Use it or lose it: a qualitative study of the maintenance of physical activity in older adults

Key points

1. 01Social interaction and class-based friendships were strong motivators for group (FaME) participants to stay active after the programme
2. 02Developing a routine or habit was especially important for home-based (OTAGO) participants who lacked group social support
3. 03Physical health deterioration, medication side effects, and joint problems were common barriers to continued activity
4. 04External feedback tools such as pedometers, exercise diaries, and tick charts helped participants recognise progress and stay motivated
5. 05Environmental barriers including poor weather, transport difficulties, cost, and inconvenient class timing frequently disrupted maintenance

How it was conducted

Design

Qualitative study using face-to-face semi-structured interviews; framework analysis with NVivo10

Parent trial

ProAct65+ multicentre randomised controlled trial of community-based strength and balance exercise programmes

Participants

30 adults aged 65 years and older; 15 from group-based FaME programme, 15 from home-based OTAGO programme

Setting

Five GP practices in Nottingham and Derby, UK; interviews conducted in participants' homes

Timing

Interviews conducted 4-6 years after end of the exercise intervention (December 2015 to March 2016)

Sampling

Maximum variation sampling across programme type, gender, age, fall history, and fear of falling

What they found

• 30 interviews completed; thematic saturation achieved
• FaME group: 10 females and 5 males, mean age 76.47 years (SD 5.6), age range 70-88 years
• OTAGO group: 12 females and 3 males, mean age 78.47 years (SD 5.7), age range 70-95 years
• At interview, 7 of 15 FaME participants (46.7%) and 9 of 15 OTAGO participants (60.0%) were achieving at least 150 minutes of moderate to vigorous physical activity per week
• FaME group mean weekly moderate-to-vigorous activity: 173 minutes (SD 130.5, range 0-375); OTAGO group: 177 minutes (SD 148.8, range 0-540)
• 13 of 15 FaME participants (86.7%) reported exercising regularly each week at interview; 8 of 15 OTAGO participants (53.3%) did so
• Four main themes identified: physical, psychological, social, and environmental facilitators and barriers
• 54% of invited eligible participants replied expressing interest in the study (53 of 99)

Limitations

• Interviews took place 4-6 years after the exercise programme ended, introducing potential recall bias for specific facilitators and barriers
• Selection bias likely: those who responded and agreed to be interviewed may have been more physically active or more positively disposed to exercise
• Sample was predominantly female and almost entirely White; only one participant from a Black or Minority Ethnic group, limiting generalisability
• Social desirability bias may have caused over-reporting of physical activity levels during interviews

Why it matters

For patients

Older adults who have finished a supervised exercise class are more likely to stay active if they find an activity they enjoy, join or form a social group around it, and build it into a daily routine.

For clinicians

When prescribing or referring older patients to exercise programmes, planning a clear follow-on pathway with social options, progress monitoring, and transport support can substantially improve long-term adherence.

For readers

This study maps the practical, real-world reasons why exercise maintenance succeeds or fails in older adults, offering a framework to guide programme design and commissioning decisions.