers and facilitators to exercise and were classified into internal factors and external factors. These factors are known to be strong predictors of exercise participation or non-participation. The major barriers to participation in exercise were pain, tiredness, helplessness, hopelessness, and low self-efficacy. Facilitators to participating in exercise included the belief in the benefits of exercise, cues to action in the form of support from others, and high self-efficacy. Perceived susceptibility and perceived seriousness of physical decline did not appear as strong predictors in exercise participation. The results enhanced an understanding of what practices are effective to address exercise participation or non-participation in the assisted living resident. This information informs development of interventions to enhance the likelihood that assisted living residents will participate in exercise