Across community aged care it is incredibly common to see physiotherapy referrals structured around low-frequency visits. A client may receive a physiotherapy visit once a week, once a fortnight, or even once a month under programs such as Support at Home or previously through Home Care Packages.

On paper, this appears to be good care. The client is receiving allied health support and professional input. But there is an important question we rarely stop to ask:

Is this actually enough to produce meaningful health improvement?

When we look closely at the evidence around exercise and ageing, the answer becomes increasingly difficult to ignore. In many cases, the traditional model of occasional physiotherapy visits simply does not deliver the exercise dose required to improve strength, mobility, balance or independence and relies heavily on the client having the required desire, motivation and capacity to exercise independently.

What the Evidence Tells Us About Exercise and Ageing

The role of exercise in healthy ageing has been well established for many years.

Research consistently demonstrates that older adults benefit from regular, structured exercise that includes three key components:

• Aerobic activity
• Strength training
• Balance retraining

Most evidence-based guidelines recommend a minimum of two hours of moderate-intensity exercise per week for older adults, alongside resistance and balance training to reduce the risks associated with ageing.

When performed regularly and at sufficient intensity, exercise has been shown to significantly reduce the risk of:

• Frailty
• Sarcopenia (age-related muscle loss)
• Falls and fall-related injuries
• Cardiovascular disease risk factors
• Functional decline and loss of independence

Exercise also plays an important role in supporting mental health, confidence and overall wellbeing. However, there is an important detail within this evidence that is often overlooked. Exercise only produces meaningful physiological change when it is performed frequently enough and at the right intensity.

Low-intensity or sporadic activity may maintain movement, but it is unlikely to produce the strength and balance adaptations required to significantly improve function or reduce falls risk.

The Reality of Physiotherapy in Home Care

Despite the strong evidence supporting structured exercise programs, physiotherapy within home care is often delivered as isolated visits spread across long periods of time. Common referral patterns include:

• Weekly visits
• Fortnightly visits
• Monthly visits

While these visits can provide valuable assessment, education and guidance, they represent only a small fraction of the exercise exposure required to achieve meaningful change. In reality, the success of this model depends heavily on one key assumption: That the client will independently continue the prescribed exercise program between visits.

Unfortunately, both research and real-world experience suggest that this assumption is often unrealistic. Many older adults receiving home care services are living with complex health challenges, including:

• Multiple chronic conditions
• Reduced confidence in movement
• Fear of falling
• Cognitive changes
• Reduced motivation associated with declining health

Under these circumstances, expecting individuals to independently adopt and maintain a structured exercise routine can require a significant degree of behaviour change and behaviour change is rarely simple.

A Question Worth Asking

None of this diminishes the value of physiotherapy or other allied health services. In fact, these professionals play a critical role in supporting the health and independence of older adults living at home.

But it does raise an important question for those responsible for coordinating services:

Are we structuring allied health interventions in a way that truly reflects the evidence around exercise and ageing? Because if the aim of these referrals is to improve strength, mobility and independence, then the frequency and structure of the intervention must align with the physiological adaptations we are hoping to achieve. Increasingly, it appears that the traditional model of occasional allied health visits may not always deliver those outcomes.

In the next article, we will explore some of the emerging research around low-dose exercise, the critical role of behaviour change in rehabilitation, and why a more restorative approach to allied health services may be needed within programs such as Support at Home.