{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:49:03Z","timestamp":1786121343355,"version":"build-2736575974"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As population aging accelerates across Asia, exercise services for older adults must address not only participation but also which professionals should provide support for individuals with different health and functional needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used an integrative review and comparative institutional analysis to examine workforce arrangements for older adult exercise services in Hong Kong, Taiwan, Japan, and Singapore. Twenty-three academic and gray-literature sources were identified through a PRISMA-ScR-informed process and appraised using AACODS and CASP-informed criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hong Kong mainly reflected a community-based fitness-extension model, Taiwan linked fitness provision with disability and long-term care prevention, Japan demonstrated the strongest documented connection between specialized health-exercise roles and collaboration with health professionals, and Singapore emphasized public health promotion and coaching development. Across all four jurisdictions, service pathways were clearer for relatively healthy and independent older adults than for those with frailty, multimorbidity, recurrent falls, functional decline, or other complex needs. Risk stratification, scope of practice, referral, monitoring, and shared-care arrangements were inconsistently defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The study proposes a tiered service and competency framework that matches provider expertise with participant risk. General fitness and community personnel may support lower-risk older adults, whereas individuals with more complex needs require advanced exercise expertise or interprofessional management. More explicit allocation of assessment, monitoring, escalation, referral, and collaborative responsibilities is needed to support safe and sustainable exercise services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1879234","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T04:22:00Z","timestamp":1786076520000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Who leads exercise for older adults? A comparative policy and workforce analysis of older adult exercise leadership in Hong Kong, Taiwan, Japan, and Singapore"],"prefix":"10.3389","volume":"14","author":[{"given":"Yi Chen","family":"Chiu","sequence":"first","affiliation":[{"name":"Department of Leisure and Recreation Management, Taipei City University of Science and Technology","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya Chun","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Leisure and Recreation Management, Taipei City University of Science and Technology","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"B1","unstructured":"WHO Guidelines on Physical Activity and Sedentary Behaviour\n          \n          2020"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World health organization, 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br J Sports Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3399\/bjgp14X676294","article-title":"Exercise prescription: what does it mean for primary care?","volume":"64","author":"Seth","year":"2014","journal-title":"Br J Gen Pract."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1249\/MSS.0b013e3181a0c95c","article-title":"American college of sports medicine position stand: exercise and physical activity for older adults","volume":"41","author":"Chodzko-Zajko","year":"2009","journal-title":"Med Sci Sports Exerc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"6064","DOI":"10.3390\/ijerph18116064","article-title":"Healthcare professionals' promotion of physical activity with older adults: a survey of knowledge and routine practice","volume":"18","author":"Cunningham","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-101512","article-title":"Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review","author":"Sherrington","year":"2020","journal-title":"Br J Sports Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1136\/bjsm.2008.055202","article-title":"Exercise physiologist's role in clinical practice","volume":"43","author":"Franklin","year":"2009","journal-title":"Br J Sports Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.jesf.2019.04.001","article-title":"The roles of exercise professionals in the health care system: a comparison between Australia and China.","volume":"17","author":"Zhou","year":"2019","journal-title":"J Exerc Sci Fitness"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e001158","DOI":"10.1136\/bmjsem-2021-001158","article-title":"Charter to establish clinical exercise physiology as a recognised allied health profession in the UK: a call to action","volume":"7","author":"Jones","year":"2021","journal-title":"BMJ Open Sport Exerc Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.aehs.2024.01.008","article-title":"A challenge of inactivity after the COVID-19 pandemic: what can we learn from Australia?","volume":"1","author":"Wang","year":"2024","journal-title":"Adv Exerc Health Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1136\/bjsports-2016-096994","article-title":"Exercise prescription is not just for medical doctors: the benefits of shared care by physicians and exercise professionals","volume":"52","author":"Maiorana","year":"2018","journal-title":"Br J Sports Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e586","DOI":"10.1093\/pubmed\/fdy072","article-title":"Making a move in exercise referral: co-development of a physical activity referral scheme","volume":"40","author":"Buckley","year":"2018","journal-title":"J Public Health."},{"key":"B13","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/s13643-025-02862-8","article-title":"How can interprofessional collaboration be fostered and sustained in team-based care integration for older people in community settings? 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