Eliciting older people's preferences for exercise programs: a best-worst scaling choice experiment

Question: What relative value do older people with a previous fall or mobility-related disability attach to different attributes of exercise?

Design: Prospective, best-worst scaling study.

Participants: Two hundred and twenty community-dwelling people, aged 60 years or older, who presented with a previous fall or mobility-related disability.

Methods: Online or face-to-face questionnaire.

Outcome measures: Utility values for different exercise attributes and levels. The utility levels were calculated by asking participants to select the attribute that they considered to be the best (ie, they were most likely to want to participate in programs with this attribute) and worst (ie, least likely to want to participate). The attributes included were: exercise type; time spent on exercise per day; frequency; transport type; travel time; out-of-pocket costs; reduction in the chance of falling; and improvement in the ability to undertake tasks inside and outside of home.

Results: The attributes of exercise programs with the highest utility values were: home-based exercise and no need to use transport, followed by an improvement of 60% in the ability to do daily tasks at home, no costs, and decreasing the chances of falling to 0%. The attributes with the lowest utility were travel time of 30 minutes or more and out-of-pocket costs of AUD50 per session.

Conclusion: The type of exercise, travel time and costs are more highly valued by older people than the health benefits. These findings suggest that physical activity engagement strategies need to go beyond education about health benefits and focus on improving accessibility to exercise programs. Exercise that can be undertaken at or close to home without any cost is most likely to be taken up by older people with past falls and/or mobility-related disability.