Ethical Considerations in Promoting Physical Activity for Nursing Home Residents With Cognitive Impairment: Implications for Policy and Practice.

PURPOSE: Promoting physical activity (PA) among nursing home (NH) residents, particularly those with cognitive impairment, often generates ethical tensions that may be rooted in paternalism, risk-averse cultures, and institutional routines. Therefore, it is necessary to address ethical considerations that can inform policy and practice aimed at promoting safe and effective PA intervention strategies. METHOD: PA promotion was examined through the bioethical principles of autonomy, beneficence, nonmaleficence, and justice. The analysis was extended by introducing a relational autonomy framework suited to contexts of cognitive vulnerability. RESULTS: By situating agency within relational, cultural, and organizational structures, the relational autonomy framework clarifies how ethically grounded and cognitively responsive PA can be enabled or constrained in long-term care settings. The analysis further demonstrated that principlist approaches alone are insufficient to address the relational dependencies and fluctuating capacities that shape NH residents' participation. CONCLUSION: Meaningful PA requires communication strategies attuned to cognitive fluctuation, identity-aligned activity design, and institutional flexibility that reduces structural barriers. Integrating relational autonomy into PA policy, staff training, and everyday care practices is ethically necessary to not only promote overall health, but to uphold agency, equity, and personhood for cognitively impaired NH residents.