Introduction

Health literacy is an important determinant of health. It represents a person's disposition to acquire, process and understand basic information about health and health services. Based on this information, he models his own knowledge, skills and attitudes, which he knows how to appropriately apply in specific everyday situations in the care of his own health (Kristová, Slezáková 2023). In relation to seniors, it is the ability to understand instructions aimed at the implementation of preventive activities and cooperation in the treatment of diseases (Zrubáková, 2023). A health-literate senior is accommodating, or independently implements various preventive activities and cooperates in pharmacological and non-pharmacological treatment.

Physical activity and exercise also belong to the areas where health literacy is the highest priority. Regular physical activity is important not only for eliminating negative changes resulting from the aging process on the movement system, but has a much more complex effect.

According to Navrátil, Šedivcová et al. (2023) increasing physical activity with increasing age brings a reduction in morbidity and mortality. Enrollment in an exercise and rehabilitation program helps to improve psychological well-being, cognitive functions, application in society, and increase the quality of life. Regular physical activity maintains the ability of safe mobility in seniors and reduces the risk of injuries, slows down the development of sarcopenia, improves metabolic functions, sensitivity of tissues to insulin, adjustment of glycoregulation, contributes to weight reduction. For seniors living at home, physical activity is a prerequisite for personal and social well-being. It enables the ability to move freely and the realization of daily life activities as well as instrumental daily activities (Zrubáková, Bartošovič et al., 2025).

Physical activity also helps with:

  • coping with daily stress without significant difficulties and fatigue, - creation of an energy reserve for acceptable coping with more physically demanding activities, increasing resistance to physical exertion, which is also important in the implementation of health care, e.g. during invasive examination, surgery, - increasing the possibilities of social application and maintaining psychological balance (Krajčík et al., 2022).

However, in order for physical activity and exercise to fulfill their purpose, the senior must know what is suitable for him and what conditions he must comply with, or what aids he can use.

Suitable activities in the community environment are walking, hiking, Nordic walking, swimming, cycling, cross-country skiing in the winter or indoor activities - cycling, walking on a treadmill, elliptical, rowing and dancing. Strengthening is important. Strength training helps increase muscle strength and helps replace the loss of muscle fibers. Regular training can replace the loss of muscle fibers by 25-100% due to muscle hypertrophy and the involvement of a larger number of muscle motor units (Longauerová, Magurová, 2008, p. 116). For geriatric patients, it can be implemented as circuit training using aids (light dumbbells weighing 0.5 kg, thera-band, overball), gravity and own body weight (Zrubáková, 2025).

Balance exercises positively help to prevent falls, maintain fitness and self-sufficiency. In a community setting, implementing an evidence-based fall reduction program into a senior living program has positive effects on strength, balance, fall risk, gait speed, frequency of falls, hospitalizations, and number of therapeutic interventions (Harnish et al, 2017).

The recommended physical activity also includes exercises to improve the condition of the spine. Good condition and correct posture are maintained with this exercise. This also includes stretching exercises. Activities operating at this level include: rehabilitation and health exercises (back school), yoga and Tai-chi (Longauerová, Magurová, 2008, p. 117).

For the safe implementation of the activity, he should follow the following recommendations:

  1. Movement activity must have its sequence. It begins with the phase of warming up the body (warm-up). It is a gradual increase of the load on the body to the level of heart rate about 20 pulses less than the target heart rate for a duration of 10 to 15 minutes (preferably walking). This phase reduces the risk of dysrhythmias, ischemia and injuries. At the end, a phase of "cooling" of the body (cooldown) is necessary, it includes low-intensity exercise lasting 5 to 10 minutes with a gradual decrease in heart rate (stretching is also suitable). The initial activities also help to stretch and warm up the muscles and ligaments, while the cooling phase prevents the occurrence of hypotension, syncope or dysrhythmias when the exercise is stopped suddenly (Hudáková, 2018, p. 38).
  2. For previously inactive seniors, you can start with light walking, swimming or cycling. The senior should be guided by the feeling of the intensity of the effort rather than its duration or the exact value of the heart rate. Systolic blood pressure values ​​should not exceed 180-190 mm Hg during exercise (Meško, 2009, In ​​Zrubáková, Bartošovič et al., 2019, p. 98).

In addition to the recommendations for physical activity in the elderly, which are published in professional and scientific works in the Slovak and Czech Republic, the principles proposed by the World Health Organization (WHO) should be accepted, which are closely related to the demographic development and risk factors occurring in this population group.

The WHO principles include:

  • older people should do at least 150-300 minutes of moderate-intensity aerobic physical activity throughout the week; or perform at least 75-150 minutes of aerobic intensive exercise; or implement their equivalent combination of medium and strong intensity.
  • Older people should also do strengthening activities of moderate or greater intensity, which involve all major muscle groups, for two or more days a week.
  • As part of their weekly physical activity, they should perform a variety of multi-component physical activities that emphasize functional balance and strength training of moderate or higher intensity, three or more days per week. They should increase their functional capacity, which is important for preventing falls.
  • Older people should start with a small amount of physical activity and gradually increase the frequency and intensity and its duration over time.
  • Older people should be as physically active as their functional abilities allow, and adapt the level of physical effort, activity to their level of fitness (WHO, 2020).

Physical activity in disease therapy

In addition to primary prevention, activation is important in the treatment of diseases and prevention of complications. It is also one of the most frequently used non-pharmacological treatment procedures. What we also found out during our own research activity with seniors in institutional facilities - Tab.1.

Tab. 1 Use of non-pharmacological methods

As the table shows, nurses in acute and long-term care most often use exercise therapy methods.

Similarly, when stating the importance of individual non-pharmacological treatment procedures, client mobility was marked as very important (a Likert scale was used, where the value 1 meant the most positive assessment and the value 5 expressed a completely negative response).

Tab. 2 Importance of individual non-pharmacological methods

The results were presented in the publication Zrubáková, Bartošovič et al. 2019.

With the help of a narrative review, we found that physical activation is used in the therapy of cardiology, oncology, neurological, metabolic, respiratory diseases and geriatric syndromes - most often in hypomobility and immobility syndrome, gait disorders and instability, general deconditioning syndrome and muscle weakness - sarcopenia and geriatric frailty syndrome.

The implemented activities included:

  • resisted (exercise using resistance to stimulate muscle contraction. Strength training also improves joint mobility and increases the strength of muscles, tendons and ligaments. It is important to maintain a slow controlled movement during resisted exercise) and aerobic exercise,
  • moderate intensity physical activity,
  • active exercise,
  • respiratory physiotherapy,
  • vascular gymnastics (Nemcová, Hlinková et al., 2024, Líška, Stráska, 2020, Kiss et al., 2024, Kim, Han, Kim, 2019).

Digital health literacy and physical activity of seniors

Digital health literacy is defined as the ability to search, understand, evaluate and use digital health information and technologies (e.g. mobile applications, websites, online consultations) to support health and prevent diseases (Magerčaková, Zrubáková, 2024). As for physical activity, it can be used to support the effective execution of exercise sets, proper handling of aids, self-control of physical activity, or to search for information about physical activity.

Seniors can use:

  • applications and wearable devices: pedometers, applications in mobile phones (smartphones), fitness bracelets, smart watches that motivate movement, check the pulse, track the route, record sports activities, monitor progress, etc.
  • Online exercise programs: YouTube videos, virtual training for seniors, applications with exercise guides.
  • Virtual communities and support: online groups focused on a healthy lifestyle that increase motivation.
  • Telemedicine and consultations: doctors, physiotherapists can recommend suitable physical activity remotely.
  • General instructions and information about exercises on the Internet.

However, seniors encounter problems using digital aids more than in other age categories. The great diversity and heterogeneity of this population and the large number of negatively affecting factors are also a problem.

The most frequently identified include:

  • low level of digital skills,
  • inadequate digital tools,
  • insufficient family background,
  • fear of technology and mistrust of the Internet,
  • visual, auditory, motor, cognitive limitations,
  • poor health,
  • financial costs for equipment and connection.

In the last 5 years, scientific studies focused on the analysis of the mentioned risk factors have been increasing in the databases (Scopus, Web of Science). They are most often focused on the demographic area (gender, education, place of residence...), the health status of seniors and the overall level of digital literacy in terms of age category.

The most important conclusions of individual scientific works include:

Higher digital health literacy is positively associated with higher levels of physical activity. In a study of 34,000 residents in the Zeeland region of Denmark, its actors (Zangger, G. et al., 2024) analyzed positive associations between a higher level of digital health literacy and activity > 30 min/week at moderate to high intensity (eHLQ 1: OR 1.24, p < 0.001; eHLQ 4: OR 1.13, p = 0.012; eHLQ 5: OR 1.25, p < 0.001), following the minimum recommendations of the World Health Organization for physical activity (eHLQ 1: OR 1.33 p < 0.001; eHLQ 4: OR 1.08 p = 0.025; eHLQ 5: OR 1.32, p < 0.001) and subjectively reported physical activity. The results also show that screening and promoting digital health literacy is important when managing digital health and digital physical activity interventions.

Author collective Lim et al. (2021) through a systematic search of the CINAHL, MEDLINE, PsychINFO and CENTRAL databases to determine the association between health literacy and physical activity in older people. After analyzing the collected studies, he concluded that physical activity and working with digital media could potentially support an increase in health literacy and empower older people to make beneficial health decisions.

The same research method - a meta-analysis of scientific studies (28 articles from 4,706 retrieved records) revealed that the digital health literacy of older adults is reflected in the scores of older adults in high-income countries. Digital health literacy of older adults was influenced by sociodemographic factors, related electronic device factors, and factors of use and social support (Shi et al., 2024). The stated results were confirmed by Cai, Li (2024), Michálková (2025) limitations of seniors when using digital tools to support activity and exercise are related to social support of the family, good economic background (they can afford to pay for the internet, have a smartphone) and satisfactory functional status.

According to team members' findings (Babak et al, 2022), physical problems and diseases are not barriers to decision-making and application of physical activity information among older adults who have high understanding and correct evaluation of physical activity recommendations. They found data in a qualitative study of older adults aged 60 to 75 years in retirement centers in Kermanshah, Iran, in 2020. A total of 25 participants were recruited through purposive sampling with maximum variation until data saturation. It was based on the hypothesis that insufficient health literacy among older adults is associated with reduced physical activity and the occurrence of several diseases.

Similarly, a study (Wei, Zhou, 2024) that aimed to analyze the impact of digital health literacy on the health of older adults, as well as mediating mechanisms related to the frequency and duration of exercise, was conducted in the urban areas of Luoyang and Zhengzhou (China) from December 2023 to January 2024. It concluded that digital health literacy has a significant impact on the health of older adults. Duration and frequency of exercise play a partial mediating role between older adults' digital health literacy and their physical health status. Digital health literacy can encourage older adults to increase the duration and frequency of exercise, which in turn supports their physical health.

Boxall et al.'s study focused directly on digital interventions. (2025), which also reports on the implementation of the "Active Lives" program, a digital intervention developed specifically for older adults. In it, the authors point out the factors preventing the use of programs in the community. Seniors, without their own digital tools, cannot participate in the intervention. Inadequate support from NHS, public health, community and third sector organizations in the UK was identified.

Conclusion

Digital health literacy and physical activity are closely related - improving digital skills allows seniors to more effectively use modern technologies to support health and an active lifestyle. The qualitative analysis of scientific works and studies also determined common goals. The main thing is the inclusive support of seniors, so that digital tools are not an obstacle, but a means to better health and the quality of their life.

Authors: PhDr. Katarína Zrubáková PhD. Catholic University in Ružomberok, Faculty of Health, Department of Nursing PhDr. Mgr. Mariana Magerčiaková, PhD., MPH, MBA Catholic University in Ružomberok, Faculty of Health, Department of Nursing Mgr. Ivana Aštaryová, PhD. Catholic University in Ružomberok, Faculty of Health, Department of Physiotherapy

The contribution is a partial output of the project KEGA 002KU 4/2025 Digital health literacy of seniors from the perspective of nursing and physiotherapy.

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