Who leads exercise for older adults? A comparative policy and workforce analysis of older adult exercise leadership in Hong Kong, Taiwan, Japan, and Singapore

Background: As population aging accelerates across Asia, exercise services for older adults must address not only participation but also which professionals should provide support for individuals with different health and functional needs. Methods: This study used an integrative review and comparative institutional analysis to examine workforce arrangements for older adult exercise services in Hong Kong, Taiwan, Japan, and Singapore. Twenty-three academic and gray-literature sources were identified through a PRISMA-ScR-informed process and appraised using AACODS and CASP-informed criteria. Results: Hong Kong mainly reflected a community-based fitness-extension model, Taiwan linked fitness provision with disability and long-term care prevention, Japan demonstrated the strongest documented connection between specialized health-exercise roles and collaboration with health professionals, and Singapore emphasized public health promotion and coaching development. Across all four jurisdictions, service pathways were clearer for relatively healthy and independent older adults than for those with frailty, multimorbidity, recurrent falls, functional decline, or other complex needs. Risk stratification, scope of practice, referral, monitoring, and shared-care arrangements were inconsistently defined. Discussion: The study proposes a tiered service and competency framework that matches provider expertise with participant risk. General fitness and community personnel may support lower-risk older adults, whereas individuals with more complex needs require advanced exercise expertise or interprofessional management. More explicit allocation of assessment, monitoring, escalation, referral, and collaborative responsibilities is needed to support safe and sustainable exercise services.