Barriers and facilitators to exercise practice in institutionalized older adults: a mixed-methods study

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.