Table 1.

Identified challenges and mitigations strategies mapped to the social–ecological model

Level	Identified challenges	Mitigation strategies
Northern and rural context	Winter weather and conditions Inaccessible built environment Lack of specialised facilities and distance to opportunities	Appropriate clothing and footwear, knowledge on strategies for being active and staying safe (eg, walking on ice to prevent falls) Adjust to seasonal activities Advocate for connected pathways and accessible sidewalks Use public transit, share limited facilities between social and physical activity programme
Health system	Fragmented communication process	Community champions leverage informal networks
	Inconsistent referral process	Take advantage of gaps to allow flexibility in community-driven ground-up response (eg, include persons identified to potentially benefit from support informally connected through personal and community networks in contrast to requiring formal referral from locum practitioner)
Physical activity programme	Balancing routine and structure with participant choice and autonomy	Flexibility to allow adjustment to cognitive and physical abilities of participants Accommodation of diverse abilities in mixed classes and/or by team instruction
	Lack of consistency in programming	Develop informal work-arounds through provider collaboration (eg, job sharing, willingness to work outside scope of practice) Programme scheduling responsive to participant needs, offer when and where demand is high Engagement of volunteers
	Lack of definition of programme, and meaning of physical activity and exercise	Allow for flexibility in programme provision (switch from physical to psychosocial goals when formal exercise provider unavailable) Accept that no one programme is everything to everyone
	Lack of accessibility to reliable information source	Knowledge sharing occurs within community social network Maintain traditional communication strategies (mail out of print activity book, person to person telephone connection)
	Lack of resources	Education and training provided by multiple sources Flexible and adaptable job roles and volunteer engagement to address human resource capacity Provider collaboration and sharing of limited resources across programmes
Programme participant	Stigma of dementia	Offer programme in neutral community location Modify language to describe programme to enhance inclusion for persons with dementia Improve knowledge of benefits of exercise by participant and/or care partner
	Perception of safety	Acknowledge fear and provide tailored programming support Education and training on risk Confidence and trust in programme providers
	Scheduling priorities	Participant and/or care partner awareness of programme availability and benefits Multiple programming options Flexibility among community health providers to accommodate participant scheduling needs Participants and care partners perceive physical activity as meaningful Transportation support