Promoting physical activity and physical functioning among residents in nursing homes - lessons learnt by the PROGRESS project.

Introduction: Nursing home residents show high sedentary behavior and limited physical functioning, while structural constraints hinder sustainable prevention. This study examined how group-based physical exercise and environmental interventions, such as activity-promoting materials and interior design, can be integrated into everyday care to promote a physical activity-promoting culture in nursing homes and identified key organizational and individual determinants of sustainable implementation. Methods: PROGRESS was a participatory, cluster-randomized cross-over trial conducted in seven nursing homes in the Münster area in Germany. Residents received two of four guided or non-guided exercise (n = 62) and/or environmental interventions (e.g., activity posters, a seated bike ergometer, walking brochures/routes; n = 65). Data from attendance logs, participatory workshops, and a follow-up questionnaire at t4 (the fourth and final measurement time point, approximately 50 weeks after baseline assessment; n = 73) were analyzed using descriptive statistics and structured content analysis for open-ended feedback. Based on these findings, the PROGRESS pyramid was developed as a framework for sustainable implementation of physical activity into everyday care. Results: Of the 73 participants, 90.4% attended at least one guided intervention session. Participation was highest in the exercise intervention, with most residents reporting weekly engagement. In contrast, engagement with environmental interventions was more variable and strongly dependent on staff support, with 63.0% of residents reporting no independent use of physical activity opportunities. Comparisons between self-reported participation and attendance records revealed substantial discrepancies, particularly for environmental interventions. Overall satisfaction with the project was high (mean = 2.7 ± 2.5 on a 0 = happy to 10 = angry scale). Most participants supported continuation of the interventions (86.0%), and 64.0% reported perceived personal benefits. Organizational and individual determinants jointly shaped participation. Conclusion: In order to promote physical activity and functioning sustainably in nursing homes, it is necessary to address organizational conditions and individual needs in a coordinated manner. The PROGRESS pyramid translates these findings into a practical framework comprising organizational and communicational foundations, resident participation, education, and staff qualification to guide the long-term integration of exercise and environmental interventions into daily routine.