The Impact of Sensorimotor Training on Physical Fitness in Older Women with Diabetes: A Pilot Study

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Cabo, Jose A. Parraca, Orlando Fernandes, Paulo Nunes, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7121619/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Nov, 2025 Read the published version in BMC Geriatrics → Version 1 posted 11 You are reading this latest preprint version Abstract Aging and diabetes mellitus (DM) are associated with declines in physical fitness, including reduced muscle strength, balance, and flexibility, which increase the risk of falls and functional limitations. This pilot study aims to evaluate the effects of a 6-month sensorimotor training (SMT) program on physical fitness in older women with type 2 diabetes. Ten elderly women (aged 65 and above) were divided into an intervention group (IG, n=5) and a control group (CG, n=5). The IG participated in a twice-weekly SMT program, while the CG maintained their usual daily activities. Physical fitness assessments, including agility (Timed Up and Go test), strength (sit-to-stand and forearm flexion tests), and flexibility (sit-and-reach and be-hind-the-back reach tests), were conducted at baseline and after 24 weeks. The IG demonstrated significant improvements in agility (p=0.020) and flexibility (p=0.049 for lower limbs; p=0.023 for upper limbs) compared to the CG. Both groups showed improvements in lower limb strength, though upper limb strength did not significantly change. The findings suggest that SMT enhances neuromuscular control, proprioception, and flexibility, which are critical for reducing fall risk and improving functional independence in older women with diabetes. This study demonstrates that SMT significantly improves agility, flexibility, and neuromuscular control in older women with type 2 diabetes, directly addressing key factors that contribute to fall risk and functional decline. These improvements are particularly beneficial for individuals with diabetes, as enhanced proprioception and balance can mitigate diabetes-related complications such as peripheral neuropathy and mobility impairments. By improving physical fitness and reducing fall risk, SMT offers a promising intervention to support better glycemic control, enhance independence, and improve the overall quality of life in older adults with diabetes. Further research with larger samples is needed to confirm these findings and refine SMT protocols for optimal diabetes management. Clinical trial registry: 01/09/2021 Clinical trial number: NCT05398354 Trial Name: Active Retirement: Effects of the Application of a Training Program exercise sensorimotor aging diabetes flexibility strength Figures Figure 1 Figure 2 Introduction Aging is characterized as a natural and physiological process that progressively accompanies the life cycle. In addition to complications within the psychosocial domain, physical losses manifest, resulting in cognitive slowing, depression, functional incapacity, diminished resilience, inactivity, and physical degeneration 1 . The functional changes intrinsic to the aging process, such as decreased mobility and muscle strength, may precipitate conditions of imbalance and, consequently, elevate the risk of falls among elderly individuals. Falls in the elderly population are associated not only with the use of medication but also with factors such as frailty and functional decline 2 , 3 . The World Health Organization (WHO) states that there is clear evidence that people over 65 years of age who are inactive have several associated diseases and that mortality rates from strokes, coronary heart disease, diabetes mellitus (DM), and hypertension, among others, are higher 4 , 5 . DM, particularly type 2 diabetes, is a significant health concern among older women, increasing the risk of cardiovascular disease, neuropathy, and musculoskeletal impairments. Age-related declines in muscle strength, balance, and coordination, combined with diabetes-related complications such as peripheral neuropathy, heighten the risk of falls and functional limitations in this population 6 . In the coming decades, the number of patients with DM is expected to triple 7 . The WHO states that there is clear evidence that regular physical activity (PA) yields significant benefits for individuals over 65 years of age. These individuals are usually less active and, therefore have diseases related to inactivity, such as DM. This metabolic disease mortality rates are lower among older adults who are more active than among those who are less active 8 . Bohn et al. 9 recently reported that fewer than one-fifth of people with DM manage to meet PA recommendations. Exercise is widely recognized as a cornerstone of diabetes management, offering significant benefits for glycemic control, cardiovascular health, and overall well-being. Regular PA has been shown to improve insulin sensitivity, reduce HbA1c levels, and support weight management, which are critical for older women with diabetes. Additionally, exercise enhances muscle strength, bone density, and balance, reducing the risk of falls and osteoporosis, which are common concerns in aging populations. Psychological benefits, including reduced stress and improved mental health, also contribute to a better quality of life for older women managing diabetes 10 , 11 . Furthermore, exercise reduces total daily insulin requirements, stress, and depression while improving the quality of life (QoL) of individuals 12 – 14 . The SMT was chosen over other types of physical exercise for its unique focus on improving balance, proprioception, and neuromuscular coordination-all critical areas that tend to decline with age. Unlike traditional strength or aerobic exercise, which typically focuses on cardiovascular health or muscle strength, SMT directly engages neural and sensory systems essential for physical stability, coordination, and efficient movement. With age, there is a natural decline in proprioception (the sense of body position), slower reaction times, and reduced coordination between sensory and motor systems. This combination heightens the risk of falls and negatively impacts everyday mobility. The SMT directly stimulates the neuromuscular system by engaging sensory pathways and motor responses that work together to sustain balance and stability, addressing precisely these age-specific declines 15 . One of the most significant benefits of sensorimotor training (SMT) is its impact on neuroplasticity and proprioception, which are often impaired in individuals with diabetes due to peripheral neuropathy 16 , 17 . Prolonged hyperglycemia damages sensory nerves, reducing proprioceptive feedback and increasing the risk of falls 18 . SMT helps restore proprioception by stimulating mechanore-ceptors in muscles and joints, improving sensory input to the central nervous system. Through repeated training, the brain strengthens neural connections responsible for postural control and movement coordination. These neural adaptations enhance reaction times and dynamic stability, helping to prevent falls and improve overall mobility 19 . Skeletal muscle function is another key area influenced by SMT. Diabetes and aging contribute to muscle atrophy and reduced strength, making daily activities more challenging. Sensorimotor exercises activate both slow-twitch and fast-twitch muscle fibers, leading to improvements in both endurance and power 20 . Additionally, neuromuscular adaptations improve motor unit synchro-nization, allowing for more efficient muscle contractions and better execution of movements. This explains why participants in the intervention group demonstrated enhanced agility and lower limb strength. Increased muscular strength is also critical for maintaining independence in older adults, as it reduces fatigue and enhances their ability to perform daily activities 21 . This specific training focuses on improving neuromuscular control, postural stability, and coordination by challenging the body's sensory and motor systems. Research indicates that SMT enhances balance, gait mechanics, and muscle activation patterns, contributing to reduced fall risk and improved mobility in older adults with type 2 diabetes mellitus (T2DM). Given that older women with DM are particularly vulnerable to functional decline, implementing sensorimotor training may serve as a targeted strategy to improve their quality of life and independence 22 , 23 . In addition, women with DM have worse metabolic control, self-care, and QoL than men do and are exposed to many stress-generating agents, both because they have a chronic disease and because of gender issues and their roles in society 24 . This study aimed to evaluate the effects of 6 months SMT on physical fitness in older women with diabetes mellitus. Materials and Methods Design This investigation is part of a study protocol, registered at ClinicalTrials.gov (Identifier: NCT05398354) under the title “Active Retirement: Effects of the Application of a Training Program.” The authors confirm that all ongoing and related trials for this intervention are registered. Participant recruitment occurred from 1 November 2021 to 2 January 2022. This study was developed at the University of Évora, and the measurements were made at two time points: the first on 5 January 2022 and the second on 30 July 2022, both in the municipality of Almada (Portugal). Participants Ten elderly women with type 2 DM were selected from the list of registered clinical trials to participate in this pilot study. These 10 women were part of an intervention and control group (IG and CG, respectively) comprising a total of 160 elderly people. Detailed information about treating diabetic patients typically involves understanding the different approaches tailored to individual needs, including lifestyle modifications, oral anti-diabetic drugs, and insulin administration. In this study, participants were treated with insulin. Subjects were selected because they have similar characteristics (weight, height, and body mass index - BMI), apart from age, and both suffer from the same pathology DM. All the samples were evaluated at equivalent times. Thus, we analyzed five participants in the IG, who carried out the training program in addition to the assessments, and a second group, the CG, who carried out only the initial and final assessments without having practiced the training program. The selection of participants was random. The participants (1) were over 65 years of age; (2) had undergone surgical intervention for less than 6 months; (3) had no musculoskeletal diagnosis or problems with locomotion; (4) did not have psychiatric diseases or neurological disorders; and (5) did not have a clinical cardiovascular condition. The participants were excluded when they had (a) vascular complications of diabetes – nephropathy, reti-nopathy or polyneuropathy, (b) high arterial hypertension, (c) diabetic foot or other lower limb dyskinesia disease. Intervention The intervention group participated in a 24-week Sensorimotor Training (SMT) program, delivered twice weekly, with each session lasting 45 minutes. The program was structured into three progressive intensity phases: Weeks 1–8 (Initial Phase – Easy): Exercises without external resistance, focusing on postural control, balance, and functional movement. Weeks 9–16 (Intermediate Phase): Introduction of low-level resistance using elastic bands, ankle weights, and hand-held weights. Weeks 17–24 (Advanced Phase): Further increase in load intensity using the same equipment to promote strength and neuromuscular control. Each session followed a consistent structure: Warm-up (10 minutes): Light walking followed by joint mobility exercises. Main training (25 minutes): Circuit training composed of 4 rounds of 8 exercises (50 seconds of activity, 15 seconds of rest). Exercises targeted balance, coordination, strength, and proprioceptive stimulation. Cool-down (10 minutes): Static stretching and breathing exercises. Progression was individualized based on performance and tolerance. Post-session perceived exertion was recorded using the Borg Scale, and monthly enjoyment and satisfaction were monitored through the Physical Activity Enjoyment Scale (PACES). Attendance was recorded at every session. The control group did not receive any structured physical training and continued with their usual activities. They only participated in the baseline and final assessments. Ethics approval The Ethics Committee of the University of Évora approved this project (approval number: 21040). In addition, the participants provided written informed consent following the Helsinki Declaration 25 . Sample Size Sample size calculations were performed using the G*Power 3.1.9.4 software (Kiel University, Kiel, Germany), selecting the statistical test to compare the difference between two independent means (two groups). The participants were selected to identify a moderate estimated effect size (ES) of at least 0.99 standard deviations for between-groups in the physical fitness outcomes. Instruments Anthropometry and body mass index Body weight (scale), height (stadimeter), and BMI were assessed. Before beginning any of the measurements, the participants were asked to remove their shoes, socks, and heavy clothing (jackets, sweaters, coats, etc.). They were also asked to empty their pockets and remove their belts and other accessories (bands, pendants, etc.). Height was measured via a stadiometer (Seca 22, Hamburg, Germany). The instrument was placed on a vertical surface with the measuring scale perpendicular to the ground. The participants stood with their shoulders balanced and their arms relaxed along the body. Height was measured in cm and rounded to the nearest mm. Body weight was measured on a scale. Body weight was recorded in kg. BMI was determined via the following formula: weight/height2. Physical fitness To assess physical fitness, two attempts were made for each test applied, including the TUG, strength, and flexibility tests. Between the two attempts, participants were given a 2-minute break to calm down and recover. The following measurements were then taken: Agility and speed were assessed by applying the timed up and go (TUG) test in seconds (s), which consists of getting up from a chair, walking to a straight line 2.44 meters away, turning, walking back, and sitting down again 26 ; (ii and iii) Strength was evaluated through the number of repetitions (reps) performed from two tests. The first consisted of evaluating lower limb strength (SL) by counting how many times the participant could sit down and stand up from a chair for 30s 27 , and the second upper limb strength was determined by the number of times a weight could be lifted by performing flexion-extension of the arms (FA) for 30s 27 ; (iv and v) flexibility was evaluated via two tests. For flexibility of the lower limbs, a “sit and reach” (SA) was performed, where the participants, from a sitting position with one leg extended, slowly lowered themselves, sliding their hands down the extended leg until touching (or passing) their toes 27 . For flexibility of the upper limbs, the “behind the back reach right and left” tests (AD and AE) were carried out, which evaluated the entire range of movement of the shoulder and consisted of measuring the distance between (or the overlap of) the middle fingers behind the back with a ruler 27 . In both cases, the measurement used was in centimeters (cm). Procedures A variety of tools were used for the assessments, based on the tests applied. All measures were taken at the beginning and end of the intervention. Before the first measurement, all the participants went through a familiarization phase to familiarize themselves with the different instruments and assessments included in this project. Experimental group: The participants enrolled in the SMT program carried out exercises for 6 months, twice a week. As the schedule progressed, the load progressively increased. To this end, the session was divided into three levels of intensity: easy (no external load during the first eight weeks), intermediate (application of an external load: elastic bands, shin guards, and free weights, from the 9th to the 16th week) and advanced (increase in the external load to the previous level, from the 17th to the 24th week). Each month, a different type of session was developed. The duration of each session was 45 min, which was divided into three phases: the initial phase (10 min), consisting of 5 min of walking followed by a joint warm-up; and the fundamental phase (25 min), where we worked on an exercise circuit. This circuit consisted of 4 cycles, with eight exercises each (50s on, 15s off) and a return to calm (10 min), where muscle stretching was performed. In addition, at the end of each session, the intensity was evaluated via the perceived exertion (PSE) scale, and the adherence rate and satisfaction level were measured via the Physical Activity Enjoyment Scale (PACES) 28 . In the CG, the participants continued with their normal daily routine, with only participants in the assessments. Statistical Analysis Descriptive statistics and calculations were performed via Jamovi (version 1.6) [computer software]. The data are presented as the means and standard deviations (M±SD). Parametric and nonparametric tests were performed according to the distribution of data normality. To compare the dependent variables, Student’s t-test and two-way ANOVA with sphericity and homogeneity tests were performed considering the group (intervention group and control group) and moment assessments. The results are divided by comparisons between the IG and the CG. The data are shown at baseline, and the results before and after the intervention were compared. Statistical significance was set at p4) (Cohen's d). Results Participant details Table 1 shows the details of the study participants. According to the results, these ten women were similar in age. In terms of weight and height, they are similar, both being overweight 30 . Table 1 Baseline characteristics of the participants Group/Variables CG IG p Age (years) 80.00 ± 3.54 74.60 ± 3.78 0.048 Weight (kg) 72.80 ± 19.90 74.90 ± 14.80 0.856 Height (m) 1.53 ± 0.05 1.54 ± 0.06 0.719 BMI (kg/m 2 ) 31.20 ± 8.20 31.60 ± 6.16 0.937 Notes: GC: Control Group; IG: Intervention Group. Data are mean ± standard deviation (SD). The Student’s t values indicate no significant differences between groups, except for age, which was significantly different (p = 0.048). To assess physical fitness, the following measurements were carried out: agility and speed of execution; strength; and flexibility. Both the weight and BMI of both groups decreased, with the IG having a greater reduction. With regard to agility and speed, as shown in Table 2 , the CG, despite having an initial value of 9.26s, which is greater than that of the IG, managed to improve its test execution time after the intervention to 7.59s. The IG started at 8.46s and reached 7.49s in the second evaluation. In terms of strength capacity, the strength of the lower limbs was evaluated through the sit-and-stand test (SL), and the strength of the upper limbs was evaluated through the forearm flexion test (FA). In the SL test, the CG had a lower mean value in the first evaluation (11.60 repetitions), and in the second evaluation, it increased the mean value to 13.80 repetitions. The IG started with a slightly greater value of 12.20 repetitions and then increased one more repetition to 13.20 repetitions in the second evaluation. Table 2 shows that CG in the FA test resulted from the first evaluation of 16.80 repetitions, but in the second evaluation, the result increased by two repetitions to 18.20 repetitions. The IG obtained a superior result in the first assessment of 18.80 repetitions but reduced its value to 18.20 repetitions, finishing the second with the same number of reps as the CG. Although we do not have significant p values, we have some moderate ES, such as weight (p = 0.351), BMI (p = 0.406), SL (p = 0.330), FA (p = 0.166), AD (p = 0.290), and large ones, such as TUG (p = 0.649) and SA (p = 0.719). Because our objective was to understand the impact of exercise on these patients, as shown in Table 2 , the IG improved, as did the CG. In other words, the group that received the in-tervention exhibited substantial differences even though there were no significant differences between the groups, which supports the ESthat we previously reported. Table 2 Main outcomes between the first and second assessments in both groups (CG n = 5; IG n = 5). Baseline 24 weeks Sig. Effect size CG IG CG IG Weight (kg) 72.80 ± 19.90 74.90 ± 14.80 71.50 ± 19.10 72.30 ± 15,4 p = 0.351 0.109 BMI (kg/m 2 ) 31.20 ± 8.20 31.60 ± 6.16 30.60 ± 7.79 30.50 ± 6,63 p = 0.406 0.088 TUG (s) 9.26 ± 2.38 8.46 ± 1.36 7.80 ± 1.63 7.49 ± 0.80 p = 0.649 0.027 SL (rep) 11.60 ± 2.70 12.20 ± 1.92 13.8 ± 4.09 13.20 ± 1.30 p = 0.330 0.118 FA (rep) 16.80 ± 3.03 18.80 ± 5.22 18.20 ± 3.56 18.20 ± 4.38 p = 0.166 0.225 SA (cm) -6.80 ± 14.40 -4.40 ± 9.18 -1.60 ± 9.48 -0.20 ± 8.98 p = 0.719 0.017 AD (cm) -23.30 ± 18.00 -17.60 ± 15.30 -20.20 ± 17.90 -10.20 ± 11.10 p = 0.290 0.138 AE (cm) -28.40 ± 13.30 -19.60 ± 14.30 -35.00 ± 18.80 -13.60 ± 11.70 p = 0.083 0.329 Notes: CG: Control Group; IG: Intervention Group; BMI: body mass index; TUG: timed up and go test; SL: sit and stand test; FA: forearm flexion test; SA: sit and reach test; AD: reach behind the back test–right; AE: reach behind the back test–left. Data presented as mean ± standard deviation (SD). In terms of flexibility, we analyzed the flexibility of the lower limbs through the sit and reach test (SA) and the flexibility of the upper limbs through the test reach behind the right back (AD) and reach behind the left back (AE). As we can see in Table 2 , in the SA test, CG obtained a value of -6.80 cm in the first evaluation, which was worse than that of IG (-4.40 cm), but its result improved by five cm, reaching − 1.60 cm. On the other hand, the IG ranged from − 4.40 cm in the first assessment to -0.20 cm. Both groups improved their scores on average in this test. In the AD test, CG presented an initial value of -23.30 cm, which was worse than that of IG (-17.60 cm) but presented improvements of three cm for the second evaluation (-20.20 cm), whereas IG improved its result by seven cm, ranging from − 17.60 cm on average to -10.20 cm. In this case, the IG obtained better results. In the AE test, CG has an initial value of -28.40 cm, which is greater than that of IG (-19.60 cm), and its value increases from 7.00 cm to -35.00 cm. The IG, in addition to presenting a lower initial value, reduces the distance on average by 5.00 cm, ending the second evaluation with a value of -13.60 cm. Table 3 Comparative analysis of variation after the exercise program (CG n = 5; IG n = 5). Variables CG IG 24-weeks p value 24-weeks p value TUG (s) 1.46 0.221 0.97 0.020 SL (rep) -2.20 0.051 -1.00 0.298 FA (rep) -1.40 0.052 0.40 0.646 SA (cm) 5.20 0.079 4.20 0.049 AD (cm) 3.10 0.212 7.4 0.080 AE (cm) -6.60 0.343 6.00 0.023 Notes: CG: Control Group; IG: Intervention Group; AV1: 1st assessment; AV2: 2nd assessment; TUG: timed up-and-go test; SL: sit-and-stand test; FA: forearm flexion test; SA: sit-and-reach test; AD: reach behind the back test–right; AE: reach behind the back test–left; p value: p < 0.05 shows significant differences. To observe the distinct evolution of individuals who underwent intervention and those who did not, we performed a statistical analysis of the variation. We confirmed that there were significant differences in the results of the TUG (p = 0.020), SA (p = 0.049), and AE (p = 0.023) tests, as shown in Table 3 . Discussion This research aimed to analyze the effects of SMTon physical fitness throughout the aging process in diabetic women. Agility and speed were assessed using the TUG test, which evaluates an individual's ability to transition from sitting to standing and walking a short distance. The IG demonstrated significant improvements in TUG performance compared to the CG, suggesting that SMTenhances reaction time and dynamic stability, both of which are essential for preventing falls. These findings align with previous research indicating that sensorimotor exercises improve neuromuscular control and proprioception, reducing fall risk in older adults 31 , 32 . Previous research has indicated that proprioception loss causes balance deficits and frequent falls in elderly individuals. An increase in proprioception lowers the elderly population's risk of falling 33 . A major concern for professionals working with elderly individuals is the high number of falls. These findings are corroborated by Chandler 33 , who reported that fatigue resistance can affect the ability to respond effectively to a disturbance in equilibrium, which is associated with mobility. Studies have shown that precarious mobility and a decrease in physical fitness are predictors of morbidity and mortality. Changes in mobility predict loss of independence and death in people over 65 years of age; individuals with mobility impairments have a higher risk of death and dependence than those who maintain their mobility 34 . Similarly, low levels of cardiorespiratory fitness have been associated with the risk of morbidity and mortality from chronic degenerative diseases, including arterial disease, coronary artery disease, systemic arterial hypertension, DM, and some types of cancer 35 . Aging is associated with a decline in muscle strength, particularly in the lower limbs, which contributes to mobility im-pairments and reduced independence. This study revealed that both IG and CG showed improvements in lower limb strength following the intervention. However, upper limb strength did not improve consistently, possibly due to the specificity of SMT, which primarily targets postural control and lower extremity function. Similar studies by Heubel et al. 36 found that multicomponent training, including strength and balance exercises, significantly enhanced functional fitness and glycemic control in older adults with DM. Aging results in a decline in physical qualities, including strength 1 , 10 , 11 , 37 . When the values obtained for lower limb strength were analyzed, we found that both methods improved the results. In the upper limb strength test, the IG decreased the number of repetitions performed in the first assessment, whereas the CG increased it. According to the reference values of Baptista and Sardinha 38 in the strength test of the lower limb strength test, the CG and IG are in the 50th percentile. The upper limb strength test results of the CG and IG were between the 75th and 90th percentiles. The values obtained in the strength test prove that both participants presented excellent capacity concerning general standards for their age. Additionally, as one of the factors that contribute to im-provements in lower limb proprioception is the learning effect, a steady increase in the difficulty of sensorimotor exercises leads to increased proprioception 16 . Flexibility, particularly in the lower limbs, is crucial for maintaining functional movement patterns and preventing injuries. The results indicated greater improvements in lower limb flexibility compared to upper limb flexibility, aligning with findings from Baptista and Sardinha 38 who reported that progressive sensorimotor exercises improve range of motion and joint stability. However, despite improvements, both IG and CG remained within lower percentiles for flexibility, suggesting that additional stretching or mobility-focused exercises may be needed alongside SMT for more comprehensive benefits. One of the key findings of this study was the improvement in proprioceptive control, which is particularly beneficial for elderly individuals with diabetes-related neuropathy. Proprioception loss is a major contributor to balance deficits and fall risk in older adults 39 . SMT, which includes unstable surface training, single-leg stance exercises, and coordinated movement drills, has been shown to improve postural stability and equilibrium control, leading to greater confidence in movement and reduced fear of falling. Heubel et al. 36 verified the effects of 16 weeks of multicomponent training, composed of strength, flexibility, and balance exercises, on the functional fitness and glycemic parameters of 13 elderly people with DM. These researchers reported significant improvements in the mean flexibility indices in the sit and reach test (11.40 ± 8.70 cm; 14.50 ± 9.80 cm) and in the strength and endurance of the upper limbs, as evaluated by the elbow flexion test at 30’’ (first evaluation 16.60 ± 3.40 reps; second evaluation 19.40 ± 4.20 reps). Compared with our study, the lower flexibility values obtained are much greater, whereas the upper limb strength values are similar. Thus, we can say that once again, the intervention improved not only the capacity for agility and speed but also the flexibility of the upper and lower limbs. Having only reduced the strength of the upper limbs. In addition to its impact on physical fitness, SMT contributes to better glycemic control and cardiovascular health. Studies have established that low levels of cardiorespiratory fitness are associated with an increased risk of chronic degenerative diseases, including coronary artery disease, hypertension, and diabetic complications 40 . By improving mobility and muscle function, SMT indirectly supports glucose metabolism and insulin sensitivity, reinforcing its role as a complementary intervention for diabetes management. Age-related physiological changes affect responsiveness to physical training, and older adults may require longer periods to show significant improvements. The CG’s improvement in certain measures suggests that baseline differences in age and related physical fitness might have led to non-significant findings even if both groups were progressing. This study contributes valuable insights into the benefits of SMTfor older women with diabetes, highlighting its role in fall prevention and enhanced functional independence. The moderate ES and observed improvements underscore the potential of this approach, though larger, age-balanced samples are necessary to confirm these results and refine the training protocol for diverse age ranges. One limitation of this research was the small number of participants, which can be explained by the introduction of the inclusion criterion of having DM in the sample. The small sample size in this study presents certain limitations, particularly concerning the study's statistical power—the probability of detecting a true effect if one exists. With a smaller sample, there is an increased risk of Type II errors, where meaningful differences or effects may go undetected due to insufficient statistical power. This limitation is especially relevant in clinical studies, where subtle but clinically significant improvements might not reach statistical significance due to sample size constraints. Future studies with larger samples are needed to validate these findings and explore physiological factors not addressed here, such as the impact of exercise on glucose levels. Conclusion This study highlights the positive effects of SMT on physical fitness in older women with diabetes. The observed gains in agility, strength, flexibility, and proprioception emphasize its potential for fall prevention and maintaining functional independence. Improvements in proprioception and neuroplasticity enhance balance and coordination, thereby reducing fall risk. Adaptations in skeletal muscle led to increased strength and agility, which contributed to enhanced mobility and independence. Better metabolic regulation through improved insulin sensitivity aids in better glucose control, lowering the risk of long-term complications from diabetes. Flexibility gains help counteract joint stiffness, promoting easier movement, while hormonal and cardiovascular advantages bolster overall health. By addressing multiple physiological factors, SMTemerges as an effective strategy for combating diabetes related physical decline and enhancing the quality of life for aging women with diabetes. However, considering the limitations of sample size and intervention duration, future research should seek to investigate long-term effects and refine training protocols to maximize benefits for older adults with diabetes. Declarations Author Contributions Conceptualization, C.A.C., C.M., O.F., M.C.E., J.A.P., and P.N.; methodology, C.A.C. and C.M.; data collection, C.A.C. and C.M.; formal analysis, C.A.C., O.F., J.A.P. and M.C.E.; data curation, C.M.; writing—original draft preparation, C.A.C., C.M., and M.C.E.; writing—review and editing, O.F., M.C.E., J.A.P., and P.N.; supervision, O.F., M.C.E., J.A.P., and P.N.; funding, P.N. All authors have read and agreed to the published version of the manuscript. Funding This study was supported by the Portuguese Foundation for Science and Technology (FCT), I.P., under grant numbers UIDB/04748/2020 and UIDP/04923, and by the Polytechnic Institute of Setúbal. Institutional Review Board Statement The Ethics Committee of the University of Évora approved this project (approval number: 21040). Human Ethics and consent to participate This study followed the Helsinki Declaration and was approved by the Research Ethics Committee of the Évora University Informed Consent Statement Informed consent was obtained from all subjects involved in the study. Data Availability Statement The data presented in this study are available on request from the corresponding author. Acknowledgments The authors would like to acknowledge the participants who allowed us to conduct this study. Declaration of interest statement The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. References Zhou, J. et al. The Complexity of Standing Postural Control in Older Adults: A Modified Detrended Fluctuation Analysis Based upon the Empirical Mode Decomposition Algorithm. PLoS ONE 8 , e62585 (2013). Giovannini, S. et al. Falls among Older Adults: Screening, Identification, Rehabilitation, and Management. 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A literature review. Diabetologia 55 , 542–551 (2012). Riddell, M. C. et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 5 , 377–390 (2017). Ahmad, I., Noohu, M. M., Verma, S., Singla, D. & Hussain, M. E. Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy. Gait & Posture 74 , 114–120 (2019). Ahmad, I., Verma, S., Noohu, M. M., Shareef, M. Y. & Hussain, M. E. Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: a randomized control trial. J Musculoskelet Neuronal Interact 20 , 234–248 (2020). Yahya, A. et al. The impact of diabetic peripheral neuropathy on pinch proprioception. Exp Brain Res 237 , 3165–3174 (2019). Freire, I. & Seixas, A. Effectiveness of a sensorimotor exercise program on proprioception, balance, muscle strength, functional mobility and risk of falls in older people. Front. Physiol. 15 , 1309161 (2024). Aman, J. E., Elangovan, N., Yeh, I.-L. & Konczak, J. The effectiveness of proprioceptive training for improving motor function: a systematic review. Front Hum Neurosci 8 , 1075 (2014). Talbot, J. & Maves, L. Skeletal muscle fiber type: using insights from muscle developmental biology to dissect targets for susceptibility and resistance to muscle disease. Wiley Interdiscip Rev Dev Biol 5 , 518–534 (2016). Zhong, Y.-J., Meng, Q. & Su, C.-H. Mechanism-Driven Strategies for Reducing Fall Risk in the Elderly: A Multidisciplinary Review of Exercise Interventions. Healthcare (Basel) 12 , 2394 (2024). Fekete, M. et al. Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases. Nutrients 15 , 47 (2022). Guo, J. et al. Aging and aging-related diseases: from molecular mechanisms to interventions and treatments. Sig Transduct Target Ther 7 , 391 (2022). Lessmann, J. C., Silva, D. M. G. V. da & Nassar, S. M. Women with type 2 diabetes mellitus: sociodemographic profile, biometrics and health. Acta paul. enferm. 25 , 81–86 (2012). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA 310 , 2191 (2013). Rikli, R. & Jones, J. Senior Fitness Test Manual . (Human Kinetics, 2013). Rikli, R. E. & Jones, C. J. Development and Validation of a Functional Fitness Test for Community-Residing Older Adults. Journal of Aging and Physical Activity 7 , 129–161 (1999). Teques, P., Calmeiro, L., Silva, C. & Borrego, C. Validation and adaptation of the Physical Activity Enjoyment Scale (PACES) in fitness group exercisers. Journal of Sport and Health Science 9 , 352–357 (2020). Cabo, C. A. et al. An Active Retirement Programme, a Randomized Controlled Trial of a Sensorimotor Training Programme for Older Adults: A Study Protocol. Healthcare 11 , 86 (2022). Lipschitz, D. A. Screening for nutritional status in the elderly. Prim Care 21 , 55–67 (1994). Tonelli, D. C. Capacidade funcional em idosas com e sem diabetes mellitus tipo 2 praticantes de exercícios físicos: um estudo transversal. (Universidade Federal de Santa Catarina. Centro de Desportos. Educação Física, Florianópolis, 2019). Mangano, G. R. A., Valle, M. S., Casabona, A., Vagnini, A. & Cioni, M. Age-Related Changes in Mobility Evaluated by the Timed Up and Go Test Instrumented through a Single Sensor. Sensors 20 , 719 (2020). Chandler, J. M. Balance and Falls in the Elderly: Issues in Evaluation and Treatment. (Guccione AA, Alexandria: Mosby, 2000). Bergland, A., Jørgensen, L., Emaus, N. & Strand, B. H. Mobility as a predictor of all-cause mortality in older men and women: 11.8 year follow-up in the Tromsø study. BMC Health Serv Res 17 , 22 (2017). Petrie, J. R., Guzik, T. J. & Touyz, R. M. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Canadian Journal of Cardiology 34 , 575–584 (2018). Heubel, A. D. et al. TREINAMENTO MULTICOMPONENTE MELHORA A APTIDÃO FUNCIONAL E CONTROLE GLICÊMICO DE IDOSOS COM DIABETES TIPO 2. J Phys Educ 29 , (2018). Sampaio, L. V. P., Castilho, L. B. & Carvalho, G. de A. Development of an application for mobile devices to evaluate the balance and risk of falls of the elderly. Rev. bras. geriatr. gerontol. 20 , 805–813 (2017). Baptista, F. & Sardinha, L. B. Avaliação Da Aptidão Física e Do Equilíbrio de Pessoas Idosas – Baterias de Fullerton . (2005). Mohamed, A. A. & Jan, Y.-K. Effect of Adding Proprioceptive Exercise to Balance Training in Older Adults with Diabetes: A Systematic Review. CDR 16 , 327–339 (2020). Ruivo, R. Novo Manual de Avaliação e Prescrição de Exercício . (Self, 2018). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Nov, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 26 Aug, 2025 Reviewers agreed at journal 13 Aug, 2025 Reviews received at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviews received at journal 11 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers invited by journal 11 Aug, 2025 Editor assigned by journal 05 Aug, 2025 Submission checks completed at journal 05 Aug, 2025 First submitted to journal 14 Jul, 2025 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. 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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-7121619","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500148833,"identity":"0ff16712-f485-4893-92a7-b8b50e91fd3c","order_by":0,"name":"Carolina A. Cabo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYLCCBwZgio2BoQJIMTM3ENaSANdyBqSFkRgtDFAtjG0gmoAW/vazDx8kFNyR528//OzBx3m10fztQC0/Krbh1CJxJt3YIMHgmeGMM2nmhjO3Hc+dcZixgbHnzG2cWgwY0tgkEgyAym4wmEnzbjuW2wBkMzO24dHC/wysxX7+DfZv0rxzjuXOJ6hFAmJL4oYbPEBbGmpyNxDSInHjGTPQL4eTN57JKTeccexA7kagloP4/MLfn8b44MOfw7bzjh/f9uBDTV3uvPOHDz74UYFbCzo4DCYPEK0eCOpIUTwKRsEoGAUjBAAALudcjEPLx6oAAAAASUVORK5CYII=","orcid":"","institution":"Universidade de Évora","correspondingAuthor":true,"prefix":"","firstName":"Carolina","middleName":"A.","lastName":"Cabo","suffix":""},{"id":500148835,"identity":"40d53149-d5e8-4018-b58c-ce3b72cce477","order_by":1,"name":"Jose A. Parraca","email":"","orcid":"","institution":"Universidade de Évora","correspondingAuthor":false,"prefix":"","firstName":"Jose","middleName":"A.","lastName":"Parraca","suffix":""},{"id":500148837,"identity":"e11dba74-efa5-49f5-9769-cd5da02ab942","order_by":2,"name":"Orlando Fernandes","email":"","orcid":"","institution":"Universidade de Évora","correspondingAuthor":false,"prefix":"","firstName":"Orlando","middleName":"","lastName":"Fernandes","suffix":""},{"id":500148838,"identity":"033916e5-7e00-44cb-a88f-ea7daebc23be","order_by":3,"name":"Paulo Nunes","email":"","orcid":"","institution":"Instituto Politécnico de Setúbal","correspondingAuthor":false,"prefix":"","firstName":"Paulo","middleName":"","lastName":"Nunes","suffix":""},{"id":500148839,"identity":"19b54fcf-4bcb-4454-b873-9d8d8333a972","order_by":4,"name":"Cláudia Mendes","email":"","orcid":"","institution":"Universidade de Évora","correspondingAuthor":false,"prefix":"","firstName":"Cláudia","middleName":"","lastName":"Mendes","suffix":""},{"id":500148840,"identity":"56991bc2-09cc-4c02-a500-56d59b8f671a","order_by":5,"name":"Mário C. Espada","email":"","orcid":"","institution":"Universidade de Évora","correspondingAuthor":false,"prefix":"","firstName":"Mário","middleName":"C.","lastName":"Espada","suffix":""}],"badges":[],"createdAt":"2025-07-14 13:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7121619/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7121619/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-025-06591-4","type":"published","date":"2025-11-24T15:58:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89306123,"identity":"370d4b8a-13de-4d20-b1ac-9b29bef249bd","added_by":"auto","created_at":"2025-08-18 15:09:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65508,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT 2025 Flow Diagram\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7121619/v1/e4bdc1a0b237bc7bcf055135.jpg"},{"id":89303669,"identity":"7ff7aaff-2e81-41d7-b744-d63d55387afe","added_by":"auto","created_at":"2025-08-18 14:53:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":141993,"visible":true,"origin":"","legend":"\u003cp\u003eIntervention used for sensorimotor training\u003csup\u003e29\u003c/sup\u003e.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7121619/v1/e4d29c125c2e2c06c44ec6a1.jpg"},{"id":97178771,"identity":"2883411f-9e10-489e-96a3-4aeb8dbb60d3","added_by":"auto","created_at":"2025-12-01 16:13:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":924541,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7121619/v1/4783fd9a-dac1-49fc-bced-86d4d6c16a6a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Sensorimotor Training on Physical Fitness in Older Women with Diabetes: A Pilot Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAging is characterized as a natural and physiological process that progressively accompanies the life cycle. In addition to complications within the psychosocial domain, physical losses manifest, resulting in cognitive slowing, depression, functional incapacity, diminished resilience, inactivity, and physical degeneration\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The functional changes intrinsic to the aging process, such as decreased mobility and muscle strength, may precipitate conditions of imbalance and, consequently, elevate the risk of falls among elderly individuals. Falls in the elderly population are associated not only with the use of medication but also with factors such as frailty and functional decline\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe World Health Organization (WHO) states that there is clear evidence that people over 65 years of age who are inactive have several associated diseases and that mortality rates from strokes, coronary heart disease, diabetes mellitus (DM), and hypertension, among others, are higher\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. DM, particularly type 2 diabetes, is a significant health concern among older women, increasing the risk of cardiovascular disease, neuropathy, and musculoskeletal impairments. Age-related declines in muscle strength, balance, and coordination, combined with diabetes-related complications such as peripheral neuropathy, heighten the risk of falls and functional limitations in this population\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In the coming decades, the number of patients with DM is expected to triple\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The WHO states that there is clear evidence that regular physical activity (PA) yields significant benefits for individuals over 65 years of age. These individuals are usually less active and, therefore have diseases related to inactivity, such as DM. This metabolic disease mortality rates are lower among older adults who are more active than among those who are less active\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBohn et al.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e recently reported that fewer than one-fifth of people with DM manage to meet PA recommendations. Exercise is widely recognized as a cornerstone of diabetes management, offering significant benefits for glycemic control, cardiovascular health, and overall well-being. Regular PA has been shown to improve insulin sensitivity, reduce HbA1c levels, and support weight management, which are critical for older women with diabetes. Additionally, exercise enhances muscle strength, bone density, and balance, reducing the risk of falls and osteoporosis, which are common concerns in aging populations. Psychological benefits, including reduced stress and improved mental health, also contribute to a better quality of life for older women managing diabetes\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Furthermore, exercise reduces total daily insulin requirements, stress, and depression while improving the quality of life (QoL) of individuals\u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe SMT was chosen over other types of physical exercise for its unique focus on improving balance, proprioception, and neuromuscular coordination-all critical areas that tend to decline with age. Unlike traditional strength or aerobic exercise, which typically focuses on cardiovascular health or muscle strength, SMT directly engages neural and sensory systems essential for physical stability, coordination, and efficient movement. With age, there is a natural decline in proprioception (the sense of body position), slower reaction times, and reduced coordination between sensory and motor systems. This combination heightens the risk of falls and negatively impacts everyday mobility. The SMT directly stimulates the neuromuscular system by engaging sensory pathways and motor responses that work together to sustain balance and stability, addressing precisely these age-specific declines\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOne of the most significant benefits of sensorimotor training (SMT) is its impact on neuroplasticity and proprioception, which are often impaired in individuals with diabetes due to peripheral neuropathy\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Prolonged hyperglycemia damages sensory nerves, reducing proprioceptive feedback and increasing the risk of falls\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. SMT helps restore proprioception by stimulating mechanore-ceptors in muscles and joints, improving sensory input to the central nervous system. Through repeated training, the brain strengthens neural connections responsible for postural control and movement coordination. These neural adaptations enhance reaction times and dynamic stability, helping to prevent falls and improve overall mobility\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSkeletal muscle function is another key area influenced by SMT. Diabetes and aging contribute to muscle atrophy and reduced strength, making daily activities more challenging. Sensorimotor exercises activate both slow-twitch and fast-twitch muscle fibers, leading to improvements in both endurance and power\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Additionally, neuromuscular adaptations improve motor unit synchro-nization, allowing for more efficient muscle contractions and better execution of movements. This explains why participants in the intervention group demonstrated enhanced agility and lower limb strength. Increased muscular strength is also critical for maintaining independence in older adults, as it reduces fatigue and enhances their ability to perform daily activities\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis specific training focuses on improving neuromuscular control, postural stability, and coordination by challenging the body's sensory and motor systems. Research indicates that SMT enhances balance, gait mechanics, and muscle activation patterns, contributing to reduced fall risk and improved mobility in older adults with type 2 diabetes mellitus (T2DM). Given that older women with DM are particularly vulnerable to functional decline, implementing sensorimotor training may serve as a targeted strategy to improve their quality of life and independence\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. In addition, women with DM have worse metabolic control, self-care, and QoL than men do and are exposed to many stress-generating agents, both because they have a chronic disease and because of gender issues and their roles in society\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. This study aimed to evaluate the effects of 6 months SMT on physical fitness in older women with diabetes mellitus.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cem\u003eDesign\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis investigation is part of a study protocol, registered at ClinicalTrials.gov (Identifier: NCT05398354) under the title \u0026ldquo;Active Retirement: Effects of the Application of a Training Program.\u0026rdquo; The authors confirm that all ongoing and related trials for this intervention are registered. Participant recruitment occurred from 1 November 2021 to 2 January 2022. This study was developed at the University of \u0026Eacute;vora, and the measurements were made at two time points: the first on 5 January 2022 and the second on 30 July 2022, both in the municipality of Almada (Portugal).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTen elderly women with type 2 DM were selected from the list of registered clinical trials to participate in this pilot study. These 10 women were part of an intervention and control group (IG and CG, respectively) comprising a total of 160 elderly people. Detailed information about treating diabetic patients typically involves understanding the different approaches tailored to individual needs, including lifestyle modifications, oral anti-diabetic drugs, and insulin administration. In this study, participants were treated with insulin.\u003c/p\u003e\n\u003cp\u003eSubjects were selected because they have similar characteristics (weight, height, and body mass index - BMI), apart from age, and both suffer from the same pathology DM. All the samples were evaluated at equivalent times. Thus, we analyzed five participants in the IG, who carried out the training program in addition to the assessments, and a second group, the CG, who carried out only the initial and final assessments without having practiced the training program. The selection of participants was random. The participants (1) were over 65 years of age; (2) had undergone surgical intervention for less than 6 months; (3) had no musculoskeletal diagnosis or problems with locomotion; (4) did not have psychiatric diseases or neurological disorders; and (5) did not have a clinical cardiovascular condition. The participants were excluded when they had (a) vascular complications of diabetes \u0026ndash; nephropathy, reti-nopathy or polyneuropathy, (b) high arterial hypertension, (c) diabetic foot or other lower limb dyskinesia disease.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIntervention\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe intervention group participated in a 24-week Sensorimotor Training (SMT) program, delivered twice weekly, with each session lasting 45 minutes. The program was structured into three progressive intensity phases:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWeeks 1\u0026ndash;8 (Initial Phase \u0026ndash; Easy): Exercises without external resistance, focusing on postural control, balance, and functional movement.\u003c/li\u003e\n \u003cli\u003eWeeks 9\u0026ndash;16 (Intermediate Phase): Introduction of low-level resistance using elastic bands, ankle weights, and hand-held weights.\u003c/li\u003e\n \u003cli\u003eWeeks 17\u0026ndash;24 (Advanced Phase): Further increase in load intensity using the same equipment to promote strength and neuromuscular control.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEach session followed a consistent structure:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eWarm-up (10 minutes): Light walking followed by joint mobility exercises.\u003c/li\u003e\n \u003cli\u003eMain training (25 minutes): Circuit training composed of 4 rounds of 8 exercises (50 seconds of activity, 15 seconds of rest). Exercises targeted balance, coordination, strength, and proprioceptive stimulation.\u003c/li\u003e\n \u003cli\u003eCool-down (10 minutes): Static stretching and breathing exercises.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eProgression was individualized based on performance and tolerance. Post-session perceived exertion was recorded using the Borg Scale, and monthly enjoyment and satisfaction were monitored through the Physical Activity Enjoyment Scale (PACES). Attendance was recorded at every session.\u003c/p\u003e\n\u003cp\u003eThe control group did not receive any structured physical training and continued with their usual activities. They only participated in the baseline and final assessments.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of the University of \u0026Eacute;vora approved this project (approval number: 21040). In addition, the participants provided written informed consent following the Helsinki Declaration\u003csup\u003e25\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample Size\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSample size calculations were performed using the G*Power 3.1.9.4 software (Kiel University, Kiel, Germany), selecting the statistical test to compare the difference between two independent means (two groups). The participants were selected to identify a moderate estimated effect size (ES) of at least 0.99 standard deviations for between-groups in the physical fitness outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInstruments\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnthropometry and body mass index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBody weight (scale), height (stadimeter), and BMI were assessed. Before beginning any of the measurements, the participants were asked to remove their shoes, socks, and heavy clothing (jackets, sweaters, coats, etc.). They were also asked to empty their pockets and remove their belts and other accessories (bands, pendants, etc.). Height was measured via a stadiometer (Seca 22, Hamburg, Germany). The instrument was placed on a vertical surface with the measuring scale perpendicular to the ground. The participants stood with their shoulders balanced and their arms relaxed along the body. Height was measured in cm and rounded to the nearest mm. Body weight was measured on a scale. Body weight was recorded in kg. BMI was determined via the following formula: weight/height2.\u003c/p\u003e\n\u003cp\u003ePhysical fitness\u003c/p\u003e\n\u003cp\u003eTo assess physical fitness, two attempts were made for each test applied, including the TUG, strength, and flexibility tests. Between the two attempts, participants were given a 2-minute break to calm down and recover. The following measurements were then taken:\u003c/p\u003e\n\u003col style=\"list-style-type: upper-roman;\"\u003e\n \u003cli\u003eAgility and speed were assessed by applying the timed up and go (TUG) test in seconds (s), which consists of getting up from a chair, walking to a straight line 2.44 meters away, turning, walking back, and sitting down again\u003csup\u003e26\u003c/sup\u003e;\u003c/li\u003e\n \u003cli\u003e(ii and iii) Strength was evaluated through the number of repetitions (reps) performed from two tests. The first consisted of evaluating lower limb strength (SL) by counting how many times the participant could sit down and stand up from a chair for 30s\u003csup\u003e27\u003c/sup\u003e, and the second upper limb strength was determined by the number of times a weight could be lifted by performing flexion-extension of the arms (FA) for 30s\u003csup\u003e27\u003c/sup\u003e;\u003c/li\u003e\n \u003cli\u003e(iv and v) flexibility was evaluated via two tests. For flexibility of the lower limbs, a \u0026ldquo;sit and reach\u0026rdquo; (SA) was performed, where the participants, from a sitting position with one leg extended, slowly lowered themselves, sliding their hands down the extended leg until touching (or passing) their toes\u003csup\u003e27\u003c/sup\u003e. For flexibility of the upper limbs, the \u0026ldquo;behind the back reach right and left\u0026rdquo; tests (AD and AE) were carried out, which evaluated the entire range of movement of the shoulder and consisted of measuring the distance between (or the overlap of) the middle fingers behind the back with a ruler\u003csup\u003e27\u003c/sup\u003e. In both cases, the measurement used was in centimeters (cm).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eProcedures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA variety of tools were used for the assessments, based on the tests applied. All measures were taken at the beginning and end of the intervention. Before the first measurement, all the participants went through a familiarization phase to familiarize themselves with the different instruments and assessments included in this project.\u003c/p\u003e\n\u003cp\u003eExperimental group: The participants enrolled in the SMT program carried out exercises for 6 months, twice a week. As the schedule progressed, the load progressively increased. To this end, the session was divided into three levels of intensity: easy (no external load during the first eight weeks), intermediate (application of an external load: elastic bands, shin guards, and free weights, from the 9th to the 16th week) and advanced (increase in the external load to the previous level, from the 17th to the 24th week). Each month, a different type of session was developed. The duration of each session was 45 min, which was divided into three phases: the initial phase (10 min), consisting of 5 min of walking followed by a joint warm-up; and the fundamental phase (25 min), where we worked on an exercise circuit. This circuit consisted of 4 cycles, with eight exercises each (50s on, 15s off) and a return to calm (10 min), where muscle stretching was performed. In addition, at the end of each session, the intensity was evaluated via the perceived exertion (PSE) scale, and the adherence rate and satisfaction level were measured via the Physical Activity Enjoyment Scale (PACES)\u003csup\u003e28\u003c/sup\u003e. In the CG, the participants continued with their normal daily routine, with only participants in the assessments.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics and calculations were performed via Jamovi (version 1.6) [computer software]. The data are presented as the means and standard deviations (M\u0026plusmn;SD). Parametric and nonparametric tests were performed according to the distribution of data normality. To compare the dependent variables, Student\u0026rsquo;s t-test and two-way ANOVA with sphericity and homogeneity tests were performed considering the group (intervention group and control group) and moment assessments.\u003c/p\u003e\n\u003cp\u003eThe results are divided by comparisons between the IG and the CG. The data are shown at baseline, and the results before and after the intervention were compared. Statistical significance was set at p\u0026lt;0.05. The ES was used to analyze the differences: it is considered trivial (0-0.2), small (0.2-0.6), moderate (0.6-1.2), large (1.2-2), very large (2-4), and extremely large (\u0026gt;4) (Cohen\u0026apos;s d).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eParticipant details\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the details of the study participants. According to the results, these ten women were similar in age. In terms of weight and height, they are similar, both being overweight\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\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 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup/Variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eCG\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eIG\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\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\u003e\u003cb\u003eAge\u003c/b\u003e \u003cem\u003e(years)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e80.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.048\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e \u003cem\u003e(kg)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.80\u0026thinsp;\u0026plusmn;\u0026thinsp;19.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.90\u0026thinsp;\u0026plusmn;\u0026thinsp;14.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.856\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeight\u003c/b\u003e \u003cem\u003e(m)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.719\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e \u003cem\u003e(kg/m\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e31.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e31.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.937\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNotes: GC: Control Group; IG: Intervention Group. Data are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe Student\u0026rsquo;s t values indicate no significant differences between groups, except for age, which was significantly different (p\u0026thinsp;=\u0026thinsp;0.048).\u003c/p\u003e\u003cp\u003eTo assess physical fitness, the following measurements were carried out: agility and speed of execution; strength; and flexibility. Both the weight and BMI of both groups decreased, with the IG having a greater reduction.\u003c/p\u003e\u003cp\u003eWith regard to agility and speed, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the CG, despite having an initial value of 9.26s, which is greater than that of the IG, managed to improve its test execution time after the intervention to 7.59s. The IG started at 8.46s and reached 7.49s in the second evaluation.\u003c/p\u003e\u003cp\u003eIn terms of strength capacity, the strength of the lower limbs was evaluated through the sit-and-stand test (SL), and the strength of the upper limbs was evaluated through the forearm flexion test (FA). In the SL test, the CG had a lower mean value in the first evaluation (11.60 repetitions), and in the second evaluation, it increased the mean value to 13.80 repetitions. The IG started with a slightly greater value of 12.20 repetitions and then increased one more repetition to 13.20 repetitions in the second evaluation.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that CG in the FA test resulted from the first evaluation of 16.80 repetitions, but in the second evaluation, the result increased by two repetitions to 18.20 repetitions. The IG obtained a superior result in the first assessment of 18.80 repetitions but reduced its value to 18.20 repetitions, finishing the second with the same number of reps as the CG. Although we do not have significant p values, we have some moderate ES, such as weight (p\u0026thinsp;=\u0026thinsp;0.351), BMI (p\u0026thinsp;=\u0026thinsp;0.406), SL (p\u0026thinsp;=\u0026thinsp;0.330), FA (p\u0026thinsp;=\u0026thinsp;0.166), AD (p\u0026thinsp;=\u0026thinsp;0.290), and large ones, such as TUG (p\u0026thinsp;=\u0026thinsp;0.649) and SA (p\u0026thinsp;=\u0026thinsp;0.719). Because our objective was to understand the impact of exercise on these patients, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the IG improved, as did the CG. In other words, the group that received the in-tervention exhibited substantial differences even though there were no significant differences between the groups, which supports the ESthat we previously reported.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMain outcomes between the first and second assessments in both groups (CG n\u0026thinsp;=\u0026thinsp;5; IG n\u0026thinsp;=\u0026thinsp;5).\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=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eBaseline\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cem\u003e24 weeks\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eSig.\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eEffect size\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eCG\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eIG\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eCG\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eIG\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWeight\u003c/b\u003e \u003cem\u003e(kg)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e72.80\u0026thinsp;\u0026plusmn;\u0026thinsp;19.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.90\u0026thinsp;\u0026plusmn;\u0026thinsp;14.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e71.50\u0026thinsp;\u0026plusmn;\u0026thinsp;19.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e72.30\u0026thinsp;\u0026plusmn;\u0026thinsp;15,4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.351\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e \u003cem\u003e(kg/m\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e31.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e31.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e30.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e30.50\u0026thinsp;\u0026plusmn;\u0026thinsp;6,63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTUG\u003c/b\u003e \u003cem\u003e(s)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e9.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e8.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e7.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e7.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.649\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSL\u003c/b\u003e \u003cem\u003e(rep)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e11.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e13.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.330\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFA\u003c/b\u003e \u003cem\u003e(rep)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e16.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e18.80\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e18.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e18.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSA\u003c/b\u003e \u003cem\u003e(cm)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e-6.80\u0026thinsp;\u0026plusmn;\u0026thinsp;14.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-4.40\u0026thinsp;\u0026plusmn;\u0026thinsp;9.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e-1.60\u0026thinsp;\u0026plusmn;\u0026thinsp;9.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e-0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.719\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAD\u003c/b\u003e \u003cem\u003e(cm)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e-23.30\u0026thinsp;\u0026plusmn;\u0026thinsp;18.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-17.60\u0026thinsp;\u0026plusmn;\u0026thinsp;15.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e-20.20\u0026thinsp;\u0026plusmn;\u0026thinsp;17.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e-10.20\u0026thinsp;\u0026plusmn;\u0026thinsp;11.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.138\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAE\u003c/b\u003e \u003cem\u003e(cm)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e-28.40\u0026thinsp;\u0026plusmn;\u0026thinsp;13.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-19.60\u0026thinsp;\u0026plusmn;\u0026thinsp;14.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e-35.00\u0026thinsp;\u0026plusmn;\u0026thinsp;18.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e-13.60\u0026thinsp;\u0026plusmn;\u0026thinsp;11.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.083\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNotes: CG: Control Group; IG: Intervention Group; BMI: body mass index; TUG: timed up and go test; SL: sit and stand test; FA: forearm flexion test; SA: sit and reach test; AD: reach behind the back test\u0026ndash;right; AE: reach behind the back test\u0026ndash;left. Data presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn terms of flexibility, we analyzed the flexibility of the lower limbs through the sit and reach test (SA) and the flexibility of the upper limbs through the test reach behind the right back (AD) and reach behind the left back (AE). As we can see in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, in the SA test, CG obtained a value of -6.80 cm in the first evaluation, which was worse than that of IG (-4.40 cm), but its result improved by five cm, reaching \u0026minus;\u0026thinsp;1.60 cm. On the other hand, the IG ranged from \u0026minus;\u0026thinsp;4.40 cm in the first assessment to -0.20 cm. Both groups improved their scores on average in this test. In the AD test, CG presented an initial value of -23.30 cm, which was worse than that of IG (-17.60 cm) but presented improvements of three cm for the second evaluation (-20.20 cm), whereas IG improved its result by seven cm, ranging from \u0026minus;\u0026thinsp;17.60 cm on average to -10.20 cm. In this case, the IG obtained better results. In the AE test, CG has an initial value of -28.40 cm, which is greater than that of IG (-19.60 cm), and its value increases from 7.00 cm to -35.00 cm. The IG, in addition to presenting a lower initial value, reduces the distance on average by 5.00 cm, ending the second evaluation with a value of -13.60 cm.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparative analysis of variation after the exercise program (CG n\u0026thinsp;=\u0026thinsp;5; IG n\u0026thinsp;=\u0026thinsp;5).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIG\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e24-weeks\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e24-weeks\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep value\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\u003e\u003cb\u003eTUG\u003c/b\u003e \u003cem\u003e(s)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSL\u003c/b\u003e \u003cem\u003e(rep)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.298\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFA\u003c/b\u003e \u003cem\u003e(rep)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.646\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSA\u003c/b\u003e \u003cem\u003e(cm)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.049\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAD\u003c/b\u003e \u003cem\u003e(cm)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAE\u003c/b\u003e \u003cem\u003e(cm)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-6.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNotes: CG: Control Group; IG: Intervention Group; AV1: 1st assessment; AV2: 2nd assessment; TUG: timed up-and-go test; SL: sit-and-stand test; FA: forearm flexion test; SA: sit-and-reach test; AD: reach behind the back test\u0026ndash;right; AE: reach behind the back test\u0026ndash;left; p value: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 shows significant differences.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTo observe the distinct evolution of individuals who underwent intervention and those who did not, we performed a statistical analysis of the variation. We confirmed that there were significant differences in the results of the TUG (p\u0026thinsp;=\u0026thinsp;0.020), SA (p\u0026thinsp;=\u0026thinsp;0.049), and AE (p\u0026thinsp;=\u0026thinsp;0.023) tests, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis research aimed to analyze the effects of SMTon physical fitness throughout the aging process in diabetic women. Agility and speed were assessed using the TUG test, which evaluates an individual's ability to transition from sitting to standing and walking a short distance. The IG demonstrated significant improvements in TUG performance compared to the CG, suggesting that SMTenhances reaction time and dynamic stability, both of which are essential for preventing falls. These findings align with previous research indicating that sensorimotor exercises improve neuromuscular control and proprioception, reducing fall risk in older adults\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePrevious research has indicated that proprioception loss causes balance deficits and frequent falls in elderly individuals. An increase in proprioception lowers the elderly population's risk of falling\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. A major concern for professionals working with elderly individuals is the high number of falls. These findings are corroborated by Chandler\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, who reported that fatigue resistance can affect the ability to respond effectively to a disturbance in equilibrium, which is associated with mobility. Studies have shown that precarious mobility and a decrease in physical fitness are predictors of morbidity and mortality. Changes in mobility predict loss of independence and death in people over 65 years of age; individuals with mobility impairments have a higher risk of death and dependence than those who maintain their mobility\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Similarly, low levels of cardiorespiratory fitness have been associated with the risk of morbidity and mortality from chronic degenerative diseases, including arterial disease, coronary artery disease, systemic arterial hypertension, DM, and some types of cancer\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAging is associated with a decline in muscle strength, particularly in the lower limbs, which contributes to mobility im-pairments and reduced independence. This study revealed that both IG and CG showed improvements in lower limb strength following the intervention. However, upper limb strength did not improve consistently, possibly due to the specificity of SMT, which primarily targets postural control and lower extremity function. Similar studies by Heubel et al.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e found that multicomponent training, including strength and balance exercises, significantly enhanced functional fitness and glycemic control in older adults with DM. Aging results in a decline in physical qualities, including strength\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. When the values obtained for lower limb strength were analyzed, we found that both methods improved the results. In the upper limb strength test, the IG decreased the number of repetitions performed in the first assessment, whereas the CG increased it. According to the reference values of Baptista and Sardinha\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e in the strength test of the lower limb strength test, the CG and IG are in the 50th percentile. The upper limb strength test results of the CG and IG were between the 75th and 90th percentiles. The values obtained in the strength test prove that both participants presented excellent capacity concerning general standards for their age. Additionally, as one of the factors that contribute to im-provements in lower limb proprioception is the learning effect, a steady increase in the difficulty of sensorimotor exercises leads to increased proprioception\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eFlexibility, particularly in the lower limbs, is crucial for maintaining functional movement patterns and preventing injuries. The results indicated greater improvements in lower limb flexibility compared to upper limb flexibility, aligning with findings from Baptista and Sardinha\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e who reported that progressive sensorimotor exercises improve range of motion and joint stability. However, despite improvements, both IG and CG remained within lower percentiles for flexibility, suggesting that additional stretching or mobility-focused exercises may be needed alongside SMT for more comprehensive benefits.\u003c/p\u003e\u003cp\u003eOne of the key findings of this study was the improvement in proprioceptive control, which is particularly beneficial for elderly individuals with diabetes-related neuropathy. Proprioception loss is a major contributor to balance deficits and fall risk in older adults\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. SMT, which includes unstable surface training, single-leg stance exercises, and coordinated movement drills, has been shown to improve postural stability and equilibrium control, leading to greater confidence in movement and reduced fear of falling. Heubel et al.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e verified the effects of 16 weeks of multicomponent training, composed of strength, flexibility, and balance exercises, on the functional fitness and glycemic parameters of 13 elderly people with DM. These researchers reported significant improvements in the mean flexibility indices in the sit and reach test (11.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.70 cm; 14.50\u0026thinsp;\u0026plusmn;\u0026thinsp;9.80 cm) and in the strength and endurance of the upper limbs, as evaluated by the elbow flexion test at 30\u0026rsquo;\u0026rsquo; (first evaluation 16.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40 reps; second evaluation 19.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20 reps). Compared with our study, the lower flexibility values obtained are much greater, whereas the upper limb strength values are similar. Thus, we can say that once again, the intervention improved not only the capacity for agility and speed but also the flexibility of the upper and lower limbs. Having only reduced the strength of the upper limbs.\u003c/p\u003e\u003cp\u003eIn addition to its impact on physical fitness, SMT contributes to better glycemic control and cardiovascular health. Studies have established that low levels of cardiorespiratory fitness are associated with an increased risk of chronic degenerative diseases, including coronary artery disease, hypertension, and diabetic complications\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. By improving mobility and muscle function, SMT indirectly supports glucose metabolism and insulin sensitivity, reinforcing its role as a complementary intervention for diabetes management.\u003c/p\u003e\u003cp\u003eAge-related physiological changes affect responsiveness to physical training, and older adults may require longer periods to show significant improvements. The CG\u0026rsquo;s improvement in certain measures suggests that baseline differences in age and related physical fitness might have led to non-significant findings even if both groups were progressing. This study contributes valuable insights into the benefits of SMTfor older women with diabetes, highlighting its role in fall prevention and enhanced functional independence. The moderate ES and observed improvements underscore the potential of this approach, though larger, age-balanced samples are necessary to confirm these results and refine the training protocol for diverse age ranges.\u003c/p\u003e\u003cp\u003eOne limitation of this research was the small number of participants, which can be explained by the introduction of the inclusion criterion of having DM in the sample. The small sample size in this study presents certain limitations, particularly concerning the study's statistical power\u0026mdash;the probability of detecting a true effect if one exists. With a smaller sample, there is an increased risk of Type II errors, where meaningful differences or effects may go undetected due to insufficient statistical power. This limitation is especially relevant in clinical studies, where subtle but clinically significant improvements might not reach statistical significance due to sample size constraints. Future studies with larger samples are needed to validate these findings and explore physiological factors not addressed here, such as the impact of exercise on glucose levels.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the positive effects of SMT on physical fitness in older women with diabetes. The observed gains in agility, strength, flexibility, and proprioception emphasize its potential for fall prevention and maintaining functional independence. Improvements in proprioception and neuroplasticity enhance balance and coordination, thereby reducing fall risk. Adaptations in skeletal muscle led to increased strength and agility, which contributed to enhanced mobility and independence. Better metabolic regulation through improved insulin sensitivity aids in better glucose control, lowering the risk of long-term complications from diabetes. Flexibility gains help counteract joint stiffness, promoting easier movement, while hormonal and cardiovascular advantages bolster overall health. By addressing multiple physiological factors, SMTemerges as an effective strategy for combating diabetes related physical decline and enhancing the quality of life for aging women with diabetes. However, considering the limitations of sample size and intervention duration, future research should seek to investigate long-term effects and refine training protocols to maximize benefits for older adults with diabetes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, C.A.C., C.M., O.F., M.C.E., J.A.P., and P.N.; methodology, C.A.C. and C.M.; data collection, C.A.C. and C.M.; formal analysis, C.A.C., O.F., J.A.P. and M.C.E.; data curation, C.M.; writing—original draft preparation, C.A.C., C.M., and M.C.E.; writing—review and editing, O.F., M.C.E., J.A.P., and P.N.; supervision, O.F., M.C.E., J.A.P., and P.N.; funding, P.N. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Portuguese Foundation for Science and Technology (FCT), I.P., under grant numbers UIDB/04748/2020 and UIDP/04923, and by the Polytechnic Institute of Setúbal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of the University of Évora approved this project (approval number: 21040).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study followed the Helsinki Declaration and was approved by the Research Ethics Committee of the Évora University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented in this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the participants who allowed us to conduct this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhou, J. \u003cem\u003eet al.\u003c/em\u003e The Complexity of Standing Postural Control in Older Adults: A Modified Detrended Fluctuation Analysis Based upon the Empirical Mode Decomposition Algorithm. \u003cem\u003ePLoS ONE\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, e62585 (2013).\u003c/li\u003e\n\u003cli\u003eGiovannini, S. \u003cem\u003eet al.\u003c/em\u003e Falls among Older Adults: Screening, Identification, Rehabilitation, and Management. \u003cem\u003eApplied Sciences\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 7934 (2022).\u003c/li\u003e\n\u003cli\u003eVaishya, R. \u0026amp; Vaish, A. 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(Self, 2018).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"exercise, sensorimotor, aging, diabetes, flexibility, strength","lastPublishedDoi":"10.21203/rs.3.rs-7121619/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7121619/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAging and diabetes mellitus (DM) are associated with declines in physical fitness, including reduced muscle strength, balance, and flexibility, which increase the risk of falls and functional limitations. This pilot study aims to evaluate the effects of a 6-month sensorimotor training (SMT) program on physical fitness in older women with type 2 diabetes. Ten elderly women (aged 65 and above) were divided into an intervention group (IG, n=5) and a control group (CG, n=5). The IG participated in a twice-weekly SMT program, while the CG maintained their usual daily activities. Physical fitness assessments, including agility (Timed Up and Go test), strength (sit-to-stand and forearm flexion tests), and flexibility (sit-and-reach and be-hind-the-back reach tests), were conducted at baseline and after 24 weeks. The IG demonstrated significant improvements in agility (p=0.020) and flexibility (p=0.049 for lower limbs; p=0.023 for upper limbs) compared to the CG. Both groups showed improvements in lower limb strength, though upper limb strength did not significantly change. The findings suggest that SMT enhances neuromuscular control, proprioception, and flexibility, which are critical for reducing fall risk and improving functional independence in older women with diabetes. This study demonstrates that SMT significantly improves agility, flexibility, and neuromuscular control in older women with type 2 diabetes, directly addressing key factors that contribute to fall risk and functional decline. These improvements are particularly beneficial for individuals with diabetes, as enhanced proprioception and balance can mitigate diabetes-related complications such as peripheral neuropathy and mobility impairments. By improving physical fitness and reducing fall risk, SMT offers a promising intervention to support better glycemic control, enhance independence, and improve the overall quality of life in older adults with diabetes. Further research with larger samples is needed to confirm these findings and refine SMT protocols for optimal diabetes management.\u003c/p\u003e\n\u003cp\u003eClinical trial registry: 01/09/2021\u003c/p\u003e\n\u003cp\u003eClinical trial number: NCT05398354\u003c/p\u003e\n\u003cp\u003eTrial Name: Active Retirement: Effects of the Application of a Training Program\u003c/p\u003e","manuscriptTitle":"The Impact of Sensorimotor Training on Physical Fitness in Older Women with Diabetes: A Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-18 14:52:58","doi":"10.21203/rs.3.rs-7121619/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-26T06:53:19+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"324690102485843621667483789089754980105","date":"2025-08-13T19:28:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-12T00:34:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58377629926235527146720441851759698935","date":"2025-08-12T00:25:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118667013187262168062589552033682742647","date":"2025-08-11T23:09:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-11T09:37:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281230011563516032470532577332435595080","date":"2025-08-11T09:23:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-11T08:24:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-05T08:10:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-05T08:09:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-07-14T13:12:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cada464b-2143-44dc-a4ca-914cc427e26b","owner":[],"postedDate":"August 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:07:15+00:00","versionOfRecord":{"articleIdentity":"rs-7121619","link":"https://doi.org/10.1186/s12877-025-06591-4","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-11-24 15:58:18","publishedOnDateReadable":"November 24th, 2025"},"versionCreatedAt":"2025-08-18 14:52:58","video":"","vorDoi":"10.1186/s12877-025-06591-4","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06591-4","workflowStages":[]},"version":"v1","identity":"rs-7121619","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7121619","identity":"rs-7121619","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}