Nursing home residents across Spain, France, and Germany did not just tolerate a twelve-week physical activity program—they loved it. A new multicentre feasibility study published in European Geriatric Medicine reports that the Join4Joy approach, a co-created physical activity intervention designed around enjoyment and social connection rather than pure exercise prescription, proved safe, feasible, and highly acceptable among older adults living in long-term care. Of 81 enrolled residents aged 65 and older, 75 completed the full intervention, yielding a retention rate of 92.6 percent, while attendance ranged from 73.8 to 95.0 percent across sites. Notably, no adverse events were recorded during the entire program, a striking safety profile for a population characterized by advanced frailty, multimorbidity, and functional dependence.
The Join4Joy project emerged from a growing recognition that today’s nursing home residents enter institutional care with more complex needs than previous generations. Physical inactivity and prolonged sedentary behaviour accelerate the biological processes underlying frailty, including declines in muscle mass, neuromuscular coordination, and cardiovascular capacity, which in turn elevate the risk of falls, disability, and hospitalization. Although structured, group-based multicomponent exercise programs have repeatedly been shown to improve physical and mental health outcomes in older adults, implementing such programs in real-world nursing home settings remains notoriously difficult. Organisational constraints, limited staff resources, the heterogeneity of residents’ physical and cognitive abilities, and low motivation toward conventional exercise routines all conspire to produce poor adherence and limited sustainability. Interventions that ignore individual preferences and the social and emotional dimensions of movement tend to fail precisely where they matter most: getting frail older adults to keep showing up.
Join4Joy took a fundamentally different starting point. Grounded in the Octalysis gamification framework and a biopsychosocial model of ageing, the approach was co-created with older adults themselves, along with their relatives, care assistants, higher education students, policy-makers, and specialists. The design integrates multicomponent movement—aerobic activity, strength training, coordination and balance work, flexibility, and rhythmic or playful movement tasks—with socially interactive, game-like elements. Before the intervention began, most participating centres conducted one-on-one interviews with each resident, exploring previous activity experiences, preferences, perceived limitations, and motivations, information that was used to tailor the sessions. Delivery involved weekly 60-minute sessions over approximately 12 weeks, at a light-to-moderate intensity corresponding to roughly 3 to 5 metabolic equivalents, monitored by facilitators through observation of visible signs of fatigue or discomfort.
The study followed a multicentre, mixed-methods, single-group pre-post design conducted in two sequential phases, registered at ClinicalTrials.gov. Phase 1 ran from November 2023 to April 2024 and was followed by structured reflection and procedural refinement; Phase 2, from July 2024 to February 2025, incorporated those refinements. Five nursing homes participated, spanning three European countries with distinct long-term care models: two facilities in Spain, two in France, and one medium-sized German home embedded in a broader geriatric care network. Participants were deliberately inclusive—residents with moderate cognitive impairment were not excluded, and 13.3 percent of the sample used wheelchairs—although those with severe cognitive decline (stage 7 on the Reisberg Global Deterioration Scale), bed-bound status, or medical contraindications to light-to-moderate activity were screened out. The final sample was predominantly female (76.0 percent) with a mean age of 84 to 85 years.
Feasibility was assessed through recruitment, attendance, retention, successful delivery, and data completion, while acceptability was measured through satisfaction ratings on a smiley-face scale and in-depth qualitative interviews and focus groups anchored in the theoretical framework of acceptability. Quantitative outcomes spanned an impressive battery of instruments: the Short Physical Performance Battery (SPPB) for physical function, the modified Barthel Index for daily functioning, the EQ-5D-5L for quality of life, the International Physical Activity Questionnaire-Short Form and the Sedentary Behaviour Questionnaire for self-reported activity, and the Physical Activity Enjoyment Scale-Short Form (PACES-SF) and Patient Global Impression of Improvement scale for enjoyment and perceived change. In Spain and Germany, participants also wore wrist-worn ActiGraph GT3X+ accelerometers for seven consecutive days before and after the intervention, with data processed at 60-second epochs using validated cut-points for very old adults.
The quantitative results told a story of stability rather than transformation. None of the pre-post changes reached statistical significance, and exploratory effect sizes were small, generally below Cohen’s d of 0.30. Accelerometry-derived variables showed even smaller shifts, with effect sizes under 0.20, indicating negligible changes in objectively measured movement behaviour over the twelve weeks. Yet the researchers caution that in this population, stability may itself be a meaningful outcome. Given the progressive nature of frailty in long-term care, where health trajectories typically trend downward, the maintenance of lower-limb function and mobility—rather than continued deterioration—can be considered an encouraging, hypothesis-generating finding. Participants themselves reported enjoying the sessions enormously, with mean PACES-SF enjoyment scores of 4.1 out of a maximum of 5.0 and perceived improvement scores of 3.8 out of 5.0 across the total sample.
The qualitative data, drawn from interviews with all 75 participants and three post-intervention focus groups, revealed five interrelated themes: enjoyment and social connection, facilitator support and trust, autonomy and adaptability, perceived benefit and pride, and sustainability and meaning. Residents described the sessions as a joyful and meaningful part of their weekly routine. “Very good, I enjoyed it. I felt better… I feel like I can do things. It makes me happy,” one Spanish participant reported. Another captured the social dimension vividly: “This gym has helped me get to know people… they like me a lot.” Participants in France emphasized newfound confidence—”I’m less afraid; I feel more confident with balance”—while German residents particularly valued the structured, supportive environment. Approximately half of the participants actively co-designed small adjustments to the sessions, most often involving music or increased variety, reinforcing their sense of ownership.
The thematic analysis also surfaced an important mechanistic insight. The discrepancy between residents’ perceived improvements and the essentially stable objective accelerometry data suggests that the intervention’s benefits may be primarily psychosocial rather than physiological. Social support, trust between facilitators and residents, positive affect during movement, and a sense of belonging and purpose appear to be key drivers of perceived benefit—mechanisms consistent with self-determination theory and evidence linking affective responses to exercise with motivation and adherence. The researchers note that the low frequency and intensity of the program, delivered once weekly for twelve weeks, would not be expected to produce substantial physiological adaptations. Self-reported questionnaires showed considerable variability, likely influenced by cognitive status, a known source of over- or underestimation compared with objective measures, while incomplete accelerometer wear-time and technical data losses likely attenuated detectable changes.
The study has clear limitations. As a non-randomised feasibility study without a control group, its findings are exploratory and cannot establish causal effects. The sample, which included a high proportion of residents with no or mild cognitive impairment and relatively low mobility limitation, may reflect selection bias and may not fully represent the broader nursing home population. Residents with moderate-to-severe cognitive impairment participated fully in the intervention, but their less coherent interview responses were excluded from the final thematic analysis of 46 datasets, meaning the qualitative findings may underrepresent the perspectives of those with more advanced cognitive decline. Mean participant age also varied substantially across sites, from 79.1 to 91.9 years, potentially acting as a modifying factor, and session intensity was monitored by facilitator observation rather than a standardized exertion scale, introducing delivery variability.
For the researchers, the most important implication lies in how future trials should measure success. The feasibility parameters generated here can inform sample size calculations for adequately powered multicentre randomized controlled trials, which are now justified. But the team argues that traditional single biomedical endpoints may fail to capture the true, heterogeneous benefits of co-created physical activity approaches in complex institutionalised populations. Future definitive evaluations, they suggest, should integrate holistic psychosocial metrics—structured measures of enjoyment, meaningful occupation, and social inclusion—alongside conventional physical function outcomes. With high attendance, exceptional retention, zero adverse events, and residents pleading to continue—”As long as the head still works, I will continue,” as one Spanish participant put it—Join4Joy has demonstrated that a program built on joy and connection can hold frail older adults’ attention in a way that conventional exercise prescriptions rarely do. The participating nursing homes, for their part, expressed interest in embedding the approach into their routine activities, hinting at a future where the question is not whether older adults in care homes should move, but whether the movement is worth showing up for.
Subject of Research: Feasibility, acceptability, and preliminary biopsychosocial effects of the co-created Join4Joy physical activity approach among older adults living in nursing homes in Spain, France, and Germany
Subject of Research: Medicine
Article Title: Feasibility, acceptability, and preliminary effects of the Join4Joy approach for older adults living in nursing homes: a multicentre mixed-methods feasibility study
Article References: Karkauskiene, E., Coll-Planas, L., Fuente-Vidal, A., Sanchez, D., Barth, N., Dallmeier, D., Socorro-Cumplido, J. L., Giné-Garriga, M., Caserotti, P., Lefebvre, G., & Jerez-Roig, J. (2026). Feasibility, acceptability, and preliminary effects of the Join4Joy approach for older adults living in nursing homes: a multicentre mixed-methods feasibility study. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01547-2
Image Credits: AI Generated
DOI: 10.1007/s41999-026-01547-2
Keywords: Nursing home, Physical activity, Older adults, Frailty, Feasibility study, Join4Joy, Social connection, Enjoyment, Co-creation, Mixed-methods, Long-term care, Quality of life
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Ophelia Keating. (September 9, 2026). Join4Joy shows promising feasibility for older nursing home residents. Scienmag. https://scienmag.com/join4joy-shows-promising-feasibility-for-older-nursing-home-residents/
Ophelia Keating. “Join4Joy shows promising feasibility for older nursing home residents.” Scienmag, 9 September 2026, https://scienmag.com/join4joy-shows-promising-feasibility-for-older-nursing-home-residents/. Accessed 9 September 2026.
Ophelia Keating. “Join4Joy shows promising feasibility for older nursing home residents.” Scienmag. September 9, 2026. https://scienmag.com/join4joy-shows-promising-feasibility-for-older-nursing-home-residents/
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