Stepwise development of ACTIVE-AGE@home: A home-based functional exercise program for frail older adults
Emma De Keyser, Jade Tambeur, Timothy Moreels, Dimitri Vrancken, Elke De Smedt, Kathleen Willems, Wim Peersman, Dominique Van de Velde, David Beckwée, Patricia De VriendtAbstract
Background and Objectives
Older adults with frailty often experience limitations in activities of daily living (ADL), threatening independence and quality of life. Existing exercise interventions rarely balance therapeutic validity with program adherence, often lacking ADL-specific training, meaningful goal integration, and co-creation with frail older adults. This study developed and evaluated ACTIVE-AGE@home (AA@H), a home-based functional exercise program co-created with frail older adults to address these gaps.
Research Design and Methods
A mixed-methods study, guided by the Medical Research Council framework, was conducted across four phases. This paper reports phases 1–3: (1) intervention development based on semi-structured interviews exploring barriers and facilitators to physical activity; (2) feasibility testing of intervention acceptability and outcome measures; and (3) a quasi-experimental study comparing AA@H1 (ADL-focused), AA@H2 (higher-intensity progression-focused), and a control group, including process and exploratory outcome evaluation with three-month qualitative follow-up.
Results
AA@H showed high feasibility and acceptability, with adherence rates of 85.7%-93.3% and no adverse events. Participants valued its personalised, home-based, and goal-oriented approach. Exploratory descriptive analyses showed increases in physical fitness and participation scores in AA@H2, and in ADL scores in AA@H1. Follow-up data revealed limited continuation of structured exercise but sustained gains in confidence, daily functioning, and participation.
Discussion and Implications
AA@H is a feasible and promising intervention for frail community-dwelling older adults. Findings highlight the importance of combining sufficient training intensity and progression with explicit ADL integration to optimise physical gains and functional transfer. Further optimisation of exercise dose, duration, and behavioural support is needed before large-scale evaluation.