Evaluation of exergames intervention on the functional abilities of 65+ older adults with frailty and pre-frailty syndrome

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Frailty is an increasingly diagnosed condition of increased susceptibility of older people to deterioration of their overall health, functional capacity and independence. According to the latest scientific reports, frailty syndrome therapy should be comprehensive, and the first-line treatment should include a multi-component physical activity program. The aim of the study was to evaluate the impact of exercise games intervention (exergames) on the functional abilities of 65+ older adults with frailty and pre-frailty syndrome. Methods. The study was conducted in 111 patients (31 men, 80 women) aged 65–89 who volunteered for an exergames rehabilitation program. The diagnosis of frailty was based on the Linda Fried criteria. A 6-week standardized training program was carried out with the use of the game rehabilitation platform with Kinect sensor. The subjects exercised under the supervision of an instructor for at least 30 minutes twice a week. The comprehensive geriatric assessment was conducted before and after the intervention. Results. The study showed significant improvement in the frailty status and scores with Kinect-based exergaming for the frail older adults. The exergames intervention elicited a modest but statistically significant reduction in overall frailty and the mean Fried frailty score decreased from 1.52 ± 1.38 before intervention to 1.39 ± 1.27 after intervention (W=72.5, p = 0.008, power=0.79). The most pronounced functional gains—including significant improvements in muscle strength (arm curl test repetitions: p = 0.023, power = 0.65, 30-second chair stand performance: p = 0.002, power = 0.90), gait speed and endurance (2-Minute Step-in-Place test: p < 0.001, power = 0.98) and balance (8-Foot Up-and-Go test: p = 0.001, power = 0.95) —were observed among pre-frail individuals. A positive effect of intervention on reducing the risk of falls was found in both pre-frail (p=0.013, power=0.77) and frail older adults (p=0.008, power=0.85). Conclusions. Exergaming exerts positive effect on the functional abilities of frail and pre-frail older adults and could be considered in clinical settings to address frailty. The findings highlight the importance of initiating physical interventions as early as possible, ideally before the onset of full frailty, to maximize adherence and therapeutic effect of the intervention. Trial registration. This study has been registered in the ClinicalTrials.gov database and has been assigned the ID NCT07036224. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research exergaming exergames frailty physical performance aged primary care Introduction Frailty is an increasingly diagnosed condition of increased susceptibility of older people to deterioration of their overall health, functional capacity and independence. The frailty process appears to be a transitional state in a dynamic progression from robustness to functional decline. During this process, total physiological reserves decline and become less likely to be adequate to maintain and repair the aging organism [ 1 ]. Frailty should be distinguished from aging and, unlike aging, can be prevented, slowed, delayed, and even reversed [ 1 – 3 ]. A scoping review conducted by Ho et al. showed that a similar number of older adults improved in frailty status as worsened (9.4% – 32.8% versus 11.0% – 34.0%) over 2–6.4 years [ 4 ]. The global prevalence of frailty was estimated at 3.5–27.3% and it was demonstrated that the prevalence of frailty syndrome increases with age; in people over 85 years of age, in the American population, 25% of the Caucasian subjects and almost 50% of African Americans met the criteria for frailty syndrome [ 5 ]. A cross-sectional study of community-dwelling adults aged ≥ 60 years found that 22.1% of older people were assessed as frail and 45.6% as prefrail [ 6 ]. In turn, a meta-analysis recently conducted by O'Caoimh et al. showed that the pooled prevalence of physical frailty and pre-frailty was 12% and 46%, respectively, in adults aged ≥ 50 [ 7 ]. Frailty increases the risk of hospitalization, institutionalization, disability and death [ 8 , 9 ]. According to Vermeiren et al. frailty increases the risk of mortality by 1.8–2.3 times, loss of activities of daily living by 1.6–2.0 times, hospitalization by 1.2–1.8 times, physical limitation by 1.5–2.6 times, and falls and fractures by 1.2–2.8 times in adults aged ≥ 65 [ 10 ]. Moreover, taking into account population prevalence and multivariate adjusted relative risks, Shamliyan et al. estimated that 3–5% of deaths in the elderly could be delayed if frailty was prevented [ 11 ]. According to the latest scientific reports, frailty therapy should be comprehensive [ 3 , 12 – 15 ], and the first-line treatment should include a multi-component physical activity program with a component of strength training and exercises for balance and flexibility [ 12 , 16 , 17 ]. Numerous studies have shown that exercise is crucial for improving physical fitness and overall health in frail older adults [ 12 , 18 – 20 ]. Physical exercises can improve frailty by exerting positive effects on skeletal muscles and cardiovascular, respiratory, and endocrine systems by reducing age-related oxidative damage and chronic inflammation, improving mitochondrial function, increasing autophagy, and increasing insulin sensitivity [ 16 ]. Exercise improves balance and coordination in older people, increases walking speed, muscle strength, range of motion, reduces the risk of falls, increases bone mineral density, relieves joint pain, improves mood, and improves cognitive abilities [ 11 ]. The multimorbidity and multidimensionality of the needs of people with frailty syndrome is a challenge for the selection of an appropriate rehabilitation program. Low interest in traditional exercise and physical activity in older people is often associated with kinesiophobia, fear of injury and lack of motivation [ 21 ]. Exergames are a new area of research in the rehabilitation of people with frailty. Exergaming is a kind of physical activity that requires players to do physical exercises to play a video game [ 22 ]. It enables solo or team training through body gestures using motion-sensing devices. Exergames seem to be acceptable by the older adults [ 23 , 24 ] enable simultaneous physical and cognitive skills training, offering multisensory feedback and opportunities for repetitive practice [ 25 ]. A meta-analysis of energy expenditure in digital exercise games showed that playing exercise games by older people significantly increases heart rate, oxygen intake and energy expenditure compared to rest, and may also facilitate the promotion of low- to moderate-intensity physical activity [ 26 , 27 ]. Exergaming is described as safe and relatively easy for older people to perform, and no published studies have shown adverse events related to this specific form of training [ 28 ]. After receiving instructions and familiarizing themselves with the exercises, stroke patients, cardiac patients and older patients with Parkinson`s disease had no problems with the game [ 28 – 30 ]. In turn, a systematic review conducted by Valenzuela et.al. showed that adherence rate to technology-based exercise programs, like exergames, is high (median 91.3%) and significantly higher than adherence rate found in conventional exercise programs (median 83.6%) [ 31 ]. The use of exergaming in frailty patients seems promising and several studies reported positive effects of such intervention on individual outcomes for older adults [ 32 – 40 ]. However the latest systematic review and meta-analysis conducted by Ho et al. showed that only five studies met eligibility criteria and could be included into the analysis; in all cases the studied groups were small and the certainty of the evidence was low [ 41 ]. Thus, given the urgent need for continued research in this area, the aim of our study was to evaluate the impact of exergames intervention on the functional abilities of 65 + older adults with frailty and pre-frailty syndrome. Before commencing the research project, the study design received approval from the Bioethics Committee at the Wroclaw Medical University (Approval No. — 172/2019 from March 5th 2019). All study participants gave written consent to participate in the study. All procedures were performed in accordance with the 1964 Helsinki Declaration and its later amendments. This study has been registered retrospectively (June 25th 2025) in the ClinicalTrials.gov database and has been assigned the ID NCT07036224 ( https://clinicaltrials.gov/study/NCT07036224 ). CONSORT and STROBE checklist has been included as a Supplementary files as well as trial protocol file. Material and methods Participants The study was conducted among 186 volunteers aged 65 to 89 years between March 2022 to November 2024 at a primary healthcare clinic in Wroclaw, Poland. Project was the continuation of preliminary research conducted by JW as her doctoral thesis [42]. Ultimately, 111 participants completed the full exercise program and filled in the required diagnostic tools. The most common reasons for withdrawal from the study included: exacerbation of chronic diseases. difficulties in accessing the study site (e.g., lack of availability of family members to provide transportation) or feeling too weak to continue exercising. For more detailed information, see Results. 80 participants were women (72.07%). The mean age of the subjects was 75.17 years (SD = 5.89). The majority of the participants had secondary education (N = 56, 50.9%) or higher education (N = 47, 43.3%). Participants were recruited through advertisements posted in the primary healthcare clinic and actively by physicians during medical visits. Each participant provided written informed consent to participate in the study and was informed about the purpose of the study, its procedure, and the possibility of withdrawing at any stage. The study procedures ensured the anonymity of the collected data. The inclusion criteria for the study were: age over 64 years and no medical contraindications to performing physical exercises in a standing position. The exclusion criteria included a diagnosed moderate or severe stage of dementia, as well as the presence of chronic diseases (e.g. chronic obstructive pulmonary disease, asthma, heart failure, arterial hypertension) that were uncontrolled or in an exacerbation phase. Anthropometric assessment To assess the measured variables, anthropometric measurements were used, including height, body weight, body mass index (BMI), and arm circumference. Body fat percentage and muscle mass were assessed using the InBody 270 scale, based on the bioelectrical impedance analysis (BIA) method. Handgrip strength was assessed using a hand dynamometer. Measurements were taken before the start of the study and after the participant completed the exercise program. Training program The participants underwent a six-week standardized training program using the Activlife rehabilitation platform designed for exergaming. The platform allows for the performance of physical exercises in a standing position while providing additional stabilization through a supportive harness with a built-in seat. The training utilized a Kinect motion sensor to track movements and ensure proper exercise execution. Participants took part in therapeutic games available within the VRTherapist application, dedicated to the Activlife platform, which incorporates movement-based games aimed at rehabilitation and functional improvement. Training protocol consisted of endurance exercises, general fitness training with elements of resistance exercises, balance and stability exercises, as well as cognitive tasks targeting memory and visuospatial orientation. A single set of exercises included the use of seven exergames concerning the movements of abduction, adduction, lifting and lowering of the upper and lower limbs, rotation of the upper limbs, flexion, rotation and oblique movements of the spine, as well as stepping exercises and precise hand movements. During these exercises, it was necessary to, for example, repeat the pose taken by a game character, collect virtual elements using body movements or imitate the flight of a spacecraft. The next two exergames included logical exercises and solving problems, e.g. simple mathematical tasks or puzzles. The training was supervised and individually tailored using the Activlife device. Participants exercised under the supervision of an instructor for 30 minutes, twice a week, over the six-week period. The parameters of the exergames were modified by JW and AF approximately every two weeks to adjust the difficulty and intensity of the tasks to the changing physical capabilities of each participant so that the exercises remain engaging and do not become boring. Assessment Instruments Before participating in the training program, as well as after its completion, the participants were evaluated using the diagnostic methods described below. Fried frailty criteria One of the diagnostic methods for frailty is patient classification using the frailty phenotype criteria proposed by Fried [8]. These criteria include: unintentional weight loss greater than 5 kg or 10% of body weight over the past year, weakness in handgrip strength, gait slowing, subjective feeling of exhaustion, and physical activity limitation. A score of one point was assigned for each criterion met. For the subjective exhaustion criterion, one point was given if the participant answered positively (i.e., "yes, for a short time" or "yes, for a moderate time") to questions 7 or 20 on the Center for Epidemiological Studies-Depression Scale (CES-D) [43]. For the physical activity limitation criterion, one point was awarded if the participant’s response to the short form of the International Physical Activity Questionnaire indicated insufficient physical activity. The threshold values for handgrip strength and gait slowing are presented in Table 1. Table 1. Threshold values for assigning points in Fried frailty scale for gait slowing and muscle weakness [8]. Gait slowing Time to walk a distance of 4.6 meters measured in seconds [s] (adjusted for height [cm]). Handgrip strength (adjusted for BMI kg/m 2 ) Female Male Female Male Height Time Height Time BMI Handgrip strength BMI Handgrip strength ≤ 159 cm ≥ 7s ≤ 173 cm ≥ 7s ≤23 ≤ 17,0 kg ≤ 24 ≤ 29 kg 23,1-26 ≤ 17,3 kg 24,1-26 ≤ 30 kg >159 cm ≥ 6s >173 cm ≥ 6s 26,1-28 ≤ 18 kg 26,1-28 ≤ 30 kg >29 ≤ 21 kg >28 ≤ 32 kg Frailty syndrome was diagnosed based on the following criteria according to the Fried scale (i.e., at least 3 out of 5 criteria). The pre-frailty group included individuals who met 1 or 2 of the following criteria, while the robust group included individuals who did not meet any of the criteria below. Center for Epidemiological Studies-Depression Scale Center for Epidemiological Studies-Depression Scale (CES-D) is one of the brief-self report screening diagnostic tools used to assess depression symptoms. CES-D consists of 20 questions pointed from 0 to 3 and assess cognitive, affective and somatic symptoms of depression. It can be considered a fairly sensitive and specific screening tool for detecting symptoms of depressive disorders [44]. Scores obtained in CES-D range from 0 to 60, and a score of 15 or higher indicates a risk for depression. In 2013, the Polish version of CES-D was validated [45]. International Physical Activity Questionnaire - short version The International Physical Activity Questionnaire (IPAQ) is a self-report questionnaire designed to assess the level of physical activity of the respondent and is also available in the Polish language version [46,47]. In this study, the short form of the questionnaire (IPAQ-SF) was used to evaluate physical activity. This version consists of 7 questions concerning different types of physical activities that are part of daily life and last for at least 10 minutes at a time. The energy expenditure of each type of activity is expressed in METs (Metabolic Equivalent of Work). The following MET values were adopted for specific activities: walking — 3.3 METs; moderate-intensity activity — 4.0 METs; and vigorous-intensity activity — 8.0 METs. Based on the total weekly energy expenditure, three categories of physical activity were distinguished: low physical activity — when the total energy expenditure does not reach 600 MET-minutes/week; moderate physical activity — when the total energy expenditure is between 600 and 1500 MET-minutes/week; and high physical activity — when the total energy expenditure exceeds 1500 MET-minutes/week. Katz Index of Independence in Activities of Daily Living The Katz Index of Independence in Activities of Daily Living (ADL), developed by Katz et al. in the 1960s, is a tool designed to assess basic activities of daily living in older adults, both in clinical practice and research settings [48]. The index evaluates six fundamental self-care activities: bathing, dressing, toileting, transferring (e.g., from bed to chair), continence, and feeding. Responses are provided in a dichotomous format — “yes” or “no” — depending on whether the individual is able to perform each task independently. The total score reflects the level of functional ability: a score of 6 indicates full independence, a score between 3 and 5 suggests moderate functional impairment, while a score of 2 or less indicates severe functional dependence. The Lawton-Brody Instrumental Activities of Daily Living Scale The Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) was developed as a tool to assess the level of functional independence in the general older adults population [49]. The scale evaluates eight complex daily activities necessary for independent living, including: using the telephone, shopping, meal preparation, housekeeping, laundry, transportation, medication management, and handling finances. The IADL is administered as a self-report questionnaire or through an interview with the patient or their primary caregiver. In the version used in this study, each item is scored from 1 to 3 points: a score of 3 indicates that the patient is able to perform the activity independently, 2 points indicate the ability to perform the activity with minimal assistance, and 1 point indicates complete dependence in performing the activity. The maximum total score is 24 points, with higher scores reflecting a greater level of functional independence. Vulnerable Elders Survey-13 The Vulnerable Elders Survey-13 (VES-13) is a diagnostic tool designed to assess the current overall functional status of older adults. It consists of 13 questions grouped into two categories evaluating functional and physical performance [50]. A score of 3 or more points on the VES-13 indicates an increased risk of significant health deterioration, functional decline, or death within the next two years, and serves as a recommendation for conducting a more comprehensive geriatric assessment. Tinetti Test/Performance Oriented Mobility Assessment The Tinetti Test, also known as the Performance Oriented Mobility Assessment (POMA), is a clinical tool used to evaluate both static and dynamic balance in older adults [51]. The assessment involves five tasks: transitioning from a sitting to a standing position, maintaining a standing posture, turning 180 degrees, transitioning from standing to sitting, and walking, which is evaluated over a distance of 3 meters. The total score is the sum of points from two subscales: the gait assessment (POMA-G), with a maximum of 12 points for 7 evaluated gait characteristics, and the balance assessment (POMA-B), with a maximum of 16 points for 9 evaluated balance parameters. The maximum total score is 28 points. A score below 25 points indicates an increased risk of falls, while a score below 19 points suggests a high risk of falling. Fullerton Fitness Test (Senior Fitness Test) The Fullerton Fitness Test, developed in 1999, is a multidimensional assessment tool designed to evaluate the physical fitness of older adults (aged 60 years and above) [52]. The test consists of six components performed by the participant: Arm Curl Test – evaluates upper body strength. The task involves performing as many arm curls as possible within 30 seconds while holding a dumbbell weighing 3.36 kg for men or 2 kg for women. The result is the number of correctly performed repetitions within the time limit. Back Scratch Test – assesses upper body flexibility. The participant attempts to touch the middle fingers of both hands placed behind the back. The result is positive if the fingertips overlap and negative if they do not reach each other. In the latter case, the distance between the fingertips (in centimeters) is recorded. 30-Second Chair Stand – evaluates lower body strength. The participant is asked to stand up and sit down from a chair as many times as possible within 30 seconds. The result is the number of correctly completed repetitions. Chair Sit and Reach – assesses lower body flexibility. The participant sits on a chair and performs a forward bend, reaching as far as possible toward the toes while maintaining the position for 2 seconds. The result is positive if the fingertips reach beyond the toes; if not, the distance (in centimeters) between the fingertips and the toes is measured. 8-Foot Up and Go – evaluates balance and agility. The participant is instructed to stand up from a seated position, walk as quickly as possible a distance of 2.44 meters (8 feet), turn around, and return to the chair, sitting down again. The time taken to complete the task is recorded. 6-Minute Walk Test / 2-Minute Step in Place – these tests assess aerobic endurance and walking speed. In the 6-minute walk test, participants walk as fast as possible (without running) around a designated course for 6 minutes, and the total distance covered (in meters) is measured. In the 2-minute step test, participants perform alternating knee lifts to a predetermined individual height (half the length of the thigh) for 2 minutes, starting with the right leg. The result is the number of right leg lifts performed within the time limit. Statistical analysis All the analyses presented in this manuscript were performed using R 4.4.2 software. For the purpose of intergroup comparisons, the participants were divided into subgroups according to their assigned classification based on the Fried et al. criteria for assessing the severity of the frailty syndrome (i.e., robust, pre-frailty, frailty). The impact of the exergaming-based training program was compared in terms of changes in anthropometric variables, physical fitness test results, as well as scores obtained in diagnostic tools assessing independence in performing activities of daily living. These analyses were also conducted for the entire study population as well as within subgroups of individuals with varying severity of frailty syndrome, stratified by sex, age, and educational level, when statistically significant differences were observed between measurements taken before and after the implemented training program. For the purpose of analyzing the influence of training depending on participants' age, two categories were established — younger participants (below 75 years of age) and older participants (75 years and above). A similar approach was applied for education level — vocational and secondary education were classified as lower education. Finally, it was verified whether the implemented training program influenced the change in the initial classification of participants within the respective frailty categories according to Fried's criteria. In cases of missing data, no imputation methods were applied, and the dataset was not supplemented for the purposes of statistical analyses. The normality of the distribution of quantitative variables was verified using the Shapiro-Wilk normality test. Only a few variables were confirmed to have this type of distribution. For this reason, nonparametric tests were used in further examination of quantitative variables. The relationship between quantitative variables and qualitative variable categories was examined using the Wilcoxon rank sum test for pairwise comparisons. The difference in the results of quantitative variables before and after training was also verified using the Wilcoxon signed-rank test for paired samples. The independence of two qualitative variables was verified using Fisher's exact test of independence. A significance level of 0.05 was adopted for all tests. The values of the calculated significance level p that were less than 0.05 were written in bold in the tables; in these cases estimation of the power of the test was performed using G*Power. Results Classification of participants into subgroups according to Fried's frailty criteria and differences in adherence rate A total of 186 willing participants were initially enrolled in the study and classified into subgroups (frailty, pre-frailty, and robust) based on the criteria proposed by Fried and colleagues, as described in the Methods section. Ultimately, 111 individuals completed the full training program. The proportion of participants who chose to complete the intervention varied significantly between subgroups, as shown in Table 2. The reasons for withdrawal from the study are presented in Table 3. Table 2. Number of participants who started and completed the research intervention and adherence rate in individual frailty subgroups among study participants. Subgroup Initial number of participants in the subgroup Number of participants who completed the research intervention Adherence rate Frailty 87 34 39.1% Pre-frailty 52 41 78.8% Robust 47 36 76.6% Table 3. Reasons for participants' withdrawal from the training program Subgroup Reason for withdrawal Number of participants who withdrew for each specific reason Frailty exacerbation of chronic diseases 22 difficulties accessing the location where the study was conducted 6 lack of time among the participant’s caregivers 5 acute infections 5 lack of suitable weather 5 feeling too weak/tired to continue exercising 4 perception of exergames as too difficult 3 injury related to fall 2 sudden death 1 Pre-frailty exacerbation of chronic diseases 4 acute infections 2 difficulties accessing the location where the study was conducted 2 lack of suitable weather 1 lack of time 1 too many family responsibilities 1 Robust lack of time 4 too many family responsibilities 3 acute infections 3 planned surgical intervention 1 boredom with exercise 1 Withdrawal reasons varied across frailty subgroups. In frail participants, the primary causes were exacerbation of chronic diseases (n= 22) and logistical barriers (e.g., access difficulties, caregiver time constraints). Health issues also dominated withdrawals among pre-frail individuals, although to a lesser extent. In contrast, robust participants primarily cited personal and motivational factors, such as lack of time and family responsibilities. Demographic data of the group that completed the full training cycle — including age, sex, and education level — divided by subgroups, are presented in Tables 4 and 5. Table 4 . Age distribution of participants within the examined subgroups before the training program. Subcategory n Mean age (in years) SD vs p frailty 34 79.12 5.07 frailty : pre-frailty 0.001 pre-frailty 41 74.34 6.04 frailty : robust <0.001 robust 36 72.33 4.22 pre-frailty : robust 0.156 Note. p - value of pairwise comparisons using Wilcoxon rank sum test with continuity correction Table 5. Distribution of sex and education level of participants within the examined subgroups. Variable frailty pre-frailty robust p n % n % n % Sex Female 23 67.6 33 80.5 24 66.7 0.315 Male 11 32.4 8 19.5 12 33.3 Education Professional education 1 2.9 1 2.4 5 14.3 0.091 Secondary education 18 52.9 18 43.9 20 57.1 Higher education 15 44.1 22 53.7 10 28.6 Note. p - value of the Fisher's exact test Significant differences in age distribution were observed between the frailty and pre-frailty subgroups (p = 0.001), as well as between the frailty and robust subgroups (p < 0.001). No significant difference was found between the pre-frailty and robust subgroups (p = 0.156). These results indicate that participants classified as frail were significantly older than those in the pre-frail and robust subgroups prior to the training program. Furthermore, no differences in education and gender were found in the studied frailty subgroups. Changes in the measured variables within subgroups before and after the completed training cycle are presented in Table 6. For the parameters where the differences were statistically significant ( p < 0.05), the statistical power of the test (G*Power) is also reported in braces. Table 6. Changes in individual examined parameters within subgroups resulting from the completed training cycle. Variable Frailty (N = 34) Pre-frailty (N = 41) Robust (N = 36) Before training After training W p (power) Before training After training W p (power) Before training After training W p (power) mean SD mean SD Mean SD mean SD mean SD mean SD Body weight (kg) 69.65 15.58 69.73 15.62 281.5 0.993 74.03 14.04 74.71 12.34 461.5 0.322 75.66 11.75 75.51 11.6 383.5 0.432 Body height (cm) 162.03 7.93 162.03 7.93 0 - 163.29 8.02 163.29 8.02 0 - 165.5 9.86 165.56 9.86 0 - BMI 26.38 5.44 26.52 5.63 227 0.688 28.28 5.17 28.1 5.1 424.5 0.152 27.60 3.0 27.54 2.93 359 0.296 Handgrip force (kg) 19.94 6.14 21.91 6.69 66 <0.001 (0.99) 24.68 5.46 24.82 5.55 285.5 0.935 27.72 7.71 27.89 7.49 222.5 0.438 Arm diameter (cm) 29.34 3.88 29.76 3.72 22 0.609 30.58 3.55 30.34 3.25 38 0.359 30.89 3.96 31.31 3.94 7 0.037 (0.60) Calf diameter (cm) 34.56 3.1 34.75 3.65 33.5 0.69 36.22 3.59 36.43 3.21 49.5 0.552 35.44 2.19 35.3 2.05 36 0.821 Body fat (%) 34.36 9.41 33.72 9.62 296 0.986 35.97 9.69 36.14 9.08 305 0.488 33.21 6.50 33.54 6.38 186.5 0.059 Muscle weight (kg) 24.15 5.24 24.35 5.33 267 0.963 26.01 5.07 25.73 4.64 501 0.224 28.20 6.27 27.91 6.02 424 0.031 (0.59) Total VES-13 (0-10 pts) 5.44 2.5 5.27 2.38 10.5 0.49 3.15 1.65 2.95 1.72 36 0.095 1.31 1.33 1.35 1.59 1.5 0.586 Total ADL (0-6 pts) 5.79 0.54 5.7 0.81 3 0.371 6 0 5.93 0.47 1 1 6.00 0.00 6.00 0.00 0 - Total IADL (0-30 pts) 24.24 3.1 24.33 3.22 11 0.351 25.83 1.39 25.82 1.48 2 1 26.8 0.40 26.9 0.23 0 1 Total Tinneti score (0-28 pts) 23.32 4.25 23.85 3.6 3.5 0.008 (0.85) 26.22 1.47 26.41 1.41 5.5 0.013 (0.77) 27.5 0.61 27.58 0.60 0 0.149 4.6 m walking time (sec) 6.08 1.41 6.24 2.79 352.5 0.201 5.01 1.01 4.9 0.87 434.5 0.051 4.17 0.7 4.15 0.81 225 0.885 Arm Curl Test (no) 21.09 16.64 18.53 5.27 191 0.79 21.12 5.2 22 5.85 123.5 0.023 (0.65) 22.64 6.73 23.00 6.2 167 0.834 Back Scratch Test (cm) 14.68 11.29 14.46 10.5 85.5 0.152 11.68 10.22 11.22 10.84 137 0.025 (0.65) 8.56 7.31 8.25 7.25 66.5 0.39 30 Second Chair Stand (no) 10.12 3.97 10.69 4.2 74.5 0.09 13.68 3.7 14.51 3.72 83 0.002 (0.90) 15.57 2.25 16.00 1.84 107 0.074 Chair Sit-and-Reach (cm) 5.43 5.55 5.24 6.18 31.5 0.72 3.1 5.49 2.98 5.37 26 0.289 2.25 3.77 2.17 3.35 23 0.523 8-Foot Up-and-Go (sec) 9.17 2.98 9.14 4.21 346.5 0.055 7.27 1.52 6.87 1.21 605 0.001 (0.95) 6.0 0.83 5.94 0.74 337 0.082 2-Minute Step-in-Place (no) 69.47 11.61 70.03 11.36 207 0.289 80.44 11.12 83.29 10.41 144 <0.001 (0.98) 92.0 7.63 93.83 6.32 165 0.008 (0.79) Note. ( W, p ) - statistic and p-value of Wilcoxon signed rank test for paired samples. The training program resulted in significant improvements in several physical and functional parameters across the different frailty subgroups. In participants classified as frail, significant gains were observed in handgrip force (p < 0.001, power = 0.99) and the total Tinetti score (p = 0.008, power = 0.85), indicating enhanced muscular strength and balance. No significant changes were noted in other examined factors. Among pre-frail participants, the intervention produced broader improvements regarding muscle strength, walking speed and balance. Significant enhancements were noted in the total Tinetti score (p = 0.013, power = 0.77), arm curl test repetitions (p = 0.023, power = 0.65), back scratch test flexibility (p = 0.025, power = 0.65), 30-second chair stand performance (p = 0.002, power = 0.90) and increased repetitions in the 2-Minute Step-in-Place test (p < 0.001, power = 0.98). Improvements in dynamic balance and agility were also evidenced by reduced times in the 8-Foot Up-and-Go test (p = 0.001, power = 0.95). In the robust subgroup, significant improvements were observed in arm diameter (p = 0.037, power = 0.60) and 2-Minute Step-in-Place performance (p = 0.008, power = 0.79). An intriguing finding is that a significant decrease in muscle mass was at the same time observed in robust patients (p = 0.031, power = 0.59). Overall, the findings indicate that while frail participants benefited primarily in strength and balance, pre-frail individuals experienced the most comprehensive functional improvements. In case of patients from robust subgroup only minor stamina benefits were observed. For variables exhibiting statistically significant differences before and after the training program, further subgroup analyses were conducted according to participants' age, sex, and level of educational attainment, see Table 7. Table 7. Changes in individual examined parameters within age, sex and educational subgroups (also divided by frailty status subgroups) resulting from the completed training cycle. Change in the variable before/after the training program Variable Category Total (N = 111) Frailty (N = 34) Pre-frailty (N = 41) Robust (N = 36) mean SD W p (power) mean SD W p (power) mean SD W p (power) mean SD W p (power) Arm diameter (cm) sex female 0.25 1.32 1333 0.064 0.23 1.45 122 0.401 0.03 0.80 146 0.151 0.56 1.70 170 0.277 male -0.21 1.50 -0.15 1.56 -0.86 2.29 0.12 0.68 age younger 0.00 1.09 1302 0.588 0.21 0.67 131.5 0.406 -0.36 1.61 172 0.586 0.34 0.80 173.5 0.643 older 0.30 1.69 -0.04 2.26 0.14 0.29 0.50 1.96 education lower 0.27 1.21 1492.5 0.388 -0.09 0.79 98.5 0.339 0.17 0.34 225.5 0.235 0.60 1.70 163 0.275 higher -0.07 1.57 0.36 2.02 -0.38 1.60 0.00 0.39 Total Tinneti score (0-28 pts) sex female 0.26 0.63 1311.5 0.515 0.57 0.95 149 0.328 0.21 0.48 144 0.612 0.04 0.20 126 0.22 male 0.26 0.82 0.45 1.29 0.12 0.35 0.17 0.39 age younger 0.17 0.49 1361.5 0.213 0.35 0.99 105 0.145 0.27 0.46 241 0.27 0.11 0.32 169 0.643 older 0.38 0.87 0.79 1.12 0.11 0.46 0.06 0.24 education lower 0.32 0.76 1609 0.423 0.68 1.16 160.5 0.464 0.21 0.54 217 0.793 0.12 0.33 154 0.251 higher 0.19 0.57 0.33 0.90 0.18 0.39 0.00 0.00 30 Second Chair Stand (no) sex female 0.63 1.72 1335.5 0.452 0.20 1.90 113 0.623 0.85 1.72 137 0.879 0.74 1.51 177.5 0.165 male 0.68 1.96 1.36 2.62 0.75 1.16 0.00 1.54 age younger 0.81 1.72 1695.5 0.201 1.05 2.01 168.5 0.314 0.95 1.65 262 0.159 0.78 1.63 189 0.229 older 0.43 1.85 -0.11 2.32 0.68 1.60 0.18 1.42 education lower 0.77 1.99 1725.5 0.13 0.76 2.64 172.5 0.293 0.79 1.93 215.5 0.872 0.76 1.48 181 0.038 (0.40) higher 0.47 1.46 0.33 1.50 0.86 1.32 -0.20 1.55 8-Foot Up-and-Go (sec) sex female -0.23 1.11 1114.5 0.411 -0.08 1.79 103.5 0.407 -0.38 0.83 159.5 0.374 -0.16 0.35 114.5 0.329 male -0.09 1.14 0.07 1.84 -0.45 0.66 -0.01 0.25 age younger -0.29 0.73 1633 0.473 -0.56 0.80 94.5 0.115 -0.32 0.92 259.5 0.19 -0.09 0.37 163.5 0.962 older -0.06 1.47 0.71 2.46 -0.48 0.63 -0.13 0.28 education lower -0.11 1.08 1552 0.814 0.16 1.83 162.5 0.498 -0.31 0.62 229.5 0.6 -0.17 0.37 84 0.068 higher -0.30 1.15 -0.28 1.74 -0.47 0.93 0.02 0.13 2-Minute Step-in-Place (no) sex female 2.35 4.01 1601 0.007 (0.60) 0.78 4.77 123.5 0.753 2.91 3.79 159 0.379 3.08 3.17 238.5 0.001 (0.81) male 0.50 4.90 0.50 5.56 2.62 6.02 -0.92 3.06 age younger 1.95 3.94 1605.5 0.449 1.65 4.94 162 0.244 2.91 2.88 212.5 0.937 1.16 3.11 137 0.442 older 1.70 4.84 -0.77 4.73 2.79 5.48 2.41 4.14 education lower 1.44 3.91 1342.5 0.379 -0.39 4.80 99 0.197 3.05 3.50 218 0.823 1.52 2.96 117 0.488 Note . The table presents the mean differences in outcomes within each subgroup before and after the training program. ( W, p ) - statistic and p-value of Wilcoxon signed rank test paired samples Further subgroup analyses revealed that women demonstrated significantly greater improvements than men in the 2-Minute Step-in-Place test, both in the total sample (p = 0.007, power=0.60) and in the robust subgroup (p = 0.001, power = 0.81). Additionally, within the robust subgroup, participants with lower educational attainment showed slightly greater improvement in the 30-Second Chair Stand test compared to those with higher education (p = 0.038, power = 0.40). No other statistically significant differences were found regarding sex, age, or educational level. Both prior to commencement of the training program and upon its completion, patients were classified into frailty categories using the criteria of Fried et al. The transitions between categories, as well as the corresponding frailty scores, are presented in Tables 8, 9 and 10. Table 8. Distribution of observed transitions between frailty categories according to Fried’s classification among participants, resulting from the training cycle. Frailty categories After training frailty (n = 26) pre-frailty (n = 48) robust (n = 37) n % n % n % Before training frailty (n = 34) 24 21.6 10 9.0 0 0.0 pre-frailty (n = 41) 2 1.8 37 33.3 2 1.8 robust (n = 36) 0 0.0 1 0.9 35 31.5 Overall, 39 of 111 participants (35.1%) experienced an upward reclassification (i.e., toward greater robustness), while only 3 participants (2.7%) showed a decline in frailty status. Table 9. Distribution of observed changes in frailty scores according to Fried’s classification among participants, resulting from the training cycle. Score in Fried frailty classification After training 0 (n = 37) 1 (n = 26) 2 (n = 22) 3 (n = 20) 4 (n = 6) n % n % n % n % n % Before training 0 (n = 36) 35 31.5 1 0.9 - - - - - - 1 (n = 25) 1 0.9 22 19.8 2 1.8 - - - - 2 (n = 16) 1 0.9 3 2.7 10 9.0 1 0.9 1 0.9 3 (n = 25) - - - - 10 9.0 15 13.5 - - 4 (n = 8) - - - - - - 4 3.6 4 3.6 5 (n = 1) - - - - - - - - 1 0.9 Analysis of Fried frailty classification scores before and after the training intervention (N = 111) demonstrated a high stability among the robust participants (score 0), with 97.2 % (35/36) remaining unchanged. Patients at low risk of developing frailty (score 1) largely maintained their status (88.0 %), although 8.0 % deteriorated to score 2. In contrast, 25.0 % of moderately frail risk individuals (score 2) improved by at least one point, and 40.0 % of those with initial score 3 shifted to score 2. Notably, half of the participants with score 4 improved to score 3, and the sole individual at score 5 improved to score 4. Overall, 18.0 % of participants exhibited a reduction in frailty score, whereas 4.5 % experienced worsening. Table 10. Impact of the training on the quantitative values of the frailty variable according to Fried’s classification. Training cycle Mean Fried frailty score SD W p (power) before 1.52 1.38 72.5 0.008 (0.79) after 1.39 1.27 Note. (W, p) - statistic and p-value of Wilcoxon signed rank test for paired samples The training cycle elicited a modest but statistically significant reduction in overall frailty, as evidenced by a decrease in the mean Fried frailty score from 1.52 ± 1.38 before intervention to 1.39 ± 1.27 after intervention (Wilcoxon signed-rank W = 72.5, p = 0.008, power = 0.79). This finding supports the efficacy of the exercise games intervention in ameliorating frailty among older adults. Discussion According to the latest scientific reports, frailty therapy should primarily include a multi-component physical activity program with a strength training component and balance and flexibility exercises [ 12 , 16 , 17 ]. Exergames are a new area of research in the rehabilitation of people with frailty. In our study the training effects of the innovative Activlife rehabilitation device, supported by the VRTherapist application and Kinect technology was assessed among older adults with frailty and pre-frailty syndrome. Adherence rate Previous studies have shown preliminary evidence that technology-based exercise programs can improve physical functioning and may have a positive effect on exercise adherence in older adults [ 31 , 36 , 53 , 54 ]. A systematic review conducted by Valenzuela et.al. showed that adherence rate to technology-based exercise programs, like exergames, is high (median 91.3%) [ 31 ]. Biesek et al. reports that physical training with exergames, proved to be safe and motivating for community-based pre-frail older women, as indicated by the high adherence rate to the study (87.7%) [ 53 ]. Participants in the older age group identified exergaming as a fun and encouraging approach to physical activity. The high adherence rate to exergaming was also reported by Karssemeijer et al. among frail older people with mild dementia; the conducted study showed that the exergame group presented high and significantly higher adherence to the training compared to the traditional aerobic group (87.3% vs 81.1% respectively) [ 55 ]. In turn, the study conducted by Moreira et al. among pre-frail older adults showed that adherence to the exergaming intervention was rather low ( 32/49 participants, 65.3%) and did not differ significantly from the traditional multicomponent training (65,3% vs 68%) [ 34 ]. In our study, the overall adherence rate to exergames intervention was low (111/186 participants, 59.7%) and varied significantly between subgroups, being 39.1% for frail, 78.8% for pre-frail, and 76.6% for robust participants. A high variability in adherence rates was also reported by Ashe et al. in the systematic review of adherence to technology-based falls prevention programs for community-dwelling older adults; the percent of participants who did not complete planned training sessions (e.g. dropped out or lost to follow up) varied from 0–32% and the review included studies with participants in different health states – with or without a clinical condition [ 56 ]. Furthermore, Valenzula et al. rightly note that although the adherence rate was high in most exergames interventions, the sample sizes were small and the studies included mostly healthy older people [ 31 ]. Returning to our research, it is therefore worth paying special attention to the very low adherence rates in the group of frail older adults, who were very often unable to complete training sessions due to exacerbations of chronic diseases or lack of family support and the possibility of reaching the training location in family practice. Hence, it seems reasonable to assume that exergames should be undertaken by older people as early as possible, before full-blown frailty syndrome and its complications develop. The social factor may also play a motivating role, as researchers report that playing physical games together and against a computer provides greater motivation to exercise than exercising alone [ 57 , 58 ]. In our study all four couples assessed as fragile (included in the frail subgroup) completed the exergaming intervention. They rated the training as enjoyable and motivated each other by competing with each other during the training. Frailty status and frailty score The study showed significant improvement in the frailty status and scores with Kinect-based exergaming for the frail older adults. The intervention elicited a modest but statistically significant reduction in overall frailty and the mean Fried frailty score decreased from 1.52 ± 1.38 before intervention to 1.39 ± 1.27 after intervention (p = 0.008, power = 0.79). Overall, 35.1% of older adults (39/111 participants) improved their frailty score (i.e. toward greater robustness), while only 2.7% (3/111 participants) showed a deterioration in frailty status (increased frailty score). In the study group before the training there were 34 people diagnosed with frailty syndrome and 41 in the early stage of frailty, and after the training there were 26 people with frailty syndrome and 48 in the pre-frail status. As a result of the exergaming nearly 30% (29.4%) of older people (10/34 participants) transferred from the frailty to the pre-frail status and 44.1% of them (15/34 participants) diminished their frailty score by at least one point category. Slight improvements were also observed in the pre-frail group where 12.2% (5/41 participants) of old adults improved by at least one point category of Fried frailty score. Promising results are also shown by other researchers. González-Bernal et al. conducted a study on 80 people over 75 years of age, under institutional care [ 35 ]. The study group, in contrast to the control group, in addition to conventional physiotherapy took part in 20 rehabilitation exergames sessions. For this purpose, a Nintendo Wii with virtual reality (VR) technology was used. After the study was completed, a significant improvement in the frailty status was observed in the exergame group. In addition to a reduction in the severity of the frailty syndrome, in the exergame group, an increase in walking speed, improved balance and a decrease in the general risk of falls was noted [ 35 ]. In turn, Liao et. al. performed the study concerning fifty-two prefrail and frail older adults who were recruited and randomized to the Kinect based exergaming group or traditional combined exercise group including resistance, aerobic, and balance training for 36 sessions over 12 weeks. The study showed that Kinect-based exergaming exerted effects that were at least as beneficial as those of combined exercise in improving frailty status and the frailty phenotype. Four out of 5 physical characteristics of the frailty phenotype, namely, exhaustion, weakness, slow walking speed, and low activity level, were significantly reversed by exergaming [ 36 ]. A significant improvement in frailty scores and in the frailty reversal rates (43.75% frail older people reverted to a pre-frail status, and 72.7% pre-frail older adults reverted to a robust status) were noted after Kinect-based exergames training. These results provide clinical evidence about efficacy of using this innovative intervention in pre-frail and frail older adults. Other researchers have also reported the beneficial effects of exergaming training among pre-frail older adults [ 34 , 38 , 53 ]. Moreira et al. in their study revealed that both traditional multicomponent training and exergaming were effective in postponing frailty status, reducing the fear of falling, increasing fall risk awareness, improving physical functions and cognitive status. In turn, Biesek et al. indicate that physical training with exergames for 12 weeks associated or not associated with protein supplementation was able to reverse the pre-frailty state in community-dwelling older women. It is also worth adding that shorter exergame programs, as in our study (6 weeks, 12 training sessions), can also bring significant benefits. In the study by Mugueta-Aguinaga, it was observed that after only 3 weeks of intervention (nine training sessions) using the exergame called FRED, 60% of 65 + older adults from the study group (12 out of 20 patients) significantly reduced the presence and risk of evidencing frailty [ 54 ]. These are very promising results, proving that even a short, low-intensity training program can produce measurable effects. Physical performance effects Frailty is a complex condition leading to functional deficits of a number of organs and systems. Sarcopenia, the syndrome of loss of muscle mass, quality and strength, is more common in older adults and has been considered a precursor syndrome or the physical manifestation of frailty [ 59 , 60 ]. Previous studies have shown that skeletal muscle mass decreases at a rate of 1–2% per year after the age of 50, while skeletal muscle strength declines by 1.5% between the ages of 50 and 60, which may lead to sarcopenia [ 61 ]. Reduced muscle mass and strength is one of the main causes of fractures in the older people, and a number of evidences indicate that sarcopenia can be considered as one of the main physical drivers of frailty [ 8 , 59 , 62 ] with a risk of adverse outcomes such as physical disability, poor quality of life and death [ 63 , 64 ]. In our study, BIA was used to measure muscle and fat mass, which is widely used in clinical settings because it is a relatively simple, quick and non-invasive method. The study did not show an effect of exergames training on either muscle or fat mass in frail and pre-frail older adults with a small significant decrease in the robust participants. Similar results were presented by Biesek et al. where exergames training demonstrated a decline in upper limbs and appendicular muscle mass with no significant change in lower limbs mass among pre-frail older women after intervention [ 53 ]. In turn, the study conducted by Tieland and al. showed an increase in strength and muscle mass in frail older people after resistance training intervention associated with 30 g of protein supplementation for 24 weeks [ 65 ]. It could suggest that dietary protein supplementation is required to allow muscle mass gain during exercise training in frail elderly people. In our study, it therefore appears that the 6-week training period was not long enough to rebuild muscle tissue. According to the available literature, a resistance training program lasting ≥ 8 weeks can be considered a highly effective preventive strategy for delaying and mitigating the negative effects of early and late sarcopenia in people aged ≥ 65 years [ 66 ]. Other studies have identified benefits when physically frail individuals perform physical training three times per week, for 30–45 min/session, for at least 16 weeks [ 67 ]. So due to the time limitation, the results of our study can only be preliminary; a longer and more intensive training program is needed to demonstrate the potential effectiveness of motor-cognitive training with the Kinect sensor in combating sarcopenia. Handgrip strength is a simple, cheap and effective method of assessing hand muscle strength, which is widely used as a predictor of overall muscle strength [ 68 , 69 ]. Low hand grip strength is strongly related to impaired mobility in both women and men [ 70 , 71 ]. It can impair upper limb dexterity and affect the ability to maintain postural balance and gait independence [ 70 , 72 ]. The decrease in the grip strength is significantly associated with the risk of falls, hospitalization and mortality in older people [ 73 ]. Studies have shown that resistance training significantly improves grip and upper limb strength in older patients with frailty syndrome [ 66 ]. Haider et al. report that even a home-based physical and nutrition intervention conducted by lay-volunteers for 12 weeks significantly increased the handgrip strength (by 2,4 kg, 95 CI: 1,0–3,8) among community-dwelling older adults and frail individuals benefit more from the intervention than pre-frail individuals [ 74 ]. Our study showed a positive effect of training on handgrip strength in the frailty subgroup (by 1,97 kg, p < 0.001, power = 0,99) with no significant improvement in the pre-frail older people. In turn, in the study performed by Biesek et al. the handgrip strength increased by 13,7% after 12 weeks of exergames training in pre-frail older women [ 53 ]. Other researchers also report promising results, demonstrating positive training effects on grip strength in both exergames and traditional combined exercise training in pre-frail and frail older adults [ 36 ]. However, there are also studies that, despite a number of beneficial effects of exergaming training among frail older adults, did not show any improvement in terms of increasing hand grip strength [ 34 , 35 ]. It is therefore advisable to continue research in this area. In the conducted study, the exergaming intervention resulted in significant improvements in endurance, gait speed, flexibility and balance parameters among some of the study participants. During training sessions with the Activlife rehabilitation platform, it was noticed that most of the movements in the exergames focused on the upper limbs and trunk. Therefore, one might expect that such training would not improve gait and balance in the subjects. However, it turns out that walking is a complex movement consisting of range of movement, speed, position and muscle training [ 75 ]. In movement games, standing or sitting, participants have to balance in various positions, such as leaning forward, reaching forward, making sideways movements. This movement can involve the trunk, hips, knees and joints. Such movements can strengthen the muscles of the trunk and lower limbs and thus improve balance control and functional efficiency of muscle groups responsible for walking. Park et al. observed that walking speed significantly increased after seated boxing training focused on stretching and strengthening the upper limbs for 6 weeks three times a week. In this study, although the training did not involve the lower limbs, it did show an improvement in gait [ 76 ]. In addition, arm swing in the human gait cycle plays an active role in the control of body posture, so when the range of motion of the upper limbs increases, it may lead to an increase in arm swing and limb coordination, which results in an increase in gait speed. This may explain the results of our study, where training was performed in a standing or sitting position, and gait speed increased significantly in the pre-frail participants (p < 0.001, power = 0.98). Gait speed is significantly associated with transitions in an individual’s frailty status [ 36 , 77 ] and slow gait speed is one of the strongest predictors of chronic disability and injurious falls [ 36 , 78 , 79 ]. According to Liao et al. results, gait speed improved by 0.13 m/s after exergaming training and by 0.06 m/s after combined traditional exercise what was clinically important as most of the small significant change estimates range from 0.04 to 0.06 m/s for gait speed [ 80 ]. Dynamic balance is also an important indicator for fall risk. It is estimated that 1 in 3 older adults living in the community suffer one or more falls in a year [ 81 , 82 ]. In older people, changes in multiple physiological systems (musculoskeletal dysfunction, impaired neurological control and energy metabolism) lead to poor locomotion or difficulties in complex coordination, which are the consequences of poor balance. Impaired postural control is one of the main causes of falls, which is manifested by a reduced ability to maintain and restore balance during physical activity [ 83 ]. There is strong evidence that appropriately designed exercise programs can prevent falls in community-dwelling older people [ 84 , 85 ]. Exercise interventions that train stepping ability have been found to be able to reduce the number of falls in older people by half likely due to improved balance, greater mobility and shorter reaction times [ 86 , 87 ]. Our research confirms these reports. The therapeutic games used in the conducted study included a series of stepping exercises and were found to significantly improve balance and possibly decrease the risk of falling. The results were found to be beneficial in both the pre-frail and frail subgroups of older participants (p = 0.013 and p = 0.008 respectively for total Tinetti score) with no improvement in the robust ones. Similar results were achieved by other researchers [ 34 – 36 , 54 , 88 ]. The study conducted by Gonzales-Bernal et al. showed that rehabilitation sessions with the use of Wii games during 8 consecutive weeks positively influenced walking speed, falling risk and balance in institutionalized older adults [ 35 ]. In turn, Liao et al. revealed that Kinect -based exercises were able to improve significantly endurance, agility, muscle strength, dynamic balance and walking speed in community dwelling pre-frail and frail older people and exergaming intervention exerted effects that were at least as beneficial as those of traditional combined exercise [ 36 ]. Moreover, Nilsagard et al. showed that playing Wii Fit games twice a week for 6 weeks moderately improved gait and confidence in balance in people with walking problems, such as those with multiple sclerosis [ 89 ]. The results seem credible and promising and certainly warrant continued research in this area. However, it is worth noting, as demonstrated in our study, that the most comprehensive improvement in physical performance (concerning muscle strength, walking speed, balance, endurance, flexibility) was among pre-frail participants. The vast majority of previous studies focused primarily on pre-frail older adults [ 34 , 53 ] or did not distinguish between pre-frail and frail individuals, analyzing the effects of the interventions on physical performance parameters collectively [ 35 , 36 , 54 , 88 , 90 ]. Therefore, it seems reasonable to emphasize that multi-component interventions in the form of exercise games among frail older people should be undertaken as early as possible, optimally still at the pre-frailty stage, before any frailty complications develop. Generally, there was no association between personal data (sex, age, education) and physical performance parameters both in the entire study group and in individual subgroups. Only, in the 2-Minute Step-in-Place test, women demonstrated significantly greater improvements than men, both in the total sample (p = 0.007) and in the robust subgroup (p = 0.001). In the study, significantly more women than men took part in the exergames intervention. The female to male ratio was similar to the typical distribution of the European population in older adults [ 91 ]. The predominance of women can also be explained by the fact that women are more willing to engage in various community activities and are more physically and socially active [ 92 , 93 ]. Women are also more willing to take care upon their health which could be reflected in the fact that there were slightly greater benefits from the intervention in the case of women, although, at the same time, it is worth to remember that this significant improvement concerned only one examined parameter of physical fitness [ 93 , 94 ]. Limitations Despite concerted efforts, several limitations must be acknowledged. First, the study population was selected among volunteers attending a primary healthcare clinic in a large Polish city, which does not reflect the demographic characteristics of the national population. Moreover, the group of participants classified as frail was significantly older than those identified as pre-frail or robust. However, this appears to be an unavoidable consequence, as the prevalence of frailty syndrome increases substantially with age at the population level. The second limitation of this study is the short duration of both the observation period and the therapeutic intervention. Measurements were taken immediately after the completion of a 6-week exergame-based training program. Extending the duration of the program or repeating it following a brief interval may potentially yield even greater benefits for the participants. Another limitation is the relatively small number of individuals in each subgroup, particularly in the frailty group. This is primarily due to difficulties in recruiting willing participants and high drop-rate, as evidenced, among other factors, by the reasons given for withdrawal. Nevertheless, the statistically significant differences observed between subgroups before and after the intervention support the efficacy of exergames in reducing the burden of frailty syndrome. The continued development of such interventions may prove particularly promising in light of the global trend of population aging. Conclusion This study confirms the potential benefits of exergaming interventions using Kinect-based technology for older adults, particularly those in the pre-frail stage. Although overall adherence to training was moderate, adherence varied significantly by frailty status, with the lowest rates observed among frail participants. These findings highlight the importance of initiating physical interventions as early as possible, ideally before the onset of full frailty, to maximize adherence and therapeutic effect. The exergaming intervention produced a statistically significant improvement in frailty scores, with notable transitions from frailty to pre-frailty. However, the most pronounced functional gains—including improvements in muscle strength, gait speed, endurance and balance—were observed among pre-frail individuals, suggesting that they may be the most responsive subgroup to such interventions. While frail participants demonstrated some physical improvements, particularly in grip strength and balance, the short duration of the training (6 weeks) may have limited the extent of muscle mass development and overall physical adaptation. The findings are consistent with prior research indicating that even short-duration, technology-assisted programs can lead to measurable improvements in physical function and frailty status [ 54 ]. However, for sustained and comprehensive effects—particularly in combating sarcopenia—longer training durations and potential adjuncts such as protein supplementation may be necessary. In light of these results, Kinect-based exergaming appears to be a promising, engaging, and partially scalable intervention for older adults at risk of frailty. Further large-scale, long-term studies are warranted to optimize training parameters, improve adherence among frail individuals, and evaluate the broader clinical utility of such digital rehabilitation tools. Abbreviations ADL Katz Index of Independence in Activities of Daily Living BIA Bioelectrical Impedance Analysis BMI Body Mass Index CES-D Center for Epidemiological Studies-Depression Scale IADL Lawton-Brody Instrumental Activities of Daily Living Scale IPAQ International Physical Activity Questionnaire IPAQ-SF International Physical Activity Questionnaire Short Form MET Metabolic Equivalent of Work POMA Performance Oriented Mobility Assessment VES-13 Vulnerable Elders Survey-13 Declarations Ethics approval and consent to participate The study design received approval from the Bioethics Committee at the Wroclaw Medical University (Approval No. — 172/2019 from March 5 th 2019). All study participants gave written consent to participate in the study. All procedures were performed in accordance with the 1964 Helsinki Declaration and its later amendments. Consent for publication All authors have read and approved the final version of the manuscript and consent to its publication. Availability of data and materials The dataset generated and analyzed during the current study are available in the Figshare repository: doi.org/10.6084/m9.figshare.29178977. Competing interests The authors declare no conflict of interest. Funding The study was financed from the researchers' own funds and the internal funds of Wroclaw Medical University. Authors' contributions MBF conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and then critically reviewed and revised the manuscript. JW assisted with the conceptualisation of the study, designed the data collection instruments, collected data, carried out the initial analysis and critically reviewed the manuscript. MS assisted with the initial analysis and drafted the initial manuscript, critically reviewed the manuscript for important intellectual content. AF collected data, helped with data processing and synthesis and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. Acknowledgements We would like to thank participating patients and their families for their involvement in the study. We would also like to acknowledge Martyna Pałys, resident in family medicine, for her help/assistance in conducting the exercise games training and data collection. The authors express their appreciation to Tomasz Kujawa for his methodological and statistical help. References Lang PO, Michel JP, Zekry D. Frailty syndrome: A transitional state in a dynamic process. Gerontology [Internet]. 2009 [cited 2025 Jun 9];55:539–49. Available from: https://pubmed.ncbi.nlm.nih.gov/19346741/ Binder EF, Schechtman KB, Ehsani AA, Steger-May K, Brown M, Sinacore DR, et al. Effects of exercise training on frailty in community-dwelling older adults: Results of a randomized, controlled trial. J Am Geriatr Soc [Internet]. 2002 [cited 2025 Jun 1];50:1921–8. 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The frailty process appears to be a transitional state in a dynamic progression from robustness to functional decline. During this process, total physiological reserves decline and become less likely to be adequate to maintain and repair the aging organism [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Frailty should be distinguished from aging and, unlike aging, can be prevented, slowed, delayed, and even reversed [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A scoping review conducted by Ho et al. showed that a similar number of older adults improved in frailty status as worsened (9.4% \u0026ndash; 32.8% versus 11.0% \u0026ndash; 34.0%) over 2\u0026ndash;6.4 years [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe global prevalence of frailty was estimated at 3.5\u0026ndash;27.3% and it was demonstrated that the prevalence of frailty syndrome increases with age; in people over 85 years of age, in the American population, 25% of the Caucasian subjects and almost 50% of African Americans met the criteria for frailty syndrome [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A cross-sectional study of community-dwelling adults aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years found that 22.1% of older people were assessed as frail and 45.6% as prefrail [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In turn, a meta-analysis recently conducted by O'Caoimh et al. showed that the pooled prevalence of physical frailty and pre-frailty was 12% and 46%, respectively, in adults aged\u0026thinsp;\u0026ge;\u0026thinsp;50 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFrailty increases the risk of hospitalization, institutionalization, disability and death [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. According to Vermeiren et al. frailty increases the risk of mortality by 1.8\u0026ndash;2.3 times, loss of activities of daily living by 1.6\u0026ndash;2.0 times, hospitalization by 1.2\u0026ndash;1.8 times, physical limitation by 1.5\u0026ndash;2.6 times, and falls and fractures by 1.2\u0026ndash;2.8 times in adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moreover, taking into account population prevalence and multivariate adjusted relative risks, Shamliyan et al. estimated that 3\u0026ndash;5% of deaths in the elderly could be delayed if frailty was prevented [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to the latest scientific reports, frailty therapy should be comprehensive [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and the first-line treatment should include a multi-component physical activity program with a component of strength training and exercises for balance and flexibility [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Numerous studies have shown that exercise is crucial for improving physical fitness and overall health in frail older adults [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Physical exercises can improve frailty by exerting positive effects on skeletal muscles and cardiovascular, respiratory, and endocrine systems by reducing age-related oxidative damage and chronic inflammation, improving mitochondrial function, increasing autophagy, and increasing insulin sensitivity [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Exercise improves balance and coordination in older people, increases walking speed, muscle strength, range of motion, reduces the risk of falls, increases bone mineral density, relieves joint pain, improves mood, and improves cognitive abilities [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe multimorbidity and multidimensionality of the needs of people with frailty syndrome is a challenge for the selection of an appropriate rehabilitation program. Low interest in traditional exercise and physical activity in older people is often associated with kinesiophobia, fear of injury and lack of motivation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Exergames are a new area of research in the rehabilitation of people with frailty. Exergaming is a kind of physical activity that requires players to do physical exercises to play a video game [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. It enables solo or team training through body gestures using motion-sensing devices. Exergames seem to be acceptable by the older adults [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] enable simultaneous physical and cognitive skills training, offering multisensory feedback and opportunities for repetitive practice [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. A meta-analysis of energy expenditure in digital exercise games showed that playing exercise games by older people significantly increases heart rate, oxygen intake and energy expenditure compared to rest, and may also facilitate the promotion of low- to moderate-intensity physical activity [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Exergaming is described as safe and relatively easy for older people to perform, and no published studies have shown adverse events related to this specific form of training [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. After receiving instructions and familiarizing themselves with the exercises, stroke patients, cardiac patients and older patients with Parkinson`s disease had no problems with the game [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In turn, a systematic review conducted by Valenzuela et.al. showed that adherence rate to technology-based exercise programs, like exergames, is high (median 91.3%) and significantly higher than adherence rate found in conventional exercise programs (median 83.6%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe use of exergaming in frailty patients seems promising and several studies reported positive effects of such intervention on individual outcomes for older adults [\u003cspan additionalcitationids=\"CR33 CR34 CR35 CR36 CR37 CR38 CR39\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However the latest systematic review and meta-analysis conducted by Ho et al. showed that only five studies met eligibility criteria and could be included into the analysis; in all cases the studied groups were small and the certainty of the evidence was low [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Thus, given the urgent need for continued research in this area, the aim of our study was to evaluate the impact of exergames intervention on the functional abilities of 65\u0026thinsp;+\u0026thinsp;older adults with frailty and pre-frailty syndrome.\u003c/p\u003e\u003cp\u003e Before commencing the research project, the study design received approval from the Bioethics Committee at the Wroclaw Medical University (Approval No. \u0026mdash; 172/2019 from March 5th 2019). All study participants gave written consent to participate in the study. All procedures were performed in accordance with the 1964 Helsinki Declaration and its later amendments. This study has been registered retrospectively (June 25th 2025) in the ClinicalTrials.gov database and has been assigned the ID NCT07036224 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://clinicaltrials.gov/study/NCT07036224\u003c/span\u003e\u003cspan address=\"https://clinicaltrials.gov/study/NCT07036224\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). CONSORT and STROBE checklist has been included as a Supplementary files as well as trial protocol file.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003ch2\u003eParticipants\u003c/h2\u003e\n\u003cp\u003eThe study was conducted among\u0026nbsp;186 volunteers aged 65 to 89 years between March 2022 to November 2024 at a primary healthcare clinic in Wroclaw, Poland. Project was the continuation of preliminary research conducted by JW as her doctoral thesis [42]. Ultimately, 111 participants completed the full exercise program and filled in the required diagnostic tools. The most common reasons for withdrawal from the study included: exacerbation of chronic diseases. difficulties in accessing the study site (e.g., lack of availability of family members to provide transportation) or feeling too weak to continue exercising. For more detailed information, see Results.\u003c/p\u003e\n\u003cp\u003e80 participants were women (72.07%). The mean age of the subjects was 75.17 years (SD = 5.89). The majority of the participants had secondary education (N = 56, 50.9%) or higher education (N = 47, 43.3%). Participants were recruited through advertisements posted in the primary healthcare clinic and actively by physicians during medical visits. Each participant provided written informed consent to participate in the study and was informed about the purpose of the study, its procedure, and the possibility of withdrawing at any stage. The study procedures ensured the anonymity of the collected data.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for the study were: age over 64 years and no medical contraindications to performing physical exercises in a standing position. The exclusion criteria included a diagnosed moderate or severe stage of dementia, as well as the presence of chronic diseases (e.g. chronic obstructive pulmonary disease, asthma, heart failure, arterial hypertension) that were uncontrolled or in an exacerbation phase.\u003c/p\u003e\n\u003ch2\u003eAnthropometric assessment\u003c/h2\u003e\n\u003cp\u003eTo assess the measured variables, anthropometric measurements were used, including height, body weight, body mass index (BMI), and arm circumference. Body fat percentage and muscle mass were assessed using the InBody 270 scale, based on the bioelectrical impedance analysis (BIA) method. Handgrip strength was assessed using a hand dynamometer. Measurements were taken before the start of the study and after the participant completed the exercise program.\u003c/p\u003e\n\u003ch2\u003eTraining program\u003c/h2\u003e\n\u003cp\u003eThe participants underwent a six-week standardized training program using the Activlife rehabilitation platform designed for exergaming. The platform allows for the performance of physical exercises in a standing position while providing additional stabilization through a supportive harness with a built-in seat. The training utilized a Kinect motion sensor to track movements and ensure proper exercise execution. Participants took part in therapeutic games available within the VRTherapist application, dedicated to the Activlife platform, which incorporates movement-based games aimed at rehabilitation and functional improvement.\u003c/p\u003e\n\u003cp\u003eTraining protocol consisted of endurance exercises, general fitness training with elements of resistance exercises, balance and stability exercises, as well as cognitive tasks targeting memory and visuospatial orientation. A single set of exercises included the use of seven exergames concerning the movements of abduction, adduction, lifting and lowering of the upper and lower limbs, rotation of the upper limbs, flexion, rotation and oblique movements of the spine, as well as stepping exercises and precise hand movements. During these exercises, it was necessary to, for example, repeat the pose taken by a game character, collect virtual elements using body movements or imitate the flight of a spacecraft. The next two exergames included logical exercises and solving problems, e.g. simple mathematical tasks or puzzles. The training was supervised and individually tailored using the Activlife device.\u003c/p\u003e\n\u003cp\u003eParticipants exercised under the supervision of an instructor for 30 minutes, twice a week, over the six-week period. The parameters of the exergames were modified by JW and AF approximately every two weeks to adjust the difficulty and intensity of the tasks to the changing physical capabilities of each participant so that the exercises remain engaging and do not become boring.\u003c/p\u003e\n\u003ch2\u003eAssessment Instruments\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp; Before participating in the training program, as well as after its completion, the participants were evaluated using the diagnostic methods described below.\u003c/p\u003e\n\u003ch3\u003eFried frailty criteria\u003c/h3\u003e\n\u003cp\u003eOne of the diagnostic methods for frailty is patient classification using the frailty phenotype criteria proposed by Fried [8]. These criteria include: unintentional weight loss greater than 5 kg or 10% of body weight over the past year, weakness in handgrip strength, gait slowing, subjective feeling of exhaustion, and physical activity limitation. A score of one point was assigned for each criterion met.\u003c/p\u003e\n\u003cp\u003eFor the subjective exhaustion criterion, one point was given if the participant answered positively (i.e., \u0026quot;yes, for a short time\u0026quot; or \u0026quot;yes, for a moderate time\u0026quot;) to questions 7 or 20 on the Center for Epidemiological Studies-Depression Scale (CES-D) [43].\u003c/p\u003e\n\u003cp\u003eFor the physical activity limitation criterion, one point was awarded if the participant\u0026rsquo;s response to the short form of the International Physical Activity Questionnaire indicated insufficient physical activity.\u003c/p\u003e\n\u003cp\u003eThe threshold values for handgrip strength and gait slowing are presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eThreshold values for assigning points in Fried frailty scale for gait slowing and muscle weakness [8].\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGait slowing\u003cbr\u003e\u003c/strong\u003eTime to walk a distance of 4.6 meters measured in seconds [s]\u003cbr\u003e\u0026nbsp;(adjusted for height [cm]).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 318px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandgrip strength\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(adjusted for BMI kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eHandgrip strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eHandgrip strength\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026le; 159 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026ge; 7s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026le; 173 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026ge; 7s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026le;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026le; 17,0 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026le; 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026le; 29 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23,1-26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026le; 17,3 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e24,1-26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026le; 30 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026gt;159 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026ge; 6s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026gt;173 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026ge; 6s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26,1-28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026le; 18 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26,1-28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026le; 30 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026gt;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026le; 21 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026gt;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026le; 32 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFrailty syndrome was diagnosed based on the following criteria according to the Fried scale (i.e., at least 3 out of 5 criteria). The pre-frailty group included individuals who met 1 or 2 of the following criteria, while the robust group included individuals who did not meet any of the criteria below.\u003c/p\u003e\n\u003ch3\u003eCenter for Epidemiological Studies-Depression Scale\u003c/h3\u003e\n\u003cp\u003eCenter for Epidemiological Studies-Depression Scale (CES-D) is one of the brief-self report screening diagnostic tools used to assess depression symptoms. CES-D consists of 20 questions pointed from 0 to 3 and assess cognitive, affective and somatic symptoms of depression. It can be considered a fairly sensitive and specific screening tool for detecting symptoms of depressive disorders [44]. Scores obtained in CES-D range from 0 to 60, and a score of 15 or higher indicates a risk for depression. In 2013, the Polish version of CES-D was validated [45].\u003c/p\u003e\n\u003ch3\u003eInternational Physical Activity Questionnaire - short version\u003c/h3\u003e\n\u003cp\u003eThe International Physical Activity Questionnaire (IPAQ) is a self-report questionnaire designed to assess the level of physical activity of the respondent and is also available in the Polish language version [46,47]. In this study, the short form of the questionnaire (IPAQ-SF) was used to evaluate physical activity. This version consists of 7 questions concerning different types of physical activities that are part of daily life and last for at least 10 minutes at a time.\u003c/p\u003e\n\u003cp\u003eThe energy expenditure of each type of activity is expressed in METs (Metabolic Equivalent of Work). The following MET values were adopted for specific activities: walking \u0026mdash; 3.3 METs; moderate-intensity activity \u0026mdash; 4.0 METs; and vigorous-intensity activity \u0026mdash; 8.0 METs. Based on the total weekly energy expenditure, three categories of physical activity were distinguished: low physical activity \u0026mdash; when the total energy expenditure does not reach 600 MET-minutes/week; moderate physical activity \u0026mdash; when the total energy expenditure is between 600 and 1500 MET-minutes/week; and high physical activity \u0026mdash; when the total energy expenditure exceeds 1500 MET-minutes/week.\u003c/p\u003e\n\u003ch3\u003eKatz Index of Independence in Activities of Daily Living\u003c/h3\u003e\n\u003cp\u003eThe Katz Index of Independence in Activities of Daily Living (ADL), developed by Katz et al. in the 1960s, is a tool designed to assess basic activities of daily living in older adults, both in clinical practice and research settings [48]. The index evaluates six fundamental self-care activities: bathing, dressing, toileting, transferring (e.g., from bed to chair), continence, and feeding. Responses are provided in a dichotomous format \u0026mdash; \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no\u0026rdquo; \u0026mdash; depending on whether the individual is able to perform each task independently. The total score reflects the level of functional ability: a score of 6 indicates full independence, a score between 3 and 5 suggests moderate functional impairment, while a score of 2 or less indicates severe functional dependence.\u003c/p\u003e\n\u003ch3\u003eThe Lawton-Brody Instrumental Activities of Daily Living Scale\u003c/h3\u003e\n\u003cp\u003eThe Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) was developed as a tool to assess the level of functional independence in the general older adults population [49]. The scale evaluates eight complex daily activities necessary for independent living, including: using the telephone, shopping, meal preparation, housekeeping, laundry, transportation, medication management, and handling finances. The IADL is administered as a self-report questionnaire or through an interview with the patient or their primary caregiver.\u003c/p\u003e\n\u003cp\u003eIn the version used in this study, each item is scored from 1 to 3 points: a score of 3 indicates that the patient is able to perform the activity independently, 2 points indicate the ability to perform the activity with minimal assistance, and 1 point indicates complete dependence in performing the activity. The maximum total score is 24 points, with higher scores reflecting a greater level of functional independence.\u003c/p\u003e\n\u003ch3\u003eVulnerable Elders Survey-13\u003c/h3\u003e\n\u003cp\u003eThe Vulnerable Elders Survey-13 (VES-13) is a diagnostic tool designed to assess the current overall functional status of older adults. It consists of 13 questions grouped into two categories evaluating functional and physical performance [50]. A score of 3 or more points on the VES-13 indicates an increased risk of significant health deterioration, functional decline, or death within the next two years, and serves as a recommendation for conducting a more comprehensive geriatric assessment.\u003c/p\u003e\n\u003ch3\u003eTinetti Test/Performance Oriented Mobility Assessment\u003c/h3\u003e\n\u003cp\u003eThe Tinetti Test, also known as the Performance Oriented Mobility Assessment (POMA), is a clinical tool used to evaluate both static and dynamic balance in older adults [51]. The assessment involves five tasks: transitioning from a sitting to a standing position, maintaining a standing posture, turning 180 degrees, transitioning from standing to sitting, and walking, which is evaluated over a distance of 3 meters. The total score is the sum of points from two subscales: the gait assessment (POMA-G), with a maximum of 12 points for 7 evaluated gait characteristics, and the balance assessment (POMA-B), with a maximum of 16 points for 9 evaluated balance parameters. The maximum total score is 28 points. A score below 25 points indicates an increased risk of falls, while a score below 19 points suggests a high risk of falling.\u003c/p\u003e\n\u003ch3\u003eFullerton Fitness Test (Senior Fitness Test)\u003c/h3\u003e\n\u003cp\u003eThe Fullerton Fitness Test, developed in 1999, is a multidimensional assessment tool designed to evaluate the physical fitness of older adults (aged 60 years and above) [52]. The test consists of six components performed by the participant:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eArm Curl Test\u003c/strong\u003e \u0026ndash; evaluates upper body strength. The task involves performing as many arm curls as possible within 30 seconds while holding a dumbbell weighing 3.36 kg for men or 2 kg for women. The result is the number of correctly performed repetitions within the time limit.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBack Scratch Test\u003c/strong\u003e \u0026ndash; assesses upper body flexibility. The participant attempts to touch the middle fingers of both hands placed behind the back. The result is positive if the fingertips overlap and negative if they do not reach each other. In the latter case, the distance between the fingertips (in centimeters) is recorded.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e30-Second Chair Stand\u003c/strong\u003e \u0026ndash; evaluates lower body strength. The participant is asked to stand up and sit down from a chair as many times as possible within 30 seconds. The result is the number of correctly completed repetitions.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eChair Sit and Reach\u003c/strong\u003e \u0026ndash; assesses lower body flexibility. The participant sits on a chair and performs a forward bend, reaching as far as possible toward the toes while maintaining the position for 2 seconds. The result is positive if the fingertips reach beyond the toes; if not, the distance (in centimeters) between the fingertips and the toes is measured.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;\u003cstrong\u003e8-Foot Up and Go\u003c/strong\u003e \u0026ndash; evaluates balance and agility. The participant is instructed to stand up from a seated position, walk as quickly as possible a distance of 2.44 meters (8 feet), turn around, and return to the chair, sitting down again. The time taken to complete the task is recorded.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;\u003cstrong\u003e6-Minute Walk Test / 2-Minute Step in Place\u003c/strong\u003e \u0026ndash; these tests assess aerobic endurance and walking speed. In the 6-minute walk test, participants walk as fast as possible (without running) around a designated course for 6 minutes, and the total distance covered (in meters) is measured. In the 2-minute step test, participants perform alternating knee lifts to a predetermined individual height (half the length of the thigh) for 2 minutes, starting with the right leg. The result is the number of right leg lifts performed within the time limit.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eAll the analyses presented in this manuscript were performed using R 4.4.2 software. For the purpose of intergroup comparisons, the participants were divided into subgroups according to their assigned classification based on the Fried et al. criteria for assessing the severity of the frailty syndrome (i.e., robust, pre-frailty, frailty).\u003c/p\u003e\n\u003cp\u003eThe impact of the exergaming-based training program was compared in terms of changes in anthropometric variables, physical fitness test results, as well as scores obtained in diagnostic tools assessing independence in performing activities of daily living. These analyses were also conducted for the entire study population as well as within subgroups of individuals with varying severity of frailty syndrome, stratified by sex, age, and educational level, when statistically significant differences were observed between measurements taken before and after the implemented training program.\u003c/p\u003e\n\u003cp\u003eFor the purpose of analyzing the influence of training depending on participants\u0026apos; age, two categories were established \u0026mdash; younger participants (below 75 years of age) and older participants (75 years and above). A similar approach was applied for education level \u0026mdash; vocational and secondary education were classified as lower education.\u003c/p\u003e\n\u003cp\u003eFinally, it was verified whether the implemented training program influenced the change in the initial classification of participants within the respective frailty categories according to Fried\u0026apos;s criteria.\u003c/p\u003e\n\u003cp\u003eIn cases of missing data, no imputation methods were applied, and the dataset was not supplemented for the purposes of statistical analyses. The normality of the distribution of quantitative variables was verified using the Shapiro-Wilk normality test. Only a few variables were confirmed to have this type of distribution. For this reason, nonparametric tests were used in further examination of quantitative variables. The relationship between quantitative variables and qualitative variable categories was examined using the Wilcoxon rank sum test for pairwise comparisons. The difference in the results of quantitative variables before and after training was also verified using the Wilcoxon signed-rank test\u003cem\u003e\u0026nbsp;\u003c/em\u003efor paired samples. The independence of two qualitative variables was verified using Fisher\u0026apos;s exact test of independence. A significance level of 0.05 was adopted for all tests. The values of the calculated significance level p that were less than 0.05 were written in bold in the tables; in these cases estimation of the power of the test was performed using G*Power.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003eClassification of participants into subgroups according to Fried\u0026apos;s frailty criteria and differences in adherence rate\u003c/h3\u003e\n\u003cp\u003eA total of 186 willing participants were initially enrolled in the study and classified into subgroups (frailty, pre-frailty, and robust) based on the criteria proposed by Fried and colleagues, as described in the Methods section. Ultimately, 111 individuals completed the full training program. The proportion of participants who chose to complete the intervention varied significantly between subgroups, as shown in Table 2. The reasons for withdrawal from the study are presented in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Number of participants who started and completed the research intervention and adherence rate in individual frailty subgroups among study participants.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubgroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial number of participants in the subgroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of participants who completed the research intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdherence rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrailty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e39.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-frailty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e78.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobust\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e76.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Reasons for participants\u0026apos; withdrawal from the training program\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubgroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReason for withdrawal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of participants who withdrew for each specific reason\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrailty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eexacerbation of chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003edifficulties accessing the location where the study was conducted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003elack of time among the participant\u0026rsquo;s caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eacute infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003elack of suitable weather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003efeeling too weak/tired to continue exercising\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eperception of exergames as too difficult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003einjury related to fall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003esudden death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-frailty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eexacerbation of chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eacute infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003edifficulties accessing the location where the study was conducted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003elack of suitable weather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003elack of time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003etoo many family responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobust\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003elack of time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003etoo many family responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eacute infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eplanned surgical intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eboredom with exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWithdrawal reasons varied across frailty subgroups. In frail participants, the primary causes were exacerbation of chronic diseases (n= 22) and logistical barriers (e.g., access difficulties, caregiver time constraints). Health issues also dominated withdrawals among pre-frail individuals, although to a lesser extent. In contrast, robust participants primarily cited personal and motivational factors, such as lack of time and family responsibilities.\u003c/p\u003e\n\u003cp\u003eDemographic data of the group that completed the full training cycle \u0026mdash; including age, sex, and education level \u0026mdash; divided by subgroups, are presented in Tables 4 and 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e. Age distribution of participants within the examined subgroups before the training program.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubcategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age (in years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003evs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003efrailty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efrailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003epre-frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003epre-frailty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efrailty\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003erobust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003erobust\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003epre-frailty\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003erobust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eNote.\u0026nbsp;\u003c/strong\u003e\u003cem\u003ep\u003c/em\u003e - value of pairwise comparisons using Wilcoxon rank sum test with continuity correction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eDistribution of sex and education level of participants within the examined subgroups.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 290px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003efrailty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epre-frailty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003erobust\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e80.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003eProfessional education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e43.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e44.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote.\u003c/strong\u003e \u003cem\u003ep\u003c/em\u003e - value of the Fisher\u0026apos;s exact test\u003c/p\u003e\n\u003cp\u003eSignificant differences in age distribution were observed between the frailty and pre-frailty subgroups (p = 0.001), as well as between the frailty and robust subgroups (p \u0026lt; 0.001). No significant difference was found between the pre-frailty and robust subgroups (p = 0.156). These results indicate that participants classified as frail were significantly older than those in the pre-frail and robust subgroups prior to the training program. Furthermore, no differences in education and gender were found in the studied frailty subgroups.\u003c/p\u003e\n\u003cp\u003eChanges in the measured variables within subgroups before and after the completed training cycle are presented in Table 6. For the parameters where the differences were statistically significant (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05), the statistical power of the test (G*Power) is also reported in braces.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003eChanges in individual examined parameters within subgroups resulting from the completed training cycle.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrailty (N = 34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-frailty (N = 41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobust (N = 36)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter\u0026nbsp;\u003cbr\u003e\u0026nbsp;training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eW\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(power)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter\u0026nbsp;\u003cbr\u003e\u0026nbsp;training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eW\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(power)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter\u0026nbsp;\u003cbr\u003e\u0026nbsp;training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eW\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(power)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003emean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBody weight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e281.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e461.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e383.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBody height (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e162.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e162.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e163.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e163.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e165.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e165.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e424.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHandgrip force (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e285.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e222.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eArm diameter (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCalf diameter (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBody fat\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.986\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e186.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMuscle weight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal VES-13 (0-10 pts)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.586\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal ADL (0-6 pts)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal IADL (0-30 pts)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal Tinneti score (0-28 pts)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e4.6 m walking time (sec)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e352.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e434.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eArm Curl Test (no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e123.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.023\u003cbr\u003e\u003c/strong\u003e(0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBack Scratch Test (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003cbr\u003e\u003c/strong\u003e(0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e66.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e30 Second Chair Stand (no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003cbr\u003e\u003c/strong\u003e(0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChair Sit-and-Reach (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e8-Foot Up-and-Go (sec)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e346.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e605\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003cbr\u003e\u003c/strong\u003e(0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2-Minute Step-in-Place (no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote.\u0026nbsp;\u003c/strong\u003e(\u003cem\u003eW, p\u003c/em\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e- statistic and p-value of Wilcoxon signed rank test for paired samples.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe training program resulted in significant improvements in several physical and functional parameters across the different frailty subgroups. In participants classified as frail, significant gains were observed in handgrip force (p \u0026lt; 0.001, power = 0.99) and the total Tinetti score (p = 0.008, power = 0.85), indicating enhanced muscular strength and balance. No significant changes were noted in other examined factors.\u003c/p\u003e\n\u003cp\u003eAmong pre-frail participants, the intervention produced broader improvements regarding muscle strength, walking speed and balance. Significant enhancements were noted in the total Tinetti score (p = 0.013, power = 0.77), arm curl test repetitions (p = 0.023, power = 0.65), back scratch test flexibility (p = 0.025, power = 0.65), 30-second chair stand performance (p = 0.002, power = 0.90) and increased repetitions in the 2-Minute Step-in-Place test (p \u0026lt; 0.001, power = 0.98). Improvements in dynamic balance and agility were also evidenced by reduced times in the 8-Foot Up-and-Go test (p = 0.001, power = 0.95).\u003c/p\u003e\n\u003cp\u003eIn the robust subgroup, significant improvements were observed in arm diameter (p = 0.037, power = 0.60) and 2-Minute Step-in-Place performance (p = 0.008, power = 0.79). An intriguing finding is that a significant decrease in muscle mass was at the same time observed in robust patients (p = 0.031, power = 0.59).\u003c/p\u003e\n\u003cp\u003eOverall, the findings indicate that while frail participants benefited primarily in strength and balance, pre-frail individuals experienced the most comprehensive functional improvements. In case of patients from robust subgroup only minor stamina benefits were observed.\u003c/p\u003e\n\u003cp\u003eFor variables exhibiting statistically significant differences before and after the training program, further subgroup analyses were conducted according to participants\u0026apos; age, sex, and level of educational attainment, see Table 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7.\u0026nbsp;\u003c/strong\u003eChanges in individual examined parameters within age, sex and educational subgroups (also divided by frailty status subgroups) resulting from the completed training cycle.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in the variable before/after\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;the training program\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N = 111)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrailty (N = 34)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-frailty (N = 41)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eRobust (N = 36)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003emean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eW\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;(power)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003emean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eW\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003cstrong\u003e(power)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003emean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eW\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003cstrong\u003e(power)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003emean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eW\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003cstrong\u003e(power)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003eArm diameter (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1333\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eyounger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1302\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e131.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.586\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e173.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eolder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eeducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003elower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1492.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e98.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e225.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ehigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003eTotal Tinneti score (0-28 pts)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1311.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eyounger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1361.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eolder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eeducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003elower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1609\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e160.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ehigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003e30 Second Chair Stand (no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1335.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.879\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e177.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eyounger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1695.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e168.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e262\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eolder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eeducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003elower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1725.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e172.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e215.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ehigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003e8-Foot Up-and-Go (sec)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1114.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e103.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e159.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e114.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eyounger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1633\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e94.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e259.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e163.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.962\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eolder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eeducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003elower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1552\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e162.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.498\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e229.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ehigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e2-Minute Step-in-Place (no)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003esex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1601\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e123.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.379\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e238.5\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;5.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eyounger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e1605.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.449\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e212.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e0.442\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eolder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;5.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eeducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003elower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1342.5\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.379\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;-0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e. The table presents the mean differences in outcomes within each subgroup before and after the training program. (\u003cem\u003eW, p\u003c/em\u003e)\u003cem\u003e\u0026nbsp;\u003c/em\u003e- statistic and p-value of Wilcoxon signed rank test paired samples\u003c/p\u003e\n\u003cp\u003eFurther subgroup analyses revealed that women demonstrated significantly greater improvements than men in the 2-Minute Step-in-Place test, both in the total sample (p = 0.007, power=0.60) and in the robust subgroup (p = 0.001, power = 0.81). Additionally, within the robust subgroup, participants with lower educational attainment showed slightly greater improvement in the 30-Second Chair Stand test compared to those with higher education (p = 0.038, power = 0.40). No other statistically significant differences were found regarding sex, age, or educational level.\u003c/p\u003e\n\u003cp\u003eBoth prior to commencement of the training program and upon its completion, patients were classified into frailty categories using the criteria of Fried et al. The transitions between categories, as well as the corresponding frailty scores, are presented in Tables 8, 9 and 10.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 8.\u0026nbsp;\u003c/strong\u003eDistribution of observed transitions between frailty categories according to Fried\u0026rsquo;s classification among participants, resulting from the training cycle.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrailty categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003efrailty (n = 26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003epre-frailty (n = 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003erobust (n = 37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003efrailty \u0026nbsp;(n = 34)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003epre-frailty (n = 41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003erobust (n = 36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eOverall, 39 of 111 participants (35.1%) experienced an upward reclassification (i.e., toward greater robustness), while only 3 participants (2.7%) showed a decline in frailty status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9.\u003c/strong\u003e Distribution of observed changes in frailty scores according to Fried\u0026rsquo;s classification among participants, resulting from the training cycle.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore in Fried\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efrailty classification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e0 (n = 37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e1 (n = 26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e2 (n = 22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e3 (n = 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e4 (n = 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (n = 36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1 (n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2 (n = 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 (n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 (n = 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (n = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAnalysis of Fried frailty classification scores before and after the training intervention (N = 111) demonstrated a high stability among the robust participants (score 0), with 97.2 % (35/36) remaining unchanged. Patients at low risk of developing frailty (score 1) largely maintained their status (88.0 %), although 8.0 % deteriorated to score 2. In contrast, 25.0 % of moderately frail risk individuals (score 2) improved by at least one point, and 40.0 % of those with initial score 3 shifted to score 2. Notably, half of the participants with score 4 improved to score 3, and the sole individual at score 5 improved to score 4. Overall, 18.0 % of participants exhibited a reduction in frailty score, whereas 4.5 % experienced worsening.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10.\u003c/strong\u003e Impact of the training on the quantitative values of the frailty variable according to Fried\u0026rsquo;s classification.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"472\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraining cycle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 181px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Fried frailty score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eW\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;(power)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003ebefore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 181px;\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e72.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003eafter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 181px;\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eNote.\u0026nbsp;\u003c/strong\u003e(W, p) - statistic and p-value of Wilcoxon signed rank test for paired samples\u003c/p\u003e\n\u003cp\u003eThe training cycle elicited a modest but statistically significant reduction in overall frailty, as evidenced by a decrease in the mean Fried frailty score from 1.52 \u0026plusmn; 1.38 before intervention to 1.39 \u0026plusmn; 1.27 after intervention (Wilcoxon signed-rank W = 72.5, p = 0.008, power = 0.79). This finding supports the efficacy of the exercise games intervention in ameliorating frailty among older adults.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to the latest scientific reports, frailty therapy should primarily include a multi-component physical activity program with a strength training component and balance and flexibility exercises [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Exergames are a new area of research in the rehabilitation of people with frailty. In our study the training effects of the innovative Activlife rehabilitation device, supported by the VRTherapist application and Kinect technology was assessed among older adults with frailty and pre-frailty syndrome.\u003c/p\u003e\u003cp\u003eAdherence rate\u003c/p\u003e\u003cp\u003ePrevious studies have shown preliminary evidence that technology-based exercise programs can improve physical functioning and may have a positive effect on exercise adherence in older adults [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. A systematic review conducted by Valenzuela et.al. showed that adherence rate to technology-based exercise programs, like exergames, is high (median 91.3%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Biesek et al. reports that physical training with exergames, proved to be safe and motivating for community-based pre-frail older women, as indicated by the high adherence rate to the study (87.7%) [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Participants in the older age group identified exergaming as a fun and encouraging approach to physical activity. The high adherence rate to exergaming was also reported by Karssemeijer et al. among frail older people with mild dementia; the conducted study showed that the exergame group presented high and significantly higher adherence to the training compared to the traditional aerobic group (87.3% vs 81.1% respectively) [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. In turn, the study conducted by Moreira et al. among pre-frail older adults showed that adherence to the exergaming intervention was \u003cem\u003erather\u003c/em\u003e low (\u003cem\u003e32/49 participants, 65.3%)\u003c/em\u003e and did not differ significantly from the traditional multicomponent training (65,3% vs 68%) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In our study, the overall adherence rate to exergames intervention was low (111/186 participants, 59.7%) and varied significantly between subgroups, being 39.1% for frail, 78.8% for pre-frail, and 76.6% for robust participants. A high variability in adherence rates was also reported by Ashe et al. in the systematic review of adherence to technology-based falls prevention programs for community-dwelling older adults; the percent of participants who did not complete planned training sessions (e.g. dropped out or lost to follow up) varied from 0\u0026ndash;32% and the review included studies with participants in different health states \u0026ndash; with or without a clinical condition [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Furthermore, Valenzula et al. rightly note that although the adherence rate was high in most exergames interventions, the sample sizes were small and the studies included mostly healthy older people [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Returning to our research, it is therefore worth paying special attention to the very low adherence rates in the group of frail older adults, who were very often unable to complete training sessions due to exacerbations of chronic diseases or lack of family support and the possibility of reaching the training location in family practice. Hence, it seems reasonable to assume that exergames should be undertaken by older people as early as possible, before full-blown frailty syndrome and its complications develop.\u003c/p\u003e\u003cp\u003eThe social factor may also play a motivating role, as researchers report that playing physical games together and against a computer provides greater motivation to exercise than exercising alone [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. In our study all four couples assessed as fragile (included in the frail subgroup) completed the exergaming intervention. They rated the training as enjoyable and motivated each other by competing with each other during the training.\u003c/p\u003e\u003cp\u003eFrailty status and frailty score\u003c/p\u003e\u003cp\u003eThe study showed significant improvement in the frailty status and scores with Kinect-based exergaming for the frail older adults. The intervention elicited a modest but statistically significant reduction in overall frailty and the mean Fried frailty score decreased from 1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38 before intervention to 1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27 after intervention (p\u0026thinsp;=\u0026thinsp;0.008, power\u0026thinsp;=\u0026thinsp;0.79).\u003c/p\u003e\u003cp\u003eOverall, 35.1% of older adults (39/111 participants) improved their frailty score (i.e. toward greater robustness), while only 2.7% (3/111 participants) showed a deterioration in frailty status (increased frailty score). In the study group before the training there were 34 people diagnosed with frailty syndrome and 41 in the early stage of frailty, and after the training there were 26 people with frailty syndrome and 48 in the pre-frail status. As a result of the exergaming nearly 30% (29.4%) of older people (10/34 participants) transferred from the frailty to the pre-frail status and 44.1% of them (15/34 participants) diminished their frailty score by at least one point category. Slight improvements were also observed in the pre-frail group where 12.2% (5/41 participants) of old adults improved by at least one point category of Fried frailty score.\u003c/p\u003e\u003cp\u003ePromising results are also shown by other researchers. Gonz\u0026aacute;lez-Bernal et al. conducted a study on 80 people over 75 years of age, under institutional care [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The study group, in contrast to the control group, in addition to conventional physiotherapy took part in 20 rehabilitation exergames sessions. For this purpose, a Nintendo Wii with virtual reality (VR) technology was used. After the study was completed, a significant improvement in the frailty status was observed in the exergame group. In addition to a reduction in the severity of the frailty syndrome, in the exergame group, an increase in walking speed, improved balance and a decrease in the general risk of falls was noted [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In turn, Liao et. al. performed the study concerning fifty-two prefrail and frail older adults who were recruited and randomized to the Kinect based exergaming group or traditional combined exercise group including resistance, aerobic, and balance training for 36 sessions over 12 weeks. The study showed that Kinect-based exergaming exerted effects that were at least as beneficial as those of combined exercise in improving frailty status and the frailty phenotype. Four out of 5 physical characteristics of the frailty phenotype, namely, exhaustion, weakness, slow walking speed, and low activity level, were significantly reversed by exergaming [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA significant improvement in frailty scores and in the frailty reversal rates (43.75% frail older people reverted to a pre-frail status, and 72.7% pre-frail older adults reverted to a robust status) were noted after Kinect-based exergames training. These results provide clinical evidence about efficacy of using this innovative intervention in pre-frail and frail older adults. Other researchers have also reported the beneficial effects of exergaming training among pre-frail older adults [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Moreira et al. in their study revealed that both traditional multicomponent training and exergaming were effective in postponing frailty status, reducing the fear of falling, increasing fall risk awareness, improving physical functions and cognitive status. In turn, Biesek et al. indicate that physical training with exergames for 12 weeks associated or not associated with protein supplementation was able to reverse the pre-frailty state in community-dwelling older women.\u003c/p\u003e\u003cp\u003eIt is also worth adding that shorter exergame programs, as in our study (6 weeks, 12 training sessions), can also bring significant benefits. In the study by Mugueta-Aguinaga, it was observed that after only 3 weeks of intervention (nine training sessions) using the exergame called FRED, 60% of 65\u0026thinsp;+\u0026thinsp;older adults from the study group (12 out of 20 patients) significantly reduced the presence and risk of evidencing frailty [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. These are very promising results, proving that even a short, low-intensity training program can produce measurable effects.\u003c/p\u003e\u003cp\u003ePhysical performance effects\u003c/p\u003e\u003cp\u003eFrailty is a complex condition leading to functional deficits of a number of organs and systems. Sarcopenia, the syndrome of loss of muscle mass, quality and strength, is more common in older adults and has been considered a precursor syndrome or the physical manifestation of frailty [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Previous studies have shown that skeletal muscle mass decreases at a rate of 1\u0026ndash;2% per year after the age of 50, while skeletal muscle strength declines by 1.5% between the ages of 50 and 60, which may lead to sarcopenia [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Reduced muscle mass and strength is one of the main causes of fractures in the older people, and a number of evidences indicate that sarcopenia can be considered as one of the main physical drivers of frailty [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e] with a risk of adverse outcomes such as physical disability, poor quality of life and death [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, BIA was used to measure muscle and fat mass, which is widely used in clinical settings because it is a relatively simple, quick and non-invasive method. The study did not show an effect of exergames training on either muscle or fat mass in frail and pre-frail older adults with a small significant decrease in the robust participants. Similar results were presented by Biesek et al. where exergames training demonstrated a decline in upper limbs and appendicular muscle mass with no significant change in lower limbs mass among pre-frail older women after intervention [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. In turn, the study conducted by Tieland and al. showed an increase in strength and muscle mass in frail older people after resistance training intervention associated with 30 g of protein supplementation for 24 weeks [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. It could suggest that dietary protein supplementation is required to allow muscle mass gain during exercise training in frail elderly people. In our study, it therefore appears that the 6-week training period was not long enough to rebuild muscle tissue. According to the available literature, a resistance training program lasting\u0026thinsp;\u0026ge;\u0026thinsp;8 weeks can be considered a highly effective preventive strategy for delaying and mitigating the negative effects of early and late sarcopenia in people aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Other studies have identified benefits when physically frail individuals perform physical training three times per week, for 30\u0026ndash;45 min/session, for at least 16 weeks [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. So due to the time limitation, the results of our study can only be preliminary; a longer and more intensive training program is needed to demonstrate the potential effectiveness of motor-cognitive training with the Kinect sensor in combating sarcopenia.\u003c/p\u003e\u003cp\u003eHandgrip strength is a simple, cheap and effective method of assessing hand muscle strength, which is widely used as a predictor of overall muscle strength [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Low hand grip strength is strongly related to impaired mobility in both women and men [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. It can impair upper limb dexterity and affect the ability to maintain postural balance and gait independence [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The decrease in the grip strength is significantly associated with the risk of falls, hospitalization and mortality in older people [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. Studies have shown that resistance training significantly improves grip and upper limb strength in older patients with frailty syndrome [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Haider et al. report that even a home-based physical and nutrition intervention conducted by lay-volunteers for 12 weeks significantly increased the handgrip strength (by 2,4 kg, 95 CI: 1,0\u0026ndash;3,8) among community-dwelling older adults and frail individuals benefit more from the intervention than pre-frail individuals [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Our study showed a positive effect of training on handgrip strength in the frailty subgroup (by 1,97 kg, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, power\u0026thinsp;=\u0026thinsp;0,99) with no significant improvement in the pre-frail older people. In turn, in the study performed by Biesek et al. the handgrip strength increased by 13,7% after 12 weeks of exergames training in pre-frail older women [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Other researchers also report promising results, demonstrating positive training effects on grip strength in both exergames and traditional combined exercise training in pre-frail and frail older adults [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. However, there are also studies that, despite a number of beneficial effects of exergaming training among frail older adults, did not show any improvement in terms of increasing hand grip strength [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. It is therefore advisable to continue research in this area.\u003c/p\u003e\u003cp\u003eIn the conducted study, the exergaming intervention resulted in significant improvements in endurance, gait speed, flexibility and balance parameters among some of the study participants. During training sessions with the Activlife rehabilitation platform, it was noticed that most of the movements in the exergames focused on the upper limbs and trunk. Therefore, one might expect that such training would not improve gait and balance in the subjects. However, it turns out that walking is a complex movement consisting of range of movement, speed, position and muscle training [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. In movement games, standing or sitting, participants have to balance in various positions, such as leaning forward, reaching forward, making sideways movements. This movement can involve the trunk, hips, knees and joints. Such movements can strengthen the muscles of the trunk and lower limbs and thus improve balance control and functional efficiency of muscle groups responsible for walking. Park et al. observed that walking speed significantly increased after seated boxing training focused on stretching and strengthening the upper limbs for 6 weeks three times a week. In this study, although the training did not involve the lower limbs, it did show an improvement in gait [\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. In addition, arm swing in the human gait cycle plays an active role in the control of body posture, so when the range of motion of the upper limbs increases, it may lead to an increase in arm swing and limb coordination, which results in an increase in gait speed. This may explain the results of our study, where training was performed in a standing or sitting position, and gait speed increased significantly in the pre-frail participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, power\u0026thinsp;=\u0026thinsp;0.98). Gait speed is significantly associated with transitions in an individual\u0026rsquo;s frailty status [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e] and slow gait speed is one of the strongest predictors of chronic disability and injurious falls [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e]. According to Liao et al. results, gait speed improved by 0.13 m/s after exergaming training and by 0.06 m/s after combined traditional exercise what was clinically important as most of the small significant change estimates range from 0.04 to 0.06 m/s for gait speed [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDynamic balance is also an important indicator for fall risk. It is estimated that 1 in 3 older adults living in the community suffer one or more falls in a year [\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e]. In older people, changes in multiple physiological systems (musculoskeletal dysfunction, impaired neurological control and energy metabolism) lead to poor locomotion or difficulties in complex coordination, which are the consequences of poor balance. Impaired postural control is one of the main causes of falls, which is manifested by a reduced ability to maintain and restore balance during physical activity [\u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e]. There is strong evidence that appropriately designed exercise programs can prevent falls in community-dwelling older people [\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e]. Exercise interventions that train stepping ability have been found to be able to reduce the number of falls in older people by half likely due to improved balance, greater mobility and shorter reaction times [\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e]. Our research confirms these reports. The therapeutic games used in the conducted study included a series of stepping exercises and were found to significantly improve balance and possibly decrease the risk of falling. The results were found to be beneficial in both the pre-frail and frail subgroups of older participants (p\u0026thinsp;=\u0026thinsp;0.013 and p\u0026thinsp;=\u0026thinsp;0.008 respectively for total Tinetti score) with no improvement in the robust ones. Similar results were achieved by other researchers [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e]. The study conducted by Gonzales-Bernal et al. showed that rehabilitation sessions with the use of Wii games during 8 consecutive weeks positively influenced walking speed, falling risk and balance in institutionalized older adults [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In turn, Liao et al. revealed that Kinect -based exercises were able to improve significantly endurance, agility, muscle strength, dynamic balance and walking speed in community dwelling pre-frail and frail older people and exergaming intervention exerted effects that were at least as beneficial as those of traditional combined exercise [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Moreover, Nilsagard et al. showed that playing Wii Fit games twice a week for 6 weeks moderately improved gait and confidence in balance in people with walking problems, such as those with multiple sclerosis [\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e]. The results seem credible and promising and certainly warrant continued research in this area.\u003c/p\u003e\u003cp\u003eHowever, it is worth noting, as demonstrated in our study, that the most comprehensive improvement in physical performance (concerning muscle strength, walking speed, balance, endurance, flexibility) was among pre-frail participants. The vast majority of previous studies focused primarily on pre-frail older adults [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e] or did not distinguish between pre-frail and frail individuals, analyzing the effects of the interventions on physical performance parameters collectively [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e]. Therefore, it seems reasonable to emphasize that multi-component interventions in the form of exercise games among frail older people should be undertaken as early as possible, optimally still at the pre-frailty stage, before any frailty complications develop.\u003c/p\u003e\u003cp\u003eGenerally, there was no association between personal data (sex, age, education) and physical performance parameters both in the entire study group and in individual subgroups. Only, in the 2-Minute Step-in-Place test, women demonstrated significantly greater improvements than men, both in the total sample (p\u0026thinsp;=\u0026thinsp;0.007) and in the robust subgroup (p\u0026thinsp;=\u0026thinsp;0.001). In the study, significantly more women than men took part in the exergames intervention. The female to male ratio was similar to the typical distribution of the European population in older adults [\u003cspan citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e]. The predominance of women can also be explained by the fact that women are more willing to engage in various community activities and are more physically and socially active [\u003cspan citationid=\"CR92\" class=\"CitationRef\"\u003e92\u003c/span\u003e, \u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e]. Women are also more willing to take care upon their health which could be reflected in the fact that there were slightly greater benefits from the intervention in the case of women, although, at the same time, it is worth to remember that this significant improvement concerned only one examined parameter of physical fitness [\u003cspan citationid=\"CR93\" class=\"CitationRef\"\u003e93\u003c/span\u003e, \u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDespite concerted efforts, several limitations must be acknowledged. First, the study population was selected among volunteers attending a primary healthcare clinic in a large Polish city, which does not reflect the demographic characteristics of the national population. Moreover, the group of participants classified as frail was significantly older than those identified as pre-frail or robust. However, this appears to be an unavoidable consequence, as the prevalence of frailty syndrome increases substantially with age at the population level. The second limitation of this study is the short duration of both the observation period and the therapeutic intervention. Measurements were taken immediately after the completion of a 6-week exergame-based training program. Extending the duration of the program or repeating it following a brief interval may potentially yield even greater benefits for the participants. Another limitation is the relatively small number of individuals in each subgroup, particularly in the frailty group. This is primarily due to difficulties in recruiting willing participants and high drop-rate, as evidenced, among other factors, by the reasons given for withdrawal. Nevertheless, the statistically significant differences observed between subgroups before and after the intervention support the efficacy of exergames in reducing the burden of frailty syndrome. The continued development of such interventions may prove particularly promising in light of the global trend of population aging.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms the potential benefits of exergaming interventions using Kinect-based technology for older adults, particularly those in the pre-frail stage. Although overall adherence to training was moderate, adherence varied significantly by frailty status, with the lowest rates observed among frail participants. These findings highlight the importance of initiating physical interventions as early as possible, ideally before the onset of full frailty, to maximize adherence and therapeutic effect.\u003c/p\u003e\u003cp\u003eThe exergaming intervention produced a statistically significant improvement in frailty scores, with notable transitions from frailty to pre-frailty. However, the most pronounced functional gains\u0026mdash;including improvements in muscle strength, gait speed, endurance and balance\u0026mdash;were observed among pre-frail individuals, suggesting that they may be the most responsive subgroup to such interventions. While frail participants demonstrated some physical improvements, particularly in grip strength and balance, the short duration of the training (6 weeks) may have limited the extent of muscle mass development and overall physical adaptation. The findings are consistent with prior research indicating that even short-duration, technology-assisted programs can lead to measurable improvements in physical function and frailty status [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. However, for sustained and comprehensive effects\u0026mdash;particularly in combating sarcopenia\u0026mdash;longer training durations and potential adjuncts such as protein supplementation may be necessary.\u003c/p\u003e\u003cp\u003eIn light of these results, Kinect-based exergaming appears to be a promising, engaging, and partially scalable intervention for older adults at risk of frailty. Further large-scale, long-term studies are warranted to optimize training parameters, improve adherence among frail individuals, and evaluate the broader clinical utility of such digital rehabilitation tools.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADL Katz Index of Independence in Activities of Daily Living \u003c/p\u003e\n\u003cp\u003eBIA Bioelectrical Impedance Analysis \u003c/p\u003e\n\u003cp\u003eBMI Body Mass Index\u003c/p\u003e\n\u003cp\u003eCES-D Center for Epidemiological Studies-Depression Scale\u003c/p\u003e\n\u003cp\u003eIADL Lawton-Brody Instrumental Activities of Daily Living Scale\u003c/p\u003e\n\u003cp\u003eIPAQ International Physical Activity Questionnaire \u003c/p\u003e\n\u003cp\u003eIPAQ-SF International Physical Activity Questionnaire Short Form\u003c/p\u003e\n\u003cp\u003eMET Metabolic Equivalent of Work\u003c/p\u003e\n\u003cp\u003ePOMA Performance Oriented Mobility Assessment \u003c/p\u003e\n\u003cp\u003eVES-13 Vulnerable Elders Survey-13 \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThe study design received approval from the Bioethics Committee at the Wroclaw Medical University (Approval No. \u0026mdash; 172/2019 from March 5\u003csup\u003eth\u003c/sup\u003e 2019). All study participants gave written consent to participate in the study. All procedures were performed in accordance with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eAll authors have read and approved the final version of the manuscript and consent to its publication.\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eThe dataset generated and analyzed during the current study are available in the Figshare repository: doi.org/10.6084/m9.figshare.29178977.\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThe study was financed from the researchers\u0026apos; own funds and the internal funds of Wroclaw Medical University.\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026apos; contributions\u003c/h3\u003e\n\u003cp\u003eMBF conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and then critically reviewed and revised the manuscript. JW\u0026nbsp;assisted with the conceptualisation of the study,\u0026nbsp;designed the data collection instruments,\u0026nbsp;collected data, carried out the initial analysis and critically reviewed the manuscript. MS\u0026nbsp;assisted with the initial analysis and drafted the initial manuscript, critically reviewed\u0026nbsp;the manuscript for important intellectual content. AF collected data, helped with data processing and synthesis and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eWe would like to thank participating patients and their families for their involvement in the study. We would also like to acknowledge Martyna Pałys, resident in family medicine, for her help/assistance in conducting the exercise games training and data collection. The authors express their appreciation to Tomasz Kujawa for his methodological and statistical help.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLang PO, Michel JP, Zekry D. Frailty syndrome: A transitional state in a dynamic process. Gerontology [Internet]. 2009 [cited 2025 Jun 9];55:539\u0026ndash;49. Available from: https://pubmed.ncbi.nlm.nih.gov/19346741/\u003c/li\u003e\n\u003cli\u003eBinder EF, Schechtman KB, Ehsani AA, Steger-May K, Brown M, Sinacore DR, et al. Effects of exercise training on frailty in community-dwelling older adults: Results of a randomized, controlled trial. J Am Geriatr Soc [Internet]. 2002 [cited 2025 Jun 1];50:1921\u0026ndash;8. Available from: https://pubmed.ncbi.nlm.nih.gov/12473001/\u003c/li\u003e\n\u003cli\u003eCameron ID, Fairhall N, Langron C, Lockwood K, Monaghan N, Aggar C, et al. A multifactorial interdisciplinary intervention reduces frailty in older people: Randomized trial. 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Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7462-1\u003c/li\u003e\n\u003cli\u003eLiao YH, Kao TW, Peng TC, Chang YW. Gender differences in the association between physical activity and health-related quality of life among community-dwelling elders. Aging Clin Exp Res [Internet]. 2021 [cited 2025 Jun 1];33:901\u0026ndash;8. Available from: https://pubmed.ncbi.nlm.nih.gov/32462499/\u003c/li\u003e\n\u003cli\u003eBertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender Differences in the Utilization of Health Care Services. J Fam Pract. 2000;49:147\u0026ndash;52. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"exergaming, exergames, frailty, physical performance, aged, primary care","lastPublishedDoi":"10.21203/rs.3.rs-7130404/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7130404/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground.\u003c/strong\u003e Frailty is an increasingly diagnosed condition of increased susceptibility of older people to deterioration of their overall health, functional capacity and independence. According to the latest scientific reports, frailty syndrome therapy should be comprehensive, and the first-line treatment should include a multi-component physical activity program. The aim of the study was to evaluate the impact of exercise games intervention (exergames) on the functional abilities of 65+ older adults with frailty and pre-frailty syndrome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods.\u003c/strong\u003e The study was conducted in 111 patients (31 men, 80 women) aged 65–89 who volunteered for an exergames rehabilitation program. The diagnosis of frailty was based on the Linda Fried criteria. A 6-week standardized training program was carried out with the use of the game rehabilitation platform with Kinect sensor. The subjects exercised under the supervision of an instructor for at least 30 minutes twice a week. The comprehensive geriatric assessment was conducted before and after the intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults.\u003c/strong\u003e The study showed significant improvement in the frailty status and scores with Kinect-based exergaming for the frail older adults. The exergames intervention elicited a modest but statistically significant reduction in overall frailty and the mean Fried frailty score decreased from 1.52 ± 1.38 before intervention to 1.39 ± 1.27 after intervention (W=72.5, p = 0.008, power=0.79). The most pronounced functional gains—including significant improvements in muscle strength (arm curl test repetitions: p = 0.023, power = 0.65, 30-second chair stand performance: p = 0.002, power = 0.90), gait speed and endurance (2-Minute Step-in-Place test: p \u0026lt; 0.001, power = 0.98) and \u0026nbsp;balance (8-Foot Up-and-Go test: p = 0.001, power = 0.95) —were observed among pre-frail individuals. A positive effect of intervention on reducing the risk of falls was found in both \u0026nbsp;pre-frail (p=0.013, power=0.77) and frail older adults (p=0.008, power=0.85).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions.\u003c/strong\u003e Exergaming exerts positive effect on the functional abilities of frail and pre-frail older adults and could be considered in clinical settings to address frailty. The findings highlight the importance of initiating physical interventions as early as possible, ideally before the onset of full frailty, to maximize adherence and therapeutic effect of the intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration. \u003c/strong\u003eThis study has been registered in the ClinicalTrials.gov database and has been assigned the ID NCT07036224.\u003c/p\u003e","manuscriptTitle":"Evaluation of exergames intervention on the functional abilities of 65+ older adults with frailty and pre-frailty syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-13 14:25:16","doi":"10.21203/rs.3.rs-7130404/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-03T13:13:31+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-29T09:16:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-22T12:18:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-21T00:24:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-20T14:15:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T00:06:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307308654749456509184684219648789805717","date":"2025-08-15T07:34:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266748170925652573307592467366087240233","date":"2025-08-13T09:10:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307154072831486245214322499146813878393","date":"2025-08-12T23:17:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33693900989729023069180042317610048330","date":"2025-08-10T23:37:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"22788892180161207461829669189502272025","date":"2025-08-10T14:53:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69438860233452898735058504985904695308","date":"2025-08-08T06:27:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-07T16:33:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-07T16:21:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-24T15:56:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-23T07:59:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-07-23T07:55:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cabb1348-8f05-403d-99f8-af3ab9336e4a","owner":[],"postedDate":"August 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":53071359,"name":"Health sciences/Diseases"},{"id":53071360,"name":"Health sciences/Health care"},{"id":53071361,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-03-16T16:02:30+00:00","versionOfRecord":{"articleIdentity":"rs-7130404","link":"https://doi.org/10.1038/s41598-026-38989-4","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-03-09 15:59:07","publishedOnDateReadable":"March 9th, 2026"},"versionCreatedAt":"2025-08-13 14:25:16","video":"","vorDoi":"10.1038/s41598-026-38989-4","vorDoiUrl":"https://doi.org/10.1038/s41598-026-38989-4","workflowStages":[]},"version":"v1","identity":"rs-7130404","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7130404","identity":"rs-7130404","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}