Objectives To provide an updated systematic review of the effectiveness of workplace interventions for chronic musculoskeletal disorders, identify key intervention components and assess their impact on health and work-related outcomes.Design Systematic review of randomised controlled trials.Data sources MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and Web of Science were searched for studies published between 2018 and 2024. Grey literature sources were also consulted.Eligibility criteria Randomised controlled trials and cluster-randomised trials evaluating workplace interventions targeting adults with chronic musculoskeletal disorders were included. Outcomes of interest included pain, functional outcomes, quality of life and work-related outcomes (eg, work ability, productivity, presenteeism and absenteeism).Data extraction and synthesis Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Due to heterogeneity, only a narrative synthesis was conducted.Results 23 studies involving 2456 participants were included and classified into physical exercise, ergonomic and multicomponent interventions. Physical exercise interventions consistently improved pain and functional outcomes. Digital delivery of exercise interventions demonstrated comparable effectiveness to face-to-face or workplace-based approaches. Multicomponent interventions, combining exercise with ergonomic strategies, demonstrated the most consistent benefits across outcomes. Evidence for work-related outcomes was limited and inconsistent, and quality of life was assessed in only a small number of studies.Conclusions Workplace interventions, particularly multicomponent approaches combining exercise, ergonomics and education, can be effective in improving health outcomes in chronic musculoskeletal disorders. However, evidence on work-related outcomes remains limited and inconsistent.PROSPERO registration number CRD420261289218.

Older adults who have fallen are at increased risk of future falls. Training cognitive and physical functions simultaneously, known as dual-task (DT) training, has been shown to improve mobility and reduce fall risks. With appropriate digital tools, such as smartphones and mobile applications (apps), it is possible to deliver DT training in unsupervised, home-based settings, thereby increasing accessibility beyond the clinical environment. This study evaluated the feasibility and acceptability of a technology-based DT training programme delivered through a blended model of supervised and self-directed sessions in older adults with a history of falls. Perspectives of healthcare professionals working in falls prevention services were also explored. A single-arm, non-randomised feasibility study was conducted with 45 community-dwelling adults aged ≥65 years with a history of falls. Participants were recruited through primary care practices, secondary care falls prevention services, and community outreach. The 24-week DT programme, which integrated balance and strength exercises with cognitive training using a mobile app, was delivered in two phases: (1) Phase 1 (12 weeks): weekly 50-minute physiotherapist-led group classes in the community, and two additional 50-minute self-directed sessions at home; and (2) Phase 2 (12 weeks): three weekly 50-minute self-directed sessions at home. Feasibility and acceptability were assessed through recruitment and retention rates, adherence, app usage, and self-reported satisfaction. Qualitative data were obtained from focus groups with 28 participants who completed the programme and 16 healthcare professionals. Quantitative data were analysed descriptively, and qualitative data thematically. We recruited 45 of the target 50 participants with most participants (n = 41) recruited through community pathways; 4 were recruited via National Health Service (NHS) pathways. Adherence was 64%, with higher adherence during Phase 1 (81%) than Phase 2 (50%). App usage was high (95%), and self-reported programme satisfaction was moderate-to-high. Retention at 24 weeks was 76%, and no adverse events occurred. Qualitative findings supported the programme’s feasibility and acceptability, emphasising social connection and tailored exercises as key to adherence—especially in home-based sessions. Healthcare professionals identified community organisations and referral pathways as the most practical routes for implementation. A blended, technology-based dual-task training programme is both feasible and acceptable for older adults at risk of falling and can be effectively delivered beyond clinical settings. Community-based recruitment outperformed NHS pathways, highlighting the value of community engagement. These findings support the feasibility and acceptability of a full-scale trial, with targeted refinements to recruitment, support structures and delivery to maximise scalability and impact. ISRCTN15123197 RR2-10.1371/journal.pone.0314829

BACKGROUND:Mobility, defined as movement in all its forms, is a hallmark of healthy ageing. As wearable technologies become increasingly integrated into population health surveillance and ageing research, the absence of standardised terminology, measurement protocols and reporting practices presents a major barrier to progress. This consensus exercise aimed to establish minimum standards for measuring mobility with wearable technology in ageing populations and set priorities for future research in the field. METHODS:A two-day, in-person consensus meeting was convened with 24 international experts in ageing, mobility and digital health. Using a modified nominal group technique facilitated by a trained moderator, participants engaged in structured small-group brainstorming, followed by iterative large-group discussions. Consensus was achieved through anonymised digital voting on proposed measures, principles and priorities. FINDINGS:Consensus (≥80% agreement) was reached on 20 core device-derived mobility measures and 30 guiding principles for the optimal use of wearable technology in older populations. Experts also identified and ranked 16 priority areas for future research, with the top five including: (i) longitudinal studies and data collection, (ii) digital biomarkers and health outcomes, (iii) contextual data capture, (iv) algorithm development and validation and (v) integration with healthcare systems. INTERPRETATIONS:These consensus-based standards provide a foundational framework for the consistent and transparent use of wearable devices in ageing research and practice. They can inform the development of regulations and guidelines, support harmonisation across studies and chart a path for future research to enhance the utility and impact of wearable technologies in ageing populations.

BACKGROUND:Home-based cardiac rehabilitation is increasingly popular for patients with cardiovascular diseases. However, this mode of rehabilitation involves unsupervised exercise, making it challenging to assess, correct, and monitor exercise fidelity (the extent to which the patient performs the exercise intended by the intervention provider). This review aimed to identify the range, validity, and acceptability of measures for assessing exercise fidelity in unsupervised, home-based cardiovascular rehabilitation. METHODS:We searched PubMed, Embase, CINAHL, Medline, and PsycINFO for studies published between 2000 and 2024 to identify observational studies, trials, and protocols published in English with a home-based cardiovascular rehabilitation intervention and at least one measure of exercise fidelity (e.g., adherence to the intended frequency, intensity, time, type, safety, progression/regression). Two reviewers selected eligible studies and extracted data, including study characteristics, exercise components, adherence definition, adherence measures, and data on measurement validity or acceptability. We conducted a narrative synthesis using a comprehensive definition of exercise fidelity, which evolved as the analysis progressed. RESULTS:Forty-six articles describing 41 studies were included. Exercise intensity was the most commonly measured fidelity component (38/41 studies), followed by exercise frequency (32/41 studies). Exercise intensity was mostly assessed by wearable devices (28/41 studies). Frequency of exercise was most commonly assessed subjectively using a self-reported exercise log or diary, but also (objectively) using wearable devices. Exercise quantity was most commonly assessed (in terms of time or duration) by self-reported exercise logs, diaries and wearable devices, or (in terms of steps or distance) mostly by wearable devices (pedometers, other step activity monitors). Safety was only assessed in 12/41 studies. No studies assessed progression or regression of exercise, quality of exercise (accuracy of movement) or the appropriateness of progression or regression. CONCLUSIONS:Most studies to date have conceptualised exercise fidelity or adherence narrowly, ignoring important elements of the initial exercise prescription and many have relied on non-validated self-report measures. We present a comprehensive framework for assessing exercise fidelity, which may be useful for designing more robust assessments of exercise fidelity in home-based rehabilitation programmes.

BACKGROUND:Few middle-aged and older adults engage in regular leisure-time exercise. Incidental physical activity (IPA) encompasses activities of daily living outside the leisure-time domain. No dose-response study is available to guide IPA-focused interventions and guidelines. We examined the associations of device-assessed IPA intensities (vigorous [VIPA], moderate [MIPA], light [LIPA]) with major adverse cardiovascular events (MACE) and mortality, and we estimated the "health equivalence" of LIPA and MIPA against 1 minute of VIPA. METHODS:A total of 24 139 nonexercisers from the 2013 to 2015 UK Biobank accelerometry substudy (56.2% women) with a mean±SD age of 61.9±7.6 years were analyzed using a prospective cohort design. IPA energy expenditure and daily durations of VIPA, MIPA, and LIPA were calculated with a validated machine learning-based intensity classifier. MACE included incident stroke, myocardial infarction, and heart failure; CVD death; CVD mortality; and all-cause mortality. RESULTS:Analyses included 22 107 (MACE), 22 174 (CVD mortality), and 24 139 (all-cause mortality) participants, corresponding to 908/223/1071 events over 7.9 years of follow-up. IPA volume exhibited an L-shaped association with a nadir at ≈35 to 38 kJ·kg-1·d-1, corresponding to hazard ratios of 0.49 (95% CI, 0.39-0.61) for MACE, 0.33 (95% CI, 0.22-0.52) for CVD mortality, and 0.31 (95% CI, 0.25-0.38) for all-cause mortality. Any amounts of VIPA or MIPA were associated with lower risk, with a plateau of ≈14 minutes per day (VIPA) and 34 to 50 minutes per day (MIPA). The median VIPA (4.6 min/d) and MIPA (23.8 min/d) durations were associated with CVD mortality hazard ratio of 0.62 (95% CI, 0.46-0.83) and 0.50 (95% CI, 0.31-0.80), respectively. LIPA showed a subtle inverse gradient which was statistically significant only for CVD mortality at levels >130 minutes per day. One minute of VIPA was equivalent to 2.8 (MACE) to 3.4 (CVD mortality) minutes of MIPA and 34.7 (CVD mortality) to 48.5 (MACE) minutes of LIPA. CONCLUSIONS:Any daily IPA amount of vigorous or moderate intensity was associated with lower CVD risk in a dose-response manner. LIPA had weak associations with all outcomes. One minute of vigorous or ≈3.0 to 3.5 minutes of moderate IPA was associated with a similar degree of lower CVD risk. Our findings highlight the potential cardiovascular health value of incidental physical activity, especially for people who struggle to do structured exercise.

Falls among older adults pose a significant public health challenge, as they lead to severe outcomes such as fractures and loss of independence. Research has shown that training cognitive function and balance simultaneously, termed Dual-Task (DT) training, improves mobility and reduces fall risks in older adults. This study aims to evaluate the feasibility and acceptability of a blended supervised and self-directed technology-based DT training programme for older adults who have high risk of falling. This is a single-arm, non-randomised feasibility study employing quantitative and qualitative methods. Fifty healthy adults aged 65 years or above will be recruited from the NHS primary and secondary care pathways and from the community. Participants will undergo supervised cognitive and balance DT training for 12 weeks, followed by self-directed DT training for an additional 12 weeks. The cognitive training will be delivered using a commercial mobile application (app) available from the AppStore or Google Play. The balance training will involve static (Marching on the spot, Tandem Stand, Hip Abduction & Extension, Squats, Tiptoe Stand, and Pendulum/Sideways Sway) and dynamic (Figure of Eight Walk, Walking Forwards and Backwards, Lunges, Functional Reach, Toe Tapping, Upper Limb Strength Exercises, and Side-Steps/Simple Grapevine) exercises focused on improving balance, postural stability and strength. Feasibility outcomes will be recruitment, adherence, usage of the app, and attrition. Outcomes measure data, that will be collected at baseline and at 24 weeks, includes the Timed- Up and Go (TUG) test (likely primary outcome in any future trial), along with self-reported questionnaires assessing cognition, fear of falling, quality of life, healthcare service usage, and the self-reported number of falls. Focus group interviews will be conducted with thirty participants and thirty healthcare professionals for in-depth exploration of the feasibility and acceptability of the DT training programme.

INTRODUCTION:Individuals with spinal cord injury (SCI) face heightened cardiovascular disease (CVD) risks. While general exercise guidelines are promoted for SCI individuals, when and how to incorporate exercise during the subacute phase post-SCI remains unclear. Consequently, early aerobic exercise to reduce CVD risks is not standard practice in subacute SCI care, potentially missing an opportunity for optimal cardiovascular rehabilitation, especially given observed reductions in cardiac structure and function within the first year post-SCI. Addressing this gap could improve long-term cardiovascular health and health-related quality of life (HRQOL) for individuals with SCI. Early intervention might prevent worsening cardiovascular function and establish beneficial exercise habits. However, few studies have evaluated the effectiveness of early exercise interventions in this population. This study aims to provide insight into the impact of moderate-intensity arm-crank exercise training (ACET) on cardiometabolic, HRQOL, functional and fitness parameters in individuals with subacute (<12 months postinjury) SCI. METHODS AND ANALYSIS:We will conduct a single-centre, two-group, single-blind randomised controlled trial with 42 participants who have sustained a cervical or thoracic SCI within the past year. The non-intervention group will receive hospital standard of care (control group) while the intervention group will receive hospital standard of care plus moderate-intensity ACET for 10 weeks in line with the SCI-specific exercise guidelines to improve cardiometabolic health. The primary outcome measure will be central arterial stiffness (carotid-to-femoral pulse wave velocity). Secondary outcomes include assessments of (1) blood biomarkers linked to CVD, (2) cardiac structure and function, (3) extracranial vasculature, (4) HRQOL, (5) cognitive function, (6) physical activity level, (7) cardiorespiratory fitness, (8) motor function and (9) feasibility outcomes. Assessments will occur at baseline (rehabilitation centre admission, -2 weeks), preintervention (0 weeks), postintervention (10 weeks) and follow-up (6 months after postintervention), for HRQOL outcomes only. ETHICS AND DISSEMINATION:Ethical approval was obtained from the Wales Research Ethics Committee (HREC 22/WA/0329). Outcome data will be presented at international conferences, patient advocacy groups, health professional networks and community health events. Findings will be published in peer-reviewed journals and widely disseminated through strategic channels to reach researchers, healthcare providers, patients and the public. TRIAL REGISTRATION NUMBER:ISRCTN99941302.

Peer-volunteering schemes can facilitate health improvement via increasing physical activity levels. Understanding what motivates peer volunteers is valuable for the feasibility of volunteering schemes. This scoping review aims to explore the motivations of peer volunteers aged over 50 who participate in programs that promote physical activity. Four databases were searched in March 2023 with no date restrictions. The inclusion criteria were adults over 50 years of age, experience in physical activity peer-volunteering schemes, assessed volunteer motivation, and uses English language. Nine studies were included (252 participants, aged 54-85) Peer-volunteer and volunteering characteristics were extracted from the papers. An inductive thematic analysis approach was taken to analyze the motivation data. The themes were then mapped onto theoretical constructs of motivation. Three themes of motivation emerged that could enable us to better design peer-volunteer recruitment strategies: altruistic (giving back), personal improvement (meeting goals), and past experience (helping others overcome experienced barriers). The review suggested that peer-volunteer motivations fall in line with the mechanisms of motivation suggested by psychological theories such as social cognitive and self-determination theories. To improve peer-volunteer uptake and retention, appropriate theoretical frameworks should be employed to inform the content of future interventions to ensure that volunteers will have their motivations met.

BACKGROUND:Digital self-management plays a key role in musculoskeletal care, yet the quality and accessibility of online resources vary. This study used a co-production approach to evaluate digital resources for chronic musculoskeletal disorders, ensuring they reflected patient priorities and practical needs. METHODS:A systematic search identified 91 digital resources, reviewed by a Patient and Public Involvement and Engagement group using a structured rating framework. They assessed visual appeal, adaptability, practicality, clarity, and interactivity. Individual evaluations and group discussions refined the rankings, while focus groups explored themes on usability, accessibility, and gaps in current resources. RESULTS:The top 50 resources offered exercise progressions, interactive tools, and adaptable content, while lower-rated ones relied on static information with little personalisation. Discussions highlighted the value of integrated platforms combining education, guided exercise, and symptom-tracking features. Gaps included limited psychological support and workplace-specific advice. High-quality resources were often harder to find than commercially optimised but lower-quality websites. DISCUSSION:These findings highlight several critical directions for future research and development. Firstly, improving the discoverability of high-quality self-management resources remains essential. Search engine optimisation techniques, the use of patient-friendly language, and clinician-led resource recommendations could significantly increase patient access and engagement. Secondly, there is a pressing need to better integrate mental health support into CMSD resources, reflecting the biopsychosocial nature of chronic pain. Lastly, tailored workplace adaptations-including pacing strategies, ergonomic advice, and communication tools-must be embedded within digital tools, particularly for supporting older employees. These priorities will ensure that digital self-management resources are not only clinically relevant, but also practical, inclusive, and widely accessible. CONCLUSIONS:Future development should focus on making evidence-based resources easier to find, integrating mental health support, and embedding workplace adaptations such as pacing, ergonomic advice, and communication tools. These priorities will help ensure digital self-management resources are clinically relevant, practical, and inclusive. TRIAL REGISTRATION:Not applicable.

While daily step count and stepping pace are linked to various health benefits in older adults, less is known about how the pattern of step accumulation affects physical function. For example, the same step count could be accumulated through clusters of frequent, short bouts (e.g., during house cleaning) or fewer, longer bouts (e.g., walking to and from work). This study aimed to explore whether stepping patterns, and trends in these patterns, were associated with physical function in older adults. We analysed accelerometer data from wrist-worn GENEActiv devices, from four time points over 24 months in n = 597 older adults (age ≥65 years, 68

BACKGROUND:Supporting older adults to maintain physical activity is a key tool in combating the rising prevalence of physical frailty and its associated social, health and economic burden. Walkability of the physical environment, which in urban areas includes pedestrian infrastructure and safety, is a key facilitator of physical activity. Road crossings may be one such factor that impacts walkability for older populations. OBJECTIVE:This study aimed to determine what proportion of community dwelling adults ≥65 years of age classified as frail/pre-frail in terms of their lower limb physical function would meet the 1.2 m/s required walking speed for pedestrian crossings, and the demographic characteristics associated with low gait speed. METHODS:Four-metre walking speed data from 1110 older adults in two randomised controlled trials were analysed. Gait speed and the proportion meeting the 1.2 m/s 'green signal' crossing time was calculated. Generalised linear models explored differences in gait speed by sex, age, education, marital status, socioeconomic status and physical function. RESULTS:Seventeen (1.5%) of the sample walked fast enough at their usual comfortable pace to cross during a 1.2 m/s green signal. The mean gait speed for the sample was 0.77 (SD 0.19). Older age, lower physical function and non-white ethnicity were characteristics associated with slower gait speed. CONCLUSIONS:Pedestrian crossings assuming a gait speed of 1.2 m/s are inadequate for mobility-limited older adults to cross at a comfortable walking speed. Further studies are needed to assess the impact of slow gait speed on outdoor physical activity and to develop policies for more accommodating pedestrian infrastructure.

Background System mapping has mainly been used to develop theories and understanding of complex systems; to hypothesise how an intervention might work in a complex system or to inform intervention development. There are a few examples of the use of system mapping as part of process evaluation. In this paper, we describe an innovative approach to using system mapping as part of the process evaluation of a randomised controlled trial of the Active, Connected, Engaged (ACE) community-based active ageing programme.Method Ten participatory workshops were held across three of the ACE sites (Cardiff, Stoke-on-Trent and Manchester, UK). These involved over 100 participants, volunteers and stakeholders (from National Health Service, statutory and voluntary sectors). Their aim was to gather area-specific information on participants’ barriers and facilitators to physical activity and the needs of peer volunteers and service providers; and create ‘baseline’ system maps before the launch of the programme in the three areas of ACE delivery.Results System maps were produced showing the main outcome (physical activity) and the interactions between the key motivators and barriers described by older people, as well as ideas from stakeholders and volunteers about how these barriers can be addressed. Findings led to refinements to ACE intervention processes and the study’s logic model.Conclusions System mapping helped to refine the ACE processes and fine-tune the logic model. The value of this approach will increase in the next phase when it will be used to explore any changes to the physical activity system including changes to stakeholders’ ways of working and collaborating to tackle barriers to activity following the completion of the ACE trial.Trial registration number ISRCTN17660493.

The present study aimed to assess the sensitivity, specificity and construct validity of the General Practice Physical Activity Questionnaire (GPPAQ) and two modified versions, GPPAQ-WALK and GPPAQ-WALK-Old in retired, community-dwelling older adults, 60–90 years. Participants completed assessments from the Senior Fitness Test (lower limb strength, dynamic balance, aerobic endurance) and used a waist-worn accelerometer for a week, following which they responded to the GPPAQ. Active/non-active GPPAQ classification was compared against accelerometry regarding meeting/not meeting the guidelines of ≥ 150 min/week of moderate-to-vigorous physical activity (MVPA). Sensitivity and specificity were calculated. T tests compared BMI and fitness scores between active and non-active participants. A total of 180 retired adults residing in Greece, mean age 72.82 ± 6.30, participated in the study, 114 of whom had valid accelerometer data corresponding to the GPPAQ recall week. The GPPAQ active classification showed 4.4

Citation: de Jong J, van der Lucht F and Stathi A (2024) Editorial: Future directions of active lifestyle promotion in community-dwelling older adults. Front. Public Health 12:1372316. doi: 10.3389/fpubh.2024.1372316

Background Physical activity (PA) is beneficial for older adults’ health, however they remain the least active age group in the UK. This qualitative longitudinal study aims to understand motivations in older adults receiving the REACT physical activity intervention, through the lens of self-determination theory. Methods Participants were older adults randomised to the intervention arm of the Retirement in ACTion (REACT) Study, a group-based physical activity and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years). Stratified purposive sampling by physical functioning (Short Physical Performance Battery scores) and 3-month attendance was employed. Fifty-one semi-structured interviews were conducted at 6, 12 and 24-months with twenty-nine older adults (Mean age (baseline) = 77.9 years, SD 6.86, 69% female) and at 24-months with twelve session leaders and two service managers. Interviews were audio recorded, transcribed verbatim and analysed using Framework Analysis. Results Perceptions of autonomy, competence and relatedness were associated with adherence to the REACT programme and maintenance of an active lifestyle. Motivational processes and participants’ support needs, changed during the 12-month REACT intervention and across the 12-months post-intervention. Group interactions were an important source of motivation during the first six months but increased competence and mobility drove motivation at the later stages (12 months) and post-intervention (24 months). Conclusions Motivational support needs vary in different stages of a 12-month group-based programme (adoption and adherence) and post-intervention (long-term maintenance). Strategies to accommodate those needs include, (a) making exercise social and enjoyable, (b) understanding participants’ capabilities and tailoring the programme accordingly, (c) capitalising on group support to motivate participants to try other activities and prepare sustainable active living plans. Trial registration The REACT study was a pragmatic multi-centre, two-arm, single-blind, parallel-group, RCT (ISRCTN registration number 45627165).

Abstract Purpose Mobility limitation in older age reduces quality of life, generates substantial health and social care costs, and increases mortality. The REtirement in ACTion (REACT) trial established that a community-based, active ageing intervention can prevent decline in physical functioning in older adults already at increased risk of mobility limitations documenting significant savings in health and social care costs. Project description Recruitment: We recruited 777 older adults (mean age 77.6 yrs (SD 6.8 yrs); 66% female; with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] mean score 7.37, (SD 1.56) from three sites (Bristol/Bath; Birmingham; Exeter) in England. In terms of ethnicity (95.11% white) and deprivation, the sample was representative of the UK population of people 65+. Intervention Participants were randomly assigned to receive three healthy ageing sessions (n = 367) or a 12-month, group-based, multimodal programme including 64x1hr exercise, 43x20 min social and 21x45-min behavioural maintenance sessions (n = 410) delivered by qualified exercise specialists. Implementation The intervention was funded and delivered by community organisations including city councils, third sector organisations/charities, leisure industry providers. Currently REACT is implemented as a community programme in Bristol, UK while a strategy for rolling-out nationally is developed. Evaluation A multicentre, pragmatic, randomised controlled trial with process and health economic evaluations at baseline, six, 12 and 24 months. At the 24-month follow-up, the SPPB score was significantly greater in the intervention arm than in the control arm. Difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Attrition rates were low (19%). Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness, enjoyment and perceived well-being benefits. The health economic analysis indicated substantial quality-of-life and health economic benefits within the 24-month trial window and across a lifetime horizon. Conclusions This study adds robust evidence that a relatively low-resource, 1-year multimodal exercise,social and behavioural maintenance intervention helps older adults to improve and retain physical functioning for at least 24 months. There are great opportunities and some challenges for a national and international roll-out of this evidence-based active ageing programme.

Abstract Background The Active Connected Engaged [ACE] study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial [RCT] with an internal pilot phase. The ACE study incorporates a multi-level mixed methods process evaluation including a systems mapping approach and an economic evaluation. ACE aims to test the effectiveness and cost-effectiveness of a peer-volunteer led active ageing intervention designed to support older adults at risk of mobility disability to become more physically and socially active within their communities and to reduce or reverse, the progression of functional limitations associated with ageing. Methods/design Community-dwelling, older adults aged 65 years and older (n = 515), at risk of mobility disability due to reduced lower limb physical functioning (Short Physical Performance Battery (SPPB) score of 4–9 inclusive) will be recruited. Participants will be randomised to receive either a minimal control intervention or ACE, a 6-month programme underpinned by behaviour change theory, whereby peer volunteers are paired with participants and offer them individually tailored support to engage them in local physical and social activities to improve lower limb mobility and increase their physical activity. Outcome data will be collected at baseline, 6, 12 and 18 months. The primary outcome analysis (difference in SPPB score at 18 months) will be undertaken blinded to group allocation. Primary comparative analyses will be on an intention-to-treat (ITT) basis with due emphasis placed on confidence intervals. Discussion ACE is the largest, pragmatic, community-based randomised controlled trial in the UK to target this high-risk segment of the older population by mobilising community resources (peer volunteers). A programme that can successfully engage this population in sufficient activity to improve strength, coordination, balance and social connections would have a major impact on sustaining health and independence. ACE is also the first study of its kind to conduct a full economic and comprehensive process evaluation of this type of community-based intervention. If effective and cost-effective, the ACE intervention has strong potential to be implemented widely in the UK and elsewhere. Trial registration ISRCTN, ISRCTN17660493. Registered on 30 September 2021. Trial Sponsor: University of Birmingham, Contact: Dr Birgit Whitman, Head of Research Governance and Integrity; Email: researchgovernance@contacts.bham.ac.uk. Protocol Version 5 22/07/22.