Implementation gap and influencing factors of exercise prescription for older adults: A large-scale survey of healthcare professionals in China

Objective: To assess the knowledge, attitudes, practices and influencing factors of exercise prescription for older adults among healthcare professionals in geriatric care in China. Methods: The survey was designed based on the Knowledge-Attitude-Practice framework and the Theoretical Domains Framework to evaluate healthcare professionals' knowledge, attitudes, practices, and perceived barriers to exercise implementation in geriatric care. Participants were recruited from across China. Ordinal logistic regression examined factors associated with prescription practices. Mediation analysis tested whether knowledge and attitudes mediated the effect of training on practice. Results: Among1,890 healthcare professionals (833 nurses, 999 physicians, 58 administrators), 43–59% had only slight awareness of exercise prescriptions. Over half never received training, yet 95% rated prescribing exercise for older adults as quite to very important. Written prescriptions were uncommon across tertiary hospitals (9%), non-tertiary hospitals (4%), and primary healthcare institutions (10%). The perceived main barriers were time constraints, lack of knowledge, safety concerns, and insufficient family support of older adults. Trained doctors (OR = 4.26, 95% CI: 3.36–5.64, p  < 0.001) and nurses (OR = 2.52, 95% CI: 1.91–3.32, p  < 0.001) were more likely to provide written prescriptions. Knowledge and attitudes mediated the relationship between training and prescription practices. Conclusions: Chinese healthcare professionals in geriatric care had limited knowledge of exercise prescriptions, with low usage of written prescriptions. Training was effective in supporting exercises prescriptions by improving knowledge and shaping attitudes. Future efforts are needed to provide target trainings for nurses and physicians, and to address practical barriers to bridging the implementation gap.