Effects of Sensory Integration Versus Traditional Resistance Training on Knee Strength and Proprioception in Older Adults

Effects of Sensory Integration Versus Traditional Resistance Training on Knee Strength and Proprioception in Older Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Effects of Sensory Integration Versus Traditional Resistance Training on Knee Strength and Proprioception in Older Adults Haixia Li, Ruiyun Zhang, Feng Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5198973/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Resistance training (RT) is a well-established exercise intervention, but the benefits of RT with sensory integration (RT-SI) in older adults remain underexplored. In this study, we compared the effects of traditional RT and RT-SI on knee muscle strength and proprioception in older adults. We randomly assigned 52 older adults to one of four groups: control (C), medium-intensity RT (MIRT), low-intensity RT-SI (LIRT-SI), and medium-intensity RT-SI (MIRT-SI). Knee strength improved significantly in all intervention groups at 8 and 16 weeks of the 16-week intervention period compared with the C group (P < 0.005), with the MIRT (extension peak torque [PT-E]: 88.1%; flexion peak torque [PT-F]: 103.4%) and MIRT-SI (PT-E: 88.2%; PT-F: 103.6%) groups demonstrating significantly greater improvements compared with the LIRT-SI group (PT-E: 50.8%; PT-F: 78.5%) (P < 0.05). The LIRT-SI (10.22%) and MIRT-SI (11.53%) groups showed significantly greater improvements in proprioceptive function compared with the MIRT group (7.45%) (P < 0.05). Therefore, while RT alone is sufficient to build muscle strength, RT-SI appears to provide additional benefits for proprioception. These findings highlight the potential of RT-SI to improve both muscle strength and proprioception in older adults, making it a promising strategy for fall prevention and functional independence. Health sciences/Health care/Geriatrics Health sciences/Health care/Public health aged knee joint muscle strength proprioception resistance training Figures Figure 1 Introduction Aging can be accompanied by declined knee joint muscle strength and proprioceptive function, which affect activities of daily living and potentially increase the risk of chronic diseases 1 . Resistance training (RT) is a widely used exercise intervention that can improve muscle strength in older adults. Studies have also shown that sensory integration (SI) training combining visual, auditory, and motor stimuli can enhance receptor activation, increase neural impulses, promote brain cell activation, and improve brain function, thereby aiding rehabilitation for cognitive decline and balance maintenance in older adults 2 . Despite evidence supporting the use of both RT and SI individually, their combined effects on muscle strength and proprioception in older adults remain largely unexplored. SI theory, which emphasises the central role of sensory input in neural development and daily functioning, has led to the development of resistance training with sensory integration (RT-SI). This innovative approach combines sensory stimuli with RT to simultaneously enhance sensory processing and muscle strength. We hypothesised that, compared with medium-intensity RT (MIRT), both medium-intensity RT-SI (MIRT-SI) and low-intensity RT-SI (LIRT-SI) would demonstrate superior benefits for knee joint muscle strength and proprioceptive function, with all intervention groups outperforming the control group. This study aimed to evaluate the efficacy of such an integrated intervention and provide a novel approach to fall prevention and quality of life improvement in older adults. Results This study enrolled a total of 52 participants (n = 13 per group). After the 16-week intervention, all participants in every group successfully completed the full intervention protocol and all assessments, with no adverse events reported. Effects of Different Intervention Methods on Knee Joint Muscle Strength in Older Adults Peak Torque of Knee Extensors Table 1 and Supplementary Material 1 presents the changes in knee extension peak torque (PT) in each group before and after the intervention. The Shapiro–Wilk test confirmed that the PT data for the knee joint followed a normal distribution (P > 0.05). After Greenhouse–Geisser correction, we verified homogeneity of variance (P > 0.05). Baseline PT data showed no significant differences between the groups (P > 0.05). Two-way repeated measures analysis of variance (ANOVA) revealed significant interaction effects for both extension and flexion PT after 16 weeks of intervention (F [2.064, 24.770] = 68.312, P < 0.05; F [3.083, 36.994] = 35.188, P < 0.05). After 8 weeks of intervention (T2), we found significant differences in knee extension PT among the groups (F [3, 36] = 44.416, P < 0.05). The control (C) group showed significant differences compared with the other three groups (P < 0.05). We also found significant differences between the LIRT-SI and MIRT groups (difference = -11.56 Nm, 95% confidence interval [CI]: -17.818 to -5.298, P < 0.05) and between the LIRT-SI and MIRT-SI groups (difference = -10.93 Nm, 95% CI: -18.279 to -3.574, P < 0.05). However, we found no significant differences between the MIRT and MIRT-SI groups. At 16 weeks (T3), we found significant differences in PT among the groups (F [3, 36] = 89.148, P < 0.05). The C group showed significant differences compared with the other three groups (P < 0.05). We also found significant differences between the LIRT-SI and MIRT groups (difference = -19.72 Nm, 95% CI: -27.40 to -12.03, P < 0.05) and between the LIRT-SI and MIRT-SI groups (difference = -19.39 Nm, 95% CI: -28.34 to -10.44, P < 0.05). The results revealed no significant differences between the MIRT and MIRT-SI groups. These results indicate significant improvements in knee extension PT in all intervention groups, with MIRT and MIRT-SI producing the largest strength gains. Table 1 Changes in Peak Torque of Knee Extensors Across Groups Before and After Intervention Indicators Group T1 T2 T3 Extensor Peak Torque(Nm) C(N = 13) 47.05 ± 7.55 46.69 ± 7.97 46.74 ± 7.88 LIRT-SI(N = 13) 46.18 ± 4.11 63.14 ± 4.70 * 69.64 ± 5.36 * MIRT(N = 13) 47.28 ± 8.83 74.70 ± 8.40 *# 89.35 ± 8.56 *# MIRT-SI(N = 13) 47.81 ± 10.28 74.07 ± 6.94 *# 89.03 ± 9.31 *# F 0.094 44.616 89.148 P 0.450 < 0.001 < 0.001 *P < 0.05 compared to Group C; #P < 0.05 compared to Group LIRT-SI. T1, 1 week before the intervention; T2, week 8 of the intervention; T3, week 16 of the intervention. C, control; LIRT-SI, low-intensity resistance training with sensory integration; MIRT, medium-intensity resistance training; MIRT-SI, medium-intensity resistance training with sensory integration. PT of Knee Flexors Table 2 and Supplementary Material 2 presents the changes in knee flexion PT in each group before and after the intervention. At T2, although the dependent variable did not meet the sphericity assumption, we confirmed homogeneity of variance after correction (P = 0.501 > 0.05). We found significant differences among the groups (F [1.054, 18.046] = 36.088, P < 0.05). Specifically, C group showed significant differences compared with the other groups (P < 0.05). We also found significant differences between the LIRT-SI and MIRT groups (difference = -6.185 Nm, 95% CI: -11.588 to -0.781, P < 0.05) and between the LIRT-SI and MIRT-SI groups (difference = -6.008 Nm, 95% CI: -12.641 to 0.625, P < 0.05). We found no significant differences between the MIRT and MIRT-SI groups. At T3, we found significant differences in knee flexion PT among the groups (F [3, 36] = 71.436, P < 0.05). Participants in the intervention groups exhibited significantly greater improvements in knee strength compared to controls (P < 0.05), suggesting that both RT and RT-SI effectively counteract age-related muscle decline. We also found significant differences between the LIRT-SI and MIRT groups (difference = -9.995 Nm, 95% CI: -15.948 to -4.042, P < 0.05) and between the LIRT-SI and MIRT-SI groups (Difference = -12.26 Nm, 95% CI: -22.057 to -2.466, P < 0.05). We found no significant differences between the MIRT and MIRT-SI groups. The results indicate significant improvements in knee flexion PT in all intervention groups, with MIRT and MIRT-SI producing the largest strength gains. Table 2 Changes in Peak Torque of Knee Flexors Across Groups Before and After Intervention Indicators Group T1 T2 T3 Flexor Peak Torque(Nm) C(N = 13) 27.75 ± 4.41 27.67 ± 4.56 27.68 ± 4.58 LIRT-SI(N = 13) 27.97 ± 5.06 42.03 ± 4.48 * 49.32 ± 6.36 * MIRT(N = 13) 29.16 ± 5.95 48.22 ± 7.81 *# 59.32 ± 5.37 *# MIRT-SI(N = 13) 30.25 ± 4.91 48.04 ± 8.94 *# 61.58 ± 10.96 *# F 0.839 36.088 71.436 P 0.450 < 0.001 < 0.001 *P < 0.05 compared to Group C; #P < 0.05 compared to Group LIRT-SI. T1, 1 week before the intervention; T2, week 8 of the intervention; T3, week 16 of the intervention. C, control; LIRT-SI, low-intensity resistance training with sensory integration; MIRT, medium-intensity resistance training; MIRT-SI, medium-intensity resistance training with sensory integration. knee joint proprioception The Shapiro–Wilk test confirmed that knee joint proprioception data followed a normal distribution (P > 0.05), without detecting outliers. Mauchly's test of sphericity indicated that the interaction between intervention methods and time had a homogeneous variance–covariance matrix after Greenhouse–Geisser correction (P > 0.05). Baseline knee joint proprioception data showed no significant differences between the groups (P > 0.05). Repeated measures ANOVA revealed that at T2, the dependent variable did not meet the sphericity assumption. However, we confirmed homogeneity of variance after correction (P > 0.05). We found no significant differences in knee joint proprioception among the groups at this time point (P = 0.43). After 16 weeks of intervention, a significant interaction effect was observed among the groups for knee joint proprioception function (F [2.671, 32.056] = 5.668, P = 0.004). At T3, we found significant differences in proprioception among the groups (P < 0.05). The C group showed significant differences compared with the MIRT, LIRT-SI, and MIRT-SI groups (P 0.05). However, both the LIRT-SI and MIRT-SI groups showed significant differences compared with the MIRT group (P < 0.05) (Fig. 1 ). Discussion Recent studies 3 have confirmed that RT of varying intensities can improve muscle strength, with a trend towards greater improvements with higher-intensity training; however, the differences did not reach statistical significance. This outcome may stem from differences in the populations studied, body parts exercised, and forms, speed, and angles of exercises, making quantitative comparisons of the effects of different intervention schemes on the same muscle or muscle groups in older adults challenging. The results of the present study showed that the C group exhibited no significant changes in knee flexion and extension muscle strength over the 16-week study period, indicating that knee muscle strength remained stable without intervention. Although previous studies have demonstrated an annual decline in muscle strength of approximately 6% in older adults, the current findings suggest that knee muscle strength does not significantly decrease over a short period (16 weeks in this study) and remains relatively stable. In contrast, the LIRT-SI group showed a significant improvement in knee flexion and extension strength, with a rapid increase during the T1 to T2 phase and a more gradual improvement during the T2 to T3 phase. Both the MIRT and MIRT-SI groups demonstrated superior intervention effects compared with the LIRT-SI group, with significant strength gains at both T2 and T3. This indicates that medium-intensity is more effective than low-intensity RT in enhancing knee joint muscle strength. Indeed, systematic reviews and meta-analyses have confirmed the superiority of high-intensity (75–80% one-repetition maximum [1RM]) over low-intensity (40–60% 1RM) RT 3 . However, we found no statistically significant differences between the MIRT and MIRT-SI groups; their PT curves for knee extension were nearly identical. This suggests that improvements in muscle strength are primarily influenced by RT intensity, with minimal contribution from cognitive resource allocation. Therefore, to achieve greater improvements in knee muscle strength, moderate- or high-intensity RT is recommended. Our findings align with previous research indicating that RT enhances muscle strength in older adults 4 . However, unlike traditional RT alone, RT-SI appears to provide additional benefits for proprioception, as suggested by Karaca et al. (2024) 5 . Both LIRT-SI and MIRT-SI significantly improved knee proprioception, outperforming MIRT. The mechanisms by which the central and peripheral nervous systems control proprioceptive function are not fully understood 6 . Age-related neurological changes are likely a primary cause of proprioceptive decline in older adults 7 . Studies on the central nervous system have shown that the ability to integrate sensory information decreases significantly with age, possibly due to reduced neuronal plasticity in the cerebral cortex and spinal cord 6 . In the peripheral nervous system, age-related degenerative changes include a reduction in intrafusal muscle fibres, axonal abnormalities, decreased density of cutaneous mechanoreceptors, and reduced sensitivity, all of which contribute to impaired transmission of peripheral sensory signals and diminished proprioceptive function 6 , 8 . Although participants in the MIRT group underwent only moderate-intensity RT, they still showed a significant improvement in knee proprioception. This may be attributed to the ability of RT to enhance peripheral nervous system function, thereby improving proprioception. Studies have shown that RT increases muscle spindle sensitivity 9 and enhances the signal transduction efficiency of cutaneous mechanoreceptors 6 , optimising neuromuscular control and significantly improving proprioceptive function.SI enhances proprioceptive function by stimulating multiple sensory systems, including visual, vestibular, and proprioceptive systems, thereby improving the ability of the central nervous system to process sensory information. Research indicates that this training promotes the integration of sensory information in the central nervous system 10 and enhances the coordination of sensorimotor pathways through increased neural plasticity 11 . Additionally, SI improves the sensitivity of muscle spindles and cutaneous mechanoreceptors, further enhancing joint position sense and motor control 12 . In this study, the significant improvements in proprioceptive function observed in the MIRT-SI and LIRT-SI groups further validate these mechanisms. Although the LIRT-SI group underwent low-intensity RT, its improvement in knee proprioception surpassed that of the MIRT group. This result may be attributed to the direct stimulation of cognitive and sensory systems by SI, which enhances the efficiency of the central nervous system in processing sensory information and compensates for the limited muscle strength gains associated with low-intensity RT 7 , 8 . Due to methodological limitations, such as the absence of a low-intensity RT group and long-term follow-up, future research is required to investigate the long-term effects of SI on fall prevention and functional mobility in diverse older adult populations, incorporating neuroimaging techniques to better understand underlying neural adaptations Conclusion This randomized controlled trial provides compelling evidence that RT-SI confers dual benefits for older adults by simultaneously enhancing knee muscle strength and proprioceptive function. Clinicians should prioritize RT-SI for older adults at high fall risk and tailor task difficulty based on individual functional capacity Methods Participants Sample Size Estimation The sample size was estimated using G*Power software (version 3.1.9.2; Universität Kiel, Germany), with a minimum of 12 participants required per group. This study included 52 older adults recruited from the Zhongyuan, Jialong, and Daning neighbourhoods of Yangpu District, Shanghai, of which 28 and 24 were male and female, respectively. Participants met the following criteria: mini mental state examination score ≥ 27, absence of severe cardiovascular or cerebrovascular diseases, no musculoskeletal impairments affecting movement, and ability to perform RT exercises safely. All eligible volunteers underwent physical examination and provided written informed consent after discussions with their family members. The daily habits and activity levels of the participants remained largely unchanged during the experiment, with no new physical exercises introduced with the exception of the planned interventions. The Shandong Sports University Ethics Committee approved the study (2023030), which was conducted in accordance with their guidelines and regulations and the principles outlined in the Declaration of Helsinki. All participants provided informed consent. We randomly allocated the participants to one of four groups: C, MIRT, LIRT-SI, and MIRT-SI, with 13 individuals in each group. Table 3 summarises the baseline demographic characteristics of the study participants. Table 3 Baseline Participant Characteristics Characteristic Control (n = 13) MIRT (n = 13) LIRT-SI (n = 13) MIRT-SI (n = 13) Sex (male: female) 7:6 7:6 7:6 7:6 Age (years) 67.69 ± 3.32 67.91 ± 3.39 67.85 ± 2.84 67.69 ± 2.28 Height (cm) 165.23 ± 8.25 165.16 ± 8.62 165.68 ± 8.16 165.74 ± 7.39 Weight (kg) 62.34 ± 7.51 65.06 ± 6.93 64.35 ± 2.43 63.20 ± 7.99 MMSE score 27.61 ± 0.76 27.50 ± 0.67 27.450 ± 0.76 27.30 ± 1.25 Data are expressed as mean ± standard deviation. LIRT-SI, low-intensity resistance training with sensory integration; MIRT, medium-intensity resistance training; MIRT-SI, medium-intensity resistance training with sensory integration; MMSE, mini mental state examination. Interventions and Data Collection SI fundamentally involves the collection of visual information, its transmission to the brain for processing, and subsequent motor execution via effectors 13 , which emphasises the integration of visual–motor coordination. Such coordination adheres to the structural framework of postural control theory, wherein the motor system (hands), sensory system (eyes), and cognitive system (brain) collaboratively regulate movement. With advancements in technology, human-machine interactive training methods, a multidisciplinary intervention integrating ergonomics and kinesiology, have emerged. These protocols, akin to computer-game paradigms, involve machine-generated signal prompts that guide participants to perform specific actions. In this study, we implemented a human-machine interactive “visual–motor coordination” protocol. The SMART series RT-SI equipment system (model SC105; Shangti Sports Development Co., Ltd., Taiwan, China) delivers visual guidance signals, which undergo central processing (brain) before triggering motor execution (limb movement). Our intervention integrates RT and SI tasks through this interactive device, enabling dual modulation of neuromuscular and cognitive pathways. The SMART series RT-SI equipment quantifies task performance via real-time kinematic feedback (e.g., angular velocity accuracy), ensuring precise control over training intensity and sensory load. RT Tasks Participants performed unilateral lower limb extension–flexion cycles with the knee joint as the pivot. During each movement cycle, one limb executed a controlled extension while the contralateral limb simultaneously flexed. Upon reaching the critical joint angle (predefined based on anatomical limits), the motion direction was reversed, completing one repetition. SI Tasks During SI, participants manipulated a mechanical lever to align a real-time blue cursor (generated by velocity sensors tracking limb motion) with a preset green cursor moving at a target angular velocity (range: 0–180°/s). The task performance was quantified as the percentage overlap between the two cursors. Difficulty was modulated by incrementally increasing angular velocity (5°/s per stage). Throughout training, one or two instructors provided verbal cues to ensure protocol adherence. RT Intensity Quantification RT intensity was quantified by identifying the 1RM resistance levels of participants using the incremental loading protocol of the equipment, with moderate intensity defined as 60–75% 1RM and low intensity as < 60% 1RM; continuous heart rate monitoring was ensured via POLAR chest straps. SI Intensity Quantification For SI load calibration, both MIRT-SI and LIRT-SI groups performed cursor-matching tasks starting at 10°/s angular velocity, requiring alignment of a participant-controlled blue cursor with a target green cursor. Performance metrics (cursor overlap percentage), real-time heart rate, and perceived task difficulty (NASA Task Load Index scale) were recorded, with angular velocity progressively increased by 5°/s until task failure (< 80% overlap for three consecutive attempts). Final SI loads were individualised based on moderate difficulty thresholds (median performance curves), ensuring standardised progression across groups, as detailed in Table 4 . Table 4 Specific Intervention Protocols for Each Group Training Type Resistance Training Intensity Angular Velocity C Educational lectures only None None MIRT Resistance training 60–75% of 1RM None LIRT-SI Resistance training with sensory integration < 60% of 1RM 25–40°/s MIRT-SI Resistance training with sensory integration 60–75% of 1RM 20 ~ 30°/s 1RM represents the load corresponding to a single successful repetition, internationally standardised in kilograms (kg). C, control; LIRT-SI, low-intensity resistance training with sensory integration; MIRT, medium-intensity resistance training; MIRT-SI, medium-intensity resistance training with sensory integration; 1RM, one-repetition maximum. We conducted this study at a community fitness centre for older adults in Shanghai. Over the 16-week intervention period, participants in the LIRT-SI, MIRT, and MIRT-SI groups engaged in three training sessions per week, each consisting of 4–6 sets with 8–12 repetitions per set. The participants rested for 2 min between sets and 5 min between larger sets. Training loads were incrementally adjusted every 4 weeks following the principle of progressive overload, with resistance increments capped at5–10% of 1RM to ensure physiological adaptation. For SI tasks, angular velocity progression was dynamically adjusted based on the prior-phase performance metrics of the participants (cursor overlap ≥ 80%). Participants failing to meet this threshold for two consecutive weeks were maintained at the current angular velocity until proficiency was re-established. We adjusted training intensity in real-time using a Polar heart rate monitor (Polar Electro, Kempele, Finland), performance metrics (cursor alignment accuracy), and subjective task difficulty (NASA Task Load Index scale) to ensure consistent and appropriate training loads in all participants. Before each session, a specialised exercise instructor measured blood pressure and assessed the physical and mental conditions of the participants. In addition, one or two coaches supervised the training process to ensure accurate task completion. Additionally, professional coaches conducted health assessments, warm-up activities, and cool-down exercises before and after each training session. We collected data one week before the start of the experiment (T1), and at the 8th (T2) and 16th week (T3) of the intervention period, with all data collected by the same team using the same equipment and methods at the same location. Study Variables Knee Joint Muscle Strength Indicator: Isokinetic Muscle Strength Measurement Isokinetic muscle strength testing is widely recognised as the gold standard for assessing muscle strength due to its scientific rigor, precision, clinical applicability, and standardised protocols 14 – 16 . We measured isokinetic muscle strength using the PHYSIOMED CON-TREX system (model TP-MJ; CMV AG, Zurich, Switzerland), which determines PT at 60°/s. The participants performed two practice attempts following a warm-up, with each test consisting of five full-effort flexion extensions 5 min apart 17 . Sensory System Indicator: Knee Joint Proprioception Proprioceptive function plays a critical role in maintaining postural stability in older adults; it tends to decline with age 7 . The passive–active joint position sense test, a widely used method for assessing joint position sense 18 , combines passive limb positioning with active angle reproduction (participant-triggered termination) to quantify proprioceptive function through angular error measurements. Smaller angular errors indicated better proprioceptive function We used the PHYSIOMED CON-TREX system (model TP-MJ; CMV AG) to measure knee joint position sense and assess proprioceptive function. The participants sat on the device with the thigh of their dominant leg securely fixed. We instructed them to close their eyes or wear an eye mask while maintaining a knee flexion angle of 90°. We then adjusted the device to passively move the lower leg of the participant at an angular velocity of 4°/s until the knee reached a flexion angle of 45°, holding it for 3 s. We asked the participants to focus on sensing and memorising this position. The lower leg was then returned to the initial position. The participants repeated this process twice. After a 5-s rest, we reconfigured the device and instructed the participants to actively extend their lower leg at an angular velocity of 2°/s. We told them to press the stop button when they perceived that their knee had reached the previously memorised 45° angle. We recorded the difference (in degrees) between the actual angle achieved and the target angle of 45° as the knee joint proprioception index. Data management and analysis We present measured indicators as means and standard deviations. We performed statistical analyses using SPSS software version 20.0 (IBM Corporation, Armonk, NY, USA). A two-way repeated-measures ANOVA was selected to analyse the interaction effects between intervention type and time, ensuring appropriate control for within-subject variability. If an interaction existed, we analysed the individual effects of the intervention method and timing on the dependent variable. If no interaction existed, we analysed the main effects of each independently. We set statistical significance to P < 0.05. Abbreviations ANOVA, analysis of variance C, control CI, confidence interval LIRT-SI, low-intensity resistance training with sensory integration MIRT, medium-intensity resistance training MIRT-SI, medium-intensity resistance training with sensory integration 1RM, one-repetition maximum PT, peak torque RT, resistance training RT-SI, resistance training with sensory integration SI, sensory integration Declarations Author contributions statement RYZ conceived the experiments, all authors conducted the experiments, HXL and FW analysed the results. HXL prepared the manuscript. All authors reviewed the manuscript. Data availability The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. References Liu, C. & Shen, Z. The epidemiological characteristics and risk factors of falls. Chin. J. Gerontol 32 , 3837-3839 (2012). Gregg, E.W., Pereira, M.A. & Caspersen, C.J. Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J. Am. Geriatr. Soc 48 , 883-893 (2015). Fielding, R.A. et al. High‐velocity resistance training increases skeletal muscle peak power in older women. J. Am. Geriatr. Soc 50 , 655-662 (2002). Fragala, M.S. et al. Resistance training for older adults: position statement from the national strength and conditioning association. J. Strength Cond Res 33 , 2019-2052 (2019). Karaca, O. & Kılınç, M. Sensory training combined with motor training improves trunk proprioception in stroke patients: a single-blinded randomized controlled trial. Neurol Res 46 , 553-560 (2024). Proske, U. & Gandevia, S.C. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. Physiol. Rev 92 , 1651-1697 (2012). Palmer, J.A., Hazen, E.M. & Billinger, S.A. Dual‐task balance control reveals cerebrovascular–behavioral relationships in older adults resistant to cognitive decline. J. Am. Geriatr. Soc 72 , 3257-3260 (2024). Shaffer, S.W. & Harrison, A.L. Aging of the somato sensory system: a translational perspective. Phys. Ther 87 , 193-207 (2007). Aagaard, P., Simonsen, E.B., Andersen, J.L., Magnusson, P. & Dyhre-Poulsen, P. Neural adaptation to resistance training: changes in evoked V-wave and H-reflex responses. J. Appl. Physiol 92 , 2309-2318 (2002). Bundy, A.C., Lane, S. J., & Murray, E. A. Sensory integration: theory and practice (4th edn.）. (F.A. Davis, Philadelphia, PA; 2021). Schaaf, R.C. & Miller, L.J. Occupational therapy using a sensory integrative approach for children with developmental disabilities. Ment. Retard. Dev. Disabil. Res. Rev 11 , 143-148 (2005). Schaaf, R.C. et al. An intervention for sensory difficulties in children with autism: a randomized trial. J. Autism Dev. Disord (2013). Schaaf, R.C. et al. State of the science: a roadmap for research in sensory integration. Am. J. Occup. Ther 69 , 1-8 (2015). Huang , T., Shen, Z., Fan, L. & Gao, D. Progress in stockinet technology in testing and training for assessment of muscle function. J. Forensic Med 29 , 49-52 (2013). Jin , Z., Li , Z. & Guo, J. Effects of isokinetic measuring system on knee joint muscles. J. Tianjin Inst. Phys. Educ 16 , 47-50 (2001). Paul, D.J. & Nassis, G.P. Testing strength and power in soccer players. J. Strength Cond. Res 29 , 1748-1758 (2015). Xiao, Z. A study on instruction of health and fitness exercises of elderly. Chin. Nurs. Res 23 , 3204-3206 (2009). Han, J., Waddington, G., Adams, R., Anson, J. & Liu, Y. Assessing proprioception: a critical review of methods. J. Sport Health Sci 5 , 80-90 (2016). Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial1.docx SupplementaryMaterial2.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 22 Apr, 2025 Reviews received at journal 20 Apr, 2025 Reviews received at journal 18 Apr, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviewers agreed at journal 13 Apr, 2025 Reviewers agreed at journal 13 Apr, 2025 Reviews received at journal 12 Apr, 2025 Reviewers agreed at journal 12 Apr, 2025 Reviewers invited by journal 12 Apr, 2025 Submission checks completed at journal 04 Apr, 2025 First submitted to journal 30 Mar, 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5198973","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":442793899,"identity":"591a86c1-c4ef-49ce-8f41-1a3151c47ee8","order_by":0,"name":"Haixia Li","email":"","orcid":"","institution":"School of Sport Management, Shandong Sport University","correspondingAuthor":false,"prefix":"","firstName":"Haixia","middleName":"","lastName":"Li","suffix":""},{"id":442793900,"identity":"1bcdeaa6-f17f-47c4-a32c-ff03d8e54bf1","order_by":1,"name":"Ruiyun Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYDACCQjFA8SMDz5U2MixsbcfIFoLs+GMM2nGfDxnEojSAgJswpxthxPnSTgY4NUhP7v52cOvew7LGNzIPcbMcCYtvU2CIYHhR8U2nFoY5xwzN5Z5dpjH4EZe2uOCCpvcNunGA4w9Z27j1MIskWAmLXEApCXH3Bjol9w2mQMJzIxtuLWwSaR/g2kxk+ZtO5zOJpFggFcLj0SOmeQHJC0JBLVISOSUSTMcSOeRPPPGGBTIhm3AQD6Izy/yM9K3Sf44YG3PdzzHEBSV8vLt7Qcf/KjArQUcBKB4VDiAJHIAu0IEYPwBsq6BkLJRMApGwSgYsQAAI0Jal3c4LAQAAAAASUVORK5CYII=","orcid":"","institution":"School of Sport Art, Shandong Sport University","correspondingAuthor":true,"prefix":"","firstName":"Ruiyun","middleName":"","lastName":"Zhang","suffix":""},{"id":442793902,"identity":"cb9508de-58f8-4d27-87fe-3894a6c2712d","order_by":2,"name":"Feng Wang","email":"","orcid":"","institution":"Department of Physical Education, Shanghai Ocean University","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-10-03 14:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5198973/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5198973/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80624696,"identity":"51ddb6a1-0232-4084-8c9b-085bde766f86","added_by":"auto","created_at":"2025-04-15 10:31:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84817,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in proprioceptive function across groups before and after the intervention.\u003c/p\u003e\n\u003cp\u003e*P \u0026lt; 0.05 compared to Group C; #P \u0026lt; 0.05 compared to Group LIRT-SI. T1, 1 week before the intervention; T2, week 8 of the intervention; T3, week 16 of the intervention.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5198973/v1/23720675912934fc25033899.png"},{"id":80626079,"identity":"0d001b15-cbc2-4a91-bca6-b594715ef654","added_by":"auto","created_at":"2025-04-15 10:47:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":806279,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5198973/v1/9d73f228-8f87-460f-ba62-2f43dbc1c8e2.pdf"},{"id":80624701,"identity":"f755c6dc-d267-4988-a785-687f92276e06","added_by":"auto","created_at":"2025-04-15 10:31:04","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":80707,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5198973/v1/c6d706fac650e4d0ae652277.docx"},{"id":80624698,"identity":"7071dade-b1c6-4d41-a654-1785ded0e420","added_by":"auto","created_at":"2025-04-15 10:31:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":82955,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5198973/v1/0779baf9fe6305fa7e262c0f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Sensory Integration Versus Traditional Resistance Training on Knee Strength and Proprioception in Older Adults","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAging can be accompanied by declined knee joint muscle strength and proprioceptive function, which affect activities of daily living and potentially increase the risk of chronic diseases\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Resistance training (RT) is a widely used exercise intervention that can improve muscle strength in older adults. Studies have also shown that sensory integration (SI) training combining visual, auditory, and motor stimuli can enhance receptor activation, increase neural impulses, promote brain cell activation, and improve brain function, thereby aiding rehabilitation for cognitive decline and balance maintenance in older adults\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Despite evidence supporting the use of both RT and SI individually, their combined effects on muscle strength and proprioception in older adults remain largely unexplored. SI theory, which emphasises the central role of sensory input in neural development and daily functioning, has led to the development of resistance training with sensory integration (RT-SI). This innovative approach combines sensory stimuli with RT to simultaneously enhance sensory processing and muscle strength. We hypothesised that, compared with medium-intensity RT (MIRT), both medium-intensity RT-SI (MIRT-SI) and low-intensity RT-SI (LIRT-SI) would demonstrate superior benefits for knee joint muscle strength and proprioceptive function, with all intervention groups outperforming the control group.\u003c/p\u003e \u003cp\u003eThis study aimed to evaluate the efficacy of such an integrated intervention and provide a novel approach to fall prevention and quality of life improvement in older adults.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study enrolled a total of 52 participants (n\u0026thinsp;=\u0026thinsp;13 per group). After the 16-week intervention, all participants in every group successfully completed the full intervention protocol and all assessments, with no adverse events reported.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEffects of Different Intervention Methods on Knee Joint Muscle Strength in Older Adults\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003ePeak Torque of Knee Extensors\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Supplementary Material 1 presents the changes in knee extension peak torque (PT) in each group before and after the intervention. The Shapiro\u0026ndash;Wilk test confirmed that the PT data for the knee joint followed a normal distribution (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After Greenhouse\u0026ndash;Geisser correction, we verified homogeneity of variance (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Baseline PT data showed no significant differences between the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Two-way repeated measures analysis of variance (ANOVA) revealed significant interaction effects for both extension and flexion PT after 16 weeks of intervention (F [2.064, 24.770]\u0026thinsp;=\u0026thinsp;68.312, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; F [3.083, 36.994]\u0026thinsp;=\u0026thinsp;35.188, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After 8 weeks of intervention (T2), we found significant differences in knee extension PT among the groups (F [3, 36]\u0026thinsp;=\u0026thinsp;44.416, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The control (C) group showed significant differences compared with the other three groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). We also found significant differences between the LIRT-SI and MIRT groups (difference = -11.56 Nm, 95% confidence interval [CI]: -17.818 to -5.298, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and between the LIRT-SI and MIRT-SI groups (difference = -10.93 Nm, 95% CI: -18.279 to -3.574, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, we found no significant differences between the MIRT and MIRT-SI groups. At 16 weeks (T3), we found significant differences in PT among the groups (F [3, 36]\u0026thinsp;=\u0026thinsp;89.148, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The C group showed significant differences compared with the other three groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). We also found significant differences between the LIRT-SI and MIRT groups (difference = -19.72 Nm, 95% CI: -27.40 to -12.03, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and between the LIRT-SI and MIRT-SI groups (difference = -19.39 Nm, 95% CI: -28.34 to -10.44, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The results revealed no significant differences between the MIRT and MIRT-SI groups. These results indicate significant improvements in knee extension PT in all intervention groups, with MIRT and MIRT-SI producing the largest strength gains.\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\u003eChanges in Peak Torque of Knee Extensors Across Groups Before and After Intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eExtensor Peak Torque(Nm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLIRT-SI(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.18\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.70\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.36\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIRT(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.28\u0026thinsp;\u0026plusmn;\u0026thinsp;8.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.70\u0026thinsp;\u0026plusmn;\u0026thinsp;8.40\u003csup\u003e\u003cb\u003e*#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.35\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56\u003csup\u003e\u003cb\u003e*#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIRT-SI(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.81\u0026thinsp;\u0026plusmn;\u0026thinsp;10.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.94\u003csup\u003e\u003cb\u003e*#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.03\u0026thinsp;\u0026plusmn;\u0026thinsp;9.31\u003csup\u003e\u003cb\u003e*#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to Group C; #P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to Group LIRT-SI. T1, 1 week before the intervention; T2, week 8 of the intervention; T3, week 16 of the intervention. C, control; LIRT-SI, low-intensity resistance training with sensory integration; MIRT, medium-intensity resistance training; MIRT-SI, medium-intensity resistance training with sensory integration.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003ePT of Knee Flexors\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Supplementary Material 2 presents the changes in knee flexion PT in each group before and after the intervention. At T2, although the dependent variable did not meet the sphericity assumption, we confirmed homogeneity of variance after correction (P\u0026thinsp;=\u0026thinsp;0.501\u0026thinsp;\u0026gt;\u0026thinsp;0.05). We found significant differences among the groups (F [1.054, 18.046]\u0026thinsp;=\u0026thinsp;36.088, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Specifically, C group showed significant differences compared with the other groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). We also found significant differences between the LIRT-SI and MIRT groups (difference = -6.185 Nm, 95% CI: -11.588 to -0.781, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and between the LIRT-SI and MIRT-SI groups (difference = -6.008 Nm, 95% CI: -12.641 to 0.625, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). We found no significant differences between the MIRT and MIRT-SI groups. At T3, we found significant differences in knee flexion PT among the groups (F [3, 36]\u0026thinsp;=\u0026thinsp;71.436, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Participants in the intervention groups exhibited significantly greater improvements in knee strength compared to controls (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), suggesting that both RT and RT-SI effectively counteract age-related muscle decline. We also found significant differences between the LIRT-SI and MIRT groups (difference = -9.995 Nm, 95% CI: -15.948 to -4.042, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and between the LIRT-SI and MIRT-SI groups (Difference = -12.26 Nm, 95% CI: -22.057 to -2.466, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). We found no significant differences between the MIRT and MIRT-SI groups. The results indicate significant improvements in knee flexion PT in all intervention groups, with MIRT and MIRT-SI producing the largest strength gains.\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\u003eChanges in Peak Torque of Knee Flexors Across Groups Before and After Intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eFlexor Peak Torque(Nm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.75\u0026thinsp;\u0026plusmn;\u0026thinsp;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLIRT-SI(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.97\u0026thinsp;\u0026plusmn;\u0026thinsp;5.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.32\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIRT(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.16\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.22\u0026thinsp;\u0026plusmn;\u0026thinsp;7.81\u003csup\u003e\u003cb\u003e*#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.37\u003csup\u003e\u003cb\u003e*#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMIRT-SI(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.04\u0026thinsp;\u0026plusmn;\u0026thinsp;8.94\u003csup\u003e\u003cb\u003e*#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.96\u003csup\u003e\u003cb\u003e*#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to Group C; #P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared to Group LIRT-SI. T1, 1 week before the intervention; T2, week 8 of the intervention; T3, week 16 of the intervention. C, control; LIRT-SI, low-intensity resistance training with sensory integration; MIRT, medium-intensity resistance training; MIRT-SI, medium-intensity resistance training with sensory integration.\u003c/p\u003e\n\u003ch3\u003eknee joint proprioception\u003c/h3\u003e\n\u003cp\u003eThe Shapiro\u0026ndash;Wilk test confirmed that knee joint proprioception data followed a normal distribution (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), without detecting outliers. Mauchly's test of sphericity indicated that the interaction between intervention methods and time had a homogeneous variance\u0026ndash;covariance matrix after Greenhouse\u0026ndash;Geisser correction (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Baseline knee joint proprioception data showed no significant differences between the groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Repeated measures ANOVA revealed that at T2, the dependent variable did not meet the sphericity assumption. However, we confirmed homogeneity of variance after correction (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). We found no significant differences in knee joint proprioception among the groups at this time point (P\u0026thinsp;=\u0026thinsp;0.43). After 16 weeks of intervention, a significant interaction effect was observed among the groups for knee joint proprioception function (F [2.671, 32.056]\u0026thinsp;=\u0026thinsp;5.668, P\u0026thinsp;=\u0026thinsp;0.004). At T3, we found significant differences in proprioception among the groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The C group showed significant differences compared with the MIRT, LIRT-SI, and MIRT-SI groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). We found no significant differences between the LIRT-SI and MIRT-SI groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, both the LIRT-SI and MIRT-SI groups showed significant differences compared with the MIRT group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eRecent studies\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e have confirmed that RT of varying intensities can improve muscle strength, with a trend towards greater improvements with higher-intensity training; however, the differences did not reach statistical significance. This outcome may stem from differences in the populations studied, body parts exercised, and forms, speed, and angles of exercises, making quantitative comparisons of the effects of different intervention schemes on the same muscle or muscle groups in older adults challenging.\u003c/p\u003e \u003cp\u003eThe results of the present study showed that the C group exhibited no significant changes in knee flexion and extension muscle strength over the 16-week study period, indicating that knee muscle strength remained stable without intervention. Although previous studies have demonstrated an annual decline in muscle strength of approximately 6% in older adults, the current findings suggest that knee muscle strength does not significantly decrease over a short period (16 weeks in this study) and remains relatively stable. In contrast, the LIRT-SI group showed a significant improvement in knee flexion and extension strength, with a rapid increase during the T1 to T2 phase and a more gradual improvement during the T2 to T3 phase. Both the MIRT and MIRT-SI groups demonstrated superior intervention effects compared with the LIRT-SI group, with significant strength gains at both T2 and T3. This indicates that medium-intensity is more effective than low-intensity RT in enhancing knee joint muscle strength. Indeed, systematic reviews and meta-analyses have confirmed the superiority of high-intensity (75\u0026ndash;80% one-repetition maximum [1RM]) over low-intensity (40\u0026ndash;60% 1RM) RT\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. However, we found no statistically significant differences between the MIRT and MIRT-SI groups; their PT curves for knee extension were nearly identical. This suggests that improvements in muscle strength are primarily influenced by RT intensity, with minimal contribution from cognitive resource allocation. Therefore, to achieve greater improvements in knee muscle strength, moderate- or high-intensity RT is recommended. Our findings align with previous research indicating that RT enhances muscle strength in older adults\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. However, unlike traditional RT alone, RT-SI appears to provide additional benefits for proprioception, as suggested by Karaca et al. (2024)\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Both LIRT-SI and MIRT-SI significantly improved knee proprioception, outperforming MIRT. The mechanisms by which the central and peripheral nervous systems control proprioceptive function are not fully understood\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Age-related neurological changes are likely a primary cause of proprioceptive decline in older adults\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Studies on the central nervous system have shown that the ability to integrate sensory information decreases significantly with age, possibly due to reduced neuronal plasticity in the cerebral cortex and spinal cord\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In the peripheral nervous system, age-related degenerative changes include a reduction in intrafusal muscle fibres, axonal abnormalities, decreased density of cutaneous mechanoreceptors, and reduced sensitivity, all of which contribute to impaired transmission of peripheral sensory signals and diminished proprioceptive function\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Although participants in the MIRT group underwent only moderate-intensity RT, they still showed a significant improvement in knee proprioception. This may be attributed to the ability of RT to enhance peripheral nervous system function, thereby improving proprioception. Studies have shown that RT increases muscle spindle sensitivity\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and enhances the signal transduction efficiency of cutaneous mechanoreceptors\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, optimising neuromuscular control and significantly improving proprioceptive function.SI enhances proprioceptive function by stimulating multiple sensory systems, including visual, vestibular, and proprioceptive systems, thereby improving the ability of the central nervous system to process sensory information. Research indicates that this training promotes the integration of sensory information in the central nervous system\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e and enhances the coordination of sensorimotor pathways through increased neural plasticity\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Additionally, SI improves the sensitivity of muscle spindles and cutaneous mechanoreceptors, further enhancing joint position sense and motor control\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, the significant improvements in proprioceptive function observed in the MIRT-SI and LIRT-SI groups further validate these mechanisms. Although the LIRT-SI group underwent low-intensity RT, its improvement in knee proprioception surpassed that of the MIRT group. This result may be attributed to the direct stimulation of cognitive and sensory systems by SI, which enhances the efficiency of the central nervous system in processing sensory information and compensates for the limited muscle strength gains associated with low-intensity RT\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Due to methodological limitations, such as the absence of a low-intensity RT group and long-term follow-up, future research is required to investigate the long-term effects of SI on fall prevention and functional mobility in diverse older adult populations, incorporating neuroimaging techniques to better understand underlying neural adaptations\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis randomized controlled trial provides compelling evidence that RT-SI confers dual benefits for older adults by simultaneously enhancing knee muscle strength and proprioceptive function. Clinicians should prioritize RT-SI for older adults at high fall risk and tailor task difficulty based on individual functional capacity\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003eSample Size Estimation\u003c/h2\u003e \u003cp\u003eThe sample size was estimated using G*Power software (version 3.1.9.2; Universit\u0026auml;t Kiel, Germany), with a minimum of 12 participants required per group.\u003c/p\u003e \u003cp\u003eThis study included 52 older adults recruited from the Zhongyuan, Jialong, and Daning neighbourhoods of Yangpu District, Shanghai, of which 28 and 24 were male and female, respectively. Participants met the following criteria: mini mental state examination score\u0026thinsp;\u0026ge;\u0026thinsp;27, absence of severe cardiovascular or cerebrovascular diseases, no musculoskeletal impairments affecting movement, and ability to perform RT exercises safely. All eligible volunteers underwent physical examination and provided written informed consent after discussions with their family members. The daily habits and activity levels of the participants remained largely unchanged during the experiment, with no new physical exercises introduced with the exception of the planned interventions. The Shandong Sports University Ethics Committee approved the study (2023030), which was conducted in accordance with their guidelines and regulations and the principles outlined in the Declaration of Helsinki. All participants provided informed consent.\u003c/p\u003e \u003cp\u003eWe randomly allocated the participants to one of four groups: C, MIRT, LIRT-SI, and MIRT-SI, with 13 individuals in each group. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the baseline demographic characteristics of the study participants.\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\u003eBaseline Participant Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMIRT (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLIRT-SI (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMIRT-SI (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male: female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7:6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7:6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7:6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7:6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.69\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165.23\u0026thinsp;\u0026plusmn;\u0026thinsp;8.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165.16\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165.68\u0026thinsp;\u0026plusmn;\u0026thinsp;8.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e165.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.34\u0026thinsp;\u0026plusmn;\u0026thinsp;7.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.20\u0026thinsp;\u0026plusmn;\u0026thinsp;7.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.450\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. LIRT-SI, low-intensity resistance training with sensory integration; MIRT, medium-intensity resistance training; MIRT-SI, medium-intensity resistance training with sensory integration; MMSE, mini mental state examination.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eInterventions and Data Collection\u003c/h2\u003e \u003cp\u003eSI fundamentally involves the collection of visual information, its transmission to the brain for processing, and subsequent motor execution via effectors\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, which emphasises the integration of visual\u0026ndash;motor coordination. Such coordination adheres to the structural framework of postural control theory, wherein the motor system (hands), sensory system (eyes), and cognitive system (brain) collaboratively regulate movement. With advancements in technology, human-machine interactive training methods, a multidisciplinary intervention integrating ergonomics and kinesiology, have emerged. These protocols, akin to computer-game paradigms, involve machine-generated signal prompts that guide participants to perform specific actions. In this study, we implemented a human-machine interactive \u0026ldquo;visual\u0026ndash;motor coordination\u0026rdquo; protocol. The SMART series RT-SI equipment system (model SC105; Shangti Sports Development Co., Ltd., Taiwan, China) delivers visual guidance signals, which undergo central processing (brain) before triggering motor execution (limb movement). Our intervention integrates RT and SI tasks through this interactive device, enabling dual modulation of neuromuscular and cognitive pathways. The SMART series RT-SI equipment quantifies task performance via real-time kinematic feedback (e.g., angular velocity accuracy), ensuring precise control over training intensity and sensory load.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRT Tasks\u003c/h2\u003e \u003cp\u003eParticipants performed unilateral lower limb extension\u0026ndash;flexion cycles with the knee joint as the pivot. During each movement cycle, one limb executed a controlled extension while the contralateral limb simultaneously flexed. Upon reaching the critical joint angle (predefined based on anatomical limits), the motion direction was reversed, completing one repetition.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSI Tasks\u003c/h2\u003e \u003cp\u003eDuring SI, participants manipulated a mechanical lever to align a real-time blue cursor (generated by velocity sensors tracking limb motion) with a preset green cursor moving at a target angular velocity (range: 0\u0026ndash;180\u0026deg;/s). The task performance was quantified as the percentage overlap between the two cursors. Difficulty was modulated by incrementally increasing angular velocity (5\u0026deg;/s per stage). Throughout training, one or two instructors provided verbal cues to ensure protocol adherence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRT Intensity Quantification\u003c/h2\u003e \u003cp\u003eRT intensity was quantified by identifying the 1RM resistance levels of participants using the incremental loading protocol of the equipment, with moderate intensity defined as 60\u0026ndash;75% 1RM and low intensity as \u0026lt;\u0026thinsp;60% 1RM; continuous heart rate monitoring was ensured via POLAR chest straps.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSI Intensity Quantification\u003c/h2\u003e \u003cp\u003eFor SI load calibration, both MIRT-SI and LIRT-SI groups performed cursor-matching tasks starting at 10\u0026deg;/s angular velocity, requiring alignment of a participant-controlled blue cursor with a target green cursor. Performance metrics (cursor overlap percentage), real-time heart rate, and perceived task difficulty (NASA Task Load Index scale) were recorded, with angular velocity progressively increased by 5\u0026deg;/s until task failure (\u0026lt;\u0026thinsp;80% overlap for three consecutive attempts). Final SI loads were individualised based on moderate difficulty thresholds (median performance curves), ensuring standardised progression across groups, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpecific Intervention Protocols for Each Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTraining Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResistance Training Intensity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAngular Velocity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEducational lectures only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMIRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResistance training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u0026ndash;75% of 1RM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLIRT-SI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResistance training with sensory integration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60% of 1RM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u0026ndash;40\u0026deg;/s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMIRT-SI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResistance training with sensory integration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u0026ndash;75% of 1RM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u0026thinsp;~\u0026thinsp;30\u0026deg;/s\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e1RM represents the load corresponding to a single successful repetition, internationally standardised in kilograms (kg). C, control; LIRT-SI, low-intensity resistance training with sensory integration; MIRT, medium-intensity resistance training; MIRT-SI, medium-intensity resistance training with sensory integration; 1RM, one-repetition maximum.\u003c/p\u003e \u003cp\u003eWe conducted this study at a community fitness centre for older adults in Shanghai. Over the 16-week intervention period, participants in the LIRT-SI, MIRT, and MIRT-SI groups engaged in three training sessions per week, each consisting of 4\u0026ndash;6 sets with 8\u0026ndash;12 repetitions per set. The participants rested for 2 min between sets and 5 min between larger sets.\u003c/p\u003e \u003cp\u003eTraining loads were incrementally adjusted every 4 weeks following the principle of progressive overload, with resistance increments capped at5\u0026ndash;10% of 1RM to ensure physiological adaptation. For SI tasks, angular velocity progression was dynamically adjusted based on the prior-phase performance metrics of the participants (cursor overlap\u0026thinsp;\u0026ge;\u0026thinsp;80%). Participants failing to meet this threshold for two consecutive weeks were maintained at the current angular velocity until proficiency was re-established. We adjusted training intensity in real-time using a Polar heart rate monitor (Polar Electro, Kempele, Finland), performance metrics (cursor alignment accuracy), and subjective task difficulty (NASA Task Load Index scale) to ensure consistent and appropriate training loads in all participants. Before each session, a specialised exercise instructor measured blood pressure and assessed the physical and mental conditions of the participants. In addition, one or two coaches supervised the training process to ensure accurate task completion. Additionally, professional coaches conducted health assessments, warm-up activities, and cool-down exercises before and after each training session.\u003c/p\u003e \u003cp\u003eWe collected data one week before the start of the experiment (T1), and at the 8th (T2) and 16th week (T3) of the intervention period, with all data collected by the same team using the same equipment and methods at the same location.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStudy Variables\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eKnee Joint Muscle Strength Indicator: Isokinetic Muscle Strength Measurement\u003c/h2\u003e \u003cp\u003eIsokinetic muscle strength testing is widely recognised as the gold standard for assessing muscle strength due to its scientific rigor, precision, clinical applicability, and standardised protocols\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. We measured isokinetic muscle strength using the PHYSIOMED CON-TREX system (model TP-MJ; CMV AG, Zurich, Switzerland), which determines PT at 60\u0026deg;/s. The participants performed two practice attempts following a warm-up, with each test consisting of five full-effort flexion extensions 5 min apart\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSensory System Indicator: Knee Joint Proprioception\u003c/h2\u003e \u003cp\u003eProprioceptive function plays a critical role in maintaining postural stability in older adults; it tends to decline with age\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The passive\u0026ndash;active joint position sense test, a widely used method for assessing joint position sense\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, combines passive limb positioning with active angle reproduction (participant-triggered termination) to quantify proprioceptive function through angular error measurements. Smaller angular errors indicated better proprioceptive function We used the PHYSIOMED CON-TREX system (model TP-MJ; CMV AG) to measure knee joint position sense and assess proprioceptive function. The participants sat on the device with the thigh of their dominant leg securely fixed. We instructed them to close their eyes or wear an eye mask while maintaining a knee flexion angle of 90\u0026deg;. We then adjusted the device to passively move the lower leg of the participant at an angular velocity of 4\u0026deg;/s until the knee reached a flexion angle of 45\u0026deg;, holding it for 3 s. We asked the participants to focus on sensing and memorising this position. The lower leg was then returned to the initial position. The participants repeated this process twice. After a 5-s rest, we reconfigured the device and instructed the participants to actively extend their lower leg at an angular velocity of 2\u0026deg;/s. We told them to press the stop button when they perceived that their knee had reached the previously memorised 45\u0026deg; angle. We recorded the difference (in degrees) between the actual angle achieved and the target angle of 45\u0026deg; as the knee joint proprioception index.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eWe present measured indicators as means and standard deviations. We performed statistical analyses using SPSS software version 20.0 (IBM Corporation, Armonk, NY, USA). A two-way repeated-measures ANOVA was selected to analyse the interaction effects between intervention type and time, ensuring appropriate control for within-subject variability. If an interaction existed, we analysed the individual effects of the intervention method and timing on the dependent variable. If no interaction existed, we analysed the main effects of each independently. We set statistical significance to P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANOVA, analysis of variance\u003c/p\u003e\n\u003cp\u003eC, control\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI, confidence interval\u003c/p\u003e\n\u003cp\u003eLIRT-SI, low-intensity resistance training with sensory integration\u003c/p\u003e\n\u003cp\u003eMIRT, medium-intensity resistance training\u003c/p\u003e\n\u003cp\u003eMIRT-SI, medium-intensity resistance training with sensory integration\u003c/p\u003e\n\u003cp\u003e1RM, one-repetition maximum\u003c/p\u003e\n\u003cp\u003ePT, peak torque\u003c/p\u003e\n\u003cp\u003eRT, resistance training\u003c/p\u003e\n\u003cp\u003eRT-SI, resistance training with sensory integration\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSI, sensory integration\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRYZ conceived the experiments, all authors conducted the experiments, HXL and FW analysed the results. HXL prepared the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLiu, C. \u0026amp; Shen, Z. The epidemiological characteristics and risk factors of falls. \u003cem\u003eChin. J. Gerontol\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 3837-3839 (2012).\u003c/li\u003e\n\u003cli\u003eGregg, E.W., Pereira, M.A. \u0026amp; Caspersen, C.J. Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. \u003cem\u003eJ. Am. Geriatr. Soc\u003c/em\u003e \u003cstrong\u003e48\u003c/strong\u003e, 883-893 (2015).\u003c/li\u003e\n\u003cli\u003eFielding, R.A. et al. High‐velocity resistance training increases skeletal muscle peak power in older women. \u003cem\u003eJ. Am. Geriatr. Soc\u003c/em\u003e \u003cstrong\u003e50\u003c/strong\u003e, 655-662 (2002).\u003c/li\u003e\n\u003cli\u003eFragala, M.S. et al. Resistance training for older adults: position statement from the national strength and conditioning association. \u003cem\u003eJ. Strength Cond Res\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e, 2019-2052 (2019).\u003c/li\u003e\n\u003cli\u003eKaraca, O. \u0026amp; Kılın\u0026ccedil;, M. Sensory training combined with motor training improves trunk proprioception in stroke patients: a single-blinded randomized controlled trial. \u003cem\u003eNeurol Res\u003c/em\u003e \u003cstrong\u003e46\u003c/strong\u003e, 553-560 (2024).\u003c/li\u003e\n\u003cli\u003eProske, U. \u0026amp; Gandevia, S.C. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force. \u003cem\u003ePhysiol. Rev\u003c/em\u003e \u003cstrong\u003e92\u003c/strong\u003e, 1651-1697 (2012).\u003c/li\u003e\n\u003cli\u003ePalmer, J.A., Hazen, E.M. \u0026amp; Billinger, S.A. Dual‐task balance control reveals cerebrovascular\u0026ndash;behavioral relationships in older adults resistant to cognitive decline. \u003cem\u003eJ. Am. Geriatr. Soc\u003c/em\u003e \u003cstrong\u003e72\u003c/strong\u003e, 3257-3260 (2024).\u003c/li\u003e\n\u003cli\u003eShaffer, S.W. \u0026amp; Harrison, A.L. Aging of the somato sensory system: a translational perspective. \u003cem\u003ePhys. Ther\u003c/em\u003e \u003cstrong\u003e87\u003c/strong\u003e, 193-207 (2007).\u003c/li\u003e\n\u003cli\u003eAagaard, P., Simonsen, E.B., Andersen, J.L., Magnusson, P. \u0026amp; Dyhre-Poulsen, P. Neural adaptation to resistance training: changes in evoked V-wave and H-reflex responses. \u003cem\u003eJ. Appl. Physiol\u003c/em\u003e \u003cstrong\u003e92\u003c/strong\u003e, 2309-2318 (2002).\u003c/li\u003e\n\u003cli\u003eBundy, A.C., Lane, S. J., \u0026amp; Murray, E. A. Sensory integration: theory and practice (4th edn.）. (F.A. Davis, Philadelphia, PA; 2021).\u003c/li\u003e\n\u003cli\u003eSchaaf, R.C. \u0026amp; Miller, L.J. Occupational therapy using a sensory integrative approach for children with developmental disabilities. \u003cem\u003eMent. Retard. Dev. Disabil. Res. Rev\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 143-148 (2005).\u003c/li\u003e\n\u003cli\u003eSchaaf, R.C. et al. An intervention for sensory difficulties in children with autism: a randomized trial. \u003cem\u003eJ. Autism Dev. Disord\u003c/em\u003e (2013).\u003c/li\u003e\n\u003cli\u003eSchaaf, R.C. et al. State of the science: a roadmap for research in sensory integration. \u003cem\u003eAm. J. Occup. Ther\u003c/em\u003e \u003cstrong\u003e69\u003c/strong\u003e, 1-8 (2015).\u003c/li\u003e\n\u003cli\u003eHuang , T., Shen, Z., Fan, L. \u0026amp; Gao, D. Progress in stockinet technology in testing and training for assessment of muscle function. \u003cem\u003eJ. Forensic Med\u003c/em\u003e \u003cstrong\u003e29\u003c/strong\u003e, 49-52 (2013).\u003c/li\u003e\n\u003cli\u003eJin , Z., Li , Z. \u0026amp; Guo, J. Effects of isokinetic measuring system on knee joint muscles. \u003cem\u003eJ. Tianjin Inst. Phys. Educ\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 47-50 (2001).\u003c/li\u003e\n\u003cli\u003ePaul, D.J. \u0026amp; Nassis, G.P. Testing strength and power in soccer players. \u003cem\u003eJ. Strength Cond. Res\u003c/em\u003e \u003cstrong\u003e29\u003c/strong\u003e, 1748-1758 (2015).\u003c/li\u003e\n\u003cli\u003eXiao, Z. A study on instruction of health and fitness exercises of elderly. \u003cem\u003eChin. Nurs. Res\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 3204-3206 (2009).\u003c/li\u003e\n\u003cli\u003eHan, J., Waddington, G., Adams, R., Anson, J. \u0026amp; Liu, Y. Assessing proprioception: a critical review of methods. \u003cem\u003eJ. Sport Health Sci\u003c/em\u003e \u003cstrong\u003e5\u003c/strong\u003e, 80-90 (2016).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"aged, knee joint, muscle strength, proprioception, resistance training","lastPublishedDoi":"10.21203/rs.3.rs-5198973/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5198973/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eResistance training (RT) is a well-established exercise intervention, but the benefits of RT with sensory integration (RT-SI) in older adults remain underexplored. In this study, we compared the effects of traditional RT and RT-SI on knee muscle strength and proprioception in older adults. We randomly assigned 52 older adults to one of four groups: control (C), medium-intensity RT (MIRT), low-intensity RT-SI (LIRT-SI), and medium-intensity RT-SI (MIRT-SI). Knee strength improved significantly in all intervention groups at 8 and 16 weeks of the 16-week intervention period compared with the C group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005), with the MIRT (extension peak torque [PT-E]: 88.1%; flexion peak torque [PT-F]: 103.4%) and MIRT-SI (PT-E: 88.2%; PT-F: 103.6%) groups demonstrating significantly greater improvements compared with the LIRT-SI group (PT-E: 50.8%; PT-F: 78.5%) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The LIRT-SI (10.22%) and MIRT-SI (11.53%) groups showed significantly greater improvements in proprioceptive function compared with the MIRT group (7.45%) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Therefore, while RT alone is sufficient to build muscle strength, RT-SI appears to provide additional benefits for proprioception. These findings highlight the potential of RT-SI to improve both muscle strength and proprioception in older adults, making it a promising strategy for fall prevention and functional independence.\u003c/p\u003e","manuscriptTitle":"Effects of Sensory Integration Versus Traditional Resistance Training on Knee Strength and Proprioception in Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-15 10:30:59","doi":"10.21203/rs.3.rs-5198973/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-22T10:33:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-20T09:52:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-18T08:46:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295724133114673653754212446947159555598","date":"2025-04-15T07:26:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31124628664715339744773026365367434725","date":"2025-04-13T09:09:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260400117362586618885973815099683038134","date":"2025-04-13T09:02:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-12T15:16:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"163401072222661834506781748144616249071","date":"2025-04-12T14:54:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-12T14:18:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-04T13:50:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-30T18:02:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"161fc527-01ca-45e1-a60b-7f6fad2900db","owner":[],"postedDate":"April 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":47139958,"name":"Health sciences/Health care/Geriatrics"},{"id":47139959,"name":"Health sciences/Health care/Public health"}],"tags":[],"updatedAt":"2026-03-30T08:10:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-15 10:30:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5198973","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5198973","identity":"rs-5198973","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}