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Acceptability of the Signpost to Health intervention for pre-frail adults

What did we do?

We undertook an in-depth qualitative research study with individuals who would be key to developing an intervention focussed on signposting people to exercise / fitness classes which are known to help reduce, or even reverse, some components of frailty. 


We explored the views of GPs, exercise professionals and older adults on how they think such a project would work in practice, and what they think might be the barriers to implementing such an intervention. 



Why is it important?

General practices in England are required to identify all patients aged 65 and over who may be living with moderate or severe frailty. For those with moderate / severe frailty, GPs need to undertake a series of activities including a medicine review and a falls risk assessment. Currently, there is no contractual obligation to identify mild or pre-frail patients within primary care.


Large numbers of older adults are classified as frail. Frailty is a condition that can result in a higher likelihood of being hospitalised, falls, loss of independence, disability and death. Although it is a long term condition, some aspects may be reversible, and the evidence shows that physical activity is an effective treatment which can reverse some of the effects. As the population continues to age, preventing or reducing frailty is a key health concern. 


We plan to identify (from primary care records) older adults who are currently classed as mildly frail, and then using a well-established tool, the Fried Phenotype [1], to further classify the individual as ‘pre-frail’ based on the presence or absence of a number of criteria:


  • unintentional weight loss,
  • fatigue/exhaustion,
  • physical inactivity,
  • slow walk speed,
  • loss of strength.


This would allow us to signpost them to particular types of exercise / fitness classes that have been evidenced as being most effective for helping to reduce certain aspects of pre-frailty, e.g. strength and balance exercise for building strength or walking groups for fatigue and exhaustion.


Given that a large proportion of older adults are estimated to be pre-frail, interventions aimed at this group have the potential to support healthy ageing, positively impacting on frailty outcomes and providing wider population health benefits.



How did we do it?

For the first stage of this research project, the team undertook 43 semi-structured interviews with the following groups:


  • Health and exercise professionals, including GPs, physical activity referral staff, falls prevention leads and physiotherapists  (n=21 interviews)
  • Older adults of 65years+ (n=22 interviews).


The interviews were structured around the broad components of designing a bespoke intervention to signpost people to exercise / fitness classes which are known to help reduce, or even reverse, some components of frailty:


  1. The overall aim of the intervention
  2. Identification of pre-frail older adults
  3. Engagement with physical activity
  4. Understanding potential barriers and facilitators
  5. Aspects of behaviour change. 




  • Across the five components (above), nine themes were identified, with key issues related to physical activity messaging, the use of the term 'frail', how to identify and recruit pre-frail older adults, and the acceptability of behaviour change techniques being proposed.
  • There was overwhelming support for a proactive approach to addressing issues around frailty and pre-frailty.



Downloadable resources


Future plans

Questions remain around how best to identify and refer people to existing provision, and how to get people engaged with an intervention that adopts behaviour change techniques. The research team is currently looking to secure further funding to develop this work which would include creating a bespoke Signpost to Health intervention.






More information



Programme Manager

Gill Rizzello

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