Building design, a sense of security, dedicated activity spaces and high staffing levels are all critical to encouraging physical activity among nursing home residents.

Researchers in the Netherlands examined 12 academic papers for clues about the role of physical environment and caregiving on inactivity levels. Their study, published in April’s BMC Geriatrics, found design that meshed well with patients’ abilities (i.e. appropriate shelf heights and appropriate hallway widths) promoted physical activity.

Combined with the right flooring, furniture and equipment, such as handrails or seating for rest breaks, those factors led to more walking. Larger buildings with more space between destinations and those with physical therapy rooms or gardens also promoted increased activity.

But the researchers found it was important that staff encourage those who tended toward inactivity. Facilities with lower staffing ratios — even just for the weekend — saw activity levels fall.

“Most activities in a nursing home may be organized for the more active residents,” wrote Johanna Douma, clinical neuropsychologist at Vrije Universiteit in Amsterdam. “We argue that the focus should be particularly on those residents who are more inactive and less able to initiate activities by themselves, and offer them activities that they enjoy participating in.”