“It’s not for me”: community-based fall prevention exercise programs for those aging into disability

PURPOSE: This study explored the constraints and needs of adults aged 50 years and older who self-reported a mobility, vision, or hearing impairment with regards to participation in community-based fall prevention exercise programs. METHODS: Using a qualitative descriptive design guided by the Health Equity Framework, semi-structured interviews were conducted virtually with 11 participants with mobility or sensory impairments (mean age = 69.8 ± 9.8 years). Interviews explored multilevel influences shaping participation in community-based fall-prevention exercise programs. Data were analyzed using thematic analysis following the Standards for Reporting Qualitative Research checklist. RESULTS: Four themes emerged: (1) solutions for lack of awareness, access, and advertising; (2) interconnected barriers that exacerbate accessibility challenges; (3) disability experiences; and (4) program design challenges and solutions. Participants described accessibility as multidimensional, encompassing physical, sensory, logistical, and financial factors, and noted that stigma, program misalignment, and self-stereotyping deter participation. CONCLUSIONS: Adults aging into disability do not identify with community-based fall prevention exercise programs due to the stigma that such programs are for those who are weak. Moreover, the changing nature of their disability creates additional challenges around accepting their limitations as they age. Co-designing inclusive, flexible, and identity-affirming programs might support participation and advance health equity.