Physical activity promotion to older adults attending out-patient rehabilitation

Background: Physical inactivity is identified as a leading risk factor for global mortality. Physical activity benefits have been extensively demonstrated. Being physically active is essential for healthy ageing; with regular physical activity reported as the most effective strategy to prevent and reduce disability and maintain functional independence among older adults. Nonetheless, an overwhelming majority of people aged 65 years and above do not meet physical activity recommendations. Physiotherapists in out-patient rehabilitation settings are well placed to assist older adults to achieve an active lifestyle by incorporating physical activity into care plans and transitioning patients from a therapeutic to a healthier lifestyle focus. However, it is not known whether physiotherapists actively plan for this transition and incorporate this aspect of care into out-patient rehabilitation programs for older adults. The overall aim of this research program was to investigate current physiotherapy practice of physical activity promotion to older adults attending an out-patient rehabilitation program.

Method: Pragmatism is the theoretical perspective that underpins this program of research. A multimethod approach was taken to answer the research questions for this research program. Two studies, a quantitative and a qualitative study, were undertaken to gain valuable insights in the promotion of physical activity to older adults attending out-patient rehabilitation. Study 1 comprised an audit of physiotherapists’ documentation in medical records of older adults who attended an out-patient rehabilitation program at a tertiary hospital. Study 2, a qualitative study, comprised three focus groups with a total of 16 physiotherapists involved in the delivery of rehabilitation to older adults. Data were analysed using reflexive thematic analysis.

Results: In Study 1, 56 medical records were reviewed. Mean age (SD) of participants was 79 (7) years. No documentation was found on the use of validated tools to assess physical activity levels of older adults. Prescription of physical activity was documented in 55/56 (98%) medical records. Seven (12.5%) medical records included documentation on goal setting regarding physical activity participation. Advice on regular physical activity post-discharge from the rehabilitation program was documented in 28/56 (50%) medical records. Formal referral to community-based physical activity programs was documented in 4/56 (7%) medical records. In Study 2, four themes were identified: 1. Patient-centred approach; 2. Support required; 3. Exercise program targeting impairments versus physical activity for health, and 4. Inadequate community follow-up systems. Participants described a patient-centred approach when promoting physical activity to older adults attending out-patient rehabilitation. Participants identified the importance of getting patients engaged and willing to participate in physical activity by setting patient-centred goals and finding activities that are enjoyable, meaningful and relevant. Physiotherapist support was identified as a crucial factor to facilitate engagement in physical activity. Education, therapeutic rapport, encouragement and motivation were topics often discussed by participants. Physical activity assessment was rarely reported by participants in this study. Participants acknowledged focusing on the primary goal of restoring older adults’ functional capacity by treating physical impairments, and concomitantly promoting an active lifestyle for health benefits. Participants perceived that inadequate community follow-up was a major barrier to transition older adults to an active lifestyle post discharge from rehabilitation.

Conclusion: The findings from this research program suggest that physiotherapists are not widely applying evidence-based practice to the promotion of physical activity to older adults attending out-patient rehabilitation. Increasing physical activity is a global priority, with the World Health Organisation Global Action Plan on Physical Activity (GAPPA) 2018-2030, ‘More active people for a healthier world’, calling for a systems-wide approach to patient assessment and counselling on physical activity across all primary health care settings. Physiotherapists are ideally placed to be actioning this strategy, though there is scope for improvement in physical activity promotion to older adults attending out-patient rehabilitation. Furthermore, the establishment of tailored physical activity programmes and services to support older adults starting and maintaining regular physical activity is recommended. Implementation research providing a guiding pathway to support physiotherapists promoting physical activity to older adults is warranted. Physiotherapists working in out-patient rehabilitation settings can and should drive older adults’ transition from a restorative and therapeutic context to a self-managed active lifestyle in the community, by integrating physical activity promotion into routine practice.