Barriers and facilitators to a physical activity guideline for older adults with mild cognitive impairment

Before a physical activity guideline for community-dwelling older adults with mild cognitive impairment can be put into practice, researchers in Shenyang, China, have mapped what could help or hinder its adoption. In a qualitative pre-implementation study published in BMC Public Health, interviews with 33 stakeholders from one residential community and two community health service centers identified 24 barriers and 25 facilitators across 19 constructs of the Consolidated Framework for Implementation Research 2.0. The work does not test whether the guideline improves health; instead, it documents, from multiple local perspectives, the practical conditions that would shape any future rollout.

The study used a qualitative descriptive design conducted from October to December 2025. Semi-structured interviews captured the views of four groups: older adults with mild cognitive impairment living in the community, their caregivers, community healthcare professionals, and community workers. Data were analyzed with content analysis combining deductive and inductive approaches, organized by the CFIR 2.0 framework. The guideline in question, referred to as the PAG-CD, targets physical activity for this population, on the premise that physical activity may help delay the progression of mild cognitive impairment, though the authors note that implementing such clinical practice guidelines in community settings can be challenging.

The barriers clustered around five major themes. Stakeholders reported limited fit of standardized recommendations to individual needs, meaning a single guideline template may not match the varying capacities of people with cognitive impairment. They also pointed to shortages of personnel and professional resources and heavy workloads, short-term interorganizational collaboration with insufficient ongoing professional support, a lack of shared accountability mechanisms alongside concerns about safety-related liability, and insufficient health information feedback with no continuous, traceable documentation. These findings came largely from the professionals and community workers, who identified issues relevant to implementation such as guideline fit, resource constraints, interorganizational collaboration, role delineation, risk management, and feedback mechanisms.

Facilitators were equally concrete. Stakeholders recognized the authority of the guideline developers and held positive perceptions of the guideline’s evidence base. They saw promise in functional stratification and content simplification, in family monitoring and support, and in trust in community healthcare professionals. Digital communication and video-based support also emerged as potential assets. Interviews with older adults with MCI and caregivers, in particular, highlighted individual and family conditions relevant to physical activity participation, complementing the system-level concerns raised by staff.

Based on these findings, the research team proposes several preliminary implementation considerations rather than tested recommendations: stratified adaptation based on the functional status and exercise-related risks of older adults with MCI; stable interorganizational collaboration with clearly defined roles; and implementation support through implementer training, standardized risk-management procedures, and low-burden feedback mechanisms. As a pre-implementation, qualitative study confined to three participating community settings in one Chinese city, the work describes perceived barriers and facilitators among a limited group of stakeholders and does not establish whether the guideline, once implemented, will change activity levels or cognitive outcomes. Its value lies in anticipating implementation problems before they arise, offering a structured, framework-based picture of what local actors consider workable as community programs for older adults with mild cognitive impairment move from paper to practice.

Subject of Research: Barriers and facilitators to implementing a physical activity guideline for community-dwelling older adults with mild cognitive impairment in Shenyang, China

Article Title: Pre-implementation barriers and facilitators to implementing a physical activity guideline for community-dwelling older adults with mild cognitive impairment: a qualitative stakeholder study

Article References: Tian, Z., Zhang, S., Ni, X., Tan, J., Chen, Z., Wang, Y., Liu, G., Kong, D., Yang, G., Ma, Y., & Zhang, F. (2026). Pre-implementation barriers and facilitators to implementing a physical activity guideline for community-dwelling older adults with mild cognitive impairment: a qualitative stakeholder study. BMC Public Health. https://doi.org/10.1186/s12889-026-30020-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-30020-9

Keywords: mild cognitive impairment, physical activity guideline, qualitative research, implementation science, CFIR 2.0, older adults, community health, Shenyang China, stakeholder interviews, pre-implementation, barriers and facilitators, BMC Public Health