Predictors of attendance to group exercise: a cohort study of older adults in long-term care facilities

Background: The benefits of regular exercise and physical activity are well known. Those living in long-term care are often frail, but have the potential to benefit from physical activity; yet are less likely to be offered exercise. Promoting exercise within residential and nursing homes may reduce health risks associated with inactivity in this population. The aim of this cohort study is to identify predictors of attendance at physiotherapy led exercise groups offered to older adults residing in long-term care in the United Kingdom. Methods: One thousand and twenty three older adults residing in residential and nursing homes, were recruited to the Older People's Exercise in Residential and nursing Accommodation (OPERA) cluster randomised controlled trial. Secondary analysis of 428 adults (aged 75 to 107) randomised to twice-weekly physiotherapy-led group exercise sessions for 12 months was undertaken. Using attendance data, linear regression analysis was utilised to separately identify individual and home-level factors predictive of attendance at exercise in the residential and nursing homes. Results: Of 428 older adults, 326 lived in residential homes and 102 in nursing homes. Mean age of the sample was 88.0 years and the majority of residents were female (324/428, 76%). Pre-intervention assessment suggested that most residents had moderate cognitive impairment; median (range) Mini Mental State Examination scores in residential homes were 19 (0-30) and 14 (0-29) in nursing homes. Median Geriatric Depression Scale (GDS-15) scores were 3 (0-13) and 5 (0-13) respectively, indicating low levels of depressive symptoms. Over a 12-month period, 3191 exercise groups were delivered. Mean number of groups in the residential homes was 82 and 78 in the nursing homes. Number of attendances at group exercise was 11,534/21,292 (54.2%) and 3295/6436 (51.2%) respectively. Linear regression analysis revealed that depression, social engagement, and socio-economic characteristics were significantly associated with participant attendance at exercise groups in the residential homes, but none of these factors predicted attendance at group exercise in nursing homes. Conclusions: Older people living in long-term care are receptive to participating in exercise programmes, but there are individual and home-level reasons for attendance and non-attendance.