Exercise Program Implementation for Frail Older Adults in Skilled Nursing Facilities: A Cross-Sectional Study

Abstract Background Frailty is highly prevalent in skilled nursing facilities (SNFs), yet little is known about how physical and occupational therapists implement exercise programs for frail older adults in real-world practice. Methods This cross-sectional study examined therapist perceptions, clinical reasoning, exercise modification strategies, and implementation challenges across three SNFs. Using a custom-developed Qualtrics survey, 62 licensed therapists (61.3% PTs; 38.7% OTs) provided quantitative and qualitative data. The FRAIL-NH scale was included to standardize frailty classification. Results Therapists primarily conceptualized frailty through mobility dependence, reduced strength, and diminished endurance, with most treating moderately or severely frail residents. Clinical reasoning varied by experience level, with more experienced therapists describing individualized and context-sensitive approaches. Education level was associated with perceived resource adequacy and confidence. Differences between PTs and OTs emerged in frailty identification strategies, though intervention priorities were similar. Common barriers included patient limitations, low motivation, and equipment scarcity. Conclusions Exercise implementation for frail SNF residents is complex and varies based on therapist