In residential aged care, promoting wellbeing through movement and physical activity is a shared goal across disciplines — and rightly so. Every member of the care team contributes meaningfully to the lives of older people. However, when it comes to the assessment, prescription, and progression of exercise programs for conditions like sarcopenia, expertise matters.
While lifestyle, leisure, and diversional therapists offer valuable engagement and social support, targeted exercise for restoring strength, mobility, and function sits firmly within the scope of practice of physiotherapists and other trained allied health professionals.
Sarcopenia Requires More Than General Activity
Sarcopenia — the age-related loss of muscle mass and strength — is widespread in aged care settings, with studies indicating prevalence rates of up to 50% among residents.
Left unaddressed, sarcopenia leads to:
- Loss of independence
- Increased risk of falls and fractures
- Incontinence
- Reduced quality of life and wellbeing
- Higher care needs and premature hospitalisation
Critically, sarcopenia is not irreversible. The right type of exercise — particularly progressive resistance training, tailored to the individual — can restore strength and slow or reverse decline. But this requires clinical skill, ongoing monitoring, and adjustment.
The Value of Scope-Appropriate Care
Physiotherapists and accredited exercise professionals are trained to:
- Diagnose and monitor sarcopenia using validated tools (e.g., gait speed, grip strength, muscle mass assessment)
- Prescribe appropriate and safe resistance training
- Progress programs based on clinical response and tolerance
- Manage exercise around comorbidities and medications
When exercise programs are delivered without this expertise, there’s a risk they become static, generic, or even unsafe. Well-intentioned activities that lack individualisation or progressive loading won’t produce the outcomes residents need.
This is not about exclusion — it’s about recognising that every discipline plays a unique role, and we must all work within our scopes to achieve the best outcomes for residents.
A Collaborative, Team-Based Approach
Effective aged care doesn’t rely on one discipline — it’s team-based. A scope-appropriate model might include:
- Physiotherapists leading assessments, designing programs, and guiding progression
- Lifestyle and diversional therapists embedding movement in daily routines and promoting engagement
- Nursing and care staff reinforcing prescribed exercises, monitoring changes, and encouraging participation
This approach respects both specialist expertise and the value of everyday relationships, ensuring care is both safe and meaningful.
A Broader System Consideration
While this blog focuses on clinical best practice, it’s worth noting a policy gap: currently, restorative care programs like those under the Support at Home initiative are not consistently funded or prioritised in residential aged care.
This raises questions about:
- Equity: Why should someone lose access to restorative services simply because they move into a care home?
- Rights: Under the Aged Care Act 1997, all older Australians have the right to services that support independence and wellbeing
- Quality standards: The Aged Care Quality and Safety Standards (especially Standards 1–3) emphasise dignity, assessment, and appropriate clinical care
If we’re to truly support reablement in aged care, access to physiotherapy-led restorative care must be built into funding and service models — not treated as optional extras.
In Summary
Promoting physical activity in aged care is essential — but it must be done well. Sarcopenia is a clinical condition, frailty is not a part of normal ageing and reversing or managing it requires clinical expertise.
By ensuring physiotherapists lead the design and progression of exercise programs — supported by a collaborative, multidisciplinary team — we give residents the best chance to maintain independence, reduce falls, and enjoy a higher quality of life.
Let’s continue to work together — across roles and scopes — to deliver care that’s not just kind, but clinically sound and truly restorative.