Unique Opportunity and Motivational Targets for Exercise Behavior Change Among Nonfrail, Prefrail, and Frail Older Adults.

Introduction: Exercise is the most effective frailty mitigation intervention studied to date, yet frail older adults may face unique hurdles to exercise behavior change.

Objective: Our objective was to compare perceived opportunities and motivation for physical activity among subgroups with varying physical capability to inform frailty intervention development.

Methods: We analyzed cross-sectional survey data from n = 101 community-dwelling, older adults (n = 30 nonfrail, n = 59 prefrail, n = 12 frail; 93% African-American). Measures were organized by the Capability, Opportunity, Motivation-Behavior change framework. The capability factor included the frailty phenotype (nonfrail, prefrail, or frail). "Opportunity" factors included: barrier and resource identification, local program awareness, the Exercise Barriers Subscale, and exercise preferences. "Motivation" factors, included the Self-Rated Abilities for Health Practices Exercise Subscale; perceived exercise need, benefits, and harms; the Outcome Expectations for Exercise Scale; and personal health goals. Kruskal-Wallis and chi-square tests identified between-group quantitative differences. Open-ended survey responses were evaluated qualitatively for themes.

Results: Frail adults had worse Exercise Barriers Subscale scores (p = .005); reported more barriers and fewer resources; were less aware of local exercise facilities; and had a narrower scope of exercise preferences. Frail adults also had worse Self-Rated Abilities for Health Practices Exercise Subscale scores (p = .004); were more likely to indicate they needed exercise; perceived more psychological exercise benefits than physical; but had worse Outcome Expectations for Exercise Scale scores (p < .001). One-year health goal themes were similar among frailty groups, with the majority identifying functional goals. Conclusion and Significance/Implications: This study identified opportunity and motivation factors unique to frail adults that could inform behavior change discussions and interventions in frail adults.