Impact of Traditional Chinese Exercise and Resistance Band Training on Sarcopenia in the Elderly: A Randomized Controlled Trial

Impact of Traditional Chinese Exercise and Resistance Band Training on Sarcopenia in the Elderly: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of Traditional Chinese Exercise and Resistance Band Training on Sarcopenia in the Elderly: A Randomized Controlled Trial Chen Jiawei, Yuan Qianwen, Li Zeyun, Xiao Le, Peng Kun, Li Jie, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6429780/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study aimed to evaluate the impact of various exercise interventions on skeletal muscle mass and physical function in elderly sarcopenic patients. Methods: Eighty elderly individuals diagnosed with sarcopenia and undergoing physical examinations in Xiangtan City between November 2022 and April 2023, were selected through convenient sampling. Participants were randomly assigned to four groups using the random number method: Baduanjin group, resistance band group, mixed exercise group, and control group, with 20 individuals in each. The Baduanjin group engaged in traditional Baduanjin exercises, the resistance band group participated in resistance band training, and the mixed exercise group performed a combination of both interventions. Each intervention was conducted three times per week, with sessions lasting 30 minutes, for a total duration of 12 weeks. Appendicular skeletal muscle mass (ASM), appendicular skeletal muscle mass index (ASMI), handgrip strength (HGS), gait speed (GS), short physical performance battery (SPPB) scores, and timed up - and - go test (TUGT) were measured through pre - and post - assessments. Results: The pre-intervention analysis revealed no significant differences in indicators among the four groups. Post-intervention intra-group comparisons indicated varying degrees of improvement in ASM, ASMI, HGS, GS, TUGT, and total SPPB scores in the Baduanjin, resistance band, and mixed exercise groups ( P< 0.05). Notably, the balance score within the SPPB subscale exhibited a significant increase in the Baduanjin group ( P< 0.05). GS and SST scores showed marked enhancement in the resistance band and mixed exercise groups ( P< 0.05). Moreover, changes in HGS, gait speed, and TUGT were significantly greater in the resistance band and mixed exercise groups compared to the control group ( P< 0.05). Inter-group comparisons of variations revealed that ASM and ASMI improvements in the resistance band group significantly surpassed those in the control group ( P 0.05). Additionally, the SPPB variation in the resistance band group exceeded that of the control group ( P< 0.05). Conclusion: Baduanjin demonstrated a substantial enhancement in balance function among sarcopenic patients, while resistance band exercises and mixed exercises contributed to notable gains in ASM and overall physical performance. Health sciences/Medical research Health sciences/Health care/Geriatrics Health sciences/Health care/Quality of life Health sciences/Health care/Therapeutics Elderly sarcopenia exercise intervention exercise rehabilitation skeletal muscle mass index Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1 Introduction Sarcopenia, a condition marked by the progressive decline of skeletal muscle mass and strength, is strongly associated with aging [ 1 ] and exhibits a high prevalence among the elderly worldwide, with an estimated incidence ranging from 10–16% [ 2 ] . This degenerative process, characterized by muscle atrophy and frailty, is accompanied by morphological and functional alterations, often coexisting with osteoporosis and increasing susceptibility to falls and fractures. In advanced stages, sarcopenia significantly compromises mobility and autonomy, potentially resulting in long-term disability [ 3 ] . Current therapeutic approaches for sarcopenia remain under investigation, yet exercise intervention continues to be the primary strategy for both its prevention and management [ 4 , 5 ] . Exercise regimens tailored for sarcopenic patients primarily include resistance and aerobic training [ 6 – 8 ] . Notably, resistance exercise demonstrates superior efficacy in enhancing muscle mass and strength [ 9 , 10 ] . Extensive research indicates that resistance training significantly increases handgrip strength (HGS) and skeletal muscle mass [ 11 ] , while also promoting protein synthesis and neural adaptability in the elderly [ 12 ] . Among resistance modalities, resistance band exercises are widely utilized and have been shown to positively impact sarcopenia treatment. Empirical evidence supports their role in increasing muscle mass, improving muscle strength, optimizing body composition, and enhancing overall physical function in older adults, thereby contributing to sarcopenia prevention and treatment [ 13 ] . Furthermore, traditional Chinese exercise (TCE), rooted in traditional Chinese medicine with a history spanning approximately 3,000 years, offers a cost-effective, accessible, and safe aerobic training option for elderly individuals [ 14 , 15 ] . Kun et al. [ 16 ] reported significant improvements in limb function among sarcopenic patients following TCE, particularly in gait speed, balance, and strength. Research suggests that TCE exerts anti-inflammatory effects, mitigating sarcopenia through the modulation of inflammatory cytokines such as interleukin-6 and C-reactive protein [ 17 ] . As a key component of non-pharmacological Chinese medicine interventions, TCE includes practices like Baduanjin, Yijin Jing, tai chi, and five-animal exercises. Preliminary studies indicate that Baduanjin, in particular, markedly enhances muscle strength in sarcopenic patients [ 18 ] . Resistance band exercises and Baduanjin offer accessible and practical options for elderly individuals to engage in community-based physical activity, requiring minimal equipment and space. Unlike high-intensity exercise, these modalities align with the physical capacities of older adults and are well-suited for widespread community implementation. While both have demonstrated beneficial effects in managing sarcopenia among the elderly, their comparative efficacy remains unclear. Existing research has yet to establish a definitive distinction between the therapeutic outcomes of resistance exercise and Baduanjin for sarcopenic patients. To bridge this gap, the present study employed a randomized controlled trial (RCT) design to evaluate the effectiveness of three exercise interventions—Baduanjin, resistance band exercises, and a combined regimen incorporating both—on muscle mass and physical function in elderly sarcopenic individuals. A comprehensive assessment of these interventions aimed to inform the development of optimized exercise prescriptions tailored to this population. 2 Participants and Methods 2. 1 Recruitment of participants A total of 556 elderly individuals aged 60 and above were recruited between November 2022 and April 2023 from Xianggang Xinsi Village, Xianggang Xinwu Village, Quanxintang Community, and Batang Village in Yuetang District, Xiangtan City, Hunan Province. A convenient sampling method was employed, and data collection, including a questionnaire survey and physical assessments, was conducted in a quiet, open community space. The study protocol was approved by the Ethical Committee of Central Hospital of Xiangtan in October 2022 (Approval No. 2022-10-001) and was registered in the Chinese Clinical Trial Registry : ChiCTR2400089722 (13/09/2024). The study was conducted per the principles of the Declaration of Helsinki. Written informed consent was obtained from all subjects. Diagnosis followed the criteria established by the Asian Working Group for Sarcopenia (AWGS) in 2019 [ 19 ] : (1) Reduced muscle strength, indicated by HGS < 28 kg in males and < 18 kg in females; (2) Declined physical performance, defined as a 6-meter gait speed (GS) < 1 m/s or short physical performance battery (SPPB) scores ≤ 9; (3) Low skeletal muscle mass, measured by the appendicular skeletal muscle index (ASMI) calculated as the sum of limb skeletal muscle mass (kg) divided by height squared (m²), with thresholds of < 7 kg/m² for males and < 5.7 kg/m² for females. Sarcopenia was diagnosed when criterion (1) or (2) was present alongside (3). The detailed screening process was illustrated in Fig. 1 . Eligibility for inclusion required: (1) fulfillment of diagnostic criteria for sarcopenia; (2) voluntary engagement in exercise following the prescribed regimen; (3) comprehension of study protocols and provision of written informed consent. Exclusion criteria included: (1) presence of hemiplegia or acute myocardial infarction; (2) diagnosis of cachexia; (3) prior systemic treatment relevant to the study; (4) active severe infection; (5) cognitive or motor impairments; (6) engagement in regular exercise within the past year, including weight-bearing activities or brisk walking. Sample size calculation was conducted using Gpower software (version 3.1.9.7) to determine statistical power. The increase in ASMI was considered a primary outcome, with calculations referencing a similar study by Zhu et al. [ 20 ] . In that study, ASMI changes exhibited significant intergroup differences, with mean values of -0.05, 0.02, and 0.11, and an SD of 0.14. Group sample sizes were 37, 40, and 36, respectively, yielding a calculated effect size of 0.46. Based on Zhu et al.’s findings, assuming an SD of 0.14, repeated measures ANOVA was selected with a statistical power of 0.95, an α level of 0.05, and four groups. A minimum of totaling 52 across all groups was required. Accounting for an anticipated 15% dropout rate, the study aimed to recruit at least 60 participants. A total of 87 sarcopenic patients were screened for eligibility, with 80 ultimately meeting the inclusion criteria and providing informed consent. All participants were stratified by gender and randomly assigned to 4 groups in a ratio of 1:1:1:1. Randomization was generated by Li Zeyun through a computer program (Research Randomizer Form www.randomizer.org ). They were assigned to three intervention groups—Baduanjin (n = 20), resistance band (n = 20), and mixed exercises (n = 20)—along with a control group (n = 20) by Chen Jiawei. Ethics approval was obtained from the Ethics Committee of Central Hospital of Xiangtan (Approval No. 2022-10-001), and the study was conducted in Xianggang Xinsi Village, Xianggang Xinwu Village, Quanxintang Community, and Batang Village in Yuetang District, Xiangtan City. The methodology adhered to the CONSORT 2010 guidelines [ 21 ] , with all procedures implemented according to the approved research protocol. 2.2 Study methods 2.2.1 Interventions The Baduanjin group performed the Baduanjin Qigong exercise method, as supervised by the General Administration of Sport of China ( [ 18 ] , video source: https://www.bilibili.com/video/av85510564/ ). Sessions lasted 30 minutes per session, three times per week, over a 12-week intervention period. The exercise regimen included the following postures: (1) Two hands hold up the heavens, (2) Drawing the bow, (3) Separating heaven and earth, (4) Wise owl gazes backwards (or look back), (5) Sway the head and shake the tail to dispel Xin Huo , (6) Two hands hold the feet to strengthen the kidneys and waist, (7) Clenching fists with an angry gaze, and (8) Bouncing on the toes. Resistance band group: The Thera-Band resistance system, as referenced in previous studies [ 22 ] , served as the primary modality for resistance band exercises. Each band color corresponds to a distinct level of elasticity, with resistance determined by the percentage of elongation. Participants selected appropriate resistance levels based on individualized needs. Sessions lasted 30 minutes, conducted three times per week over a 12-week period. Exercise intensity was prescribed according to the ICFSR Expert Consensus Guidelines [ 23 ] , maintaining a range of 40–80% 1RM. A licensed intermediate rehabilitation therapist provided training and supervision throughout the intervention. The Rating of Perceived Exertion (RPE) scale regulated exercise intensity throughout the training, with individual exercise load tolerance set within a specific range. The RPE score (12–16) aligned with the moderate-intensity exercise scale recommended by the American College of Sports Medicine [ 24 ] . Exercise selection followed prior research [ 13 ] , incorporating six upper limb strength exercises (pulldown, pullback, shoulder abduction, biceps curl, triceps extension, and stand-up) and six lower limb strength exercises (leg press, ankle eversion, ankle dorsiflexion, knee extension, knee flexion, and hip flexion). Participants initially trained with the lowest resistance band (yellow), progressively increasing resistance until failure to complete 10 repetitions (10 RM) at the next level. The final resistance band successfully completed at 10 RM was designated for the training program. Each session included two sets at an intensity corresponding to 40–80% of 10 RM, with a one-minute rest interval between sets. Throughout the 12-week intervention, training volume for both upper and lower limbs remained constant, with 10 to 15 repetitions per set. Maximum strength (10 RM) was assessed using progressively higher-resistance bands. If participants successfully completed 10 RM, resistance was increased every four weeks; if progression was not feasible, band length was reduced by half to maintain intensity. This protocol was sustained through the 12-week intervention. The mixed exercise group underwent a combined regimen of Baduanjin and resistance band exercises, with each session comprising 15 minutes of each modality, totaling 30 minutes per session, performed three times per week over a 12-week period. Participants in the control group received no specific intervention and were instructed to maintain their usual daily activities while refraining from engaging in any structured exercise programs (Table 1). Table 1 The trial protocol for exercise intervention. Groups Exercise types Intensity Each session Frequency and Period Control group No exercise intervention NA NA NA Baduanjin group Baduanjin Qigong RPE Score (12–16) Warm up for 5min + 30min exercise + 5min relaxation 3 times / week for 12 weeks Resistance band group Resistance band exercises 40%-80% 1 RM; RPE Score (12–16) Warm up for 5min + 30min exercises (1-2min interval between sets) + 5min relaxation 3 times / week for 12 weeks Mixed exercise group Baduanjin Qigong and resistance band exercises 40%-80% 1 RM; RPE Score (12–16) Warm up for 5min + 30min practice (15min Baduanjin Qigong + 15min resistance band exercises / 1-2min between sets) + 5min relaxation 3 times / week for 12 weeks HRmax: Max Heart Rate;RPE༚Rating of Perceived Exertion༛RM: Repetition Maximum, equation: 1RM = (1 + (0.0333 × reps)) × repetition load 33 . Exercise sessions must be discontinued immediately if any of the following conditions arise: (i) respiratory distress, including shortness of breath or difficulty breathing, chest tightness, or related symptoms; (ii) muscle spasms or joint pain; (iii) abnormal physiological responses, such as blood pressure exceeding 180 mmHg, heart rate below 60 beats/min, or blood oxygen saturation falling below 88%; (iv) signs of excessive physical exertion intolerance. In the event of these occurrences, exercise cessation is required, followed by rest or appropriate pharmacological intervention. If symptoms persist despite medication, urgent referral to a specialized medical facility is warranted [ 18 ] . The complete trial process was illustrated in Fig. 2 . 2.2.2 Outcome measures Primary outcomes: Skeletal muscle mass was evaluated using bioimpedance analysis (BIA) with a human body composition analyzer (InbodyS10), providing measurements of ASM. ASMI was derived using the formula: ASM (kg)/height² (m²) [ 19 ] . Secondary outcomes: Handgrip strength (HGS) was assessed using a handgrip strength meter (Sammons Preston, USA) with measurements recorded in kilograms. The test was conducted on the dominant hand while the patient remained seated, maintaining the arm close to the body with an unsupported forearm, a 90° elbow flexion, and a neutral wrist position. The handgrip strength meter handle was adjusted to ensure the middle phalanx of the third finger aligned perpendicularly to the handle’s long axis. Patients were instructed to exert maximal force for 3–5 seconds while verbal encouragement was provided. A 30-second interval was maintained between trials, and the average of three attempts was recorded as the final handgrip strength value [ 22 ] . Under resting conditions, normal HGS for the dominant hand is defined as > 25 kg for males and > 18 kg for females, with most individuals being right-handed [ 25 ] . Short physical performance battery (SPPB): it is a comprehensive assessment tool used to evaluate the physical function and mobility of older adults. It consists of three subtests that measure different aspects of physical performance. Here is a detailed explanation: 1. Balance test: it includes standing with feet together, in a semi-tandem position (one foot in front of the other with a small distance between them), and in a tandem position (one foot directly in front of the other). Each position could be held up to 10 s with their time being recorded in seconds and subsequently scored. 2. Gait speed test: it was completed with the participant having both feet behind a marked line. Participants were asked to walk at their normal pace for accurate gait analysis. Timing began when participant made their first movement and ended when trailing foot passed the marked line at the end of the course. 3. Sit-to-stand test: it was performed using an armless chair. Participants were seated in the chairwith arms crossed over the chest. Participants stood five consecutive times, with time starting from first movement and ending when participants returned to the seated position after the fifth repetition. SPPB with a maximum of 12 points. Scores of 10–12 indicate preserved muscle function, 7–9 reflect moderate impairment, and 0–6 signify severe impairment [ 26 ] . The scale's reliability is supported by a Cronbach’s alpha coefficient of 0.87 [ 27 ] . For the six-meter gait speed test, a straight 6-meter walking track was marked on the ground using yellow tape. Participants were instructed to walk the distance at a normal pace, with completion time measured using a stopwatch. Gait speed was then calculated accordingly [ 28 ] . TUGT: During the assessment, the patient remained in regular footwear and was seated in a chair with armrests (seat height: approximately 45 cm; armrest height: approximately 20 cm), with the back resting against the chair and hands positioned on the armrests. If a walker was used, it must be held during the test. A clearly visible marker, such as a colored strip or thick line, was placed on the floor 3 meters from the seat. Upon the tester’s "start" command, the patient rose from the chair, maintained stability, and proceeded to walk 3 meters with a natural gait. After crossing the marker, the patient turned, returned to the chair, turned again, and sat down with the back resting against the chair. No physical assistance was permitted during the test. Before the formal assessment, 1 to 2 practice trials were provided to ensure comprehension of the procedure [ 29 ] . The scale’s Cronbach's alpha coefficient was 0.74 [ 30 ] . Blinding was used at all times in assessing outcomes, and all assessment workers were not told which group the participants were from. 2.3 Statistical analysis Data analysis was conducted using SPSS 21.0 (EASYBIO, China), while GraphPad 9.5 was employed for statistical processing and image visualization. Measurement data were presented as mean ± standard deviation (‾x ± s). The Shapiro-Wilk test assessed normality, and all outcome variables conformed to a normal distribution. A paired sample t-test evaluated differences between pre- and post-test measurements. One-way ANOVA analyzed pre- and post-test mean differences across multiple groups, followed by the Tukey test for post-hoc comparisons. If normality was not met, a non-parametric approach was applied, with the Kruskal-Wallis H test for intergroup comparisons and the Dunnett-t test for multiple comparisons. Count data were expressed as case numbers (%), with comparisons performed via the χ² test. Statistical significance was defined as P < 0.05. A P-value below 0.01 indicated a highly significant difference, while P < 0.001 denoted an extremely significant difference. 3 Results Following the 12-week intervention period, 4 participants withdrew from the Baduanjin group, 4 from the resistance band group, 5 from the mixed exercise group, and 5 from the control group. A detailed flow chart was provided in Fig. 2 . 3.1 Baseline demographic and clinical characteristic of the participants. No significant differences were observed in baseline characteristics across the four groups ( P > 0.05), indicating comparability, as shown in Table 2 . Table 2 Baseline demographic and clinical characteristic of the participants.. Demographic characteristic Control group (N = 16) Baduanjin group (N = 16) Resistance band group (N = 15) Mixed exercise group (N = 15) F/χ² P Sex,n(%) 0.661 0.882 Male 7 (43.75) 8 (50.00) 6 (40.00) 8 (53.33) Female 9 (56.25) 8 (50.00) 9 (60.00) 7 (46.67) Age (year) 78.44 ± 6.79 78.44 ± 7.24 76.80 ± 6.00 79.00 ± 5.69 0.324 0.808 Height (m) 1.50 ± 0.06 1.53 ± 0.06 1.54 ± 0.04 1.55 ± 0.08 1.414 0.248 Weight (kg) 47.16 ± 6.81 49.28 ± 3.41 50.61 ± 4.71 50.48 ± 5.34 5.605 0.133 BMI (kg/m 2 ) 20.84 ± 2.19 21.19 ± 2.18 21.35 ± 1.57 21.16 ± 1.71 0.191 0.902 MNA-SF(score) 10.50 ± 1.91 11.3 ± 1.66 10.8 ± 2.14 9.93 ± 1.62 1.500 0.224 Diabetes, n (%) 8 (50.00) 9 (56.25) 7 (46.66) 8 (53.33) 0.660 0.882 Hypertension, n (%) 9 (56.25) 12 (75.00) 10 (66.67) 7 (46.66) 2.970 0.396 BMI: body mass index; MNA-SF༚short-form mini-nutritional assessment. 3.2 Comparison of skeletal muscle mass and physical function across the four groups before and after intervention Pre-intervention, no significant differences were observed among the four groups. Post-intervention, within-group comparisons revealed significant improvements in ASM and ASMI in both the resistance band and mixed exercise groups ( P < 0.05) (Table 3 ). The inter-group comparison indicated that the resistance band group showed significantly greater changes than the control group ( P < 0.05) (Fig. 3 ). Regarding physical function, post-intervention intra-group comparisons demonstrated significant improvements in HGS, gait speed, balance, and SPPB in the Baduanjin, resistance band, and mixed exercise groups ( P < 0.05) (Table 3 ). Inter-group comparisons revealed that both the resistance band and mixed exercise groups showed greater improvements than the control group in HGS, gait speed, and SPPB ( P < 0.05). The resistance band group outperformed the control group in HGS and SPPB ( P < 0.05), while the mixed exercise group showed greater gains than the control group in HGS, gait speed, and balance ( P 0.05). Table 3 Comparison of change values of appendicular skeletal muscle mass and physical function in the four groups before and after intervention. Outcome variable Group Pre Post Change (95% CI) F P ASM(kg) 8.680 0.034 Control group (N = 16) 13.43 ± 2.27 13.39 ± 2.26 -0.04 ( -0.19 to 0.10 ) Baduanjin group (N = 16) 3.62 ± 2.28 13.74 ± 2.18 0.12 ( -0.15 to 0.40 ) Resistance band group(N = 15) 13.99 ± 1.79 14.25 ± 1.73 ### 0.26 ( 0.15 to 0.37 ) Mixed exercise group (N = 15) 14.05 ± 2.45 14.25 ± 2.63 # 0.19 ( 0.03 to 0.36 ) ASMI(kg/m²) 8.635 0.035 Control group (N = 16) 5.91 ± 0.59 5.89 ± 0.60 -0.02 ( -0.08 to 0.04 ) Baduanjin group (N = 16) 5.80 ± 0.69 5.86 ± 0.72 0.06 ( -0.06 to 0.18 ) Resistance band group(N = 15) 5.88 ± 0.49 6.00 ± 0.47 ### 0.11 ( 0.07 to 0.16 ) Mixed exercise group (N = 15) 5.84 ± 0.50 5.92 ± 0.56 # 0.08 ( 0.01 to 0.14 ) HGS(kg) 13.160 0.004 Control group (N = 16) 19.01 ± 6.25 19.54 ± 4.85 0.53 ( -2.21 to 3.28 ) Baduanjin group (N = 16) 17.05 ± 4.59 21.33 ± 5.34 # 4.21 ( 2.89 to 5.52 ) Resistance band group(N = 15) 16.29 ± 4.23 21.84 ± 1.42 ### 5.55 ( 4.40 to 6.70 ) Mixed exercise group (N = 15) 16.20 ± 5.36 21.14 ± 3.09 ## 4.95 ( 1.74 to 8.16 ) Gait speed(m/s) 7.526 0.003 Control group (N = 16) 0.71 ± 0.12 0.67 ± 0.12 -0.05 ( -0.09 to -0.00 ) Baduanjin group (N = 16) 0.75 ± 0.11 0.78 ± 0.14 0.03 ( -0.05 to 0.11 ) Resistance band group(N = 15) 0.78 ± 0.07 0.89 ± 0.08 ### 0.12 ( 0.07 to 0.17 ) Mixed exercise group (N = 15) 0.76 ± 0.06 0.83 ± 0.06 ## 0.07 ( 0.05 to 0.09 ) Balance(scores) 6.424 0.093 Control group (N = 16) 3.06 ± 0.77 3.06 ± 1.06 0.00 ( -0.44 to 0.44 ) Baduanjin group (N = 16) 3.06 ± 0.44 3.69 ± 0.48 ## 0.63 ( 0.30 to 0.96 ) Resistance band group(N = 15) 2.73 ± 0.70 3.00 ± 1.07 0.27 ( -0.41 to 0.94 ) Mixed exercise group (N = 15) 2.73 ± 0.59 3.00 ± 0.66 0.27 ( -0.06 to 0.60 ) Gait speed(scores) 10.960 0.012 Control group (N = 16) 2.81 ± 0.66 2.75 ± 0.68 -0.06 ( -0.43 to 0.30 ) Baduanjin group (N = 16) 2.75 ± 0.58 3.13 ± 0.81 0.38 ( -0.10 to 0.85 ) Resistance band group(N = 15) 2.93 ± 0.26 3.67 ± 0.49 ## 0.73 ( 0.41 to 1.06 ) Mixed exercise group (N = 15) 2.93 ± 0.26 3.53 ± 0.52 ## 0.47 ( 0.18 to 0.75 ) SST(scores) 4.446 0.215 Control group (N = 16) 2.25 ± 0.58 2.00 ± 1.46 -0.25 ( -1.11 to 0.61 ) Baduanjin group (N = 16) 2.12 ± 0.62 2.75 ± 1.34 0.63 ( -0.26 to 1.51 ) Resistance band group(N = 15) 1.73 ± 0.70 2.40 ± 1.06 # 0.67 ( 0.05 to 1.28 ) Mixed exercise group (N = 15) 2.27 ± 0.96 2.93 ± 0.70 # 0.67 ( 0.27 to 1.07 ) SPPB(scores) 9.722 0.021 Control group (N = 16) 8.12 ± 0.96 7.81 ± 1.94 -0.31 ( -1.39 to 0.77 ) Baduanjin group (N = 16) 7.94 ± 1.00 9.56 ± 1.63 ## 1.63 ( 0.49 to 2.76 ) Resistance band group(N = 15) 7.40 ± 1.12 9.07 ± 1.71 ## 1.67 ( 0.63 to 2.71 ) Mixed exercise group (N = 15) 7.93 ± 1.49 9.47 ± 1.64 ## 1.53 ( 0.91 to 2.16 ) TUGT(s) 10.510 < 0.001 Control group (N = 16) 13.65 ± 3.94 14.01 ± 3.94 0.36 ( -1.78 to 2.50 ) Baduanjin group (N = 16) 13.15 ± 3.19 12.36 ± 3.38 ## -0.79 ( -2.96 to 0.06 ) Resistance band group(N = 15) 13.53 ± 4.05 12.09 ± 3.82 ### -1.43 ( -2.72 to 0.48 ) Mixed exercise group (N = 15) 13.23 ± 2.91 12.14 ± 3.06 ## -1.09 ( -3.48 to 0.84 ) ASM: appendicular skeletal muscle mass;ASMI༚appendicular skeletal muscle index༛HGS: handgrip strength༛SST༚sit-to-stand test; SPPB༚short physical performance battery༛TUGT༚timed up-and-go test༛Significant differences pre- to post-training༚ # p < 0.05, ## p < 0.01, ### p < 0.001. 3.3 Adverse events No adverse events were reported. 4 Discussion This RCT evaluated the effectiveness of three exercise interventions—Baduanjin, resistance band exercises, and mixed exercises—in treating senile sarcopenia. Results indicated that both the resistance band and mixed exercise groups exhibited significant improvements in ASM and ASMI post-intervention compared to baseline measurements. Additionally, all three exercise groups demonstrated marked increases in HGS, SPPB, and TUGT following the intervention. When comparing the change values for each parameter, distinct differences in effectiveness were observed between the exercise groups and the control group. 4.1 Skeletal muscle mass Following the intervention, both the resistance band group and the mixed exercise group showed significant improvements in the skeletal muscle mass of sarcopenic patients' limbs, as indicated by increases in ASM and ASMI, compared to baseline measurements. In contrast, the Baduanjin group exhibited no significant changes. These findings align with previous research, which suggests that 12 weeks of resistance band training can notably enhance ASM and ASMI in elderly sarcopenic individuals [ 22 ] . Currently, limited studies have investigated the effects of Baduanjin on sarcopenia. A meta-analysis [ 31 ] revealed no significant difference in muscle mass improvement between the tai chi exercise group and the control group among frail and sarcopenic patients. Based on these results, it is hypothesized that resistance band exercises offer greater benefits in improving ALM than Baduanjin, likely due to the higher load applied to limb muscles during resistance training. Herda et al. [ 32 ] demonstrated in a RCT that six weeks of resistance band exercises can enhance ALM in older adults. A separate meta-analysis indicated that resistance band training (40–60 minutes per session, performed more than three times per week for 12 weeks) notably increased skeletal muscle mass in elderly sarcopenic patients [ 33 ] . While the resistance band group showed significant improvements in ASM and ASMI compared to the control group, no substantial statistical differences were observed among the three exercise intervention groups. This may be attributed to the relatively short duration of the interventions—12 weeks in total, with each session lasting only 30 minutes—less than the exercise duration used in other studies [ 33 ] . Additionally, some participants experienced mild malnutrition, and muscle metabolic adaptations typically require a longer timeframe to manifest significant differences between groups [ 34 ] . Consequently, no significant variations were observed across the three groups. 4.2 Physical function Significant improvements in HGS were observed in the resistance band and mixed exercise groups compared to the baseline and control group. This enhancement is likely due to the nature of resistance band exercises, where both hands must counteract the elastic retraction force of the bands. Similar results were reported by Seo et al. [ 35 ] , who found that resistance band exercises notably increased HGS in sarcopenic patients. Additionally, Liao et al. [ 22 ] observed significant improvements in HGS among elderly women with sarcopenia following a 12-week regimen of thrice-weekly resistance band training. Muscle glycogen, the polysaccharide storage form of glucose in skeletal muscle, is inversely regulated by glycogen synthase kinase-3β (GSK-3β). Resistance exercise enhances the activity of skeletal muscle protein kinase B, which in turn promotes the phosphorylation of GSK-3β, facilitating glucose uptake and muscle glycogen synthesis [ 36 ] . In contrast, the Baduanjin group did not exhibit a significant improvement in HGS compared to the control group. This can be attributed to the specific nature of the Baduanjin exercises; aside from the "drawing the bow " and "clenching fists with an angry gaze" postures, the other six involve minimal finger engagement, leading to insufficient stimulation of the muscles responsible for HGS. In this study, resistance band exercises and mixed exercise regimens had been shown to significantly enhance gait speed in individuals with sarcopenia. These findings align with previous studies. A RCT by Pablo et al. [ 13 ] demonstrated that resistance band exercises performed three times per week over 12 weeks notably improved gait speed in sarcopenic patients. The instability inherent in resistance band training stimulates substantial muscle activation, thereby effectively targeting muscle groups during both walking and posture maintenance. This mechanism is in line with the improved motor function observed in other elderly cohorts. Similarly, Villareal et al. [ 37 ] reported that resistance training significantly enhanced gait speed among older adults. Conversely, a related study indicated that, compared to a non-exercise control group, TCE did not produce a significant improvement in gait speed in sarcopenic individuals [ 31 ] , a result consistent with the gait speed performance observed in the Baduanjin group in the current study. For the TUGT, the resistance band group demonstrated significantly greater improvement compared to the control group. This suggests that resistance band exercises may exert a more pronounced effect on lower limb function. A detailed analysis of the movements reveals that during the TUGT, the gluteus maximus and quadriceps femoris contract concentrically to extend the hip and knee joints, raising the center of gravity. During walking, the primary force driving forward motion is generated by the contraction of the triceps surae and quadriceps femoris. Resistance band training targets these muscle groups specifically. Several studies support the notion that resistance exercise enhances knee extension strength in individuals with sarcopenia and frailty [ 38 ] . A meta-analysis indicated that lower limb resistance exercises significantly improved performance on the functional reach test, which assesses dynamic balance. Furthermore, muscle strength plays a vital role in postural stability. Resistance training increases both muscle volume and the content of contractile proteins in the elderly, with the most substantial gains occurring in type II muscle fibers. This enhances reaction speed, balance, and neuromuscular function in older adults [ 39 ] . Research has shown that training with elastic devices, such as bands or tubes, can increase the conduction velocity of motor units [ 40 ] , likely due to the increased recruitment of fast motor units in elastic band exercises [ 13 ] . These factors likely contribute to the improved TUGT performance observed in the resistance band and mixed exercise groups in this study. This study demonstrated significant changes in SPPB scores pre- and post-intervention across all three intervention groups. These results contrast with a prior study that reported no significant changes in short-term SPPB scores following 10 weeks of resistance training among elderly individuals in the early stages of sarcopenia [ 41 ] . The participants in the latter study included both elderly and young individuals with early-stage sarcopenia, with an average baseline SPPB score of 11.2 out of 12. Given that many participants had near-maximal scores, a ceiling effect was assumed. However, this effect did not apply to the elderly sarcopenic participants in the present study, who exhibited lower baseline SPPB scores. Notably, in the standing balance subcomponent of the SPPB, the Baduanjin group showed significantly greater improvement compared to the control group. This can be attributed to Baduanjin Qigong's emphasis on static balance training, incorporating movements such as lower limb half squats and dynamic exercises, including the "drawing the bow" and "sway the head and shake the tail to dispel Xin Huo " to promote internal balance. These exercises focus on closed-chain lower limb movements, which exert higher resistance, while even upper limb resistance training requires lower limb muscles to maintain static contraction. Studies have demonstrated that 12 weeks of TCE training can enhance the neuromuscular response in the lower limbs of elderly sarcopenic patients, reducing their neuromuscular response time during balance loss and improving postural control [ 42 ] . Regarding the sit-to-stand test (SST) sub-item, no significant changes were observed in the Baduanjin group following the exercise intervention, consistent with previous research. Chia-Yu Huang et al. [ 31 ] suggested that traditional exercises, such as tai chi, did not notably improve SST performance compared to controls. In contrast, significant differences were observed in both the resistance band and mixed exercise groups post-intervention, although no significant change was noted when compared to the control group. Silva et al. [ 43 ] found that 12 weeks of resistance exercise significantly improved SST performance in elderly individuals with sarcopenia. The discrepancy with our findings may be attributed to the use of different evaluation systems: this study employed a 4-point scale for the SST, whereas Silva et al. measured performance in seconds. Had the SST been evaluated in seconds, the results might have aligned with those of Silva et al. 4.3 Limitations This study has several limitations. First, due to the sample characteristics, only community-dwelling participants without mobility impairments were included, limiting the generalizability of the results to elderly individuals with sarcopenia who are partially dependent on others for activities of daily living or are severely frail. Second, the study did not control or record participants' dietary intake (including protein, carbohydrates, lipids, and micronutrients), which could influence body composition and physical fitness. Third, due to the impact of the pandemic, no follow-up assessments were conducted post-intervention, preventing an evaluation of the long-term effects. Future research should extend the intervention duration, incorporate follow-up assessments, monitor nutrient intake, and include additional measures such as electromyography and immunomics to comprehensively explore the therapeutic effects and mechanisms of various exercise interventions on primary sarcopenia in the elderly, thereby providing further guidance for exercise prescriptions for sarcopenia. 5 Conclusions This study highlights the distinct effects of three exercise modalities on improving skeletal muscle mass and physical function in sarcopenic patients. Baduanjin notably enhanced balance, while resistance band and mixed exercises effectively increased skeletal muscle mass and other physical function indicators. These results not only demonstrate the targeted efficacy of each exercise method for sarcopenia management but also emphasize the importance of tailoring exercise interventions to individual needs, thereby providing robust evidence for clinical treatment strategies. Consequently, a multifaceted approach incorporating various exercise modalities should be considered in the comprehensive management of sarcopenia to optimize functional outcomes. Abbreviations BMI: body mass index; MNA-SF: short-form mini-nutritional assessment; ASM: appendicular skeletal muscle mass; ASMI: appendicular skeletal muscle index; HGS: handgrip strength; TCE: traditional Chinese exercise; RCT: randomized controlled trial; SST: sit-to-stand test; SPPB: short physical performance battery; TUGT: timed up-and-go test; HRmax：Max Heart Rate; RPE: Rating of Perceived Exertion; RM: Repetition Maximum. Declarations CONSORT statement We affirm that the manuscript of this study adheres to the CONSORT (Consolidated Standards of Reporting Trials) guidelines. We have ensured that our manuscript includes all relevant items listed in the CONSORT checklist and provides sufficient detail to allow other researchers to fully understand, evaluate, and replicate our research methods. Ethics approval and consent to participate Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. Ethics approval was obtained from the Institutional Review Board (IRB) at Central Hospital of Xiangtan (Approval No. 2022-10-001). All participants provided written informed consent to participate in this study. Trial registration The study was registered with the Chinese Clinical Trial Registry under the International Clinical Trial Registration Platform of the World Health Organization , https://www.chictr.org.cn/bin/project/edit?pid=239117.ChiCTR2400089722 (13/09/2024) Data availability The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Acknowledgements The authors are grateful to the patients for their valuable contribution to this research. Funding This study was supported by grants through Hunan Provincial Clinical Medical Technology Innovation Guidance Project (2021SK52408) Contributions This research was jointly completed by CJW, YQW, LZY, XL, PK, LJ and ZLN. CJW and LZY were responsible for the overall design and planning of the research; XL, PK, LJ participated in the collection and collation of experimental data; CJW, YQW made important contributions in data analysis and interpretation; ZLN was responsible for the research and discussion of relevant theories; LZY undertook some experimental operations; CJW conducted in-depth analysis and discussion of the research results. All the authors have made efforts in the development of the research work and the acquisition of the results, and jointly participated in the writing and revision of the paper. Competing interests The authors declare no competing interests. References Mielgo-Ayuso J, Fernández-Lázaro D. Sarcopenia, Exercise and Quality of Life. Int J Environ Res Public Health . 2021;18(10). doi:10.3390/ijerph18105156 Yuan S, Larsson SC. Epidemiology of sarcopenia: Prevalence, risk factors, and consequences. Metabolism . 2023;144:155533. doi:10.1016/j.metabol.2023.155533 Cho MR, Lee S, Song SK. A Review of Sarcopenia Pathophysiology, Diagnosis, Treatment and Future Direction. J Korean Med Sci . 2022;37(18):e146. doi:10.3346/jkms.2022.37.e146 Colleluori G, Villareal DT. Aging, obesity, sarcopenia and the effect of diet and exercise intervention. Exp Gerontol . 2021;155:111561. doi:10.1016/j.exger.2021.111561 Bilski J, Pierzchalski P, Szczepanik M, Bonior J, Zoladz JA. Multifactorial Mechanism of Sarcopenia and Sarcopenic Obesity. Role of Physical Exercise, Microbiota and Myokines. Cells . 2022;11(1):160. doi:10.3390/cells11010160 Sieber CC. Malnutrition and sarcopenia. Aging Clin Exp Res . 2019;31(6):793-798. doi:10.1007/s40520-019-01170-1 Hurst C, Robinson SM, Witham MD, et al. 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Exp Gerontol . 2023;172:112044. doi:10.1016/j.exger.2022.112044 Gómez JF, Curcio CL, Alvarado B, Zunzunegui MV, Guralnik J. Validity and reliability of the Short Physical Performance Battery (SPPB): a pilot study on mobility in the Colombian Andes. Colomb Med (Cali) . 2013;44(3):165-171. Nishikawa H, Asai A, Fukunishi S, et al. Screening Tools for Sarcopenia. In Vivo . 2021;35(6):3001-3009. doi:10.21873/invivo.12595 Martinez BP, Gomes IB, Oliveira CS de, et al. Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. Clinics (Sao Paulo) . 2015;70(5):369-372. doi:10.6061/clinics/2015(05)11 Botolfsen P, Helbostad JL, Moe-Nilssen R, Wall JC. Reliability and concurrent validity of the Expanded Timed Up-and-Go test in older people with impaired mobility. Physiother Res Int . 2008;13(2):94-106. doi:10.1002/pri.394 Huang CY, Mayer PK, Wu MY, Liu DH, Wu PC, Yen HR. The effect of Tai Chi in elderly individuals with sarcopenia and frailty: A systematic review and meta-analysis of randomized controlled trials. Ageing Res Rev . 2022;82:101747. doi:10.1016/j.arr.2022.101747 Herda AA, Nabavizadeh O. Short-term resistance training in older adults improves muscle quality: A randomized control trial. Exp Gerontol . 2021;145:111195. doi:10.1016/j.exger.2020.111195 Zhao H, Cheng R, Song G, et al. The Effect of Resistance Training on the Rehabilitation of Elderly Patients with Sarcopenia: A Meta-Analysis. Int J Environ Res Public Health . 2022;19(23):15491. doi:10.3390/ijerph192315491 Nakahara S, Takasaki M, Abe S, et al. Aggressive nutrition therapy in malnutrition and sarcopenia. Nutrition . 2021;84:111109. doi:10.1016/j.nut.2020.111109 Seo MW, Jung SW, Kim SW, Lee JM, Jung HC, Song JK. Effects of 16 Weeks of Resistance Training on Muscle Quality and Muscle Growth Factors in Older Adult Women with Sarcopenia: A Randomized Controlled Trial. Int J Environ Res Public Health . 2021;18(13):6762. doi:10.3390/ijerph18136762 Case N, Thomas J, Sen B, et al. Mechanical regulation of glycogen synthase kinase 3β (GSK3β) in mesenchymal stem cells is dependent on Akt protein serine 473 phosphorylation via mTORC2 protein. J Biol Chem . 2011;286(45):39450-39456. doi:10.1074/jbc.M111.265330 Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults - PubMed. Accessed December 25, 2023. https://pubmed.ncbi.nlm.nih.gov/28514618/ Chen N, He X, Feng Y, Ainsworth BE, Liu Y. Effects of resistance training in healthy older people with sarcopenia: a systematic review and meta-analysis of randomized controlled trials. Eur Rev Aging Phys Act . 2021;18(1):23. doi:10.1186/s11556-021-00277-7 Karlsen A, Soendenbroe C, Malmgaard-Clausen NM, et al. Preserved capacity for satellite cell proliferation, regeneration, and hypertrophy in the skeletal muscle of healthy elderly men. FASEB J . 2020;34(5):6418-6436. doi:10.1096/fj.202000196R Melchiorri G, Rainoldi A. Muscle fatigue induced by two different resistances: Elastic tubing versus weight machines. J Electromyogr Kinesiol . 2011;21(6):954-959. doi:10.1016/j.jelekin.2011.07.015 Vikberg S, Sörlén N, Brandén L, et al. Effects of Resistance Training on Functional Strength and Muscle Mass in 70-Year-Old Individuals With Pre-sarcopenia: A Randomized Controlled Trial. J Am Med Dir Assoc . 2019;20(1):28-34. doi:10.1016/j.jamda.2018.09.011 Huang D, Ke X, Jiang C, et al. Effects of 12 weeks of Tai Chi on neuromuscular responses and postural control in elderly patients with sarcopenia: a randomized controlled trial. Front Neurol . 2023;14:1167957. doi:10.3389/fneur.2023.1167957 Silva AC, Pereira MA, Peixoto LM, et al. 12 weeks of resistance training with progressive intensity improves the diagnostic parameters of sarcopenia in individuals of advanced age. Geriatr Nurs . 2023;54:60-65. doi:10.1016/j.gerinurse.2023.08.015 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6429780","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":453524117,"identity":"6e55a3a8-479f-4a7a-a1be-d72076dd3f3a","order_by":0,"name":"Chen Jiawei","email":"","orcid":"","institution":"Central Hospital of Xiangtan","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Jiawei","suffix":""},{"id":453524119,"identity":"e5ad2c56-3e49-4e1a-b569-83fb09a1f407","order_by":1,"name":"Yuan Qianwen","email":"","orcid":"","institution":"National Research Tomsk State University","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Qianwen","suffix":""},{"id":453524120,"identity":"512ef330-8ee4-4686-ae15-196342d91945","order_by":2,"name":"Li Zeyun","email":"","orcid":"","institution":"Central Hospital of Xiangtan","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Zeyun","suffix":""},{"id":453524121,"identity":"72d0b451-3524-4c7c-a9c3-a8533073100b","order_by":3,"name":"Xiao Le","email":"","orcid":"","institution":"Central Hospital of Xiangtan","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Le","suffix":""},{"id":453524122,"identity":"45442269-965e-4fff-ad4b-de066bf2d0aa","order_by":4,"name":"Peng Kun","email":"","orcid":"","institution":"Central Hospital of Xiangtan","correspondingAuthor":false,"prefix":"","firstName":"Peng","middleName":"","lastName":"Kun","suffix":""},{"id":453524123,"identity":"274ccf36-6889-457c-9cb8-77390ff8c05a","order_by":5,"name":"Li Jie","email":"","orcid":"","institution":"Central Hospital of Xiangtan","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Jie","suffix":""},{"id":453524124,"identity":"0ba9b7b4-a866-471c-8c64-225bede0af7f","order_by":6,"name":"Zhang Linan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBACfvbmgw8SKmzq+dkbiNQi2XMs2eDDmbQEyZ4DRGoxuOFjJjiz7XCCwYwEYm2ZwWDGzMOWlmcg+XjjDYYam2iCWvilG9Ie8/DYFJtLpxVbMBxLy20gaMucA8eNeSTSGHfOzjGTYGw4TFiLwY3ENmkeg8OMG26eIVpLMpvkjITDiRtu8BCpBRjIzAYfDqQZS/YA/ZJAjF/42fs/Pkj8ZyPHz354440PNTaEtaA4UiKBFOUQLaTqGAWjYBSMgpEBACi/RBjQ1U6EAAAAAElFTkSuQmCC","orcid":"","institution":"Hunan Traditional Chinese Medical College","correspondingAuthor":true,"prefix":"","firstName":"Zhang","middleName":"","lastName":"Linan","suffix":""}],"badges":[],"createdAt":"2025-04-11 15:53:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6429780/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6429780/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82374719,"identity":"d7f7becf-1fc9-45f7-a570-397f7aba1a1b","added_by":"auto","created_at":"2025-05-09 14:25:34","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34277,"visible":true,"origin":"","legend":"\u003cp\u003eScreening flowchart\u003c/p\u003e\n\u003cp\u003eM: male; F: female; HGS: handgrip strength; GS: gait speed; SPPB: short physical performance battery; BIA: Bioelectrical impedance analysis\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6429780/v1/ae74c77cd1bc2c12ad879292.jpg"},{"id":82374720,"identity":"03f73325-031a-40e2-83d1-06faf329733b","added_by":"auto","created_at":"2025-05-09 14:25:34","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":63630,"visible":true,"origin":"","legend":"\u003cp\u003eStudy design and participant flow following the 2010 CONSORT reporting guidelines.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6429780/v1/c8061c4f4826d78e18c2bf05.jpg"},{"id":82375613,"identity":"0adebe13-a0f4-42d5-b3be-f453a9e0bc90","added_by":"auto","created_at":"2025-05-09 14:33:34","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":36196,"visible":true,"origin":"","legend":"\u003cp\u003eInter-group comparisons of changes in skeletal muscle masscomposition. (A) Change of ASM, (B) Change of ASMI. Abbreviations: ASM, appendicular skeletal muscle mass; ASMI, appendicular skeletal muscle index； * p \u0026lt; 0.05.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6429780/v1/1c0a8dba0560065a3b0dba21.jpg"},{"id":82374722,"identity":"d191d2a1-7b87-4376-8f0c-7c63014b1389","added_by":"auto","created_at":"2025-05-09 14:25:34","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":46191,"visible":true,"origin":"","legend":"\u003cp\u003eInter-group comparisons of change in SPPB scores. (A) Change of Balance, (B) Change of GS, (C) Change of SST, (D) Change of SPPB. Abbreviations: GS, gait speed; SST, sit-to-stand test; SPPB, short physical performance battery. * p \u0026lt; 0.05, ** p \u0026lt; 0.01.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6429780/v1/17ad5a3370cc38d7ea64e569.jpg"},{"id":82376738,"identity":"6480d966-004a-4a87-bb52-bf16f4a7b97c","added_by":"auto","created_at":"2025-05-09 14:41:34","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":38039,"visible":true,"origin":"","legend":"\u003cp\u003eInter-group comparison of changes in HGS, GS and TUGT performance. (A) Change of HGS, (B) Change of GS, (C) Change of TUGT. Abbreviations: HGS, handgrip strength；GS, gait speed；TUGT, timed up-and-go test； * p \u0026lt; 0.05, ** p \u0026lt; 0.01, *** p \u0026lt; 0.001\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6429780/v1/ba074472015830ca70b7171d.jpg"},{"id":83133974,"identity":"2fd58be3-3d69-491f-b2b0-05422cd08faf","added_by":"auto","created_at":"2025-05-20 11:02:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1286792,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6429780/v1/c03c418e-ba02-4692-ba26-74fbf9fb7bcd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Traditional Chinese Exercise and Resistance Band Training on Sarcopenia in the Elderly: A Randomized Controlled Trial","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eSarcopenia, a condition marked by the progressive decline of skeletal muscle mass and strength, is strongly associated with aging \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e and exhibits a high prevalence among the elderly worldwide, with an estimated incidence ranging from 10\u0026ndash;16% \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. This degenerative process, characterized by muscle atrophy and frailty, is accompanied by morphological and functional alterations, often coexisting with osteoporosis and increasing susceptibility to falls and fractures. In advanced stages, sarcopenia significantly compromises mobility and autonomy, potentially resulting in long-term disability \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCurrent therapeutic approaches for sarcopenia remain under investigation, yet exercise intervention continues to be the primary strategy for both its prevention and management \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Exercise regimens tailored for sarcopenic patients primarily include resistance and aerobic training \u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Notably, resistance exercise demonstrates superior efficacy in enhancing muscle mass and strength \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Extensive research indicates that resistance training significantly increases handgrip strength (HGS) and skeletal muscle mass \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, while also promoting protein synthesis and neural adaptability in the elderly \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Among resistance modalities, resistance band exercises are widely utilized and have been shown to positively impact sarcopenia treatment. Empirical evidence supports their role in increasing muscle mass, improving muscle strength, optimizing body composition, and enhancing overall physical function in older adults, thereby contributing to sarcopenia prevention and treatment \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Furthermore, traditional Chinese exercise (TCE), rooted in traditional Chinese medicine with a history spanning approximately 3,000 years, offers a cost-effective, accessible, and safe aerobic training option for elderly individuals \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Kun et al. \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e reported significant improvements in limb function among sarcopenic patients following TCE, particularly in gait speed, balance, and strength. Research suggests that TCE exerts anti-inflammatory effects, mitigating sarcopenia through the modulation of inflammatory cytokines such as interleukin-6 and C-reactive protein \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. As a key component of non-pharmacological Chinese medicine interventions, TCE includes practices like Baduanjin, Yijin Jing, tai chi, and five-animal exercises. Preliminary studies indicate that Baduanjin, in particular, markedly enhances muscle strength in sarcopenic patients \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eResistance band exercises and Baduanjin offer accessible and practical options for elderly individuals to engage in community-based physical activity, requiring minimal equipment and space. Unlike high-intensity exercise, these modalities align with the physical capacities of older adults and are well-suited for widespread community implementation. While both have demonstrated beneficial effects in managing sarcopenia among the elderly, their comparative efficacy remains unclear. Existing research has yet to establish a definitive distinction between the therapeutic outcomes of resistance exercise and Baduanjin for sarcopenic patients. To bridge this gap, the present study employed a randomized controlled trial (RCT) design to evaluate the effectiveness of three exercise interventions\u0026mdash;Baduanjin, resistance band exercises, and a combined regimen incorporating both\u0026mdash;on muscle mass and physical function in elderly sarcopenic individuals. A comprehensive assessment of these interventions aimed to inform the development of optimized exercise prescriptions tailored to this population.\u003c/p\u003e"},{"header":"2 Participants and Methods","content":"\n\u003ch3\u003e2. 1 Recruitment of participants\u003c/h3\u003e\n\u003cp\u003eA total of 556 elderly individuals aged 60 and above were recruited between November 2022 and April 2023 from Xianggang Xinsi Village, Xianggang Xinwu Village, Quanxintang Community, and Batang Village in Yuetang District, Xiangtan City, Hunan Province. A convenient sampling method was employed, and data collection, including a questionnaire survey and physical assessments, was conducted in a quiet, open community space. The study protocol was approved by the Ethical Committee of Central Hospital of Xiangtan in October 2022 (Approval No. 2022-10-001) and was registered in the Chinese Clinical Trial Registry : ChiCTR2400089722 (13/09/2024). The study was conducted per the principles of the Declaration of Helsinki. Written informed consent was obtained from all subjects.\u003c/p\u003e \u003cp\u003eDiagnosis followed the criteria established by the Asian Working Group for Sarcopenia (AWGS) in 2019 \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e: (1) Reduced muscle strength, indicated by HGS\u0026thinsp;\u0026lt;\u0026thinsp;28 kg in males and \u0026lt;\u0026thinsp;18 kg in females; (2) Declined physical performance, defined as a 6-meter gait speed (GS)\u0026thinsp;\u0026lt;\u0026thinsp;1 m/s or short physical performance battery (SPPB) scores\u0026thinsp;\u0026le;\u0026thinsp;9; (3) Low skeletal muscle mass, measured by the appendicular skeletal muscle index (ASMI) calculated as the sum of limb skeletal muscle mass (kg) divided by height squared (m\u0026sup2;), with thresholds of \u0026lt;\u0026thinsp;7 kg/m\u0026sup2; for males and \u0026lt;\u0026thinsp;5.7 kg/m\u0026sup2; for females. Sarcopenia was diagnosed when criterion (1) or (2) was present alongside (3). The detailed screening process was illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e Eligibility for inclusion required: (1) fulfillment of diagnostic criteria for sarcopenia; (2) voluntary engagement in exercise following the prescribed regimen; (3) comprehension of study protocols and provision of written informed consent.\u003c/p\u003e \u003cp\u003eExclusion criteria included: (1) presence of hemiplegia or acute myocardial infarction; (2) diagnosis of cachexia; (3) prior systemic treatment relevant to the study; (4) active severe infection; (5) cognitive or motor impairments; (6) engagement in regular exercise within the past year, including weight-bearing activities or brisk walking.\u003c/p\u003e \u003cp\u003eSample size calculation was conducted using Gpower software (version 3.1.9.7) to determine statistical power. The increase in ASMI was considered a primary outcome, with calculations referencing a similar study by Zhu et al. \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. In that study, ASMI changes exhibited significant intergroup differences, with mean values of -0.05, 0.02, and 0.11, and an SD of 0.14. Group sample sizes were 37, 40, and 36, respectively, yielding a calculated effect size of 0.46. Based on Zhu et al.\u0026rsquo;s findings, assuming an SD of 0.14, repeated measures ANOVA was selected with a statistical power of 0.95, an α level of 0.05, and four groups. A minimum of totaling 52 across all groups was required. Accounting for an anticipated 15% dropout rate, the study aimed to recruit at least 60 participants.\u003c/p\u003e \u003cp\u003eA total of 87 sarcopenic patients were screened for eligibility, with 80 ultimately meeting the inclusion criteria and providing informed consent. All participants were stratified by gender and randomly assigned to 4 groups in a ratio of 1:1:1:1. Randomization was generated by Li Zeyun through a computer program (Research Randomizer Form \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.randomizer.org\u003c/span\u003e\u003cspan address=\"http://www.randomizer.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). They were assigned to three intervention groups\u0026mdash;Baduanjin (n\u0026thinsp;=\u0026thinsp;20), resistance band (n\u0026thinsp;=\u0026thinsp;20), and mixed exercises (n\u0026thinsp;=\u0026thinsp;20)\u0026mdash;along with a control group (n\u0026thinsp;=\u0026thinsp;20) by Chen Jiawei. Ethics approval was obtained from the Ethics Committee of Central Hospital of Xiangtan (Approval No. 2022-10-001), and the study was conducted in Xianggang Xinsi Village, Xianggang Xinwu Village, Quanxintang Community, and Batang Village in Yuetang District, Xiangtan City. The methodology adhered to the CONSORT 2010 guidelines \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, with all procedures implemented according to the approved research protocol.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study methods\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Interventions\u003c/h2\u003e \u003cp\u003eThe Baduanjin group performed the Baduanjin Qigong exercise method, as supervised by the General Administration of Sport of China (\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, video source: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bilibili.com/video/av85510564/\u003c/span\u003e\u003cspan address=\"https://www.bilibili.com/video/av85510564/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Sessions lasted 30 minutes per session, three times per week, over a 12-week intervention period. The exercise regimen included the following postures: (1) Two hands hold up the heavens, (2) Drawing the bow, (3) Separating heaven and earth, (4) Wise owl gazes backwards (or look back), (5) Sway the head and shake the tail to dispel \u003cem\u003eXin Huo\u003c/em\u003e, (6) Two hands hold the feet to strengthen the kidneys and waist, (7) Clenching fists with an angry gaze, and (8) Bouncing on the toes.\u003c/p\u003e \u003cp\u003eResistance band group: The Thera-Band resistance system, as referenced in previous studies \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, served as the primary modality for resistance band exercises. Each band color corresponds to a distinct level of elasticity, with resistance determined by the percentage of elongation. Participants selected appropriate resistance levels based on individualized needs. Sessions lasted 30 minutes, conducted three times per week over a 12-week period. Exercise intensity was prescribed according to the ICFSR Expert Consensus Guidelines \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, maintaining a range of 40\u0026ndash;80% 1RM. A licensed intermediate rehabilitation therapist provided training and supervision throughout the intervention. The Rating of Perceived Exertion (RPE) scale regulated exercise intensity throughout the training, with individual exercise load tolerance set within a specific range. The RPE score (12\u0026ndash;16) aligned with the moderate-intensity exercise scale recommended by the American College of Sports Medicine \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Exercise selection followed prior research \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, incorporating six upper limb strength exercises (pulldown, pullback, shoulder abduction, biceps curl, triceps extension, and stand-up) and six lower limb strength exercises (leg press, ankle eversion, ankle dorsiflexion, knee extension, knee flexion, and hip flexion). Participants initially trained with the lowest resistance band (yellow), progressively increasing resistance until failure to complete 10 repetitions (10 RM) at the next level. The final resistance band successfully completed at 10 RM was designated for the training program. Each session included two sets at an intensity corresponding to 40\u0026ndash;80% of 10 RM, with a one-minute rest interval between sets. Throughout the 12-week intervention, training volume for both upper and lower limbs remained constant, with 10 to 15 repetitions per set. Maximum strength (10 RM) was assessed using progressively higher-resistance bands. If participants successfully completed 10 RM, resistance was increased every four weeks; if progression was not feasible, band length was reduced by half to maintain intensity. This protocol was sustained through the 12-week intervention.\u003c/p\u003e \u003cp\u003eThe mixed exercise group underwent a combined regimen of Baduanjin and resistance band exercises, with each session comprising 15 minutes of each modality, totaling 30 minutes per session, performed three times per week over a 12-week period.\u003c/p\u003e \u003cp\u003eParticipants in the control group received no specific intervention and were instructed to maintain their usual daily activities while refraining from engaging in any structured exercise programs (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;1 The trial protocol for exercise intervention.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExercise types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEach session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFrequency and Period\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo exercise intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaduanjin group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin Qigong\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRPE Score (12\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWarm up for 5min\u0026thinsp;+\u0026thinsp;30min exercise\u0026thinsp;+\u0026thinsp;5min relaxation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 times / week for 12 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResistance band group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band exercises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40%-80% 1 RM; RPE Score (12\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWarm up for 5min\u0026thinsp;+\u0026thinsp;30min exercises (1-2min interval between sets)\u0026thinsp;+\u0026thinsp;5min relaxation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 times / week for 12 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed exercise group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin Qigong and resistance band exercises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40%-80% 1 RM; RPE Score (12\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWarm up for 5min\u0026thinsp;+\u0026thinsp;30min practice (15min Baduanjin Qigong\u0026thinsp;+\u0026thinsp;15min resistance band exercises / 1-2min between sets)\u0026thinsp;+\u0026thinsp;5min relaxation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 times / week for 12 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eHRmax: Max Heart Rate;RPE༚Rating of Perceived Exertion༛RM: Repetition Maximum, equation: 1RM = (1 + (0.0333 \u0026times; reps)) \u0026times; repetition load\u003csup\u003e33\u003c/sup\u003e.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eExercise sessions must be discontinued immediately if any of the following conditions arise: (i) respiratory distress, including shortness of breath or difficulty breathing, chest tightness, or related symptoms; (ii) muscle spasms or joint pain; (iii) abnormal physiological responses, such as blood pressure exceeding 180 mmHg, heart rate below 60 beats/min, or blood oxygen saturation falling below 88%; (iv) signs of excessive physical exertion intolerance. In the event of these occurrences, exercise cessation is required, followed by rest or appropriate pharmacological intervention. If symptoms persist despite medication, urgent referral to a specialized medical facility is warranted \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. The complete trial process was illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2 Outcome measures\u003c/h2\u003e \u003cp\u003ePrimary outcomes:\u003c/p\u003e \u003cp\u003eSkeletal muscle mass was evaluated using bioimpedance analysis (BIA) with a human body composition analyzer (InbodyS10), providing measurements of ASM. ASMI was derived using the formula: ASM (kg)/height\u0026sup2; (m\u0026sup2;) \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSecondary outcomes:\u003c/p\u003e \u003cp\u003eHandgrip strength (HGS) was assessed using a handgrip strength meter (Sammons Preston, USA) with measurements recorded in kilograms. The test was conducted on the dominant hand while the patient remained seated, maintaining the arm close to the body with an unsupported forearm, a 90\u0026deg; elbow flexion, and a neutral wrist position. The handgrip strength meter handle was adjusted to ensure the middle phalanx of the third finger aligned perpendicularly to the handle\u0026rsquo;s long axis. Patients were instructed to exert maximal force for 3\u0026ndash;5 seconds while verbal encouragement was provided. A 30-second interval was maintained between trials, and the average of three attempts was recorded as the final handgrip strength value \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Under resting conditions, normal HGS for the dominant hand is defined as \u0026gt;\u0026thinsp;25 kg for males and \u0026gt;\u0026thinsp;18 kg for females, with most individuals being right-handed \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eShort physical performance battery (SPPB): it is a comprehensive assessment tool used to evaluate the physical function and mobility of older adults. It consists of three subtests that measure different aspects of physical performance. Here is a detailed explanation: 1. Balance test: it includes standing with feet together, in a semi-tandem position (one foot in front of the other with a small distance between them), and in a tandem position (one foot directly in front of the other). Each position could be held up to 10 s with their time being recorded in seconds and subsequently scored. 2. Gait speed test: it was completed with the participant having both feet behind a marked line. Participants were asked to walk at their normal pace for accurate gait analysis. Timing began when participant made their first movement and ended when trailing foot passed the marked line at the end of the course. 3. Sit-to-stand test: it was performed using an armless chair. Participants were seated in the chairwith arms crossed over the chest. Participants stood five consecutive times, with time starting from first movement and ending when participants returned to the seated position after the fifth repetition. SPPB with a maximum of 12 points. Scores of 10\u0026ndash;12 indicate preserved muscle function, 7\u0026ndash;9 reflect moderate impairment, and 0\u0026ndash;6 signify severe impairment \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. The scale's reliability is supported by a Cronbach\u0026rsquo;s alpha coefficient of 0.87 \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFor the six-meter gait speed test, a straight 6-meter walking track was marked on the ground using yellow tape. Participants were instructed to walk the distance at a normal pace, with completion time measured using a stopwatch. Gait speed was then calculated accordingly \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTUGT: During the assessment, the patient remained in regular footwear and was seated in a chair with armrests (seat height: approximately 45 cm; armrest height: approximately 20 cm), with the back resting against the chair and hands positioned on the armrests. If a walker was used, it must be held during the test. A clearly visible marker, such as a colored strip or thick line, was placed on the floor 3 meters from the seat. Upon the tester\u0026rsquo;s \"start\" command, the patient rose from the chair, maintained stability, and proceeded to walk 3 meters with a natural gait. After crossing the marker, the patient turned, returned to the chair, turned again, and sat down with the back resting against the chair. No physical assistance was permitted during the test. Before the formal assessment, 1 to 2 practice trials were provided to ensure comprehension of the procedure \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. The scale\u0026rsquo;s Cronbach's alpha coefficient was 0.74 \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBlinding was used at all times in assessing outcomes, and all assessment workers were not told which group the participants were from.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted using SPSS 21.0 (EASYBIO, China), while GraphPad 9.5 was employed for statistical processing and image visualization. Measurement data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s). The Shapiro-Wilk test assessed normality, and all outcome variables conformed to a normal distribution. A paired sample t-test evaluated differences between pre- and post-test measurements. One-way ANOVA analyzed pre- and post-test mean differences across multiple groups, followed by the Tukey test for post-hoc comparisons. If normality was not met, a non-parametric approach was applied, with the Kruskal-Wallis H test for intergroup comparisons and the Dunnett-t test for multiple comparisons. Count data were expressed as case numbers (%), with comparisons performed via the χ\u0026sup2; test. Statistical significance was defined as \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05. A P-value below 0.01 indicated a highly significant difference, while \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.001 denoted an extremely significant difference.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eFollowing the 12-week intervention period, 4 participants withdrew from the Baduanjin group, 4 from the resistance band group, 5 from the mixed exercise group, and 5 from the control group. A detailed flow chart was provided in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline demographic and clinical characteristic of the participants.\u003c/h2\u003e \u003cp\u003eNo significant differences were observed in baseline characteristics across the four groups (\u003cem\u003eP\u0026thinsp;\u0026gt;\u003c/em\u003e\u0026thinsp;0.05), indicating comparability, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline demographic and clinical characteristic of the participants..\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBaduanjin group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResistance band group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eF/χ\u0026sup2;\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex,n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (43.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (53.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (56.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (60.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (46.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.44\u0026thinsp;\u0026plusmn;\u0026thinsp;7.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.80\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.16\u0026thinsp;\u0026plusmn;\u0026thinsp;6.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.28\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMNA-SF(score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (56.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (46.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (53.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (56.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (75.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (46.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.396\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eBMI: body mass index; MNA-SF༚short-form mini-nutritional assessment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e3.2 Comparison of skeletal muscle mass and physical function across the four groups before and after intervention\u003c/p\u003e \u003cp\u003ePre-intervention, no significant differences were observed among the four groups. Post-intervention, within-group comparisons revealed significant improvements in ASM and ASMI in both the resistance band and mixed exercise groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The inter-group comparison indicated that the resistance band group showed significantly greater changes than the control group (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Regarding physical function, post-intervention intra-group comparisons demonstrated significant improvements in HGS, gait speed, balance, and SPPB in the Baduanjin, resistance band, and mixed exercise groups (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Inter-group comparisons revealed that both the resistance band and mixed exercise groups showed greater improvements than the control group in HGS, gait speed, and SPPB (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05). The resistance band group outperformed the control group in HGS and SPPB (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05), while the mixed exercise group showed greater gains than the control group in HGS, gait speed, and balance (\u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). No significant differences were observed among the three intervention groups across all indicators (\u003cem\u003eP\u0026thinsp;\u0026gt;\u003c/em\u003e\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of change values of appendicular skeletal muscle mass and physical function in the four groups before and after intervention.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChange (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASM(kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.39\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.04 ( -0.19 to 0.10 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.12 ( -0.15 to 0.40 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003csup\u003e###\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26 ( 0.15 to 0.37 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.63\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19 ( 0.03 to 0.36 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASMI(kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e8.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.02 ( -0.08 to 0.04 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06 ( -0.06 to 0.18 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003csup\u003e###\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11 ( 0.07 to 0.16 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.08 ( 0.01 to 0.14 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGS(kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e13.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.01\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.54\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53 ( -2.21 to 3.28 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.21 ( 2.89 to 5.52 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003csup\u003e###\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.55 ( 4.40 to 6.70 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.95 ( 1.74 to 8.16 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGait speed(m/s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e7.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.05 ( -0.09 to -0.00 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03 ( -0.05 to 0.11 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003csup\u003e###\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.12 ( 0.07 to 0.17 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07 ( 0.05 to 0.09 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalance(scores)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00 ( -0.44 to 0.44 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63 ( 0.30 to 0.96 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.27 ( -0.41 to 0.94 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.27 ( -0.06 to 0.60 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGait speed(scores)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e10.960\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.06 ( -0.43 to 0.30 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38 ( -0.10 to 0.85 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.73 ( 0.41 to 1.06 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47 ( 0.18 to 0.75 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSST(scores)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.25 ( -1.11 to 0.61 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63 ( -0.26 to 1.51 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67 ( 0.05 to 1.28 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67 ( 0.27 to 1.07 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSPPB(scores)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e9.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.31 ( -1.39 to 0.77 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.63 ( 0.49 to 2.76 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.67 ( 0.63 to 2.71 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.53 ( 0.91 to 2.16 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTUGT(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e10.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.01\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36 ( -1.78 to 2.50 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaduanjin group (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.79 ( -2.96 to 0.06 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResistance band group(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.09\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003csup\u003e###\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.43 ( -2.72 to 0.48 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed exercise group (N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003csup\u003e##\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.09 ( -3.48 to 0.84 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eASM: appendicular skeletal muscle mass;ASMI༚appendicular skeletal muscle index༛HGS: handgrip strength༛SST༚sit-to-stand test; SPPB༚short physical performance battery༛TUGT༚timed up-and-go test༛Significant differences pre- to post-training༚\u003csup\u003e#\u003c/sup\u003e p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003csup\u003e##\u003c/sup\u003e p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, \u003csup\u003e###\u003c/sup\u003e p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Adverse events\u003c/h2\u003e \u003cp\u003eNo adverse events were reported.\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis RCT evaluated the effectiveness of three exercise interventions\u0026mdash;Baduanjin, resistance band exercises, and mixed exercises\u0026mdash;in treating senile sarcopenia. Results indicated that both the resistance band and mixed exercise groups exhibited significant improvements in ASM and ASMI post-intervention compared to baseline measurements. Additionally, all three exercise groups demonstrated marked increases in HGS, SPPB, and TUGT following the intervention. When comparing the change values for each parameter, distinct differences in effectiveness were observed between the exercise groups and the control group.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Skeletal muscle mass\u003c/h2\u003e \u003cp\u003eFollowing the intervention, both the resistance band group and the mixed exercise group showed significant improvements in the skeletal muscle mass of sarcopenic patients' limbs, as indicated by increases in ASM and ASMI, compared to baseline measurements. In contrast, the Baduanjin group exhibited no significant changes. These findings align with previous research, which suggests that 12 weeks of resistance band training can notably enhance ASM and ASMI in elderly sarcopenic individuals \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Currently, limited studies have investigated the effects of Baduanjin on sarcopenia. A meta-analysis \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e revealed no significant difference in muscle mass improvement between the tai chi exercise group and the control group among frail and sarcopenic patients. Based on these results, it is hypothesized that resistance band exercises offer greater benefits in improving ALM than Baduanjin, likely due to the higher load applied to limb muscles during resistance training. Herda et al. \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e demonstrated in a RCT that six weeks of resistance band exercises can enhance ALM in older adults. A separate meta-analysis indicated that resistance band training (40\u0026ndash;60 minutes per session, performed more than three times per week for 12 weeks) notably increased skeletal muscle mass in elderly sarcopenic patients \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. While the resistance band group showed significant improvements in ASM and ASMI compared to the control group, no substantial statistical differences were observed among the three exercise intervention groups. This may be attributed to the relatively short duration of the interventions\u0026mdash;12 weeks in total, with each session lasting only 30 minutes\u0026mdash;less than the exercise duration used in other studies \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. Additionally, some participants experienced mild malnutrition, and muscle metabolic adaptations typically require a longer timeframe to manifest significant differences between groups \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Consequently, no significant variations were observed across the three groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Physical function\u003c/h2\u003e \u003cp\u003eSignificant improvements in HGS were observed in the resistance band and mixed exercise groups compared to the baseline and control group. This enhancement is likely due to the nature of resistance band exercises, where both hands must counteract the elastic retraction force of the bands. Similar results were reported by Seo et al. \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e, who found that resistance band exercises notably increased HGS in sarcopenic patients. Additionally, Liao et al. \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e observed significant improvements in HGS among elderly women with sarcopenia following a 12-week regimen of thrice-weekly resistance band training. Muscle glycogen, the polysaccharide storage form of glucose in skeletal muscle, is inversely regulated by glycogen synthase kinase-3β (GSK-3β). Resistance exercise enhances the activity of skeletal muscle protein kinase B, which in turn promotes the phosphorylation of GSK-3β, facilitating glucose uptake and muscle glycogen synthesis \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. In contrast, the Baduanjin group did not exhibit a significant improvement in HGS compared to the control group. This can be attributed to the specific nature of the Baduanjin exercises; aside from the \"drawing the bow \" and \"clenching fists with an angry gaze\" postures, the other six involve minimal finger engagement, leading to insufficient stimulation of the muscles responsible for HGS.\u003c/p\u003e \u003cp\u003eIn this study, resistance band exercises and mixed exercise regimens had been shown to significantly enhance gait speed in individuals with sarcopenia. These findings align with previous studies. A RCT by Pablo et al. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e demonstrated that resistance band exercises performed three times per week over 12 weeks notably improved gait speed in sarcopenic patients. The instability inherent in resistance band training stimulates substantial muscle activation, thereby effectively targeting muscle groups during both walking and posture maintenance. This mechanism is in line with the improved motor function observed in other elderly cohorts. Similarly, Villareal et al. \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e reported that resistance training significantly enhanced gait speed among older adults. Conversely, a related study indicated that, compared to a non-exercise control group, TCE did not produce a significant improvement in gait speed in sarcopenic individuals \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e, a result consistent with the gait speed performance observed in the Baduanjin group in the current study.\u003c/p\u003e \u003cp\u003eFor the TUGT, the resistance band group demonstrated significantly greater improvement compared to the control group. This suggests that resistance band exercises may exert a more pronounced effect on lower limb function. A detailed analysis of the movements reveals that during the TUGT, the gluteus maximus and quadriceps femoris contract concentrically to extend the hip and knee joints, raising the center of gravity. During walking, the primary force driving forward motion is generated by the contraction of the triceps surae and quadriceps femoris. Resistance band training targets these muscle groups specifically. Several studies support the notion that resistance exercise enhances knee extension strength in individuals with sarcopenia and frailty \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. A meta-analysis indicated that lower limb resistance exercises significantly improved performance on the functional reach test, which assesses dynamic balance. Furthermore, muscle strength plays a vital role in postural stability. Resistance training increases both muscle volume and the content of contractile proteins in the elderly, with the most substantial gains occurring in type II muscle fibers. This enhances reaction speed, balance, and neuromuscular function in older adults \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. Research has shown that training with elastic devices, such as bands or tubes, can increase the conduction velocity of motor units \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e, likely due to the increased recruitment of fast motor units in elastic band exercises \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. These factors likely contribute to the improved TUGT performance observed in the resistance band and mixed exercise groups in this study.\u003c/p\u003e \u003cp\u003eThis study demonstrated significant changes in SPPB scores pre- and post-intervention across all three intervention groups. These results contrast with a prior study that reported no significant changes in short-term SPPB scores following 10 weeks of resistance training among elderly individuals in the early stages of sarcopenia \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. The participants in the latter study included both elderly and young individuals with early-stage sarcopenia, with an average baseline SPPB score of 11.2 out of 12. Given that many participants had near-maximal scores, a ceiling effect was assumed. However, this effect did not apply to the elderly sarcopenic participants in the present study, who exhibited lower baseline SPPB scores. Notably, in the standing balance subcomponent of the SPPB, the Baduanjin group showed significantly greater improvement compared to the control group. This can be attributed to Baduanjin Qigong's emphasis on static balance training, incorporating movements such as lower limb half squats and dynamic exercises, including the \"drawing the bow\" and \"sway the head and shake the tail to dispel \u003cem\u003eXin Huo\u003c/em\u003e\" to promote internal balance. These exercises focus on closed-chain lower limb movements, which exert higher resistance, while even upper limb resistance training requires lower limb muscles to maintain static contraction. Studies have demonstrated that 12 weeks of TCE training can enhance the neuromuscular response in the lower limbs of elderly sarcopenic patients, reducing their neuromuscular response time during balance loss and improving postural control \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. Regarding the sit-to-stand test (SST) sub-item, no significant changes were observed in the Baduanjin group following the exercise intervention, consistent with previous research. Chia-Yu Huang et al. \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e suggested that traditional exercises, such as tai chi, did not notably improve SST performance compared to controls. In contrast, significant differences were observed in both the resistance band and mixed exercise groups post-intervention, although no significant change was noted when compared to the control group. Silva et al. \u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e found that 12 weeks of resistance exercise significantly improved SST performance in elderly individuals with sarcopenia. The discrepancy with our findings may be attributed to the use of different evaluation systems: this study employed a 4-point scale for the SST, whereas Silva et al. measured performance in seconds. Had the SST been evaluated in seconds, the results might have aligned with those of Silva et al.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Limitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, due to the sample characteristics, only community-dwelling participants without mobility impairments were included, limiting the generalizability of the results to elderly individuals with sarcopenia who are partially dependent on others for activities of daily living or are severely frail. Second, the study did not control or record participants' dietary intake (including protein, carbohydrates, lipids, and micronutrients), which could influence body composition and physical fitness. Third, due to the impact of the pandemic, no follow-up assessments were conducted post-intervention, preventing an evaluation of the long-term effects. Future research should extend the intervention duration, incorporate follow-up assessments, monitor nutrient intake, and include additional measures such as electromyography and immunomics to comprehensively explore the therapeutic effects and mechanisms of various exercise interventions on primary sarcopenia in the elderly, thereby providing further guidance for exercise prescriptions for sarcopenia.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusions","content":"\u003cp\u003eThis study highlights the distinct effects of three exercise modalities on improving skeletal muscle mass and physical function in sarcopenic patients. Baduanjin notably enhanced balance, while resistance band and mixed exercises effectively increased skeletal muscle mass and other physical function indicators. These results not only demonstrate the targeted efficacy of each exercise method for sarcopenia management but also emphasize the importance of tailoring exercise interventions to individual needs, thereby providing robust evidence for clinical treatment strategies. Consequently, a multifaceted approach incorporating various exercise modalities should be considered in the comprehensive management of sarcopenia to optimize functional outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI: body mass index; MNA-SF: short-form mini-nutritional assessment; ASM: appendicular skeletal muscle mass; ASMI: appendicular skeletal muscle index; HGS: handgrip strength; TCE: traditional Chinese exercise; RCT: randomized controlled trial; SST: sit-to-stand test; SPPB: short physical performance battery; TUGT: timed up-and-go test; HRmax：Max Heart Rate; RPE: Rating of Perceived Exertion; RM: Repetition Maximum.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCONSORT statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe affirm that the manuscript of this study adheres to the CONSORT (Consolidated Standards of Reporting Trials) guidelines. We have ensured that our manuscript includes all relevant items listed in the CONSORT checklist and provides sufficient detail to allow other researchers to fully understand, evaluate, and replicate our research methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. Ethics approval was obtained from the Institutional Review Board (IRB) at Central Hospital of Xiangtan (Approval No. 2022-10-001). All participants provided written informed consent to participate in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was registered with the Chinese Clinical Trial Registry under the International Clinical Trial Registration Platform of the World Health Organization , https://www.chictr.org.cn/bin/project/edit?pid=239117.ChiCTR2400089722 (13/09/2024)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the patients for their valuable contribution to this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by grants through Hunan Provincial Clinical Medical Technology Innovation Guidance Project (2021SK52408)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was jointly completed by CJW, YQW, LZY, XL, PK, LJ and ZLN. CJW and LZY were responsible for the overall design and planning of the research; XL, PK, LJ participated in the collection and collation of experimental data; CJW, YQW made important contributions in data analysis and interpretation; ZLN was responsible for the research and discussion of relevant theories; LZY undertook some experimental operations; CJW conducted in-depth analysis and discussion of the research results. All the authors have made efforts in the development of the research work and the acquisition of the results, and jointly participated in the writing and revision of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMielgo-Ayuso J, Fern\u0026aacute;ndez-L\u0026aacute;zaro D. 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Effects of 12 weeks of Tai Chi on neuromuscular responses and postural control in elderly patients with sarcopenia: a randomized controlled trial. \u003cem\u003eFront Neurol\u003c/em\u003e. 2023;14:1167957. doi:10.3389/fneur.2023.1167957\u003c/li\u003e\n\u003cli\u003eSilva AC, Pereira MA, Peixoto LM, et al. 12 weeks of resistance training with progressive intensity improves the diagnostic parameters of sarcopenia in individuals of advanced age. \u003cem\u003eGeriatr Nurs\u003c/em\u003e. 2023;54:60-65. doi:10.1016/j.gerinurse.2023.08.015\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Elderly, sarcopenia, exercise intervention, exercise rehabilitation, skeletal muscle mass index","lastPublishedDoi":"10.21203/rs.3.rs-6429780/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6429780/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eThis study aimed to evaluate the impact of various exercise interventions on skeletal muscle mass and physical function in elderly sarcopenic patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Eighty elderly individuals diagnosed with sarcopenia and undergoing physical examinations in Xiangtan City between November 2022 and April 2023, were selected through convenient sampling. Participants were randomly assigned to four groups using the random number method: Baduanjin group, resistance band group, mixed exercise group, and control group, with 20 individuals in each. The Baduanjin group engaged in traditional Baduanjin exercises, the resistance band group participated in resistance band training, and the mixed exercise group performed a combination of both interventions. Each intervention was conducted three times per week, with sessions lasting 30 minutes, for a total duration of 12 weeks. Appendicular skeletal muscle mass (ASM), appendicular skeletal muscle mass index (ASMI), handgrip strength (HGS), gait speed (GS), short physical performance battery (SPPB) scores, and timed up - and - go test (TUGT) were measured through pre - and post - assessments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe pre-intervention analysis revealed no significant differences in indicators among the four groups. Post-intervention intra-group comparisons indicated varying degrees of improvement in ASM, ASMI, HGS, GS, TUGT, and total SPPB scores in the Baduanjin, resistance band, and mixed exercise groups (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). Notably, the balance score within the SPPB subscale exhibited a significant increase in the Baduanjin group (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). GS and SST scores showed marked enhancement in the resistance band and mixed exercise groups (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). Moreover, changes in HGS, gait speed, and TUGT were significantly greater in the resistance band and mixed exercise groups compared to the control group (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05). Inter-group comparisons of variations revealed that ASM and ASMI improvements in the resistance band group significantly surpassed those in the control group (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05), while no significant differences were observed in comparison with the other two intervention groups (\u003cem\u003eP\u0026gt;\u003c/em\u003e0.05). Additionally, the SPPB variation in the resistance band group exceeded that of the control group (\u003cem\u003eP\u0026lt;\u003c/em\u003e0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eBaduanjin demonstrated a substantial enhancement in balance function among sarcopenic patients, while resistance band exercises and mixed exercises contributed to notable gains in ASM and overall physical performance.\u003c/p\u003e","manuscriptTitle":"Impact of Traditional Chinese Exercise and Resistance Band Training on Sarcopenia in the Elderly: A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 14:25:30","doi":"10.21203/rs.3.rs-6429780/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"981d1bfb-62f3-42be-9fd7-2b7ae321d344","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":48229882,"name":"Health sciences/Medical research"},{"id":48229883,"name":"Health sciences/Health care/Geriatrics"},{"id":48229884,"name":"Health sciences/Health care/Quality of life"},{"id":48229885,"name":"Health sciences/Health care/Therapeutics"}],"tags":[],"updatedAt":"2025-05-20T10:53:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 14:25:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6429780","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6429780","identity":"rs-6429780","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}