Facilitators and Barriers to Physical Activity in the Elderly: A Qualitative Study on the Perceptions of Elderly, Caretakers and Healthcare Professionals

Facilitators and Barriers to Physical Activity in the Elderly: A Qualitative Study on the Perceptions of Elderly, Caretakers and Healthcare Professionals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Facilitators and Barriers to Physical Activity in the Elderly: A Qualitative Study on the Perceptions of Elderly, Caretakers and Healthcare Professionals Ahurira Felix, Dan mwangye Bigirwa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9165713/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The global elderly population, set to double by 2050, faces increasing concerns about their physical well-being. Studies indicate rising inactivity among them, with factors like dependence and limited engagement. Despite WHO's recommendation of 150 weekly minutes of activity, many elderly fail to meet this due to various reasons. In South Western Uganda, 51.5% of elderly were found to be physically inactive. Some studies have found out that facilitators of physical activity among the elderly include community support, cultural values, and motivation, while barriers involve insufficient facilities, social support, and finances. Although physical inactivity among the elderly is prevalent in the region, there is limited literature exploring the facilitators and barriers to physical activity among the elderly in south western Uganda. Methods We recruited 22 participants who are elderly, caretakers, and healthcare professionals, where qualitative research was used designed and convenience sampling was used to recruit study participants. Data was collected using focus group discussions and in depths, semi-structured interview guides and audio recorders were used. Data was analyzed using an inductive thematic data analysis approach. Results The study revealed three main themes and nine subthemes: Engagement in Physical Activity included two subthemes i.e. i) Engagement in light intensity physical activities, and ii) Irregular frequency of engagement in physical activities. Facilitators of Physical Activity included three subthemes i.e. i) Social meetings and support, ii) Mobility aids, and iii) Medical workers' advice. Barriers to Physical Activity encompassed four subthemes i.e. i) Health problems, ii) Aging, iii) Insufficient knowledge about physical activity, and iv) Lack of self-motivation. Conclusion The study found out that elderly at ROTOM engage in light intensity activities, a positive behavior compared to being sedentary. However, to maximize health benefits, transitioning to moderate or high intensity activities is suggested. Strengthening facilitators and addressing barriers could promote recommended activity thus enhancing elderly quality of life. Population Biology Physical activity Facilitators of physical activity Barriers to physical activity and Elderly 1. Introduction There is rapidly growing elderly population worldwide, that is expected to double by 2050 and has raised concerns about their physical well-being(WHO, 2019). Numerous studies have highlighted a rising trend of physical inactivity among the elderly(Alodhialah et al., 2025; Guwatudde et al., 2016; Keadle et al., 2016; Sun et al., 2013; WHO, 2019). The World Health Organization (WHO) recommends a minimum of 150 minutes of physical activity per week for the elderly, yet many fail to meet this requirement due to factors such as dependence and limited engagement in sustained activities(Baldwin et al., 2020; Bull et al., 2020; Choe et al., 2025; Lee & Howard, 2019; Sun et al., 2013). In South Western Uganda, a prevalence of 51.5% for physical inactivity among the elderly was identified (Guwatudde et al., 2016; Kiiza Mondo et al., 2013). Studies have shown that facilitators of elderly physical activity include community support, social cohesion, accessibility to resources, cultural values, and individual motivation(Adekunle Adedeji, 2023; Meredith et al., 2023; Osokpo et al., 2022; Steinhoff & Reiner, 2024; Yu, 2025). And the barriers to elderly physical activity included insufficient facilities, lack of social support, and financial constraints(Biedenweg et al., 2014; Justine et al., 2013; Moschny et al., 2011; Yarmohammadi et al., 2019). Physical activity is essential for maintaining health and independence in older adults, yet many elderly individuals face significant barriers to engaging in regular exercise and these obstacles range from physical limitations and chronic health conditions to psychological factors such as fear of injury and lack of motivation(Miller & Brown, 2017). Additionally, social and environmental influences, including inadequate support from caregivers and healthcare professionals, further hinder participation in physical activity(Dijkstra et al., 2022). Despite these challenges, facilitators such as social encouragement, structured exercise programs, and accessible environments can enhance physical activity levels among the elderly(Mjøsund et al., 2022). Understanding these perceptions from the perspectives of elderly individuals, caregivers, and healthcare professionals is crucial for developing effective interventions that promote physical activity and improve overall well-being. Despite of all this, there is limited literature exploring the facilitators and barriers to elderly engagement in regular physical activity in Uganda. Therefore, this study aimed to establish the facilitators and barriers to physical activity among the elderly based on the perceptions of the elderly, caretakers, and healthcare professionals at Reach One Touch One Ministries (ROTOM). 2. Methods 2.1. Study design This was phenomenological research in which we recruited 22 participants who were elderly, caretakers, and healthcare professionals and convenience sampling was used to recruit study participants in the months of March and April of 2023. 2.2. Study setting The study setting was Reach One Touch One Ministries (ROTOM) Muhanga-Rukiga district center is found in greater Kabale region, South Western Uganda. ROTOM is an international Christian organization that operates as a non-profit, non-denominational entity with the mission of empowering underprivileged elderly individuals in Uganda and Ethiopia to live dignified and fulfilled lives through a multi-faceted approach that strives to address their physical, emotional, mental and financial well-being with two centers in Uganda, one in Muhanga-Rukiga District, southwestern Uganda, and another in Namubiru-Mukono District, central Uganda. ROTOM, Muhanga-Rukiga district centre region was chosen for this study because it has a higher population of elderly persons (29,672) compared to other districts in Southwestern Uganda such as Mbarara (20,442), Bushenyi (12,476) and Ibanda (12,230) according to the UBOS-statistics of 2014. The facility is currently taking care of 500 elderly people providing them with food, medical care and financial aid where necessary. It comprises of a professional staff of 8 members i.e., 1 Laboratory officer, 4 Nurses, 1 Medical officer, I clinical officer and 1 physiotherapist. The elderly who are in worse conditions due to various causes like chronic illnesses are taken care of at the facility and the rest are taken care of in their respective homes with the field nurses and other staff members checking on them daily. ROTOM was chosen because they have a big population of the elderly and caretakers and therefore it was possible for the study target population to be easily accessed. They also have a big team of healthcare professionals who have direct contact with the elderly and the researchers needed to get their perceptions as well regarding the study topic. 2.3 Sampling procedure The researchers used a convenience method of sampling, and this was based on choosing participants that were present at the time of the study and met the study inclusion criteria. The study sample included; the elderly, who were aged 60 and above and were able to ambulate, Caretakers , People taking care of the elderly on a daily basis ensuring that they have eaten all meals, bathed at the right time, their beds are made, and their health needs are met and healthcare professionals, who were employed by the organization to provide geriatric services to the elderly, and they were key informants. These included nurses, a medical officer, and a clinical officer. Over 50 elderly people were staying within the vicinity of ROTOM. Among the 50, 15 elderly people were bed ridden, 10 did not consent to participate, 5 elderly people had cognitive impairments, and the 5 withdrew from the study during the data collection process and 7 had caretakers below 18 years. A total of 8 elderly people participated. These eight elderly people together with their caretakers acted as study participants. Six health care professionals were present during the time of the study and consented to participate, hence a total sample of 22 participants. 2.4. Eligibility criteria Participants were separated into three groups; the elderly, the caretakers, and healthcare professionals. 2.4.1 Inclusion criteria Elderly people who were aged 60 years and above that consented and participated. Elderly people who were able to ambulate either with support or without support to the data collection center. Elderly people who were present at the time of study. Caretakers who were aged 18 years and above. Healthcare professionals who were employed at ROTOM at the time of study. Healthcare professionals who had spent at least 6 months as employees at ROTOM. 2.4.2 Exclusion criteria Elderly people who did not speak or understand English or Runyankore. Elderly people who were critically ill. Elderly people who had mental health problems e.g. dementia. Caretakers below 18 years of age were not recruited. Caretakers who were not able to speak or understand English or Runyankore. Healthcare professionals who did not consent to be part of the study. 2.5. Data collection procedure The researchers approached the nurse in charge who helped to organize the study participants. The researchers briefed the study participants about the study and then informed consent was obtained from the selected participants before the interviews commenced. Data was collected by a group of five researchers. Four Focus Group Discussions (FGDs) were conducted among the elderly and caretakers. Each FGD consisted of 4 conveniently selected participants from the categories of elderly people and caretakers. The FGDs were homogenous i.e., one FGD was for the elderly who are male, another was for the elderly who are female, then one FGD was for the caretakers who are male, and another was for the caretakers who are female. The researchers used homogenous FGDs to allow participants to freely share their views and ideas without fear of the opposite sex members. Each FGD lasted averagely 25 minutes. FGDs were conducted in a private and secured location. One to one in-depth interviews were held with healthcare professionals at the setting. The health care professionals were included as key informants because they are responsible for giving the elderly advice on health lifestyles such as physical activity. The interviews consisted of 6 healthcare professionals at ROTOM. Each interview lasted averagely 15 minutes. Field notes were also taken to complement the audio taped interviews. The FGDs and the in-depth interviews helped the researchers to gain insights of the participant ‘s perceptions regarding the facilitators and barriers to physical activity among the elderly. 2.6. Data collection tools The researchers used three semi-structured interview guides and probing questions to achieve in-depth interviews and focus group discussions. The researchers also used pens, papers, and audio recorders while conducting the focus group discussions and in-depth interviews. 2.7. Data analysis Verbatim transcriptions were generated from the audio recordings of the in depths interviews and focus group discussions (FGDs). An inductive thematic data analysis approach was employed to examine these transcriptions and the field notes. This technique involved interpreting raw data by identifying codes and constructing thematic elements. This robust methodology facilitates comprehension of individuals' perspectives, thoughts, encounters, knowledge, viewpoints, and behaviors based on qualitative data collections. The researchers commenced by immersing themselves in the accumulated data, repeatedly and actively reading through it. This process involved recognizing commonalities and interconnections within the various data segments. Both field notes and transcriptions were referenced to pinpoint crucial sections pertinent to the research questions. Each team member received a transcript and was tasked with reading, highlighting, and noting any insights generated from the examined data. The transcripts were then exchanged among team members, ensuring that every member engaged with all the original data, promoting a more comprehensive grasp. Notable details, along with participant designations, were extracted from the transcripts to construct a thematic map that encompassed the entire dataset. The data was subsequently restructured to reflect its essence, forming themes and subthemes that were identified and categorized. Each theme and sub-theme were briefly labeled, defined, and described in line with the research questions. The ultimate phase of the data analysis involved discussing the findings. 2.8. Ethical consideration Approval was sought from the department of physiotherapy research committee of Mbarara University of Science and Technology (MUST), then to research ethics committee of Mbarara University of Science and Technology for approval and clearance. Then researchers sought permission from the chief administrative officer through the district health officer of Rukiga district, then sought permission from the administration of ROTOM, Muhanga-Rukiga district. Written consent was obtained before the start of the group discussions or interviews for all the study participants. Then researchers approached and obtained informed consent in the preferred language (Runyankore or English). The person obtaining consent explained the purpose of the study, the intended method of data collection, potential risks, and how any risk would be mitigated. All participants confirmed their understanding of the entire informed consent. In case of illiteracy, the informed consent document was directly read to the participant with the same comprehension questions used and a witness present. After the consent documents were stored in a safe place as identified by the group leader of the team. Each participant was assigned a study number and any information related to this number was kept in secure files. There was no collected information with participants’ identities on it. The recordings of interviews and discussions were recorded under a pseudonym. Audio consent was sought from the participants before start of recording. Contact information was only used to contact participants to conduct interviews and group discussions. 3. Results 3.1 Summary characteristics of the participants Overall, 22 participants participated in the study. The age range for the elderly participants was 60 to 82 years, caretaker participants was 20 to 51 years and healthcare professionals were 22 to 35 years. Three main themes and nine subthemes emerged after data analysis. Theme 1: Engagement in Physical Activity Under this theme, two sub-themes emerged: i) Engagement in light intensity physical activities, and ii) Irregular frequency of engagement in physical activities. i. Engagement in Light Intensity Physical Activities Participants described engaging mostly in low energy activities like weaving baskets and mats, attending church, and taking leisurely walks. For example; “the physical activity that I know is that I used to dig, it’s the work that I started doing long time ago, digging. But now, I do work like weaving baskets, weaving mats, all in all I work ” (FGD 2, P1, 80/F). ii. Irregular Frequency of Engagement in Physical Activity This sub-theme highlights the inconsistent participation of elderly individuals in physical activities. for example; “still, some wake up, move around a little, sit around and the day ends just like that. And sometimes we have the bedridden ones, so what they do they only wake up and be changed from this side to this side and wait for the afternoon or evening and still be changed like once with the help of our nurses ” (IDI, P2, 24/F). Theme 2: Facilitators of Physical Activity Under this theme, three sub-themes emerged: i) Social Meetings and Support, ii) Presence of Walking Aids, and iii) Advice from Medical Workers. i. Social Meetings and Support This sub-theme emphasizes the importance of social interaction and support in promoting physical activity among the elderly. For example; “They enjoy devotions when they are outside in the field more than at the health center. Like I said, when they are in their devotions, they meet together, they enjoy dancing, cooking together, singing” (IDI, P2, 24/F) ii. Presence of Walking Aids This sub-theme highlights the impact of walking aids on the physical activity levels of the elderly. For example; “If she wants something, she gets her walking stick, which helps her to walk to the shop and walk back home.” (FGD 4, P1, 51/M). iii. Advice from Medical Workers Participants described that medical workers’ advice plays a role in facilitating the elderly to engage in regular physical activities. For example; “Then others are encouraged by medical workers so that they don’t spend most of their time when they are not doing anything and encourage them to do some chores if they can” (IDI, P4, 25/F). Theme 3: Barriers to Physical Activity Under this theme, four sub-themes emerged: i) Health Problems, ii) Aging, iii) Insufficient Knowledge about Physical Activity, and iv) Lack of Self-Motivation. i. Health Problems Participants pointed out health problems as a barrier to physical activity among the elderly. For example; “you also develop health complications and this may deter you from doing exercises. A lot of diseases come because of age and disturb us, sickness deters us from doing physical activities” (FGD2, P3, 67/F). ii. Aging Aging was presented as a barrier, with participants expressing the perception that physical activity is incompatible with older age. For example; “Though I know that physical activities mean digging, fetching water, and keeping active with work. But when age set in, I stopped doing all that” (FGD2, P4,80/F). iii. Insufficient Knowledge about Physical Activity Participants’ limited knowledge about physical activity was also pointed out as a barrier to elderly engagement in physical activities. For example; “for me the activity that I engage in is praying for this country, and whatever is in this country, that’s what I engage in all the time, praying to God to give me a good place in heaven. To give me peace, give my children good health, knowledge. That’s what I do night and day” (FGD2, P3, 80/F). iv. Lack of Self-Motivation Low self-motivation among the elderly was identified as a barrier to physical activity. For example; "Our elderly are not willing especially those from well to do families, like they are from a good setting. You try to convince them to try and walk, he tells you why should I walk" (IDI, P4,25/F). 4. Discussion Our study found out that a significant proportion of the elderly population is involved in light intensity physical activities, such as weaving baskets, walking to church, bathing, and weaving mats. These activities require minimal energy expenditure and are classified as light intensity, defined by their limited impact on heart rate and breathing(Chastin et al., 2019). Such activities are preferred by many elderly individuals due to their lower energy demands and reduced risk of injury (Zhang, 2024). This is in agreement with a study done from South Korea which highlighted that 79% of elderly individuals primarily engaged in low-intensity activities (Kim et al., 2022). While these activities may not meet international physical activity guidelines, they still offer advantages over a sedentary lifestyle. Our finding also, revealed that the frequency of physical activity among the elderly is characterized by irregularity, with most failing to meet the World Health Organization's recommendation of engaging in activities for at least 5 days a week. Some elderly participants reported engaging in physical activities only twice a week, while others were even less active. Research indicates a gradual decline in physical activity frequency with age (Paterson & Warburton, 2010) and this similar with findings of (Musich et al., 2017) revealed that a significant portion of elderly participants engaged in physical activities 0-2 days per week. In addition, our study found out that mobility aids, particularly walking sticks, serve as encouragers for elderly individuals to participate in walking activities and the use of these aids, mentioned frequently by participants, allows them to engage in activities like walking to church and visiting friends. This is in line with other studies which corroborates the positive impact of mobility aids on walking engagement, highlighting the role of walking sticks, frames, and wheelchairs in promoting physical activity (Phillips and Flesner, 2013; Kalinowski et al., 2012; Brown et al., 2012) and the provision of extra support and a sense of security by these aids contributes to enhanced mobility and confidence(Bertrand, 2017). It also found out that social meetings and support play a role in motivating the elderly to maintain physical activity, caretakers and peers provide assistance with tasks like laundry and chores, fostering a sense of community and well-being. And this is in agreement with other study finding which indicated that social support enhances independence and helps individuals cope with physical limitations linked to aging(Shen et al., 2022). It has been found out that family members contribute significantly to social support, encouraging physical activity participation. It is also noted that regular interactions with fellow seniors also facilitate mobility and encourage various physical activities(Stehr et al., 2021). Our study findings revealed that advice from healthcare providers emerges as a facilitator for regular physical activity among the elderly. Medical professionals educate individuals about the benefits of physical activity and the risks of a sedentary lifestyle. This is similar with what (Horne et al., 2013) stated that elderly individuals hold medical advice in high regard and are more likely to adhere to it and this is similar with what (Cunningham & O’Sullivan, 2021) who found out that participants in Northern Ireland recognized the important role of healthcare professionals in promoting physical activity. It’s noted that healthcare providers' expertise influences older adults' perceptions, motivating them to value and incorporate physical activity into their routines (Babiker, 2014). More to that our study found out that health problems hinder elderly individuals from engaging in physical activities. Chronic illnesses, particularly, emerge as prevalent barriers. And these findings are in line with other findings which asserts that health problems often lead to inactivity and compromise overall well-being (Moschny et al., 2011a). Researchers have argued that discomfort and tiredness associated with chronic conditions discourage physical activity participation, with increased chronic conditions correlating to reduced engagement (Wiśniowska-Szurlej et al., 2022). General aches and pains also contribute to activity avoidance (Lim & Taylor, 2005). In addition to that our findings of this study revealed aging is a barrier to the elderly engagement in physical activities. Age-related physical changes, including reduced strength and balance, contribute to a fear of injury during activity. This perception runs counter to the importance of physical activity for healthy aging(McPhee et al., 2016). Similarly, this is in agreement with some other studies which have highlighted increasing physical inactivity rates with age and emphasize the need to challenge negative age-related perceptions (Costa E et al., 2017; Gluchowski et al., 2022). Furthermore, our study found out that limited knowledge regarding the positive impact of regular physical activity on overall well-being is a barrier. This knowledge gap diminishes motivation to engage in physical activity. Similarly, other studies have demonstrated that insufficient knowledge correlates with reduced activity among the elderly, highlighting the importance of education and awareness(Yin et al., 2013) . Finally, our study findings also revealed that elderly individuals often lack self-motivation to engage in physical activities, influenced by aging-related changes like reduced energy levels. This is in line with the findings of other researchers who have noted that challenges associated with aging, such as fatigue, contribute to the perception that physical activities are arduous, impacting motivation (al, 2016; Hans Degens et al., 2016). Addressing this issue is crucial for promoting sustained physical activity, particularly among older individuals who may experience musculoskeletal discomfort(M. Felicia et al., 2022). While interpreting our findings the following limitations should be put into consideration. This study was limited to only to the elderly who are already being taken care of in organized facility, their caretakers, and healthcare professionals in the same facility which could have an impact on generalization of its findings. Also, the background of researchers as physiotherapists might have influenced participants' responses, potentially biasing results. In addition to that language barriers posed a challenge during transcription and translation, as participants spoke Runyankore, therefore translation from Runyankore to English might have led to omissions or unclear interpretations, impacting the data quality. Conclusion Our study revealed that most ROTOM elderly are active in light intensity physical activities, a positive alternative to sedentary behavior. To enhance health benefits, transitioning to moderate or high intensity activities is advised. Also, strengthening facilitators and addressing barriers could promote recommended activity thus enhancing elderly quality of life. Therefore, we recommend that trainings for healthcare professionals on elderly physical activity promotion be put in place, provision of assistive devices to elderly where necessary, increasing the frequency of social meetings with physical activities for the elderly. Declarations Author Contributions Conceptualization: A F, N C & M A. Writing the first draft: A M, AF, N C, & A C. Review and editing: A F &DMB. Supervision: O J. Acknowledgments We are grateful to our participants who provided us with their time to participate in interviews or focused group discussion. We also grateful to the administration of ROTOM- Rukiga center who cleared our study to be done from their center. lastly, we are grateful to department of physiotherapy Mbarara University of Science and Technology for offering supervisor to the study and for processing research ethics clearance for the study. Disclosure statement The authors have no conflict of interest to declare. Funding: This study received no external funding. Ethics approval and consent to participate Approval was sought from the department of physiotherapy research committee of Mbarara University of Science and Technology (MUST), then to research ethics committee of Mbarara University of Science and Technology for approval and clearance. Then researchers sought permission from the chief administrative officer through the district health officer of Rukiga district, then sought permission from the administration of ROTOM, Muhanga-Rukiga district. Written consent was obtained before the start of the group discussions or interviews for all the study participants. Then researchers approached and obtained informed consent in the preferred language (Runyankore or English). The person obtaining consent explained the purpose of the study, the intended method of data collection, potential risks, and how any risk would be mitigated. All participants confirmed their understanding of the entire informed consent. In case of illiteracy, the informed consent document was directly read to the participant with the same comprehension questions used and a witness present. After the consent documents were stored in a safe place as identified by the group leader of the team. Each participant was assigned a study number and any information related to this number was kept in secure files. There was no collected information with participants’ identities on it. The recordings of interviews and discussions were recorded under a pseudonym. Audio consent was sought from the participants before start of recording. Contact information was only used to contact participants to conduct interviews and group discussions. Availability of Data and Material The datasets associated with this manuscript during the current study are available from the corresponding author upon request. References Adekunle Adedeji, E. S. I. (2023). (PDF) Well-Being and Culture: An African Perspective. In ResearchGate . https://doi.org/10.5772/intechopen.109842 al, J. S. M. et. (2016). 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Journal of Family Medicine and Disease Prevention , 8 (2). https://doi.org/10.23937/2469-5793/1510151 McPhee, J. S., French, D. P., Jackson, D., Nazroo, J., Pendleton, N., & Degens, H. (2016). Physical activity in older age: Perspectives for healthy ageing and frailty. Biogerontology , 17 (3), 567–580. https://doi.org/10.1007/s10522-016-9641-0 Meredith, S. J., Cox, N. J., Ibrahim, K., Higson, J., McNiff, J., Mitchell, S., Rutherford, M., Wijayendran, A., Shenkin, S. D., Kilgour, A. H. M., & Lim, S. E. R. (2023). Factors that influence older adults’ participation in physical activity: A systematic review of qualitative studies. Age and Ageing , 52 (8), afad145. https://doi.org/10.1093/ageing/afad145 Miller, W., & Brown, P. R. (2017). Motivators, Facilitators, and Barriers to Physical Activity in Older Adults: A Qualitative Study. Holistic Nursing Practice , 31 (4), 216–224. https://doi.org/10.1097/hnp.0000000000000218 Mjøsund, H. L., Uhrenfeldt, L., Burton, E., & Moe, C. F. (2022). Promotion of physical activity in older adults: Facilitators and barriers experienced by healthcare personnel in the context of reablement. BMC Health Services Research , 22 (1), 956. https://doi.org/10.1186/s12913-022-08247-0 Moschny, A., Platen, P., Klaassen-Mielke, R., Trampisch, U., & Hinrichs, T. (2011). Barriers to physical activity in older adults in Germany: A cross-sectional study. The International Journal of Behavioral Nutrition and Physical Activity , 8 , 121. https://doi.org/10.1186/1479-5868-8-121 Musich, S., Wang, S. S., Hawkins, K., & Greame, C. (2017). The Frequency and Health Benefits of Physical Activity for Older Adults. Population Health Management , 20 (3), 199–207. https://doi.org/10.1089/pop.2016.0071 Osokpo, O. H., Lewis, L. M., Ikeaba, U., Chittams, J., Barg, F. K., & Riegel, B. J. (2022). Self-Care of African Immigrant Adults with Chronic Illness. Clinical Nursing Research , 31 (3), 413–425. https://doi.org/10.1177/10547738211056168 Paterson, D. H., & Warburton, D. E. (2010). Physical activity and functional limitations in older adults: A systematic review related to Canada’s Physical Activity Guidelines. International Journal of Behavioral Nutrition and Physical Activity , 7 (1), 38. https://doi.org/10.1186/1479-5868-7-38 Shen, L., Jhund, P. S., Docherty, K. F., Vaduganathan, M., Petrie, M. C., Desai, A. S., Køber, L., Schou, M., Packer, M., Solomon, S. D., Zhang, X., & McMurray, J. J. V. (2022). Accelerated and personalized therapy for heart failure with reduced ejection fraction. European Heart Journal , 43 (27), 2573–2587. https://doi.org/10.1093/eurheartj/ehac210 Stehr, P., Luetke Lanfer, H., & Rossmann, C. (2021). Beliefs and motivation regarding physical activity among older adults in Germany: Results of a qualitative study. International Journal of Qualitative Studies on Health and Well-Being , 16 (1), 1932025. https://doi.org/10.1080/17482631.2021.1932025 Steinhoff, P., & Reiner, A. (2024). Physical activity and functional social support in community-dwelling older adults: A scoping review. BMC Public Health , 24 , 1355. https://doi.org/10.1186/s12889-024-18863-6 Sun, F., Norman, I. J., & While, A. E. (2013). Physical activity in older people: A systematic review. BMC Public Health , 13 (1), 449. https://doi.org/10.1186/1471-2458-13-449 WHO. (2019). Ageing and health . https://www.who.int/news-room/fact-sheets/detail/ageing-and-health Yarmohammadi, S., Mozafar Saadati, H., Ghaffari, M., & Ramezankhani, A. (2019). A systematic review of barriers and motivators to physical activity in elderly adults in Iran and worldwide. Epidemiology and Health , 41 , e2019049. https://doi.org/10.4178/epih.e2019049 Yin, Z., Geng, G., Lan, X., Zhang, L., Wang, S., Zang, Y., & Peng, M. (2013). Status and determinants of health behavior knowledge among the elderly in China: A community-based cross-sectional study. BMC Public Health , 13 (1), 710. https://doi.org/10.1186/1471-2458-13-710 Yu, C.-Y. (2025). The Reciprocal Relationship Between Neighborhood Social Cohesion and Leisure-Time Physical Activity for Older Adults. Urban Science , 9 (4), Article 4. https://doi.org/10.3390/urbansci9040108 Zhang, L. (2024). Leisure Activities and the Oldest Old’s Health. In L. Zhang (Ed.), Living Longer and Healthier at Older Ages: A Longitudinal Analysis of Chinese Oldest Old’s Health and Its Determinants (pp. 151–165). Springer International Publishing. https://doi.org/10.1007/978-3-031-69773-9_8 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Introduction","content":"\u003cp\u003eThere is \u0026nbsp;rapidly growing elderly population worldwide, that is expected to double by\u0026nbsp;2050 and has raised concerns about their physical well-being(WHO, 2019). Numerous studies have highlighted a rising trend of physical inactivity among the elderly(Alodhialah et al., 2025; Guwatudde et al., 2016; Keadle et al., 2016; Sun et al., 2013; WHO, 2019). The World Health Organization (WHO) recommends a minimum of 150 minutes of physical activity per week for the elderly, yet many fail to meet this requirement due to factors such as dependence and limited engagement in sustained activities(Baldwin et al., 2020; Bull et al., 2020; Choe et al., 2025; Lee \u0026amp; Howard, 2019; Sun et al., 2013). In South Western Uganda, a prevalence of 51.5% for physical inactivity among the elderly was identified (Guwatudde et al., 2016; Kiiza Mondo et al., 2013). Studies have shown that facilitators of elderly physical activity include community support, social cohesion, accessibility to resources, cultural values, and individual motivation(Adekunle Adedeji, 2023; Meredith et al., 2023; Osokpo et al., 2022; Steinhoff \u0026amp; Reiner, 2024; Yu, 2025). \u0026nbsp;And the barriers to elderly physical activity included insufficient facilities, lack of social support, and financial constraints(Biedenweg et al., 2014; Justine et al., 2013; Moschny et al., 2011; Yarmohammadi et al., 2019). Physical activity is essential for maintaining health and independence in older adults, yet many elderly individuals face significant barriers to engaging in regular exercise and these obstacles range from physical limitations and chronic health conditions to psychological factors such as fear of injury and lack of motivation(Miller \u0026amp; Brown, 2017). Additionally, social and environmental influences, including inadequate support from caregivers and healthcare professionals, further hinder participation in physical activity(Dijkstra et al., 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite these challenges, facilitators such as social encouragement, structured exercise programs, and accessible environments can enhance physical activity levels among the elderly(Mj\u0026oslash;sund et al., 2022). Understanding these perceptions from the perspectives of elderly individuals, caregivers, and healthcare professionals is crucial for developing effective interventions that promote physical activity and improve overall well-being. Despite of all this, there is limited literature exploring the facilitators and barriers to elderly engagement in regular physical activity in Uganda. Therefore, this study aimed to establish the facilitators and barriers to physical activity among the elderly based on the perceptions of the elderly, caretakers, and healthcare professionals at Reach One Touch One Ministries (ROTOM).\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was phenomenological research in which we recruited 22 participants who were elderly, caretakers, and healthcare professionals and convenience sampling was used to recruit study participants in the months of March and April of 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Study setting\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study setting was Reach One Touch One Ministries (ROTOM) Muhanga-Rukiga district center is found in greater Kabale region, South Western Uganda. \u0026nbsp;ROTOM is an international Christian organization that operates as a non-profit, non-denominational entity with the mission of empowering underprivileged elderly individuals in Uganda and Ethiopia to live dignified and fulfilled lives through a multi-faceted approach that strives to address their physical, emotional, mental and financial well-being with two centers in Uganda, one in Muhanga-Rukiga District, southwestern Uganda, and another in Namubiru-Mukono District, central Uganda.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eROTOM, Muhanga-Rukiga district centre\u0026nbsp;region was chosen for this study because it has a higher population of elderly persons (29,672) compared to other districts in Southwestern Uganda such as Mbarara (20,442), Bushenyi (12,476) and Ibanda (12,230) according to the UBOS-statistics of 2014.\u003c/p\u003e\n\u003cp\u003eThe facility is currently taking care of 500 elderly people providing them with food, medical care and financial aid where necessary. It comprises of a professional staff of 8 members i.e., 1 Laboratory officer, 4 Nurses, 1 Medical officer, I clinical officer and 1 physiotherapist. The elderly who are in worse conditions due to various causes like chronic illnesses are taken care of at the facility and the rest are taken care of in their respective homes with the field nurses and other staff members checking on them daily. ROTOM was chosen because they have a big population of the elderly and caretakers and therefore it was possible for the study target population to be easily accessed. They also have a big team of healthcare professionals who have direct contact with the elderly and the researchers needed to get their perceptions as well regarding the study\u0026nbsp;topic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Sampling procedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers used a convenience method of sampling, and this was based on choosing participants that were present at the time of the study and met the study inclusion criteria. The study sample included; the elderly, who were aged 60 and above and were able to ambulate, \u0026nbsp;Caretakers\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003ePeople taking care of the elderly on a daily basis ensuring that they have eaten all meals, bathed at the right time, their beds are made, and their health needs are met and healthcare professionals, who were employed by the organization to provide geriatric services to the elderly, and they were key informants. These included nurses, a medical officer, and a clinical officer. Over 50 elderly people were staying within the vicinity of ROTOM.\u003c/p\u003e\n\u003cp\u003eAmong the 50, 15 elderly people were bed ridden, 10 did not consent to participate, 5 elderly people had cognitive impairments, and the 5 withdrew from the study during the data collection process and 7 had caretakers below 18 years. A total of 8 elderly people participated. These eight elderly people together with their caretakers acted as study participants. Six health care professionals were present during the time of the study and consented to participate, hence a total sample of 22 participants.\u003c/p\u003e\n\u003cp id=\"_Toc153797917\"\u003e\u003cstrong\u003e2.4.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Eligibility criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were separated into three groups; the elderly, the caretakers, and healthcare professionals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.1 Inclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElderly people who were aged 60 years and above that consented and participated.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eElderly people who were able to ambulate either with support or without support to the data collection center.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eElderly people who were present at the time of study. Caretakers who were aged 18 years and above.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eHealthcare professionals who were employed at ROTOM at the time of study. Healthcare professionals who had spent at least 6 months as employees at ROTOM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.2 Exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElderly people who did not speak or understand English or Runyankore. Elderly people who were critically ill. \u0026nbsp;Elderly people who had mental health problems e.g. dementia. Caretakers below 18 years of age were not recruited. Caretakers who were not able to speak or understand English or Runyankore. Healthcare professionals who did not consent to be part of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Data collection\u0026nbsp;procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers approached the nurse in charge who helped to organize the study participants. The researchers briefed the study participants about the study and then informed consent was obtained from the selected participants before the interviews commenced. Data was collected by a group of five researchers. Four Focus Group Discussions (FGDs) were conducted among the elderly and caretakers. Each FGD consisted of 4 conveniently selected participants from the categories of elderly people and caretakers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;FGDs\u0026nbsp;were\u0026nbsp;homogenous i.e., one FGD was for the elderly who are male, another was for the elderly who are female, then one FGD was for the caretakers who are male, and another was for the caretakers who are female. The researchers used homogenous FGDs to allow participants to freely share their views and ideas without fear of the opposite sex members. Each FGD lasted averagely 25 minutes. FGDs were conducted in a private and secured location. One to one in-depth interviews were held with healthcare professionals at the setting. The health care professionals were included as key informants because they are responsible for giving the elderly advice on health lifestyles such as physical activity. The interviews consisted of 6 healthcare professionals at ROTOM. Each interview lasted averagely 15 minutes. Field notes were also taken to complement the audio taped\u0026nbsp;interviews.\u0026nbsp;The\u0026nbsp;FGDs\u0026nbsp;and\u0026nbsp;the\u0026nbsp;in-depth\u0026nbsp;interviews\u0026nbsp;helped\u0026nbsp;the\u0026nbsp;researchers\u0026nbsp;to\u0026nbsp;gain\u0026nbsp;insights of the participant \u0026lsquo;s perceptions regarding the facilitators and barriers to physical activity among the elderly.\u003c/p\u003e\n\u003cp id=\"_Toc153797921\"\u003e\u003cstrong\u003e2.6. \u0026nbsp;Data collection tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers used three semi-structured interview guides and probing questions to achieve in-depth interviews and focus group discussions. The researchers also used pens, papers, and audio recorders while conducting the focus group discussions and in-depth interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.7. \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eData\u0026nbsp;analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbatim transcriptions were generated from the audio recordings of the in depths interviews and focus group discussions (FGDs). An inductive thematic data analysis approach was employed to examine these transcriptions and the field notes. This technique involved interpreting raw data by identifying codes and constructing thematic elements. This robust methodology facilitates comprehension of individuals\u0026apos; perspectives, thoughts, encounters, knowledge, viewpoints, and behaviors based on qualitative data collections. The researchers commenced by immersing themselves in the accumulated data, repeatedly and actively reading through it. This process involved recognizing commonalities and interconnections within the various data segments. Both field notes and transcriptions were referenced to pinpoint crucial sections pertinent to the research questions. Each team member received a transcript and was tasked with reading, highlighting, and noting any insights generated from the examined data. The transcripts were then exchanged among team members, ensuring that every member engaged with all the original data, promoting a more comprehensive grasp. Notable details, along with participant designations, were extracted from the transcripts to construct a thematic map that encompassed the entire dataset. The data was subsequently restructured to reflect its essence, forming themes and subthemes that were identified and categorized. Each theme and sub-theme were briefly labeled, defined, and described in line with the research questions. The ultimate phase of the data analysis involved discussing the findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.8. \u0026nbsp; \u0026nbsp; \u0026nbsp; Ethical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was sought from the \u0026nbsp;department of physiotherapy research committee of Mbarara University of Science and Technology (MUST), then to research ethics committee of Mbarara University of Science and Technology for approval and clearance. Then researchers sought permission from the chief administrative officer through the district health officer of Rukiga district, then sought permission from the administration of ROTOM, Muhanga-Rukiga district. Written consent was obtained before the start of the group discussions or interviews for all the study participants. Then researchers approached and obtained informed consent in the preferred language (Runyankore or English). The person obtaining consent explained the purpose of the study, the intended method of data collection, potential risks, and how any risk would be mitigated. All participants confirmed their understanding of the entire informed consent. In case of illiteracy, the informed consent document was directly read to the participant with the same comprehension questions used and a witness present. After the consent documents were stored in a safe place as identified by the group leader of the team. Each participant was assigned a study number and any information related to this number was kept in secure files. There was no collected information with participants\u0026rsquo; identities on it. The recordings of interviews and discussions were recorded under a pseudonym. Audio consent was sought from the participants before start of recording. Contact information was only used to contact participants to conduct interviews and group discussions.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Summary characteristics of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 22 participants participated in the study. The age range for the elderly participants was 60 to 82 years, caretaker participants was 20 to 51 years and healthcare professionals were 22 to 35 years. Three main themes and nine subthemes emerged after data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Engagement in Physical Activity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnder this theme, two sub-themes emerged: i) Engagement in light intensity physical activities, and ii) Irregular frequency of engagement in physical activities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ei. Engagement in Light Intensity Physical Activities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described engaging mostly in low energy activities like weaving baskets and mats, attending church, and taking leisurely walks. For example; \u003cem\u003e\u0026ldquo;the physical activity that I know is that I used to dig, it\u0026rsquo;s the work that I started doing long time ago, digging. But now, I do work like weaving baskets, weaving mats, all in all I work\u003c/em\u003e\u0026rdquo; (FGD 2, P1, 80/F).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. Irregular Frequency of Engagement in Physical Activity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis sub-theme highlights the inconsistent participation of elderly individuals in physical activities. for example; \u003cem\u003e\u0026ldquo;still, some wake up, move around a little, sit around and the day ends just like that. And sometimes we have the bedridden ones, so what they do they only wake up and be changed from this side to this side and wait for the afternoon or evening and still be changed like once with the help of our nurses\u003c/em\u003e\u0026rdquo; (IDI, P2, 24/F).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Facilitators of Physical Activity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnder this theme, three sub-themes emerged: i) Social Meetings and Support, ii) Presence of Walking Aids, and iii) Advice from Medical Workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ei. Social Meetings and Support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis sub-theme emphasizes the importance of social interaction and support in promoting physical activity among the elderly. For example; \u003cem\u003e\u0026ldquo;They enjoy devotions when they are outside in the field more than at the health center. Like I said, when they are in their devotions, they meet together, they enjoy dancing, cooking together, singing\u0026rdquo;\u0026nbsp;\u003c/em\u003e(IDI, P2, 24/F)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. \u0026nbsp;Presence of Walking Aids\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis sub-theme highlights the impact of walking aids on the physical activity levels of the elderly. For example; \u003cem\u003e\u0026ldquo;If she wants something, she gets her walking stick, which helps her to walk to the shop and walk back home.\u0026rdquo;\u003c/em\u003e (FGD 4, P1, 51/M).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. \u0026nbsp;Advice from Medical Workers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described that medical workers\u0026rsquo; advice plays a role in facilitating the elderly to engage in regular physical activities. For example; \u003cem\u003e\u0026ldquo;Then others are encouraged by medical workers so that they don\u0026rsquo;t spend most of their time when they are not doing anything and encourage them to do some chores if they can\u0026rdquo;\u0026nbsp;\u003c/em\u003e(IDI, P4, 25/F).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Barriers to Physical Activity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnder this theme, four sub-themes emerged: i) Health Problems, ii) Aging, iii) Insufficient Knowledge about Physical Activity, and iv) Lack of Self-Motivation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ei. Health Problems\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants pointed out health problems as a barrier to physical activity among the elderly. For example; \u003cem\u003e\u0026ldquo;you also develop health complications and this may deter you from doing exercises. A lot of diseases come because of age and disturb us, sickness deters us from doing physical activities\u0026rdquo;\u003c/em\u003e (FGD2, P3, 67/F).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eii. Aging\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAging was presented as a barrier, with participants expressing the perception that physical activity is incompatible with older age. For example; \u003cem\u003e\u0026ldquo;Though I know that physical activities mean digging, fetching water, and keeping active with work. But when age set in, I stopped doing all that\u0026rdquo;\u003c/em\u003e (FGD2, P4,80/F).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiii. Insufficient Knowledge about Physical Activity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants\u0026rsquo; limited knowledge about physical activity was also pointed out as a barrier to elderly engagement in physical activities. For example; \u003cem\u003e\u0026ldquo;for me the activity that I engage in is praying for this country, and whatever is in this country, that\u0026rsquo;s what I engage in all the time, praying to God to give me a good place in heaven. To give me peace, give my children good health, knowledge. That\u0026rsquo;s what I do night and day\u0026rdquo;\u003c/em\u003e (FGD2, P3, 80/F).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eiv. Lack of Self-Motivation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLow self-motivation among the elderly was identified as a barrier to physical activity. For example; \u003cem\u003e\u0026quot;Our elderly are not willing especially those from well to do families, like they are from a good setting. You try to convince them to try and walk, he tells you why should I walk\u0026quot;\u003c/em\u003e (IDI, P4,25/F).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eOur study found out that a significant proportion of the elderly population is involved in light intensity physical activities, such as weaving baskets, walking to church, bathing, and weaving mats. These activities require minimal energy expenditure and are classified as light intensity, defined by their limited impact on heart rate and breathing(Chastin et al., 2019). Such activities are preferred by many elderly individuals due to their lower energy demands and reduced risk of injury (Zhang, 2024). This is in agreement with a study done from South Korea which highlighted that 79% of elderly individuals primarily engaged in low-intensity activities (Kim et al., 2022). While these activities may not meet international physical activity guidelines, they still offer advantages over a sedentary lifestyle. Our finding also, revealed that the frequency of physical activity among the elderly is characterized by irregularity, with most failing to meet the World Health Organization\u0026apos;s recommendation of engaging in activities for at least 5 days a week. Some elderly participants reported engaging in physical activities only twice a week, while others were even less active. Research indicates a gradual decline in physical activity frequency with age (Paterson \u0026amp; Warburton, 2010) and this similar with findings of (Musich et al., 2017) revealed that a significant portion of elderly participants engaged in physical activities 0-2 days per week. In addition, our study found out that mobility aids, particularly walking sticks, serve as encouragers for elderly individuals to participate in walking activities and the use of these aids, mentioned frequently by participants, allows them to engage in activities like walking to church and visiting friends. This is in line with other studies which corroborates the positive impact of mobility aids on walking engagement, highlighting the role of walking sticks, frames, and wheelchairs in promoting physical activity (Phillips and Flesner, 2013; Kalinowski et al., 2012; Brown et al., 2012) and the provision of extra support and a sense of security by these aids contributes to enhanced mobility and confidence(Bertrand, 2017). It also found out that social meetings and support play a role in motivating the elderly to maintain physical activity, caretakers and peers provide assistance with tasks like laundry and chores, fostering a sense of community and well-being. And this is in agreement with other study finding which indicated that social support enhances independence and helps individuals cope with physical limitations linked to aging(Shen et al., 2022). It has been found out that family members contribute significantly to social support, encouraging physical activity participation. It is also noted that regular interactions with fellow seniors also facilitate mobility and encourage various physical activities(Stehr et al., 2021).\u003c/p\u003e\n\u003cp\u003eOur study findings revealed that advice from healthcare providers emerges as a facilitator for regular physical activity among the elderly. Medical professionals educate individuals about the benefits of physical activity and the risks of a sedentary lifestyle. This is similar with what (Horne et al., 2013) \u0026nbsp; stated that elderly individuals hold medical advice in high regard and are more likely to adhere to it and this is similar with what (Cunningham \u0026amp; O\u0026rsquo;Sullivan, 2021) who found out that \u0026nbsp;participants in Northern Ireland recognized the important role of healthcare professionals in promoting physical activity. It\u0026rsquo;s noted that healthcare providers\u0026apos; expertise influences older adults\u0026apos; perceptions, motivating them to value and incorporate physical activity into their routines (Babiker, 2014). More to that our study found out that health problems hinder elderly individuals from engaging in physical activities. Chronic illnesses, particularly, emerge as prevalent barriers. And these findings are in line with other findings which asserts that health problems often lead to inactivity and compromise overall well-being (Moschny et al., 2011a). Researchers have argued that discomfort and tiredness associated with chronic conditions discourage physical activity participation, with increased chronic conditions correlating to reduced engagement (Wiśniowska-Szurlej et al., 2022). General aches and pains also contribute to activity avoidance (Lim \u0026amp; Taylor, 2005). In addition to that our findings of this study revealed aging is a barrier to the elderly engagement in physical activities. Age-related physical changes, including reduced strength and balance, contribute to a fear of injury during activity. This perception runs counter to the importance of physical activity for healthy aging(McPhee et al., 2016). Similarly, this is in agreement with some other studies which have highlighted increasing physical inactivity rates with age and emphasize the need to challenge negative age-related perceptions (Costa E et al., 2017; Gluchowski et al., 2022). Furthermore, our study found out that limited knowledge regarding the positive impact of regular physical activity on overall well-being is a barrier. This knowledge gap diminishes motivation to engage in physical activity. Similarly, other studies have demonstrated that insufficient knowledge correlates with reduced activity among the elderly, highlighting the importance of education and awareness(Yin et al., 2013) . Finally, our study findings also revealed that elderly individuals often lack self-motivation to engage in physical activities, influenced by aging-related changes like reduced energy levels. This is in line with the findings of other researchers who have noted that challenges associated with aging, such as fatigue, contribute to the perception that physical activities are arduous, impacting motivation (al, 2016; Hans Degens et al., 2016). Addressing this issue is crucial for promoting sustained physical activity, particularly among older individuals who may experience musculoskeletal discomfort(M. Felicia et al., 2022).\u003c/p\u003e\n\u003cp\u003eWhile interpreting our findings the following limitations should be put into consideration. This study was limited to only to the elderly who are already being taken care of in organized facility, their caretakers, and healthcare professionals in the same facility which could have an impact on generalization of its findings. Also, the background of researchers as physiotherapists might have influenced participants\u0026apos; responses, potentially biasing results. In addition to that language barriers posed a challenge during transcription and translation, as participants spoke Runyankore, therefore translation from Runyankore to English might have led to omissions or unclear interpretations, impacting the data quality.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study revealed that most ROTOM elderly are active in light intensity physical activities, a positive alternative to sedentary behavior. To enhance health benefits, transitioning to moderate or high intensity activities is advised. Also, strengthening facilitators and addressing barriers could promote recommended activity thus enhancing elderly quality of life. Therefore, we recommend that trainings for healthcare professionals on elderly physical activity promotion be put in place, provision of assistive devices to elderly where necessary, increasing the frequency of social meetings with physical activities for the elderly.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: A F, N C \u0026amp; M A. Writing the first draft: A M, AF, N C, \u0026amp; A C. Review and editing: A F \u0026amp;DMB. Supervision: O J.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to our participants who provided us with their time to participate in interviews or focused group discussion. We also grateful to the administration of ROTOM- Rukiga center who cleared our study to be done from their center. lastly, we are grateful to department of physiotherapy Mbarara University of Science and Technology for offering supervisor to the study and for processing research ethics clearance for the study. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflict of interest to declare. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was sought from the department of physiotherapy research committee of Mbarara University of Science and Technology (MUST), then to research ethics committee of Mbarara University of Science and Technology for approval and clearance. Then researchers sought permission from the chief administrative officer through the district health officer of Rukiga district, then sought permission from the administration of ROTOM, Muhanga-Rukiga district. Written consent was obtained before the start of the group discussions or interviews for all the study participants. Then researchers approached and obtained informed consent in the preferred language (Runyankore or English). The person obtaining consent explained the purpose of the study, the intended method of data collection, potential risks, and how any risk would be mitigated. All participants confirmed their understanding of the entire informed consent. In case of illiteracy, the informed consent document was directly read to the participant with the same comprehension questions used and a witness present. After the consent documents were stored in a safe place as identified by the group leader of the team. Each participant was assigned a study number and any information related to this number was kept in secure files. There was no collected information with participants\u0026rsquo; identities on it. The recordings of interviews and discussions were recorded under a pseudonym. Audio consent was sought from the participants before start of recording. Contact information was only used to contact participants to conduct interviews and group discussions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets associated with this manuscript during the current study are available from the corresponding author upon request.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdekunle Adedeji, E. S. I. (2023). (PDF) Well-Being and Culture: An African Perspective. 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(2019). \u003cem\u003eAgeing and health\u003c/em\u003e. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health\u003c/li\u003e\n\u003cli\u003eYarmohammadi, S., Mozafar Saadati, H., Ghaffari, M., \u0026amp; Ramezankhani, A. (2019). A systematic review of barriers and motivators to physical activity in elderly adults in Iran and worldwide. \u003cem\u003eEpidemiology and Health\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e, e2019049. https://doi.org/10.4178/epih.e2019049\u003c/li\u003e\n\u003cli\u003eYin, Z., Geng, G., Lan, X., Zhang, L., Wang, S., Zang, Y., \u0026amp; Peng, M. (2013). Status and determinants of health behavior knowledge among the elderly in China: A community-based cross-sectional study. \u003cem\u003eBMC Public Health\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(1), 710. https://doi.org/10.1186/1471-2458-13-710\u003c/li\u003e\n\u003cli\u003eYu, C.-Y. (2025). The Reciprocal Relationship Between Neighborhood Social Cohesion and Leisure-Time Physical Activity for Older Adults. \u003cem\u003eUrban Science\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(4), Article 4. https://doi.org/10.3390/urbansci9040108\u003c/li\u003e\n\u003cli\u003eZhang, L. (2024). Leisure Activities and the Oldest Old\u0026rsquo;s Health. In L. Zhang (Ed.), \u003cem\u003eLiving Longer and Healthier at Older Ages: A Longitudinal Analysis of Chinese Oldest Old\u0026rsquo;s Health and Its Determinants\u003c/em\u003e (pp. 151\u0026ndash;165). Springer International Publishing. https://doi.org/10.1007/978-3-031-69773-9_8\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Mbarara University of Science and Technology","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Physical activity, Facilitators of physical activity, Barriers to physical activity, and Elderly","lastPublishedDoi":"10.21203/rs.3.rs-9165713/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9165713/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe global elderly population, set to double by 2050, faces increasing concerns about their physical well-being. Studies indicate rising inactivity among them, with factors like dependence and limited engagement. Despite WHO's recommendation of 150 weekly minutes of activity, many elderly fail to meet this due to various reasons. In South Western Uganda, 51.5% of elderly were found to be physically inactive. Some studies have found out that facilitators of physical activity among the elderly include community support, cultural values, and motivation, while barriers involve insufficient facilities, social support, and finances. Although physical inactivity among the elderly is prevalent in the region, there is limited literature exploring the facilitators and barriers to physical activity among the elderly in south western Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We recruited 22 participants who are elderly, caretakers, and healthcare professionals, where qualitative research was used designed and convenience sampling was used to recruit study participants. Data was collected using focus group discussions and in depths, semi-structured interview guides and audio recorders were used. Data was analyzed using an inductive thematic data analysis approach.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study revealed three main themes and nine subthemes: Engagement in Physical Activity included two subthemes i.e. i) Engagement in light intensity physical activities, and ii) Irregular frequency of engagement in physical activities. Facilitators of Physical Activity included three subthemes i.e. i) Social meetings and support, ii) Mobility aids, and iii) Medical workers' advice. Barriers to Physical Activity encompassed four subthemes i.e. i) Health problems, ii) Aging, iii) Insufficient knowledge about physical activity, and iv) Lack of self-motivation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study found out that elderly at ROTOM engage in light intensity activities, a positive behavior compared to being sedentary. However, to maximize health benefits, transitioning to moderate or high intensity activities is suggested. Strengthening facilitators and addressing barriers could promote recommended activity thus enhancing elderly quality of life.\u003c/p\u003e","manuscriptTitle":"Facilitators and Barriers to Physical Activity in the Elderly: A Qualitative Study on the Perceptions of Elderly, Caretakers and Healthcare Professionals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-20 02:59:40","doi":"10.21203/rs.3.rs-9165713/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ba4b2a92-9376-4e35-959a-a90bcaa88cdf","owner":[],"postedDate":"March 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":64822409,"name":"Population Biology"}],"tags":[],"updatedAt":"2026-03-20T02:59:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-20 02:59:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9165713","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9165713","identity":"rs-9165713","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}