148 | Chapter 7 transition from a FPP to a regular exercise programs or sports activities, such as Tai Chi, walking, walking football, dancing, pilates or yoga. Possibly, for the continuationg of FPPs, eventually even with the same FPP group, online programs could be used. Such an online program can also help to contribute to engagement and socialization for example using an age-friendly online platform with a chat or a forum, live sessions how to do exercises and videos for review or practice (296). Digital programs can provide a training program and enhance long term motivation and continuation at relatively low cost (297). Organisational factors, such as partnership formation, networking, community capacity, financial resources, a lack of coordination and the participation of older people were the most reported influences for continuation of FPPs affect program continuation and sustainability (228, 298). Also a regular start of the FPP is important for the continuity and and provides clarity for the FPP participants and partners involved when the program is going to start again. Strengths and limitations of this study A strength of this study is that we had a substantial number of FPP participants, therapists and stakeholders participating in both the quantiative and qualitative study. The participants were included from several places across the Netherlands; this makes the results more generalizable. Second, all participants were older adults who followed the training program, therapists who provided the program, or stakeholders who are responsible for the offering of FPPs and thus are experts by experience (299). Experts by experience tend to emphasise experience-related issues, which is their strength and the value-adding reason for involving them. Another strength is that an independent and experienced researcher moderated the focus group and has assisted in the design of the focus group guideline. In doing so we ought to create a safe and open environment so that the participants dared to share their experiences, also the negative ones. Despite efforts to include also people who are less enthousiastic about the In Balance program from the RCT in the focus groups, there may be selection bias. Participants who were positive about the program mostly signed up to participate in the focus groups, which may have lead to an overly optimistic view of the In Balance program. Moreover, although we had a substantial number of participants divided over the country, it was quite a homogeneous group of participants; mostly people with a higher socioeconomic status without a migration background. Ideally, we have had a representative sample of the society in our study. Possibly, people with a lower socioeconimic status or a migration background may have other or additional preferences regarding the In Balance program and thus may result in other recommendations for the optimalisation of the program. It also should be noted that the questionnaires used in this study were not validated, yet they were carefully designed in collaboration with therapists and experts in this field.
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