Physical activity perceptions, barriers, and needs among nursing home residents: an explanatory sequential mixed-methods study

Background/objectives Physical activity is essential for maintaining health and preventing functional decline among older adults residing in nursing homes. However, engagement in physical activity remains suboptimal in this population due to multifactorial influences. This study aimed to examine the perceptions, barriers, and needs related to physical activity among nursing home residents. Methods An explanatory sequential mixed-methods design was employed from September to December 2024. In the quantitative phase, data were collected from 254 residents across 20 nursing homes in Korea using structured questionnaires assessing physical activity frequency, fall efficacy, outcome expectations, and social support. Hierarchical logistic regression analyses were conducted to identify factors associated with physical activity participation. In the subsequent qualitative phase, in-depth interviews were conducted with 12 residents and analyzed using reflexive thematic analysis. Findings from both phases were integrated to provide a comprehensive interpretation of the contextual influences on physical activity. Results Facility size, program frequency, program duration, social support, and education level were significantly associated with physical activity. Residents living in facilities with 30 or more beds were less likely to engage in physical activity. Higher program frequency was positively associated with physical activity participation, whereas program sessions lasting 30 min or longer were negatively associated with participation. Greater perceived social support was also associated with higher physical activity participation. Residents with a middle school education or higher were more likely to engage in physical activity. Qualitative analysis identified five themes: meanings shaped by past experiences; physical activity as restoration; motivating forces amid decline; multilayered barriers; and expectations for improved opportunities. Integration of findings revealed that personal meaning, interpersonal relationships, and institutional contexts dynamically interact to shape physical activity engagement. Conclusion Physical activity among nursing home residents is shaped by the dynamic interplay of individual experiences, social support, and environmental conditions. Strategies to promote physical activity should therefore adopt a holistic and context-sensitive approach.