In the first article, we explored the mismatch between the evidence supporting exercise for older adults and the way allied health services are often delivered within community aged care, in doing so understanding the importance of exercise is only one part of the story. Equally important is understanding how exercise is implemented and sustained in everyday life, as prescribing exercise is only half the solution, the client needs to have the belief that they are relevant to improving the aspects of their life they are struggling with, valuable and important enough to make time for them regularly and confidence and safe in doing them to carry them out.

The Often Overlooked Role of Behaviour Change

A core role of clinicians whether physiotherapists, occupational therapists or speech pathologists, is not simply to deliver an intervention during a scheduled appointment.

The goal is not just to perform exercises while the clinician is present. The real objective is to help the client understands the importance, applicability and value and offer strategies to embed those exercises into their daily life, so that progress can continue both within and beyond supervised sessions.

In other words, clinicians are not just prescribing exercises, they are helping clients adopt new behaviours and behaviour change can be challenging, hence why low frequency visits for clients that are already experiencing functional decline is unlikely to be effective and achieve the expected results.

Older adults receiving home care support may face a range of barriers that make consistent exercise difficult, including:

• Fear of falling
• Reduced confidence with movement
• Pain or fatigue
• Cognitive changes
• Low motivation or social isolation
• Long-established sedentary habits

Under these circumstances, expecting a client to maintain a new exercise program independently without support can be unrealistic. This is why clinicians play a critical role not only in designing exercise programs, but also in helping clients develop the confidence, understanding and routine required to sustain those programs over time and thisrequires the support of case managers and aged care providers to consider investing in a higher intensity of scheduled services for a defined period. Essentially, adopting the “Restorative Model” of care under all funding levels of the Support at Home program rather than those clients that are funded specifically to receive the “Restorative Care Program”. Without the appropriate intensity of service deliver and appropriately targeted this behavioural component, even the most carefully designed exercise program may fail to produce lasting results.

A Complex Puzzle

Improving physical function in older adults living at home is not simply about getting the exercise prescription right, it involves solving a much larger and more complex puzzle. Effective interventions require:

• The correct exercise dosage (intensity, frequency and progression)
• The right support and environment to perform exercises safely
• The behaviour change strategies needed to sustain participation over time

If any one of these pieces is missing, the likelihood of achieving meaningful outcomes is significantly reduced.

What About Low-Dose Exercise, “Exercise Snacks”?

In recent years there has been growing interest in the concept of low-dose exercise, often referred to as “exercise snacking.” This approach involves performing short bouts of exercise multiple times throughout the day, rather than longer structured sessions. The concept is appealing because it may feel more achievable for individuals who are currently inactive or deconditioned but obviously comes with the requirement for the client to be motivated and safe to complete this independently multiple times a day throughout the week.

Early research suggests that these short exercise bouts may lead to improvements in functional tasks such as sit-to-stand performance and improves overall mortality rates.

However, it is important to understand that these programs must be structured to ensure the client is working at or above 70% maximum of one repetition maximum for 6-10 repetitions of at least one set, across 5 exercises per occasion of exercise.

For deconditioned clients completing exercises to the point of failure is rarely achieved as is successfully getting them to work at such a high work rate.

Even though the exercise bouts are short, they are typically:

• Performed multiple times per day
• Prescribed at specific intensities
• Regularly progressed over time
• Evidence based on equipment for high levels of resistance to achieve >70% 1RM
• Require them delivered in structured or supervised environments
• Most improvements are noted in early stages
• Don’t improve much power or cause hypertrophy

Don’t get me wrong, there is much benefits in “Exercise Snacking” research and how it could be used in this population and there is certainly health benefits generated from adopting this low-dose form of exercise structuring for the “right” client population who are adequately motivated and able to safely complete the multiple episodes and days it requires to achieve desired outcomes. I can see it being a great value option for time poor parents who are keen to get back into shape, perhaps those looking for weight loss if higher resistance is used like HITT style workouts that support this form that align with short bouts or perhaps most acute illness or surgery for middle age population that are keen to regain fitness.

For older adults that may have issues with confidence, balance or motivation, the way allied health services are often referred and subsequently delivered in community aged care—that is through infrequent visits spread across long periods of time—it is not currently aligned with the principles of low-dose exercise research, and as such monthly physiotherapy visit is not a deliberate low-dose training strategy.

More often is the case being that the trend of infrequent allied health scheduling reflects service patterns that have evolved over time due to budget/ funding restrains, rather than an approach grounded in exercise science or best practice.

The Opportunity for a Restorative Approach

This is where an important shift in thinking may be needed, particularly for case managers responsible for coordinating care and services. Rather than spreading physiotherapy input thinly across a month, there may be greater value in adopting a restorative model of care. A restorative approach focuses on shorter, more intensive interventions designed to produce measurable functional improvement within a defined period may offer a client more value for money, achieve greater functional outcomes and then allow a less intense longer maintenance program be offered and easing the burden on a client’s financial budget.

This may involve:

• More frequent physiotherapy sessions during an intervention period at least twice weekly, for a period of 8 weeks minimum
• Structured and progressive exercise programs
• Clear client centred functional SMART goals
• Ongoing review and progression of the program, with regular clinical updates
• Consideration of more cost effective value options such as centre based programs

By concentrating allied health input during targeted periods, this model is more likely to deliver the exercise dosage required to produce meaningful physiological change.

Importantly, this approach also aligns closely with the broader intent of programs such as Support at Home, which aim to help older Australians maintain independence and remain safely in their communities for as long as possible.

Budget vs Outcomes, Can You Have Both?

As the Support at Home Program reshapes how care is delivered, many clients are facing increasing pressure on already limited funding. At Agestrong Health Group, we believe innovation is essential to ensure clients continue to receive meaningful, outcomes-focused care. Our centre-based exercise and cognitive rehabilitation sessions are delivered multiple times per week in fully supervised, one-hour formats and provide individualised programs aligned with each client’s current function and functional reablement goals, at roughly one-third the cost of a single home visit. These are not standard chair-based, OTAGO, or Stepping On style classes; they are purpose-built programs designed to retrain functional motor patterns, engage cognitive processes, and build the strength, balance, and mobility required for safer independence. In an environment where funding must stretch further, collaborative and innovative service models like these will be critical to ensuring clients continue to progress not just maintain.