{"paper_id":"3ff648e6-a379-4c3a-8bfa-d1d1f8fbbba8","body_text":"Exercise groups implemented by municipalities promote older adults’ physical functioning: the Strength in Old Age Program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exercise groups implemented by municipalities promote older adults’ physical functioning: the Strength in Old Age Program Eerika Saloranta, Annele Urtamo, Erja Rappe, Satu Jyväkorpi, Pirjo Kalmari, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8424750/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The implementation and outcomes of physical activity promotion programs are less studied. This study examines whether physical exercise groups implemented by municipalities are feasible and promote physical functioning among community-dwelling older adults in real-life settings. Methods Five municipalities participating in the Strength in Old Age Program organized guided exercise to 176 voluntary participants (79.5 ± 4.2 years, 75% women), who were recruited into Strength-Balance training Groups (twice a week) or Other Exercise Groups (e.g. chair and balance exercise or senior dance once a week plus home exercise). SPPB was conducted by local exercise instructors and perceived daily activity performance was assessed before and after the 8–12-week exercise period. Changes in outcomes by exercise group and baseline functioning were analyzed. Results Average attendance rate to exercise sessions was 87%. Both exercise groups showed significant improvement in the SPPB score, balance score, gait speed and chair stand time. Participants with lower SPPB baseline score (SPPB < 10) had a greater improvement in the SPPB score, balance score and chair stand time compared to the participants with better baseline functioning (SPPB ≥ 10). No significant differences in changes of gait speed were found between lower- and higher-functioning groups. Significant improvement was found in perceived performance of daily activities. Subgroup analysis revealed that the improvement occurred in the Strength-Balance Groups and among participants with higher functioning. Conclusions In real-life settings, municipalities successfully implemented physical exercise groups and mobility tests. Older adults’ physical functioning improved. For municipal exercise groups, it is recommended to include baseline testing and to pay attention to the recruitment of participants with lower physical functioning. Trial registration Clinical trial number: not applicable Community-dwelling Implementation Older adults Physical activity Physical fitness Program evaluation Short Physical Performance Battery Figures Figure 1 Introduction The current demographic development of ageing demands effective promotion of physical activity among older adults. Sound evidence show that physical activity preserves physical functioning [ 1 , 2 ] and supports independent living at home [ 3 , 4 ]. Particularly strength and balance training are shown to associate with many health-related outcomes, such as frailty, dementia, mobility limitations, and mortality [ 2 , 5 ]. Strength or balance training protocols, using controlled [ 6 – 9 ] and intervention [ 10 – 12 ] study designs, have been carried out among community-dwelling older adults and they have shown systematic improvements in mobility. Importantly, the randomised controlled trial SPRINTT showed that participants with lower baseline physical performance benefited most from the training and had fewer functional limitations at the follow-up [ 10 ]. National physical activity programs often fail to show their impacts and face many challenges [ 13 ], such as lack of resources or expertise to carry out research and publish in peer-reviewed journals [ 14 ]. It is also known that translating theory to practice into real-life setting is challenging and unpredictable [ 15 ]. Thus, creating and practicing evidence-based public health is a demanding task, where long-term impacts are often overlooked in favour of narrow, short-term outcomes. Further, it is less known that there are existing theoretical frameworks available, such as Results-Based Management [ 16 ], the Theory of Change [ 17 ] and RE-AIM [ 18 ], which facilitate the planning, guidance, monitoring and evaluation of health enhancing programs. The need to carry out implementation research has become higher in many public health agendas. Thus, to tackle the research-to-practice gap and to show efficacy, we studied a Finnish national physical activity program. This study examines whether physical exercise groups implemented by municipalities are feasible and promote physical and perceived performance of daily activities among community-dwelling older adults in real-life settings. In addition, we studied whether the potential changes in physical functioning varied across different types of exercise groups and depending on the baseline level of physical functioning. Methods The Strength in Old Age Program (hereafter the Program), coordinated by Age Institute in Finland, has launched guided strength and balance exercise for independently living older adults over 75 years of age with decreased physical functioning. Municipalities are chosen on application to participate in the Program for the three-year mentoring to implement the good practices including progressive gym and balance training and mobility assessments. The Program started in 2005. This was a quasi-experimental study conducted in real-life settings. Invitation letters by e-mail were sent to municipalities that were currently or had previously been in the Program. Five municipalities were recruited in the study in 2022. The instructors in the municipalities were advised to recruit older adults aged 75 years or older, who lived independently and had decreased physical functioning. Participants without severe illnesses that prevent exercise were included in the study. In total, 176 voluntary participants were recruited into the guided exercise groups (either Strength-Balance Groups at the gym or Other Exercise Groups not including gym training) for 2 months in 2023. The local exercise instructors in each municipality were sent short written instructions for the study protocol and data collection, and the additional study material (e.g. questionnaires). Exercise instructors were briefed via Microsoft Teams or phone call before the exercise period started. Age Institute obtained research permission and data processing agreements from each municipality and wellbeing services counties in the study. Written informed consent was obtained from all participants before the study. Exercise instructors were asked to report all possible adverse events during the exercise sessions. Ethical approval was received from HUS Regional Committee on Medical Research Ethics (HUS/13574/2022). In the five municipalities, altogether 24 Strength-Balance Groups started with 136 participants and three Other Exercise Groups with 40 participants. The Strength-Balance Groups had progressive gym and balance training twice a week. The Other Exercise Groups had chair and balance exercise or senior dance once a week as well as unsupervised home exercise once a week. The length of exercise period varied from 8 to 12 weeks (mean 9.0 weeks). The duration of the exercise sessions was 60–75 min in the Strength-Balance Groups and 45–75 min in the Other Exercise Groups. The participants in all exercise groups received written nutritional guide for older adults produced by the National Nutrition Council. The exercise instructors of Strength-Balance Groups were advised to discuss on the nutritional themes with participants for 5–10 minutes during the exercise sessions. Short Physical Performance Battery (SPPB) test was conducted before and after the exercise period by exercise instructors [ 19 ]. The test includes balance, 4-meter gait and five-time chair stand test. The outcomes were SPPB total score (0–12 points), subscores of balance, gait and chair stand tests (0–4 points for each), gait time (seconds), gait speed (meter per second) and chair stand time (seconds). The participants were also divided into lower- and higher-functioning groups based on SPPB baseline score (< 10 points and ≥ 10 points) to be used in the subgroup analyses. Perceived performance of daily activities was assessed by the following question: ‘How would you rate yourself coping with daily activities?’. The response categories were: ‘very well’, ‘well’, ‘poorly’, and ‘very poorly’. Sociodemographic characteristics (age, gender, relationship status, living alone, education, financial difficulties), self-rated health, perceived difficulty in walking 500 m and climbing stairs [ 20 ], use of mobility assistive device, and history of falls were self-reported and assessed by a questionnaire at baseline. Physical activity was assessed by a single-item scale [ 21 ], slightly modified. Attendance to guided exercise sessions was monitored by the exercise instructors. Exercise adherence rate (%) was calculated as the number of exercises attended divided by the number of sessions offered. Self-reported adverse events were collected by a questionnaire after the exercise period. Descriptives are presented as percentages for categorical variables and means with standard deviation (SD) for continuous variables. Normality of continuous variables were assessed by examining skewness and kurtosis. Differences between baseline and follow-up within groups were analyzed by paired sample t-test. Analysis of covariance (ANCOVA) were performed for analyzing differences in changes of SPPB outcomes (SPPB total score, balance score, gait speed, chair stand time) between participant with lower and higher functioning (SPPB baseline score < 10 and ≥ 10). The change variables (i.e. post–baseline) were treated as continuous variables. Models were adjusted for age, exercise adherence and the type of exercise group. Wilcoxon signed-rank test was used for analyzing changes in perceived performance of daily activities between baseline and follow-up. Subgroup analyses were performed by exercise group and baseline functioning status. The goal was to recruit at least 50 participants in both exercise groups. Sample size was calculated with power calculations based on change in chair stand test of SPPB and included anticipated dropout level of 15% [22]. Participants having both pre- and post-test results (n = 147–151) were included in the analysis. Out of the 176 recruited participants, 25 persons were lost to follow-up. Sensitivity analyses were conducted for dropouts of SPPB (n = 25). SPSS version 29.0.2.0 was used for the analysis. Results Participants (n = 176) had a mean age of 79.5 years (SD 4.2) and 75% were women, 44% were in a relationship, 59% lived alone, 43% were highly educated, and 81% perceived no financial difficulties with current income (Table 1 ). Of the participants, 49% reported good or fairly good health, 66% were physically active, 69% had no difficulties in walking 500 meters, 72% had no difficulties in climbing stairs, 38% used mobility assistive device, 30% had history of falls in the past half year. Mean adherence to guided exercise sessions was 87%. Table 1 Baseline characteristics of participants by exercise group All (n = 176) Strength-Balance Group (n = 136) Other Exercise Group (n = 40) Age, years, mean 79.5 79.1 81.0 Women (%) 75.0 70.6 90.0 In a relationship (%) 44.0 47.8 30.8 Living alone (%) 58.9 54.8 72.5 Education (%) a Low 29.3 26.7 38.5 Medium 27.6 30.4 17.9 High 43.1 43.0 43.6 Getting on with available income without difficulties (%) 80.7 77.2 92.5 Good or fairly good self-rated health (%) 48.9 47.8 52.5 Physical activity (%) b Low (1–2) 33.7 39.7 12.8 Moderate (3–4) 45.7 43.4 53.8 High (5–6) 20.6 16.9 33.3 Walking 500 m without difficulties (%) 69.0 65.9 79.5 Climbing stairs without difficulties (%) 72.0 71.9 72.5 Mobility assistive device (%) 37.6 36.1 42.5 Falls during last half year (%) Once 22.7 22.8 22.5 More than once 6.8 7.4 5.0 Adherence rate to exercise (%), mean c 87.4 87.0 89.0 Note: Based on self-reported information, except for adherence rate reported by exercise group instructors. a Education: Low (Elementary school, basic education or lower secondary education), Medium (Vocational school/equivalent or upper secondary education/high school), High (Non-university lower education, Bachelor’s Degree (university of applied science/ college/similar) or Master’s Degree (university degree/MA/similar). b Physical activity: Low (1 = not moving more than is necessary to perform daily activities, 2 = casual walks and light outdoor recreation 1–2 times/week, Moderate (3 = casual walks and light outdoor recreation several times a week; 4 = 1–2 times/week brisk physical activity), High (5 = 3–5 times/week a brisk physical activity, 6 = fitness exercises several times a week). c Adherence rate to exercise as percentage: Number of exercise sessions attended of maximum number of exercise sessions offered (%) There were statistically significant improvements (Table 2 ) in the SPPB total score (pre: mean 9.9, post: mean 11.1, p < 0.001), balance score (pre: mean 3.3, post: mean 3.7, p < 0.001), gait time (pre: mean 3.8, post: mean 3.4, p < 0.001), gait speed (pre: mean 1.1, post: mean 1.3, p < 0.001), gait score (pre: mean 3.8, post: mean 3.9, p < 0.001), chair stand time (pre: mean 13.4, post: mean 10.9, p < 0.001) and chair stand score (pre: mean 2.9, post: mean 3.5, p < 0.001) among all participants (Table 2 ). There were also statistically significant changes between pre- and post-test within both exercise groups. Only in gait score among participants in the Other Exercise Group we found no statistically significant changes. The SPPB total score improved in 59%, remained unchanged in 36% and decreased in 5% of the participants. Table 2 SPPB outcomes at baseline and after the 2-month exercise period among exercise group participants (n = 151) All (n = 151) Strength-Balance Group (n = 117) Other Exercise Group (n = 34) Pre Post a Pre Post a Pre Post a SPPB: Total score (0–12), mean (SD) 9.9 (2.1) 11.1 (1.4) *** 9.8 (2.2) 11.0 (1.5) *** 10.4 (1.8) 11.2 (1.1) *** ≤ 9 (%) 36.4 7.9 38.5 8.5 29.4 5.9 10 (%) 15.9 14.6 16.2 14.5 14.7 14.7 11 (%) 18.5 24.5 17.9 24.8 20.6 23.5 12 (%) 29.1 53.0 27.4 52.1 35.3 55.9 SPPB: Balance score (0–4), mean (SD) 3.3 (1.0) 3.7 (0.6) *** 3.2 (1.0) 3.7 (0.6) *** 3.5 (0.8) 3.8 (0.5) ** 0 (%) 1.3 0 1.7 0 0 0 1 (%) 4.0 0.7 4.3 0.9 2.9 0 2 (%) 20.5 6.0 23.1 6.0 11.8 5.9 3 (%) 16.6 14.6 16.2 17.1 17.6 5.9 4 (%) 57.6 78.8 54.7 76.1 67.6 88.2 SPPB: Gait time (s), mean (SD) 3.8 (1.2) 3.4 (1.3) *** 3.9 (1.3) 3.4 (1.4) *** 3.7 (0.9) 3.3 (0.8) ** SPPB: Gait speed (m/s), mean (SD) 1.1 (0.3) 1.3 (0.3) *** 1.1 (0.3) 1.3 (0.3) *** 1.1 (0.2) 1.3 (0.3) ** SPPB: Gait score (0–4), mean (SD) 3.8 (0.5) 3.9 (0.4) ** 3.8 (0.6) 3.9 (0.5) * 3.9 (0.4) 3.9 (0.3) 0 (%) 0 0 0 0 0 0 1 (%) 1.3 0.7 1.7 0.9 0 0 2 (%) 2.6 2.6 2.6 2.6 2.9 2.9 3 (%) 9.3 2.6 10.3 3.4 5.9 0 4 (%) 86.8 94.0 85.5 93.2 91.2 97.1 SPPB: Chair stand time (s), mean (SD) 13.4 (4.7) 10.9 (2.8) *** 13.7 (5.1) 10.9 (3.0) *** 12.3 (3.1) 10.9 (2.1) *** SPPB: Chair stand score (0–4), mean (SD) 2.9 (1.1) 3.5 (0.8) *** 2.8 (1.1) 3.5 (0.8) *** 3.0 (1.1) 3.5 (0.7) ** 0 (%) 0.7 0.7 0.9 0.9 0 0 1 (%) 15.9 3.3 17.1 4.3 11.8 0 2 (%) 19.9 6.6 18.8 5.1 23.5 11.8 3 (%) 25.2 27.2 26.5 26.5 20.6 29.4 4 (%) 38.4 62.3 36.8 63.2 44.1 58.8 a Paired sample t-test; * p < 0.05, ** p < 0.01, *** p < 0.001; SPPB = Short Physical Performance Battery. SD = Standard deviation. Including participants having both pre- and post-test results When looking at the changes in all the SPPB components stratified by baseline functioning (SPPB < 10 and ≥ 10), both lower-functioning group and higher-functioning group improved their test results of the SPPB after the exercise period (Fig. 1 ). Participants with lower baseline score had greater improvements compared to the participants with better baseline score. There were statistically significant differences in changes in the SPPB total score (lower-functioning group: mean change 2.3; higher-functioning group: mean change 0.5, F = 84.6, p < 0.001), balance score (0.9 and 0.2, respectively; F = 25.7, p < 0.001), and chair stand time (-4.6 and − 1.3, respectively; F = 37.2, p < 0.001), when adjusted for age, exercise adherence and exercise group. For gait speed, we found no difference in the magnitude of improvement between lower and higher-functioning group. Means and 95% confidence intervals of pre- and post-test results for a) SPPB total score, b) balance score, c) gait speed and d) chair stand time among exercise group participants by baseline functioning (lower-functioning: SPPB score < 10, higher-functioning: SPPB score ≥ 10). Differences between pre- and post-test within groups: t-test. Differences in mean changes (post–pre) between groups: analysis of covariance (ANCOVA) adjusted for age, exercise adherence and exercise group. Statistical significance: **p < 0.01, ***p < 0.001, ns = non-significant. a) ANCOVA: F(1,146) = 84.6, b) ANCOVA: F(1,146) = 25.7, c) ANCOVA: F(1,146) = 2.0, d) ANCOVA: F(1,146) = 37.2. SPPB = Short Physical Performance Battery Statistically significant improvements were found between the baseline and 2-month follow-up in perceived performance of daily activities (Z=-2.14, p = 0.033) (Table 3 ). Improvement was seen in the proportion of those who performed very well in daily activities (pre: 20.5%, post: 30.1%). Differences in perceived performance of daily activities at baseline and follow-up were also statistically significant in the Strength-Balance Group (from 19.8% to 32.4%; Z=-2.50, p = 0.012), but not in the Other Exercise Group (Z = 0.00, p = 1.000). Subgroup analysis showed that the participants with higher SPPB score at baseline (≥ 10 points) reported better performance in daily activities after the exercise period (Z=-2.35, p = 0.019), but any change weren’t seen among the participants with lower SPPB baseline score (< 10 points) (Z=-0.30, p = 0.763). Table 3 Perceived performance of daily activities at baseline and after the 2-month exercise period All (n = 146) Strength-Balance Group (n = 111) Other Exercise Group (n = 35) Lower functioning at baseline (SPPB < 10, n = 53) Higher functioning at baseline (SPPB ≥ 10, n = 88) Pre Post Pre Post Pre Post Pre Post Pre Post Perceived performance of daily activities (%) p = 0.033 p = 0.012 p = 1.000 p = 0.763 p = 0.019 Very well 20.5 30.1 19.8 32.4 22.9 22.9 3.8 9.4 30.7 43.2 Well 70.5 60.3 69.4 55.9 74.3 74.3 81.1 71.7 65.9 54.5 Poorly 8.9 9.6 10.8 11.7 2.9 2.9 15.1 18.9 3.4 2.3 Very poorly 0 0 0 0 0 0 0 0 0 0 The p -values (Wilcoxon signed-rank tests) compare changes between pre- and post-tests within each group; SPPB = Short Physical Performance Battery Sensitivity analysis showed no statistically significant differences in the SPPB outcomes at baseline between the dropouts having only pre-test (n = 25) and the participants who attended to both pre- and post-test. Adherence to exercise sessions of dropouts was moderate (mean 67%, median 75%). Seven of the participants reported adverse events of exercise group participation after the exercise period, such as knee, back or hip pain (n = 5), muscle soreness (n = 1) or under-recovery (n = 1). One participant reported that physician had told to stop the group participation due to worsen back and hip conditions (n = 1). Discussion In this study using a real-life setting of a national physical activity program, we found that municipalities can implement physical exercise groups and mobility tests successfully and promote physical functioning among community-dwelling older adults. Our results showed improvements in physical performance after two months of group exercise when measured with SPPB and self-rated performance in daily activities. Our findings indicate that especially older adults with lower functioning at baseline and those participated in strength and balance training at gym may benefit the most from guided group exercise organized by municipalities. Similar results to our findings have been reported before in more controlled study designs [ 6 – 12 ]. Our subgroup analysis revealed that functioning measured by SPPB (total score, balance and chair stand time but not gait speed) improved more among the participants who had lower baseline functioning (i.e. SPPB score < 10), as shown in previous study [ 10 ]. In addition, the participants with higher functioning and those who attended strength-balance training at gym reported better performance in daily activities. Similar interpretations were drawn in a review suggesting that effects may vary based on training intensity and target group [ 23 ]. Our findings indicate that while the access to the exercise groups must be open to all citizens, the most efficient outcomes may be seen in those already experiencing limited mobility and in gym-based groups. Yet, it is important to acknowledge that the changes in different outcomes in our study were seen for all, showing that all types of training in any participant were seen beneficial on average. Lower physical performance is known to increase the risk for activities of daily living disability [ 24 ]. Interestingly, despite the greatest improvements in SPPB outcomes among older adults with lower functioning in the present study, the training period was not found to associate with better self-rated performance of everyday activities after the exercise period. On the contrary, the participants with higher baseline functioning (SPPB score ≥ 10) perceived better ability to perform daily activities after exercise group participation. Participants in the strength-balance groups at gym but not in the other groups perceived improvements in daily activities, suggesting that gym training twice a week might have some extra benefits over other type of training once a week. Everyday activities may require quite good fitness level, indicating the need for longer exercise period for older adults with lower functioning. Transferring improvements in physical performance to better performance in daily activities may also need e.g. functional training [ 25 ]. Many other factors not studied here, such as living circumstances, may also be related to the older adults’ perceptions about their ability to perform daily chores. Yet, majority of study participants reported good ability to perform daily activities already at baseline. More research is needed to assess the effects of different types of exercise on daily activities among different target groups. Since our study design was real-life setting, it is important to study feasibility. The organizing of the groups was implemented in five municipalities according to planned schedule and all exercise groups were carried out accordingly. The adherence rate was high, 87%, indicating good motivational level by the older adults. Many other studies have evaluated the feasibility (e.g. [ 26 ]) in terms of implementation process, adherence, supervision, social aspects and fit within real-life situation. We perceived the real-life setting particularly important, as the study was a) implemented as part of the Program implementation and mentoring, b) the municipal exercise instructors carried out the research protocol as part of their normal daily routines, and c) the participants were laypeople from the community who participated voluntarily. Since we carried out our study in real-life settings, we realized some relevant points to discuss regarding the participants. We had no strict screenings to enter the study, and all participants had a sufficient health status to be included in the study. As a result of loose entrance, the sample had heterogeneous baseline functioning. The heterogeneity showed that those with lower baseline functioning improved most their performance score. This suggests that in real life, better implementation results could be obtained if the exercise groups were more carefully formed based on baseline functioning level. Thus, more emphasis should be paid to the recruitment of the participants in the exercise groups. For example, health care professionals could guide the persons with frailty and sarcopenia to join the groups. The exercise counselling chain from health care sector to services in sports sector could benefit from more careful participant profile analysis. Our study has several strengths and limitations. Strengths include the novelty value of our real-life setting, measured SPPB outcomes for efficacy, and good adherence to exercise and post-tests among older adults. The limitations of our study are the lack of control group that was not possible to create in the real-life setting with volunteers and the study framework which limits our conclusions on causality. Further, our study is limited with its sample that also included participants with fairly good baseline SPPB score and the ceiling effect with it. It was difficult to improve functioning among those who were already close to maximum points. Another limitation of our sample was a slightly smaller sample size in the Other Exercise Group, which may have lowered statistical power to observe changes or differences across the exercise groups. Further, we did not follow the adherence to home-exercise sessions. Conclusions The study of a national physical activity program, ‘Strength in Old Age’, showed that exercise groups organized by municipalities are effective in improving physical functioning among community-dwelling older adults in real-life setting. The findings indicate that exercise may improve physical functioning more among those older adults who have lower physical performance level and among those who participate in strength and balance training at gym. Baseline testing is recommended to identify the target groups that might benefit from training the most. Abbreviations SPPB Short Physical Performance Battery Declarations Ethical approval and informed consent This study received ethical approval from the Helsinki University Hospital Regional Committee on Medical Research Ethics (Helsinki, Finland, no. HUS/13574/2022). Informed consent was obtained from all individual participants included in the study. Consent for publication Not applicable. Availability of data and materials The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Competing of interests The authors declare that they have no competing interests. Funding This work was supported by the Juho Vainio Foundation (Grant numbers 202200084, 202300435, 202400124) and the Päivikki and Sakari Sohlberg Foundation (Grant number 22008). Authors’ contributions All authors contributed to the study conception, design and material preparation. Data collection and analysis were performed by ES, KB and ER. The first draft of the manuscript was written by ES and KB. All authors contributed to review and editing of the manuscript and approved the final manuscript. Acknowledgements We thank all the participants in the exercise groups, the municipal exercise instructors and decision makers for their work in Hämeenlinna, Kankaanpää, Kerava, Pudasjärvi and Turku. References Liu CJ, Latham NK. 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J Gerontol. 1994;49:M85–94. https://doi.org/10.1093/geronj/49.2.m85 . McWhinnie JR. Disability assessment in population surveys: results of the O.E.C.D. Common Development Effort. Rev Epidemiol Sante Publique. 1981;29:413–9. Hirvensalo M, Lampinen P, Rantanen T. Physical Exercise in Old Age: An Eight-Year Follow-Up Study on Involvement, Motives, and Obstacles among Persons Age 65–84. J Aging Phys Act. 1998;6:157. 1998. https://doi.org/10.1123/japa.6.2.157 Makizako H, Shimada H, Doi T, Tsutsumimoto K, Nakakubo S, Hotta R, et al. Predictive Cutoff Values of the Five-Times Sit-to-Stand Test and the Timed Up & Go Test for Disability Incidence in Older People Dwelling in the Community. Phys Ther. 2017;97:417–24. https://doi.org/10.2522/ptj.20150665 . Chase JAD, Phillips LJ, Brown M. Physical Activity Intervention Effects on Physical Function Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. J Aging Phys Act. 2017;25:149–70. https://doi.org/10.1123/japa.2016-0040 . Wang DXM, Yao J, Zirek Y, Reijnierse EM, Maier AB. Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. J Cachexia Sarcopenia Muscle. 2020;11:3–25. https://doi.org/10.1002/jcsm.12502 . Liu C, Shiroy DM, Jones LY, Clark DO. Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act. 2014;11:95–106. https://doi.org/10.1007/s11556-014-0144-1 . van Dongen EJI, Doets EL, de Groot LCPGM, Dorhout BG, Haveman-Nies A. Process Evaluation of a Combined Lifestyle Intervention for Community-Dwelling Older Adults: ProMuscle in Practice. Gerontologist. 2020;60:1538–54. https://doi.org/10.1093/geront/gnaa027 . Additional Declarations No competing interests reported. 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08:34:33\",\"extension\":\"html\",\"order_by\":6,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":122561,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8424750/v1/089a77e639bfdfcdfd421184.html\"},{\"id\":100866546,\"identity\":\"7e5b46ea-2134-477d-9a44-ae0c10779bce\",\"added_by\":\"auto\",\"created_at\":\"2026-01-22 08:34:32\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":166275,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSPPB outcomes at baseline and after 2-month exercise period by baseline functioning (SPPB\\u0026lt;10 and SPPB≥10).\\u003c/p\\u003e\\n\\u003cp\\u003eMeans and 95% confidence intervals of pre- and post-test results for a) SPPB total score, b) balance score, c) gait speed and d) chair stand time among exercise group participants by baseline functioning (lower-functioning: SPPB score\\u0026lt;10, higher-functioning: SPPB score≥10). Differences between pre- and post-test within groups: t-test. Differences in mean changes (post–pre) between groups: analysis of covariance (ANCOVA) adjusted for age, exercise adherence and exercise group. Statistical significance: **p\\u0026lt;0.01, ***p\\u0026lt;0.001, ns = non-significant. a) ANCOVA: F(1,146) = 84.6, b) ANCOVA: F(1,146) = 25.7, c) ANCOVA: F(1,146) = 2.0, d) ANCOVA: F(1,146) = 37.2. SPPB = Short Physical Performance Battery\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8424750/v1/ca2a088fb5b3bccec5a9a164.png\"},{\"id\":102983197,\"identity\":\"b972580b-ec8e-463d-82d0-cbff4b650035\",\"added_by\":\"auto\",\"created_at\":\"2026-02-19 09:26:54\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1035455,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8424750/v1/3ea763f2-f6cd-47f1-8ade-e0b376811b7c.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Exercise groups implemented by municipalities promote older adults’ physical functioning: the Strength in Old Age Program\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe current demographic development of ageing demands effective promotion of physical activity among older adults. Sound evidence show that physical activity preserves physical functioning [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e] and supports independent living at home [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Particularly strength and balance training are shown to associate with many health-related outcomes, such as frailty, dementia, mobility limitations, and mortality [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Strength or balance training protocols, using controlled [\\u003cspan additionalcitationids=\\\"CR7 CR8\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e] and intervention [\\u003cspan additionalcitationids=\\\"CR11\\\" citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e] study designs, have been carried out among community-dwelling older adults and they have shown systematic improvements in mobility. Importantly, the randomised controlled trial SPRINTT showed that participants with lower baseline physical performance benefited most from the training and had fewer functional limitations at the follow-up [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eNational physical activity programs often fail to show their impacts and face many challenges [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e], such as lack of resources or expertise to carry out research and publish in peer-reviewed journals [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. It is also known that translating theory to practice into real-life setting is challenging and unpredictable [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Thus, creating and practicing evidence-based public health is a demanding task, where long-term impacts are often overlooked in favour of narrow, short-term outcomes. Further, it is less known that there are existing theoretical frameworks available, such as Results-Based Management [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], the Theory of Change [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e] and RE-AIM [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e], which facilitate the planning, guidance, monitoring and evaluation of health enhancing programs.\\u003c/p\\u003e \\u003cp\\u003eThe need to carry out implementation research has become higher in many public health agendas. Thus, to tackle the research-to-practice gap and to show efficacy, we studied a Finnish national physical activity program. This study examines whether physical exercise groups implemented by municipalities are feasible and promote physical and perceived performance of daily activities among community-dwelling older adults in real-life settings. In addition, we studied whether the potential changes in physical functioning varied across different types of exercise groups and depending on the baseline level of physical functioning.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eThe Strength in Old Age Program (hereafter the Program), coordinated by Age Institute in Finland, has launched guided strength and balance exercise for independently living older adults over 75 years of age with decreased physical functioning. Municipalities are chosen on application to participate in the Program for the three-year mentoring to implement the good practices including progressive gym and balance training and mobility assessments. The Program started in 2005.\\u003c/p\\u003e \\u003cp\\u003eThis was a quasi-experimental study conducted in real-life settings. Invitation letters by e-mail were sent to municipalities that were currently or had previously been in the Program. Five municipalities were recruited in the study in 2022. The instructors in the municipalities were advised to recruit older adults aged 75 years or older, who lived independently and had decreased physical functioning. Participants without severe illnesses that prevent exercise were included in the study. In total, 176 voluntary participants were recruited into the guided exercise groups (either Strength-Balance Groups at the gym or Other Exercise Groups not including gym training) for 2 months in 2023. The local exercise instructors in each municipality were sent short written instructions for the study protocol and data collection, and the additional study material (e.g. questionnaires). Exercise instructors were briefed via Microsoft Teams or phone call before the exercise period started.\\u003c/p\\u003e \\u003cp\\u003e Age Institute obtained research permission and data processing agreements from each municipality and wellbeing services counties in the study. Written informed consent was obtained from all participants before the study. Exercise instructors were asked to report all possible adverse events during the exercise sessions. Ethical approval was received from HUS Regional Committee on Medical Research Ethics (HUS/13574/2022).\\u003c/p\\u003e \\u003cp\\u003eIn the five municipalities, altogether 24 Strength-Balance Groups started with 136 participants and three Other Exercise Groups with 40 participants. The Strength-Balance Groups had progressive gym and balance training twice a week. The Other Exercise Groups had chair and balance exercise or senior dance once a week as well as unsupervised home exercise once a week. The length of exercise period varied from 8 to 12 weeks (mean 9.0 weeks). The duration of the exercise sessions was 60\\u0026ndash;75 min in the Strength-Balance Groups and 45\\u0026ndash;75 min in the Other Exercise Groups. The participants in all exercise groups received written nutritional guide for older adults produced by the National Nutrition Council. The exercise instructors of Strength-Balance Groups were advised to discuss on the nutritional themes with participants for 5\\u0026ndash;10 minutes during the exercise sessions.\\u003c/p\\u003e \\u003cp\\u003eShort Physical Performance Battery (SPPB) test was conducted before and after the exercise period by exercise instructors [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. The test includes balance, 4-meter gait and five-time chair stand test. The outcomes were SPPB total score (0\\u0026ndash;12 points), subscores of balance, gait and chair stand tests (0\\u0026ndash;4 points for each), gait time (seconds), gait speed (meter per second) and chair stand time (seconds). The participants were also divided into lower- and higher-functioning groups based on SPPB baseline score (\\u0026lt;\\u0026thinsp;10 points and \\u0026ge;\\u0026thinsp;10 points) to be used in the subgroup analyses.\\u003c/p\\u003e \\u003cp\\u003ePerceived performance of daily activities was assessed by the following question: \\u0026lsquo;How would you rate yourself coping with daily activities?\\u0026rsquo;. The response categories were: \\u0026lsquo;very well\\u0026rsquo;, \\u0026lsquo;well\\u0026rsquo;, \\u0026lsquo;poorly\\u0026rsquo;, and \\u0026lsquo;very poorly\\u0026rsquo;.\\u003c/p\\u003e \\u003cp\\u003eSociodemographic characteristics (age, gender, relationship status, living alone, education, financial difficulties), self-rated health, perceived difficulty in walking 500 m and climbing stairs [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], use of mobility assistive device, and history of falls were self-reported and assessed by a questionnaire at baseline. Physical activity was assessed by a single-item scale [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e], slightly modified. Attendance to guided exercise sessions was monitored by the exercise instructors. Exercise adherence rate (%) was calculated as the number of exercises attended divided by the number of sessions offered. Self-reported adverse events were collected by a questionnaire after the exercise period.\\u003c/p\\u003e \\u003cp\\u003eDescriptives are presented as percentages for categorical variables and means with standard deviation (SD) for continuous variables. Normality of continuous variables were assessed by examining skewness and kurtosis. Differences between baseline and follow-up within groups were analyzed by paired sample t-test. Analysis of covariance (ANCOVA) were performed for analyzing differences in changes of SPPB outcomes (SPPB total score, balance score, gait speed, chair stand time) between participant with lower and higher functioning (SPPB baseline score\\u0026thinsp;\\u0026lt;\\u0026thinsp;10 and \\u0026ge;\\u0026thinsp;10). The change variables (i.e. post\\u0026ndash;baseline) were treated as continuous variables. Models were adjusted for age, exercise adherence and the type of exercise group. Wilcoxon signed-rank test was used for analyzing changes in perceived performance of daily activities between baseline and follow-up. Subgroup analyses were performed by exercise group and baseline functioning status.\\u003c/p\\u003e \\u003cp\\u003eThe goal was to recruit at least 50 participants in both exercise groups. Sample size was calculated with power calculations based on change in chair stand test of SPPB and included anticipated dropout level of 15% [22]. Participants having both pre- and post-test results (n\\u0026thinsp;=\\u0026thinsp;147\\u0026ndash;151) were included in the analysis. Out of the 176 recruited participants, 25 persons were lost to follow-up. Sensitivity analyses were conducted for dropouts of SPPB (n\\u0026thinsp;=\\u0026thinsp;25). SPSS version 29.0.2.0 was used for the analysis.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eParticipants (n\\u0026thinsp;=\\u0026thinsp;176) had a mean age of 79.5 years (SD 4.2) and 75% were women, 44% were in a relationship, 59% lived alone, 43% were highly educated, and 81% perceived no financial difficulties with current income (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Of the participants, 49% reported good or fairly good health, 66% were physically active, 69% had no difficulties in walking 500 meters, 72% had no difficulties in climbing stairs, 38% used mobility assistive device, 30% had history of falls in the past half year. Mean adherence to guided exercise sessions was 87%.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eBaseline characteristics of participants by exercise group\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAll\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;176)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eStrength-Balance\\u003c/p\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;136)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eOther Exercise Group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;40)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAge, years, mean\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e79.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e79.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e81.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eWomen (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e75.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e70.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e90.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eIn a relationship (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e44.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e30.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eLiving alone (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e58.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e54.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e72.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eEducation (%) \\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLow\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e38.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMedium\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHigh\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e43.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e43.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eGetting on with available income without difficulties (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e80.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e77.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e92.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eGood or fairly good self-rated health (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e48.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e52.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical activity (%) \\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLow (1\\u0026ndash;2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e33.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e39.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eModerate (3\\u0026ndash;4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e45.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e43.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e53.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHigh (5\\u0026ndash;6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e33.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eWalking 500 m without difficulties (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e69.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e65.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e79.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eClimbing stairs without difficulties (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e72.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e71.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e72.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eMobility assistive device (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e42.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eFalls during last half year (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOnce\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMore than once\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAdherence rate to exercise (%), mean \\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e87.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e87.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e89.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003eNote: Based on self-reported information, except for adherence rate reported by exercise group instructors.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003csup\\u003ea\\u003c/sup\\u003e Education: Low (Elementary school, basic education or lower secondary education), Medium (Vocational school/equivalent or upper secondary education/high school), High (Non-university lower education, Bachelor\\u0026rsquo;s Degree (university of applied science/ college/similar) or Master\\u0026rsquo;s Degree (university degree/MA/similar).\\u003c/p\\u003e \\u003cp\\u003e \\u003csup\\u003eb\\u003c/sup\\u003e Physical activity: Low (1\\u0026thinsp;=\\u0026thinsp;not moving more than is necessary to perform daily activities, 2\\u0026thinsp;=\\u0026thinsp;casual walks and light outdoor recreation 1\\u0026ndash;2 times/week, Moderate (3\\u0026thinsp;=\\u0026thinsp;casual walks and light outdoor recreation several times a week; 4\\u0026thinsp;=\\u0026thinsp;1\\u0026ndash;2 times/week brisk physical activity), High (5\\u0026thinsp;=\\u0026thinsp;3\\u0026ndash;5 times/week a brisk physical activity, 6\\u0026thinsp;=\\u0026thinsp;fitness exercises several times a week).\\u003c/p\\u003e \\u003cp\\u003e \\u003csup\\u003ec\\u003c/sup\\u003e Adherence rate to exercise as percentage: Number of exercise sessions attended of maximum number of exercise sessions offered (%)\\u003c/p\\u003e \\u003cp\\u003eThere were statistically significant improvements (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e) in the SPPB total score (pre: mean 9.9, post: mean 11.1, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), balance score (pre: mean 3.3, post: mean 3.7, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), gait time (pre: mean 3.8, post: mean 3.4, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), gait speed (pre: mean 1.1, post: mean 1.3, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), gait score (pre: mean 3.8, post: mean 3.9, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), chair stand time (pre: mean 13.4, post: mean 10.9, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and chair stand score (pre: mean 2.9, post: mean 3.5, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) among all participants (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). There were also statistically significant changes between pre- and post-test within both exercise groups. Only in gait score among participants in the Other Exercise Group we found no statistically significant changes. The SPPB total score improved in 59%, remained unchanged in 36% and decreased in 5% of the participants.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSPPB outcomes at baseline and after the 2-month exercise period among exercise group participants (n\\u0026thinsp;=\\u0026thinsp;151)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"10\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eAll\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;151)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003eStrength-Balance Group (n\\u0026thinsp;=\\u0026thinsp;117)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c10\\\" namest=\\\"c9\\\"\\u003e \\u003cp\\u003eOther Exercise Group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;34)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePre\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePost \\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePre\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePost \\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003ePre\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003ePost \\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSPPB: Total score\\u003c/p\\u003e \\u003cp\\u003e(0\\u0026ndash;12), mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9.9 (2.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11.1 (1.4) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e9.8 (2.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e11.0 (1.5) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e10.4 (1.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e11.2 (1.1) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026le;\\u0026thinsp;9 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e38.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e8.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e29.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e5.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e16.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e14.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e14.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e14.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e17.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e24.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e20.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e23.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e53.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e27.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e52.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e35.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e55.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSPPB: Balance score (0\\u0026ndash;4), mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.3 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.7 (0.6) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.2 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e3.7 (0.6) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3.5 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e3.8 (0.5) **\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e23.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e6.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e11.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e5.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e16.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e17.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e17.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e5.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e57.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e78.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e54.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e76.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e67.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e88.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSPPB: Gait time (s), mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.8 (1.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.4 (1.3) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.9 (1.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e3.4 (1.4) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3.7 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e3.3 (0.8) **\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSPPB: Gait speed (m/s), mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.1 (0.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.3 (0.3) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.1 (0.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.3 (0.3) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.1 (0.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e1.3 (0.3) **\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSPPB: Gait score (0\\u0026ndash;4), mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.8 (0.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.9 (0.4) **\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.8 (0.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e3.9 (0.5) *\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3.9 (0.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e3.9 (0.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e2.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e10.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e3.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e86.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e94.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e85.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e93.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e91.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e97.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSPPB: Chair stand time (s), mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13.4 (4.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.9 (2.8) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e13.7 (5.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e10.9 (3.0) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e12.3 (3.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e10.9 (2.1) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSPPB: Chair stand score (0\\u0026ndash;4), mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.9 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.5 (0.8) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.8 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e3.5 (0.8) ***\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3.0 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e3.5 (0.7) **\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e17.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e4.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e11.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e18.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e23.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e11.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e27.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e26.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e26.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e20.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e29.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e62.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e36.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e63.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e44.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e58.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003e\\u003csup\\u003ea\\u003c/sup\\u003e Paired sample t-test; *\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05, **\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01, ***\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001; SPPB\\u0026thinsp;=\\u0026thinsp;Short Physical Performance Battery. SD\\u0026thinsp;=\\u0026thinsp;Standard deviation. Including participants having both pre- and post-test results\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eWhen looking at the changes in all the SPPB components stratified by baseline functioning (SPPB\\u0026thinsp;\\u0026lt;\\u0026thinsp;10 and \\u0026ge;\\u0026thinsp;10), both lower-functioning group and higher-functioning group improved their test results of the SPPB after the exercise period (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Participants with lower baseline score had greater improvements compared to the participants with better baseline score. There were statistically significant differences in changes in the SPPB total score (lower-functioning group: mean change 2.3; higher-functioning group: mean change 0.5, F\\u0026thinsp;=\\u0026thinsp;84.6, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), balance score (0.9 and 0.2, respectively; F\\u0026thinsp;=\\u0026thinsp;25.7, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and chair stand time (-4.6 and \\u0026minus;\\u0026thinsp;1.3, respectively; F\\u0026thinsp;=\\u0026thinsp;37.2, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), when adjusted for age, exercise adherence and exercise group. For gait speed, we found no difference in the magnitude of improvement between lower and higher-functioning group.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eMeans and 95% confidence intervals of pre- and post-test results for a) SPPB total score, b) balance score, c) gait speed and d) chair stand time among exercise group participants by baseline functioning (lower-functioning: SPPB score\\u0026thinsp;\\u0026lt;\\u0026thinsp;10, higher-functioning: SPPB score\\u0026thinsp;\\u0026ge;\\u0026thinsp;10). Differences between pre- and post-test within groups: t-test. Differences in mean changes (post\\u0026ndash;pre) between groups: analysis of covariance (ANCOVA) adjusted for age, exercise adherence and exercise group. Statistical significance: **p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01, ***p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, ns\\u0026thinsp;=\\u0026thinsp;non-significant. a) ANCOVA: F(1,146)\\u0026thinsp;=\\u0026thinsp;84.6, b) ANCOVA: F(1,146)\\u0026thinsp;=\\u0026thinsp;25.7, c) ANCOVA: F(1,146)\\u0026thinsp;=\\u0026thinsp;2.0, d) ANCOVA: F(1,146)\\u0026thinsp;=\\u0026thinsp;37.2. SPPB\\u0026thinsp;=\\u0026thinsp;Short Physical Performance Battery\\u003c/p\\u003e \\u003cp\\u003eStatistically significant improvements were found between the baseline and 2-month follow-up in perceived performance of daily activities (Z=-2.14, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.033) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Improvement was seen in the proportion of those who performed very well in daily activities (pre: 20.5%, post: 30.1%). Differences in perceived performance of daily activities at baseline and follow-up were also statistically significant in the Strength-Balance Group (from 19.8% to 32.4%; Z=-2.50, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.012), but not in the Other Exercise Group (Z\\u0026thinsp;=\\u0026thinsp;0.00, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;1.000). Subgroup analysis showed that the participants with higher SPPB score at baseline (\\u0026ge;\\u0026thinsp;10 points) reported better performance in daily activities after the exercise period (Z=-2.35, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.019), but any change weren\\u0026rsquo;t seen among the participants with lower SPPB baseline score (\\u0026lt;\\u0026thinsp;10 points) (Z=-0.30, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.763).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePerceived performance of daily activities at baseline and after the 2-month exercise period\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"12\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eAll\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;146)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eStrength-Balance Group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;111)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c8\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003eOther Exercise Group\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;35)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c10\\\" namest=\\\"c9\\\"\\u003e \\u003cp\\u003eLower functioning at baseline\\u003c/p\\u003e \\u003cp\\u003e(SPPB\\u0026thinsp;\\u0026lt;\\u0026thinsp;10, n\\u0026thinsp;=\\u0026thinsp;53)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c12\\\" namest=\\\"c11\\\"\\u003e \\u003cp\\u003eHigher functioning at baseline\\u003c/p\\u003e \\u003cp\\u003e(SPPB\\u0026thinsp;\\u0026ge;\\u0026thinsp;10, n\\u0026thinsp;=\\u0026thinsp;88)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePre\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePost\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ePre\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePost\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePre\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003ePost\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003ePre\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003ePost\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003ePre\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003ePost\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePerceived performance of daily activities (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.033\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.763\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.019\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVery well\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e19.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e32.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e22.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e22.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e9.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e30.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e43.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWell\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e70.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e60.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e69.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e55.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e74.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e74.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e81.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e71.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e65.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e54.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoorly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e11.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e2.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e15.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e18.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e3.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e2.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVery poorly\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"12\\\"\\u003eThe \\u003cem\\u003ep\\u003c/em\\u003e-values (Wilcoxon signed-rank tests) compare changes between pre- and post-tests within each group; SPPB\\u0026thinsp;=\\u0026thinsp;Short Physical Performance Battery\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eSensitivity analysis showed no statistically significant differences in the SPPB outcomes at baseline between the dropouts having only pre-test (n\\u0026thinsp;=\\u0026thinsp;25) and the participants who attended to both pre- and post-test. Adherence to exercise sessions of dropouts was moderate (mean 67%, median 75%).\\u003c/p\\u003e \\u003cp\\u003eSeven of the participants reported adverse events of exercise group participation after the exercise period, such as knee, back or hip pain (n\\u0026thinsp;=\\u0026thinsp;5), muscle soreness (n\\u0026thinsp;=\\u0026thinsp;1) or under-recovery (n\\u0026thinsp;=\\u0026thinsp;1). One participant reported that physician had told to stop the group participation due to worsen back and hip conditions (n\\u0026thinsp;=\\u0026thinsp;1).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study using a real-life setting of a national physical activity program, we found that municipalities can implement physical exercise groups and mobility tests successfully and promote physical functioning among community-dwelling older adults. Our results showed improvements in physical performance after two months of group exercise when measured with SPPB and self-rated performance in daily activities. Our findings indicate that especially older adults with lower functioning at baseline and those participated in strength and balance training at gym may benefit the most from guided group exercise organized by municipalities.\\u003c/p\\u003e \\u003cp\\u003eSimilar results to our findings have been reported before in more controlled study designs [\\u003cspan additionalcitationids=\\\"CR7 CR8 CR9 CR10 CR11\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Our subgroup analysis revealed that functioning measured by SPPB (total score, balance and chair stand time but not gait speed) improved more among the participants who had lower baseline functioning (i.e. SPPB score\\u0026thinsp;\\u0026lt;\\u0026thinsp;10), as shown in previous study [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. In addition, the participants with higher functioning and those who attended strength-balance training at gym reported better performance in daily activities. Similar interpretations were drawn in a review suggesting that effects may vary based on training intensity and target group [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Our findings indicate that while the access to the exercise groups must be open to all citizens, the most efficient outcomes may be seen in those already experiencing limited mobility and in gym-based groups. Yet, it is important to acknowledge that the changes in different outcomes in our study were seen for all, showing that all types of training in any participant were seen beneficial on average.\\u003c/p\\u003e \\u003cp\\u003eLower physical performance is known to increase the risk for activities of daily living disability [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Interestingly, despite the greatest improvements in SPPB outcomes among older adults with lower functioning in the present study, the training period was not found to associate with better self-rated performance of everyday activities after the exercise period. On the contrary, the participants with higher baseline functioning (SPPB score\\u0026thinsp;\\u0026ge;\\u0026thinsp;10) perceived better ability to perform daily activities after exercise group participation. Participants in the strength-balance groups at gym but not in the other groups perceived improvements in daily activities, suggesting that gym training twice a week might have some extra benefits over other type of training once a week. Everyday activities may require quite good fitness level, indicating the need for longer exercise period for older adults with lower functioning. Transferring improvements in physical performance to better performance in daily activities may also need e.g. functional training [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. Many other factors not studied here, such as living circumstances, may also be related to the older adults\\u0026rsquo; perceptions about their ability to perform daily chores. Yet, majority of study participants reported good ability to perform daily activities already at baseline. More research is needed to assess the effects of different types of exercise on daily activities among different target groups.\\u003c/p\\u003e \\u003cp\\u003eSince our study design was real-life setting, it is important to study feasibility. The organizing of the groups was implemented in five municipalities according to planned schedule and all exercise groups were carried out accordingly. The adherence rate was high, 87%, indicating good motivational level by the older adults. Many other studies have evaluated the feasibility (e.g. [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]) in terms of implementation process, adherence, supervision, social aspects and fit within real-life situation. We perceived the real-life setting particularly important, as the study was a) implemented as part of the Program implementation and mentoring, b) the municipal exercise instructors carried out the research protocol as part of their normal daily routines, and c) the participants were laypeople from the community who participated voluntarily.\\u003c/p\\u003e \\u003cp\\u003eSince we carried out our study in real-life settings, we realized some relevant points to discuss regarding the participants. We had no strict screenings to enter the study, and all participants had a sufficient health status to be included in the study. As a result of loose entrance, the sample had heterogeneous baseline functioning. The heterogeneity showed that those with lower baseline functioning improved most their performance score. This suggests that in real life, better implementation results could be obtained if the exercise groups were more carefully formed based on baseline functioning level. Thus, more emphasis should be paid to the recruitment of the participants in the exercise groups. For example, health care professionals could guide the persons with frailty and sarcopenia to join the groups. The exercise counselling chain from health care sector to services in sports sector could benefit from more careful participant profile analysis.\\u003c/p\\u003e \\u003cp\\u003eOur study has several strengths and limitations. Strengths include the novelty value of our real-life setting, measured SPPB outcomes for efficacy, and good adherence to exercise and post-tests among older adults. The limitations of our study are the lack of control group that was not possible to create in the real-life setting with volunteers and the study framework which limits our conclusions on causality. Further, our study is limited with its sample that also included participants with fairly good baseline SPPB score and the ceiling effect with it. It was difficult to improve functioning among those who were already close to maximum points. Another limitation of our sample was a slightly smaller sample size in the Other Exercise Group, which may have lowered statistical power to observe changes or differences across the exercise groups. Further, we did not follow the adherence to home-exercise sessions.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eThe study of a national physical activity program, \\u0026lsquo;Strength in Old Age\\u0026rsquo;, showed that exercise groups organized by municipalities are effective in improving physical functioning among community-dwelling older adults in real-life setting. The findings indicate that exercise may improve physical functioning more among those older adults who have lower physical performance level and among those who participate in strength and balance training at gym. Baseline testing is recommended to identify the target groups that might benefit from training the most.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSPPB\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eShort Physical Performance Battery\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthical approval and informed consent\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study received ethical approval from the Helsinki University Hospital Regional Committee on Medical Research Ethics (Helsinki, Finland, no. HUS/13574/2022). Informed consent was obtained from all individual participants included in the study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting of interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis work was supported by the Juho Vainio Foundation (Grant numbers 202200084, 202300435, 202400124) and the P\\u0026auml;ivikki and Sakari Sohlberg Foundation (Grant number 22008).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors contributed to the study conception, design and material preparation. Data collection and analysis were performed by ES, KB and ER. The first draft of the manuscript was written by ES and KB. All authors contributed to review and editing of the manuscript and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe thank all the participants in the exercise groups, the municipal exercise instructors and decision makers for their work in H\\u0026auml;meenlinna, Kankaanp\\u0026auml;\\u0026auml;, Kerava, Pudasj\\u0026auml;rvi and Turku.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eLiu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. 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Phys Ther. 2017;97:417\\u0026ndash;24. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.2522/ptj.20150665\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eChase JAD, Phillips LJ, Brown M. Physical Activity Intervention Effects on Physical Function Among Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. J Aging Phys Act. 2017;25:149\\u0026ndash;70. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1123/japa.2016-0040\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eWang DXM, Yao J, Zirek Y, Reijnierse EM, Maier AB. Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. J Cachexia Sarcopenia Muscle. 2020;11:3\\u0026ndash;25. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1002/jcsm.12502\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003eLiu C, Shiroy DM, Jones LY, Clark DO. Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act. 2014;11:95\\u0026ndash;106. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s11556-014-0144-1\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003evan Dongen EJI, Doets EL, de Groot LCPGM, Dorhout BG, Haveman-Nies A. Process Evaluation of a Combined Lifestyle Intervention for Community-Dwelling Older Adults: ProMuscle in Practice. Gerontologist. 2020;60:1538\\u0026ndash;54. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1093/geront/gnaa027\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Community-dwelling, Implementation, Older adults, Physical activity, Physical fitness, Program evaluation, Short Physical Performance Battery\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8424750/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8424750/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eThe implementation and outcomes of physical activity promotion programs are less studied. This study examines whether physical exercise groups implemented by municipalities are feasible and promote physical functioning among community-dwelling older adults in real-life settings.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eFive municipalities participating in the Strength in Old Age Program organized guided exercise to 176 voluntary participants (79.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.2 years, 75% women), who were recruited into Strength-Balance training Groups (twice a week) or Other Exercise Groups (e.g. chair and balance exercise or senior dance once a week plus home exercise). SPPB was conducted by local exercise instructors and perceived daily activity performance was assessed before and after the 8\\u0026ndash;12-week exercise period. Changes in outcomes by exercise group and baseline functioning were analyzed.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eAverage attendance rate to exercise sessions was 87%. Both exercise groups showed significant improvement in the SPPB score, balance score, gait speed and chair stand time. Participants with lower SPPB baseline score (SPPB\\u0026thinsp;\\u0026lt;\\u0026thinsp;10) had a greater improvement in the SPPB score, balance score and chair stand time compared to the participants with better baseline functioning (SPPB\\u0026thinsp;\\u0026ge;\\u0026thinsp;10). No significant differences in changes of gait speed were found between lower- and higher-functioning groups. Significant improvement was found in perceived performance of daily activities. Subgroup analysis revealed that the improvement occurred in the Strength-Balance Groups and among participants with higher functioning.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eIn real-life settings, municipalities successfully implemented physical exercise groups and mobility tests. Older adults\\u0026rsquo; physical functioning improved. For municipal exercise groups, it is recommended to include baseline testing and to pay attention to the recruitment of participants with lower physical functioning.\\u003c/p\\u003e\\u003ch2\\u003eTrial registration\\u003c/h2\\u003e \\u003cp\\u003eClinical trial number: not applicable\\u003c/p\\u003e\",\"manuscriptTitle\":\"Exercise groups implemented by municipalities promote older adults’ physical functioning: the Strength in Old Age Program\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-01-22 08:34:27\",\"doi\":\"10.21203/rs.3.rs-8424750/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"9ac353c7-fe2b-40e5-b5bd-08f96baee572\",\"owner\":[],\"postedDate\":\"January 22nd, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-02-19T09:25:58+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-01-22 08:34:27\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8424750\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8424750\",\"identity\":\"rs-8424750\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}