Experiences and Perceptions of Older Adults Participating in Physical Exercise, Cognitive Training, and Health Education Programs: A Qualitative Study Nested in a Randomized Controlled Trial

Background: Multimodal interventions combining physical exercise and cognitive stimulation may improve sleep and healthy aging among older adults. However, little is known about how participants experience these interventions. This study explored the experiences and perceptions of older adults who participated in physical exercise, combining physical exercise and cognitive training, or health education programs designed to improve sleep. Methods: A qualitative process evaluation using reflexive thematic analysis was conducted following a randomized controlled trial in Toledo, Spain. Twenty-one community-dwelling adults aged ≥65 years from the control, physical exercise (Otago), and combined exercise plus CogniFit® groups completed semistructured interviews. The interviews were audio-recorded, transcribed from the recordings, and analyzed using reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Six themes emerged: participation experience, perceived changes in sleep, benefits beyond sleep, evaluation of program components, facilitators and barriers, and maintenance of healthy habits. The participants reported high levels of satisfaction across all the groups. Beyond perceived changes in sleep, participants described perceived benefits related to physical well-being, cognitive stimulation, social interaction, and healthier habits. The participants also identified facilitators and barriers affecting engagement and maintenance. Exercise was valued for its simplicity and adaptability, whereas cognitive training was considered stimulating despite initial technological challenges. The main barriers were preexisting health conditions and difficulties using digital technology. Many participants intended to maintain the healthy habits acquired during the intervention. Conclusions: The participants who completed the qualitative interviews generally described positive experiences across the three groups. These findings provide insights relevant to the design of person-centered and accessible interventions and highlight factors that may influence engagement and maintenance in community settings.