Reasons for Frail Older Adults in Nursing Homes Declining Participation in Exercise Interventions: A Life Course Perspective Qualitative Study

ABSTRACT Aim To explore how life course factors shape the exercise participation decisions of frail older adults living in nursing homes. Design This qualitative study is from the approach of social constructivism. Methods Seventeen frail older adults were purposefully recruited from a nursing home in Beijing, China. Data were collected through face‐to‐face semi‐structured interviews between October 2024 and December 2024. Interviews were audio‐recorded, transcribed verbatim and analysed using reflexive thematic analysis. Data collection and analysis continued until thematic saturation was achieved. Results Three overarching themes were identified: (1) cumulative effects of key elements in the life course; (2) deficiencies in existing support across various systemic levels; and (3) lack of individual subjective agency. These factors interact dynamically to inhibit participation in exercise interventions. Conclusion This study highlights the complex interplay between life course experiences, systemic barriers and individual‐level limitations that collectively discourage exercise participation among frail older adults in nursing homes. Tailored and culturally sensitive strategies, strengthened institutional support, family engagement and improved policy communication are needed to address these barriers. Impact These findings offer practical insights for designing person‐centred exercise interventions that align with frail older adults' lived experiences and promote active ageing in institutional settings. Patient or Public Contribution No patient or public contribution. Reporting Method COREQ (Consolidated criteria for Reporting Qualitative research).