# Barriers in motion: a multi-methods approach to exploring physical activity, physical function, and program challenges in adult day services

## TL;DR

This study explores physical activity and its challenges in adult day centers for older adults, highlighting barriers like staffing and funding.

## Contribution

The study introduces a multi-methods approach to assess physical activity and program challenges in adult day services.

## Key findings

- Participants engaged in 36.4 minutes of moderate to vigorous PA per day, with 68% meeting PA guidelines.
- Physical function scores indicated elevated risks for falls and mortality.
- ADC directors identified staffing, funding, and safety as major barriers to PA programming.

## Abstract

Physical activity (PA) helps older adults age in place and retain independence. Adult Day Centers (ADCs) are critical community-based spaces that provide PA programming, yet the dosage and impact of PA in these settings remains empirically unassessed.

This study used a multi-methods cross-sectional design to assess PA and physical function among ADC participants, as well as directors’ perspectives on PA programming. PA was assessed via an ActivPAL inclinometer, and physical function was assessed via the Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG) test. Semi-structured interviews were conducted with ADC directors. Data from interviews was coded openly and axially, and analyzed inductively and deductively to extract major themes. The qualitative analysis was subsequently guided by the Frequency, Intensity, Type, and Time principles to assess PA dosage.

On average, ADC participants (N = 48; MAge = 74.8 ± 7.2; 78.6% Female; 76.9% Low-Income; 70.7% Hispanic) engaged in 36.4 ± 28.8 min of moderate to vigorous PA per day, with 68% of participants meeting the PA guidelines. Physical function scores indicated an elevated risk for falls, morbidity, and mortality (MSPPB = 8.8 ± 2.1, MTUG = 14.7 ± 4.0). Interviews with five ADC directors revealed overarching themes: (1) PA dosage and programming at ADCs, (2) barriers to PA (staff shortages, funding, and safety and liability), and (3) programming facilitators.

Findings reflect broader systemic challenges that influence PA programming at ADCs. The directors cited barriers such as staffing limitations, funding constraints, and safety concerns, emphasizing the need for and desire to receive additional support. These challenges were also reflected in the ADC participants’ PA and physical function. It is imperative to support ADCs in delivering evidence-based programming as they can be key to retaining physical functional status and improving the quality of life of ADC participants. Future studies should consider community-based strategies involving liaisons and PA experts to support ADC staff, increase PA training, and reduce staff burden and turnover.