Center for Excellence in Assisted Living CEAL@UNC

Advancing the well-being of the people who live and work in assisted living through research, practice, and policy.

Physical Activity

Barriers and Facilitators to Physical Activity Among Older Adults in Residential Aged Care Facilities: A Mixed Methods Systematic Review Using the Social Ecological Model

Dec 1, 2025
This systematic review of 67 studies examined the barriers and facilitators to physical activity in long-term care settings from the perspectives of residents, staff, and family members. Using thematic synthesis, 51 themes emerged, 27 relating to facilitators and 24 to barriers. Interpersonal factors, such as social support, were the most commonly cited facilitator and intrapersonal factors, such as health, were the most commonly cited barrier.

Barriers and Facilitators to Physical Activity Among Older Adults in Residential Aged Care Facilities: A Mixed Methods Systematic Review Using the Social Ecological Model

by Lea Efird-Green

This systematic review of 67 studies examined the barriers and facilitators to physical activity in long-term care settings from the perspectives of residents, staff, and family members. Using thematic synthesis, 51 themes emerged, 27 relating to facilitators and 24 to barriers. Interpersonal factors, such as social support, were the most commonly cited facilitator and intrapersonal factors, such as health, were the most commonly cited barrier.

Physical Activity and Sedentary Behavior in Assisted Living Residents: Feasibility and Acceptability of a Longitudinal Study

Dec 1, 2025
This study of 44 residents from 9 AL communities in Michigan examined the feasibility of a longitudinal study on physical activity and sedentary behavior. Over the six months, physical activity slightly decreased, which was more prominent in residents with cognitive change, and sedentary behaviors slightly increased. The study supported the feasibility of longitudinal testing to track these behavior changes.

Physical Activity and Sedentary Behavior in Assisted Living Residents: Feasibility and Acceptability of a Longitudinal Study

by Lea Efird-Green

This study of 44 residents from 9 AL communities in Michigan examined the feasibility of a longitudinal study on physical activity and sedentary behavior. Over the six months, physical activity slightly decreased, which was more prominent in residents with cognitive change, and sedentary behaviors slightly increased. The study supported the feasibility of longitudinal testing to track these behavior changes.

Analysis of Exercise Programs in Assisted Living Facilities – A Cross-Sectional Study

Nov 1, 2025
This descriptive study examined exercise programs in 12 AL communities using data form 216 residents. Overall, 55% of participants used assistive devices, but only 17% had their devices assessed by a healthcare professional within the last 12 months; all facilities offered seated exercises, and four also included standing exercises. Exercise programs focused on a range of motion, some combined with resistance or functional training, but there was a predominance of low-intensity regimens. The findings indicated a need for better training for activity directors in moderate and high intensity exercises, and need for engaging more of a community's residents in physical activity.

Analysis of Exercise Programs in Assisted Living Facilities – A Cross-Sectional Study

by Lea Efird-Green

This descriptive study examined exercise programs in 12 AL communities using data form 216 residents. Overall, 55% of participants used assistive devices, but only 17% had their devices assessed by a healthcare professional within the last 12 months; all facilities offered seated exercises, and four also included standing exercises. Exercise programs focused on a range of motion, some combined with resistance or functional training, but there was a predominance of low-intensity regimens. The findings indicated a need for better training for activity directors in moderate and high intensity exercises, and need for engaging more of a community’s residents in physical activity.

Stand When You Can: Feasibility of a Multilevel, Multisite Sedentary Behavior Intervention in Assisted-Living Residences

Sep 1, 2025
This study assessed the feasibility of Stand When You Can, an intervention designed to increase standing and movement in AL residents, with 68 residents in 5 Canadian AL communities. It was found that only one site showed good intervention fidelity and there was high attrition of participants due to limited capacity for staff to manage the program, meaning that additional staff support may be required for the best outcomes.

Stand When You Can: Feasibility of a Multilevel, Multisite Sedentary Behavior Intervention in Assisted-Living Residences

by Lea Efird-Green

This study assessed the feasibility of Stand When You Can, an intervention designed to increase standing and movement in AL residents, with 68 residents in 5 Canadian AL communities. It was found that only one site showed good intervention fidelity and there was high attrition of participants due to limited capacity for staff to manage the program, meaning that additional staff support may be required for the best outcomes.

Real-Time Fatigue and Physical Activity of Older Adults in Assisted Living: Feasibility of Ecological Momentary Assessment

Aug 1, 2025
This study examined real-time measurements of fatigue and physical activity via monitoring devices, a type of ecological momentary assessment (EMA), in 34 residents in AL communities to assess the feasibility and acceptability of this data collection method. Participants rated the monitoring device as comfortable, had no trouble inputing fatigue scores (completing 76% on average). This study supports EMA as a feasible data collection method for establishing a temporal order of events in real time.

Real-Time Fatigue and Physical Activity of Older Adults in Assisted Living: Feasibility of Ecological Momentary Assessment

by Lea Efird-Green

This study examined real-time measurements of fatigue and physical activity via monitoring devices, a type of ecological momentary assessment (EMA), in 34 residents in AL communities to assess the feasibility and acceptability of this data collection method. Participants rated the monitoring device as comfortable, had no trouble inputing fatigue scores (completing 76% on average). This study supports EMA as a feasible data collection method for establishing a temporal order of events in real time.

Daily Total Physical Activity and Hospitalization or Death in Older Adults in Assisted Living Residences: An Exploratory Cohort Study Using Two ActivPAL Accelerometers in Japan

Jul 1, 2025
This exploratory study used ActivPAL accelerometers to examine the association between physical activity, hospitalizations, and/or death in 112 AL residents in Japan. An upright time of less than 150 minutes per day significantly increased risk of hospitalization and mortality, indicating that upright time might be a useful measure of physical activity. In addition, they suggest that encouraging residents to spend time outside their rooms may increase upright time.

Daily Total Physical Activity and Hospitalization or Death in Older Adults in Assisted Living Residences: An Exploratory Cohort Study Using Two ActivPAL Accelerometers in Japan

by Lea Efird-Green

This exploratory study used ActivPAL accelerometers to examine the association between physical activity, hospitalizations, and/or death in 112 AL residents in Japan. An upright time of less than 150 minutes per day significantly increased risk of hospitalization and mortality, indicating that upright time might be a useful measure of physical activity. In addition, they suggest that encouraging residents to spend time outside their rooms may increase upright time.

Inactivity Is Isolation: Insights from a Sedentary Time Intervention in Assisted Living

Apr 1, 2025
WHAT THIS MEANS FOR YOU: This exploratory study included 18 residents across three Canadian assisted living facilities who participated in a 12-week intervention to promote active aging. In post-intervention focus groups, 5 themes emerged: intervention effectiveness, physical and social engagement work together, influence of congregate living environment, environment supporting relationships, and personal preferences. The intervention was considered feasible and acceptable by participants, and could merit further testing.

Inactivity Is Isolation: Insights from a Sedentary Time Intervention in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This exploratory study included 18 residents across three Canadian assisted living facilities who participated in a 12-week intervention to promote active aging. In post-intervention focus groups, 5 themes emerged: intervention effectiveness, physical and social engagement work together, influence of congregate living environment, environment supporting relationships, and personal preferences. The intervention was considered feasible and acceptable by participants, and could merit further testing.

Perceived Physical Activity Levels and Objective Measures: A Mixed-Methods Study of Residents Aged 65 and Above in Assisted Living Homes in Australia

Nov 1, 2024
WHAT THIS MEANS FOR YOU: This Australian mixed-methods study examined thirty five older adults from 4 AL communities to assess their physical activity levels and examine their perception of barriers and promoters of activity. Females, younger residents, those with lower BMIs, and those who did not need ambulatory assistance showed higher activity levels. Those using more support services and who had more comorbidities showed lower activity levels. The interview portion of the study revealed older adults believed exercise was important, but they had misconceptions about their own activity levels, perceiving that they were more active than they were.

Perceived Physical Activity Levels and Objective Measures: A Mixed-Methods Study of Residents Aged 65 and Above in Assisted Living Homes in Australia

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This Australian mixed-methods study examined thirty five older adults from 4 AL communities to assess their physical activity levels and examine their perception of barriers and promoters of activity. Females, younger residents, those with lower BMIs, and those who did not need ambulatory assistance showed higher activity levels. Those using more support services and who had more comorbidities showed lower activity levels. The interview portion of the study revealed older adults believed exercise was important, but they had misconceptions about their own activity levels, perceiving that they were more active than they were.

Barriers and Facilitators to Physical Activity Among Older Adults in Residential Aged Care Facilities: A Mixed Methods Systematic Review Using the Social Ecological Model

Nov 1, 2024
WHAT THIS MEANS FOR YOU: This systematic review examined 67 studies to understand barriers and facilitators to physical exercise for older adults in residential aged care facilities (RACFs). Out of those studies, 51 themes emerged (27 facilitators and 24 barriers), with intrapersonal factors being the most commonly cited barrier, and interpersonal factors being the most commonly cited facilitator, meaning that a multilevel approach is likely needed to address physical activity in residential care.

Barriers and Facilitators to Physical Activity Among Older Adults in Residential Aged Care Facilities: A Mixed Methods Systematic Review Using the Social Ecological Model

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This systematic review examined 67 studies to understand barriers and facilitators to physical exercise for older adults in residential aged care facilities (RACFs). Out of those studies, 51 themes emerged (27 facilitators and 24 barriers), with intrapersonal factors being the most commonly cited barrier, and interpersonal factors being the most commonly cited facilitator, meaning that a multilevel approach is likely needed to address physical activity in residential care.

Adaptive Biking for Assisted Living Memory Care Residents and Staff: A Feasibility Study

Aug 1, 2024
WHAT THIS MEANS FOR YOU: This study paired 8 memory care residents and 7 staff members from an AL community to test a biking program as an intervention to improve health and well-being. The pairs completed eight 20-30 minute bike rides over 4 weeks. The rides gave residents and staff a chance to discuss issues around health and well-being. Qualitative results indicate further piloting of the program could be warranted given its acceptability and feasibility.

Adaptive Biking for Assisted Living Memory Care Residents and Staff: A Feasibility Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study paired 8 memory care residents and 7 staff members from an AL community to test a biking program as an intervention to improve health and well-being. The pairs completed eight 20-30 minute bike rides over 4 weeks. The rides gave residents and staff a chance to discuss issues around health and well-being. Qualitative results indicate further piloting of the program could be warranted given its acceptability and feasibility.

Experiences of COVID-19 Restrictions on Physical Activity in Assisted Living

Apr 1, 2024
WHAT THIS MEANS FOR YOU: Interviews with 7 participants from one South Carolina AL community revealed overall reduced levels of physical activity during the COVID-19 pandemic. Key barriers to physical activity included health issues, resource limitations (e.g., gyms being closed), and negative physical activity experiences (e.g., being required to wear a mask during exercise).

Experiences of COVID-19 Restrictions on Physical Activity in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: Interviews with 7 participants from one South Carolina AL community revealed overall reduced levels of physical activity during the COVID-19 pandemic. Key barriers to physical activity included health issues, resource limitations (e.g., gyms being closed), and negative physical activity experiences (e.g., being required to wear a mask during exercise).

Objectively Measured Physical Activity and Sedentary Behaviors Among Older Adults in Assisted Living Facilities: A Scoping Review

Apr 1, 2024
WHAT THIS MEANS FOR YOU: This scoping review included 20 articles from 15 studies that used devices to track physical activity behavior in AL residents. On average, residents spent between 96 and 201 minutes each day doing light physical activity, but only 1 to 9.74 minutes on moderate to vigorous activity. In addition, residents were sedentary for 8.5 to 11 hours while awake. Personal, social, and environmental factors influenced completion of physical activity in the included studies; however, none of the included interventions successfully increased activity or reduced sedentary behavior.

Objectively Measured Physical Activity and Sedentary Behaviors Among Older Adults in Assisted Living Facilities: A Scoping Review

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This scoping review included 20 articles from 15 studies that used devices to track physical activity behavior in AL residents. On average, residents spent between 96 and 201 minutes each day doing light physical activity, but only 1 to 9.74 minutes on moderate to vigorous activity. In addition, residents were sedentary for 8.5 to 11 hours while awake. Personal, social, and environmental factors influenced completion of physical activity in the included studies; however, none of the included interventions successfully increased activity or reduced sedentary behavior.

Accelerometer-Measured Physical Activity and Posture among Older Adults in Assisted-Living Residences

Jan 1, 2024
WHAT THIS MEANS FOR YOU: A total of 35 Japanese AL residents had their physical activity tracked and were then divided into 3 groups based on how much help they needed for daily tasks, based on a previously validated index: fully independent, requiring minimal assistance, and requiring care. Fully independent residents walked an average of 3,587 steps per day, those requiring minimal assistance walked 1,681, while those needing care walked 429 steps. Amount of time spent upright and amount of time spent standing were lower for participants who required assistance and care. Lying down for long periods was associated with preexisting diagnoses of depression.

Accelerometer-Measured Physical Activity and Posture among Older Adults in Assisted-Living Residences

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A total of 35 Japanese AL residents had their physical activity tracked and were then divided into 3 groups based on how much help they needed for daily tasks, based on a previously validated index: fully independent, requiring minimal assistance, and requiring care. Fully independent residents walked an average of 3,587 steps per day, those requiring minimal assistance walked 1,681, while those needing care walked 429 steps. Amount of time spent upright and amount of time spent standing were lower for participants who required assistance and care. Lying down for long periods was associated with preexisting diagnoses of depression.

Physical Activity Programming for Older Adults in Assisted Living: Residents’ Perspectives

Feb 1, 2023
WHAT THIS MEANS FOR YOU: In a study gathering recommendations from AL residents about a program to increase physical activity. most residents were interested in increasing their activity and thought of it as being important. However, they had concerns about the program’s level of difficulty, the length of sessions, and how the end goals were framed. Thus, it is vital to elicit feedback from residents when designing a new program in AL.

Physical Activity Programming for Older Adults in Assisted Living: Residents’ Perspectives

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In a study gathering recommendations from AL residents about a program to increase physical activity. most residents were interested in increasing their activity and thought of it as being important. However, they had concerns about the program’s level of difficulty, the length of sessions, and how the end goals were framed. Thus, it is vital to elicit feedback from residents when designing a new program in AL.

Yoga Practice as a Coping Strategy for Older Adults in Assisted Living Facilities: A Qualitative Content Analysis

Jun 1, 2022
WHAT THIS MEANS FOR YOU: This study explored how 15 residents of 4 assisted living communities used yoga as a coping strategy during and after an 8-week yoga intervention. Qualitative interviews indicated that residents found yoga helpful for relaxing, felt more energized, and that it helped connect them with others.

Yoga Practice as a Coping Strategy for Older Adults in Assisted Living Facilities: A Qualitative Content Analysis

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study explored how 15 residents of 4 assisted living communities used yoga as a coping strategy during and after an 8-week yoga intervention. Qualitative interviews indicated that residents found yoga helpful for relaxing, felt more energized, and that it helped connect them with others.

Physical Activity and Sedentary Behavior of Residents in Assisted Living: A Preliminary Study

Apr 1, 2022
WHAT THIS MEANS FOR YOU: This study examined physical activity and sedentary behavior in assisted living residents and their relationship with a variety of outcomes. Participants included 54 residents from 8 communities, who had an average of 253 minutes of physical activity per day and 661 minutes of sedentary behavior per day. Depression related to lower activity, while use of assistive devices and fatigue related to higher sedentary behavior.

Physical Activity and Sedentary Behavior of Residents in Assisted Living: A Preliminary Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study examined physical activity and sedentary behavior in assisted living residents and their relationship with a variety of outcomes. Participants included 54 residents from 8 communities, who had an average of 253 minutes of physical activity per day and 661 minutes of sedentary behavior per day. Depression related to lower activity, while use of assistive devices and fatigue related to higher sedentary behavior.

Effects of the Mobility-Fit Physical Activity Program on Strength and Mobility in Older Adults in Assisted Living: A Feasibility Study

Apr 1, 2022
WHAT THIS MEANS FOR YOU: In a 12-week study of 30 assisted living residents, the Mobility-Fit program - which focuses on upper-limb strength to help prevent falls and includes exercises targeting strength, agility, coordination, and balance - participants experienced improvements in knee extension strength, reaction time, and time to stand from a sitting position.

Effects of the Mobility-Fit Physical Activity Program on Strength and Mobility in Older Adults in Assisted Living: A Feasibility Study

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: In a 12-week study of 30 assisted living residents, the Mobility-Fit program – which focuses on upper-limb strength to help prevent falls and includes exercises targeting strength, agility, coordination, and balance – participants experienced improvements in knee extension strength, reaction time, and time to stand from a sitting position.

Replication of Implementing a Sit-to-Stand Exercise Program in an Assisted Living Facility

Mar 1, 2022
WHAT THIS MEANS FOR YOU: A 20-bed AL community in rural North Carolina implemented a sit-to-stand exercise program (i.e., having residents rise from a sitting position and then sit back down). A total of 13 residents participated in the program which was offered twice daily over 82 days. The average attendance rate for participants for all sessions was over 90%, and each participant was able to complete all 5 exercises during each session. Over the course of the program participants saw modest increases in average activities of daily living independence scores; however, these changes were not statistically significant. Activities that were measured included toileting, bathing, dressing, transferring, and continence.

Replication of Implementing a Sit-to-Stand Exercise Program in an Assisted Living Facility

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: A 20-bed AL community in rural North Carolina implemented a sit-to-stand exercise program (i.e., having residents rise from a sitting position and then sit back down). A total of 13 residents participated in the program which was offered twice daily over 82 days. The average attendance rate for participants for all sessions was over 90%, and each participant was able to complete all 5 exercises during each session. Over the course of the program participants saw modest increases in average activities of daily living independence scores; however, these changes were not statistically significant. Activities that were measured included toileting, bathing, dressing, transferring, and continence.

The Impact of Cognitive Impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings

Feb 1, 2022
WHAT THIS MEANS FOR YOU: This study included 550 AL residents from 59 communities, and assessed how cognitive impairment relates to physical activity, pain, and willingness to receive staff-assisted function-focused care. It found that cognitively impaired residents were less active, experienced more pain, and were less interested in staff-assisted function-focused care activities.

The Impact of Cognitive Impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This study included 550 AL residents from 59 communities, and assessed how cognitive impairment relates to physical activity, pain, and willingness to receive staff-assisted function-focused care. It found that cognitively impaired residents were less active, experienced more pain, and were less interested in staff-assisted function-focused care activities.