# Co-creation of a motor–cognitive exercise programme—a qualitative study with older people and physiotherapists

## TL;DR

This study explores how older people and physiotherapists co-create a motor-cognitive exercise program to prevent falls, focusing on safety, motivation, and individual needs.

## Contribution

The study introduces a rare co-creative approach to developing motor-cognitive exercise programs for fall prevention in older adults.

## Key findings

- Participants found motor-cognitive exercises enjoyable but challenging to implement safely.
- Regular individual follow-up was seen as essential for maintaining motivation and compliance.
- Group-based exercises led by a leader and integrated into daily routines were suggested for better engagement.

## Abstract

To reduce the risk of falls, tailored interventions including exercise that simultaneously challenges cognition (motor–cognitive) are recommended. However, considerable variation in motor–cognitive approaches exist, and its use in clinical practice is less widespread. This study aimed to explore older peoples’ and physiotherapists’ perspectives on motor–cognitive exercise and their suggestions for programme development during co-creation.

Community-dwelling women (n = 8) and men (n = 9), aged (mean ± SD) 74 ± 5.6 years, and 4 physiotherapists working in geriatric rehabilitation were included. Data were collected through nine workshops. The discussions were audio-recorded and analysed employing a qualitative content analysis approach. This study aligns with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

The analysis resulted in four themes and nine categories. The themes were: discovering the motor–cognitive concept through engagement in activity, balancing safety and challenge, navigating the complexity of individualisation, and managing motivation and compliance. The context was initially difficult to grasp. Performing practical activities led to understanding, and motor–cognitive exercises were experienced as enjoyable yet challenging to perform. Balancing safety while providing exercises that were challenging enough to make the programme effective was perceived as challenging by both older participants and physiotherapists. Regular individual follow-up during the exercise programme was considered important for promoting progression and compliance. Leader-led, group-based exercises later incorporated into daily life routines were suggested to support motivation and promote safety.

Incorporating motor–cognitive exercise in fall prevention exercises programmes for older people at risk of falls, may enhance enjoyment and motivation but requires consideration for safe and effective delivery. The co-creative design in this context is rare and the results may be useful for further research and for the development of fall prevention interventions.

Not applicable.

The online version contains supplementary material available at 10.1186/s12877-025-06522-3.