Older adults’ physical activity is often neglected in long-term care despite its importance for health, functioning, and wellbeing. This study aimed to produce a comprehensive understanding of older adults’ physical activity promotion in institutional long-term care as nursing practice using the environment. The study was theoretically driven according to the nursing metaparadigm, examining the domains of client, practice, and environment.

A convergent mixed-method design with four phases was used. In Phase I, a systematic literature review was conducted to synthesize earlier literature. In Phase II, using photo-elicitation, and in Phase III, using a mixed-method case study and participatory action, the topic was explored in the Finnish care context. Older adults (n=27), their family members (n=6), and staff (n=30) participated. Collected data included interviews, observations, workshops, and patient record transcripts, among others, as well as pre- and post-measurements of outcomes, such as physical activity. Data were analysed with thematic analysis, descriptive statistics, and Student’s T-tests, and integrated using merging and threading. In Phase IV, the findings of Phases I-III were merged in a thematic synthesis according to the nursing metaparadigm domains, developing a metaphorical model.

Based on the findings, older adults’ physical activity consisted of basic activities of daily living, independent ambulation, outdoor activity, organized recreation, exercise, and daily chores, of which, only the first three were promoted by nurses. The physical and social environment provided various opportunities to promote older adults’ physical activity but their use was limited. Care culture and time formed a context for physical activity promotion. The metaphorical model depicts the relationships of different concepts in the nursing metaparadigm domains, producing a novel holistic perspective for the promotion of older adults’ physical activity. The developed model can be used to inform practice, research, and policy to improve physical activity promotion. Future research could focus on developing an adaptable intervention and continuing theoretical development of the model to support nurses in promoting the physical activity of older adults using the environment.