Long-term combined “new sports” and resistance exercise improves the physical and mental health of elderly people with stroke-associated hemiplegia

Long-term combined “new sports” and resistance exercise improves the physical and mental health of elderly people with stroke-associated hemiplegia | 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 Long-term combined “new sports” and resistance exercise improves the physical and mental health of elderly people with stroke-associated hemiplegia Ji-Eun Lee, Takayuki Akimoto, Ho-Seong Lee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3794487/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract In this study, we examined the effects of 24 weeks of a combined “new sports” and resistance exercise program on the physical and mental health of elderly people with hemiplegia. Thirty elderly people aged 65–74 years with hemiplegia were randomly divided into combined new sports and resistance exercise (NS+RE), resistance exercise (RE), and control groups. Indicators of physical health (range of motion [ROM], Berg Balance Scale [BBS], Functional Gait Assessment, and Instrumental Activities of Daily Living) and mental health (Grooved Pegboard Test [GPT], Geriatric Depression Scale [GDS], Rosenberg Self-Esteem Scale [RSES], and Stroke-Specific Quality of Life [SS-QOL]) were measured before and at 8, 16, and 24 weeks of exercise training. Compared with the RE and control groups, the NS+RE group showed significant improvements in ROM, RSES, and SS-QOL starting at 8 weeks, GPT starting at 16 weeks, and BBS and GDS at 24 weeks. We conclude that combined new sports and resistance exercise was more effective than resistance exercise alone in terms of improving the physical and mental health of elderly people with hemiplegia. Our findings highlight the importance of integrating new sports into rehabilitation strategies and sustaining long-term exercise for lasting benefits. Health sciences/Health care Health sciences/Health care/Geriatrics Health sciences/Neurology/Neurological disorders/Stroke Figures Figure 1 Introduction Hemiplegia is one of the most common disabling sequelae of stroke 1 , affecting one in four older adults 2 . Elderly people with hemiplegia exhibit difficulties in daily life due to decreased muscle and postural control 3 , reduced balance and walking function 4 , muscle weakness and stiffness, and reduced joint movements 5 . These impairments in physical health also have a negative impact on the person’s mental health, such as depression and quality of life (QOL) 6 . Resistance exercise efficiently increases muscle mass and muscular endurance 7 . It is also beneficial for elderly people with hemiplegia by increasing their muscle strength 8 . In particular, long-term resistance exercise training improves muscle strength by inducing skeletal muscle hypertrophy 9 and improves the physical health of elderly people after stroke 10 . However, most exercise intervention studies in elderly people with hemiplegia are limited to relatively short-term interventions (within 8 weeks) 11 – 13 . A variety of exercise programs have shown beneficial effects on the mental health of elderly people with hemiplegia 14 , 15 . Most previous studies examined the effect of individualized exercise programs rather than group-based exercise programs on cognition and depression 16 , 17 . Individualized exercise is goal-oriented, whereas group exercise focuses on fun, and reduces anxiety and depression 18 . Group exercise has positive effects on mental health, regardless of the person’s age and disease, suggesting that such programs are more effective in promoting exercise participation and persistence than individualized exercise programs 19 . The idea of “new sports” has gained popularity after its inception in Europe, following the “Sport for All” movement, which highlights the benefits of impromptu physical activity in daily life for improving and preserving physical well-being 20 , 21 . New sports are participant-centered sports that can involve various exercises in a complex manner. New sports have a positive impact on physical activity and fitness 22 and improve interactions and social skills because “participation is open to even inexperienced exercisers who are not physically active” 23 . For instance, the new sport “speedminton” is a lightweight hybrid of badminton and tennis that is easy to play without a net, and is suitable for people with less physical prowess or lower fitness levels 22 . Shin et al. introduced “new sports tennis” as a sport that combines circuit training and tennis skills, including side steps, back steps, and backhand movements, and found that it had positive effects on physical health of postmenopausal women 24 . Meanwhile “new sports softball,” which combines the grip movements and manipulation techniques of badminton and tennis, improved physical and mental health of patients with Parkinson’s disease 25 . Nevertheless, few studies have investigated the effects of new sports in elderly people with hemiplegia. The aim of this study was to examine the effects of a long-term combined exercise program (new sports + resistance exercise [NS + RE]) on the physical and mental health of elderly people with hemiplegia. We hypothesized that the combined exercise program would improve the participants’ physical and mental health better than resistance exercise alone. Results Participant characteristics The general characteristics of the subjects are shown in Table 1 . Sex, age, affected side, time since onset, and MMSE-K scores were not significantly different among the NS + RE, RE, and CON groups. No dropouts or adverse events were reported during the course of the study. Table 1 Participant characteristics. Values are means ± standard deviation or number of participants. NS new sports, RE resistance exercise, CON control, MMSE-K Korean Mini-Mental State Examination. Variables NS + RE (n = 10) RE (n = 10) CON (n = 10) F p Sex (male/female) 4/6 3/7 3/7 0.136 0.873 Age (years) 69.60 ± 2.50 69.30 ± 2.58 69.80 ± 2.53 0.098 0.907 Affected side (right/left) 3/7 5/5 2/8 1.016 0.375 Time since onset (months) 52.00 ± 4.69 50.90 ± 5.70 53.20 ± 4.02 0.561 0.577 MMSE-K score 25.40 ± 0.52 25.40 ± 0.52 25.60 ± 0.52 0.500 0.612 Physical health The changes in the physical health outcomes are shown in Table 2 for ROM and Table 3 for BBS, FGA, and IADL. SE and HE increased significantly in the NS + RE group at 8, 16, and 24 weeks of the exercise program compared with the RE and CON groups (p < 0.05). Additionally, SE and HE increased significantly in the RE group at 8, 16, and 24 weeks compared with the CON group (p < 0.05). KF, KF, DF, and PF increased significantly in the NS + RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p < 0.05). Within the NS + RE group, SF, SE, HF, HE, KF, DF, and PF were significantly increased at 8, 16, and 24 weeks compared with the pre-exercise (0 weeks) values (p < 0.05). Within the RE group, SF, SE, HE, KF, DF, and PF were significantly increased at 8, 16, and 24 weeks, and HF was significantly increased at 16 and 24 weeks compared with the pre-exercise values (p < 0.05). Table 2 ROM before and during the exercise program in the NS + RE, RE, and CON groups. Values are means ± standard deviation. *p < 0.05 vs. pre-exercise (week 0); † p < 0.05 vs. CON; ‡ p < 0.05 vs. RE. ROM range of motion, NS new sports, RE resistance exercise, CON control, SF shoulder flexion, SE shoulder extension, HF hip flexion, HE hip extension, KF knee flexion, DF ankle dorsiflexion, PF ankle plantarflexion, G group, T timepoint. Variables Group Pre-exercise 8 weeks 16 weeks 24 weeks F SF (°) NS + RE 119.80 ± 6.34 122.30 ± 5.81* 123.70 ± 5.44* 125.00 ± 4.71* G = 2.866 T = 5.571* G × T = 6.775* RE 121.30 ± 5.64 123.40 ± 5.21* 123.90 ± 6.56* 125.70 ± 5.31* CON 119.20 ± 5.67 119.00 ± 5.68 119.30 ± 5.31 116.00 ± 5.16 SE (°) NS + RE 32.50 ± 1.84 38.30 ± 2.98* †‡ 39.40 ± 2.50* †‡ 39.60 ± 3.06* † G = 33.251* T = 22.016* G × T = 7.994* RE 32.60 ± 1.26 35.80 ± 1.75* † 36.30 ± 3.20* † 37.50 ± 2.64* † CON 32.10 ± 1.60 31.40 ± 1.90 32.00 ± 2.58 31.60 ± 2.17 HF (°) NS + RE 84.40 ± 2.55 86.30 ± 2.00* 88.90 ± 2.08* 89.20 ± 1.62* G = 1.149 T = 11.356* G × T = 2.882* RE 87.10 ± 3.84 88.40 ± 2.22 89.80 ± 2.44* 89.20 ± 3.30* CON 87.40 ± 3.44 87.50 ± 4.25 87.90 ± 3.67 87.50 ± 2.64 HE (°) NS + RE 10.10 ± 2.13 14.50 ± 1.58* †‡ 16.10 ± 1.66* †‡ 16.50 ± 2.42* †‡ G = 10.894* T = 29.525* G × T = 10.160* RE 9.50 ± 2.37 12.10 ± 2.38* † 12.50 ± 2.64* † 13.60 ± 2.84* † CON 9.80 ± 2.49 9.60 ± 3.34 9.00 ± 3.43 10.00 ± 3.33 KF (°) NS + RE 104.40 ± 6.67 109.70 ± 6.91* † 111.70 ± 6.06* † 116.00 ± 5.16* † G = 3.881* T = 15.907* G × T = 10.356* RE 105.80 ± 7.21 110.50 ± 5.50* † 111.70 ± 7.41* † 114.10 ± 7.26* † CON 105.90 ± 7.67 104.00 ± 5.16 104.50 ± 5.99 102.50 ± 5.40 DF (°) NS + RE 6.30 ± 1.34 11.40 ± 2.07* † 12.70 ± 2.00* † 13.00 ± 2.58* † G = 17.382* T = 74.115* G × T = 20.176* RE 6.20 ± 1.23 10.80 ± 1.03* † 11.80 ± 2.39* † 13.00 ± 2.75* † CON 6.80 ± 1.81 6.80 ± 2.39 7.00 ± 2.31 6.40 ± 1.71 PF (°) NS + RE 8.40 ± 1.58 14.40 ± 1.07* † 14.80 ± 0.63* † 14.80 ± 0.63* † G = 46.689* T = 60.870* G × T = 16.803* RE 7.70 ± 1.06 13.00 ± 2.58* † 13.30 ± 2.79* † 14.00 ± 2.11* † CON 7.20 ± 1.81 7.20 ± 2.10 6.70 ± 2.36 7.20 ± 2.49 Table 3 BBS, FGA, and IADL before and during the exercise program in the NS + RE, RE, and CON groups. Values are means ± standard deviation. *p < 0.05 vs. pre-exercise (week 0); † p < 0.05 vs. CON; ‡ p < 0.05 vs. RE. BBS Berg Balance Scale, FGA Functional Gait Assessment, IADL Instrumental Activities of Daily Living, NS new sports, RE resistance exercise, CON control, G group, T timepoint. Variables Group Pre-exercise 8 weeks 16 weeks 24 weeks F BBS (score) NS + RE 22.70 ± 1.89 27.20 ± 2.04*† 31.60 ± 2.46*† 40.30 ± 3.27*†‡ G = 30.166* T = 111.700* G × T = 32.810* RE 22.80 ± 2.04 27.00 ± 2.83*† 30.70 ± 4.00*† 36.10 ± 3.63*† CON 23.40 ± 3.17 23.60 ± 3.47 23.10 ± 2.96 23.00 ± 2.49 FGA (score) NS + RE 16.20 ± 2.66 19.20 ± 2.66* 21.20 ± 2.66*† 21.20 ± 2.62*† G = 4.077* T = 37.843* G × T = 8.162* RE 16.10 ± 2.60 18.10 ± 2.60* 20.10 ± 2.60*† 20.70 ± 2.67*† CON 16.20 ± 2.66 16.90 ± 2.60 16.80 ± 2.70 16.40 ± 2.50 IADL (score) NS + RE 24.80 ± 1.32 19.00 ± 1.76*† 18.90 ± 1.10*† 18.20 ± 0.79*† G = 99.260* T = 102.479* G × T = 27.080* RE 24.90 ± 1.37 19.20 ± 1.81*† 18.80 ± 1.14*† 18.20 ± 0.42*† CON 24.70 ± 1.34 24.60 ± 1.17 24.70 ± 1.25 25.00 ± 1.05 BBS increased significantly in the NS + RE group at 24 weeks compared with the RE and CON groups (p < 0.05). Moreover, BBS increased significantly in the NS + RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p < 0.05). FGA increased significantly in the NS + RE and RE groups at 16 and 24 weeks compared with the CON group (p < 0.05). IADL decreased significantly in the NS + RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p < 0.05). Within the NS + RE and RE groups, BBS, FGA, and IADL were significantly improved at 8, 16, and 24 weeks compared with the pre-exercise values (p < 0.05). Mental health The changes in mental health are shown in Fig. 1 . GPT significantly decreased in the NS + RE group compared with both the RE and CON groups at 16 and 24 weeks of the exercise program (p < 0.05). Additionally, GPT decreased significantly in the NS + RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p < 0.05). GDS decreased significantly in the NS + RE group at 24 weeks compared with the RE and CON groups (p < 0.05). Moreover, GDS decreased significantly in the NS + RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p < 0.05). RSES increased significantly in the NS + RE group at 8, 16, and 24 weeks compared with the RE and CON groups (p < 0.05). Additionally, RSES increased significantly in the RE group at 8, 16, and 24 weeks compared with the CON group (p < 0.05). SS-QOL increased significantly in the NS + RE group at 8, 16, and 24 weeks compared with the RE and CON groups (p < 0.05). Furthermore, SS-QOL increased significantly in the RE group at 24 weeks compared with the CON group (p < 0.05). Within the NS + RE and RE groups, GPT, GDS, RSES, and SS-QOL were significantly improved at 8, 16, and 24 weeks compared with the pre-exercise values (p < 0.05). Discussion We hypothesized that a combined new sports and resistance exercise program would achieve greater improvements in physical and mental health compared with resistance exercise alone. Our findings support our hypothesis about the gains in physical and mental health outcomes: the NS+RE group showed greater improvements in ROM, RSES, and SS-QOL from 8 weeks, GPT from 16 weeks, and BBS and GDS from 24 weeks of the program compared with the RE group. Exercise programs for elderly people with post-stroke hemiplegia have only been evaluated over a short period of time, generally 4–8 weeks 11–13 , and there has not been any extensive research examining the effects of long-term exercise in this setting. We designed the present study to determine the long-term effect of the combined exercise program on the physical health of elderly people with post-stroke hemiplegia because Snijders et al. suggested that a long-term, consistent exercise program was needed for elderly people to experience the full benefits of resistance training 38 . Shrestha et al. suggested that multidirectional step exercises, which include weight shifting, are more effective for improving balance and gait than a single-mode exercise 17 . Previous studies also revealed that exercise on an unstable surface and weight shifting training can improve the balance ability of chronic stroke patients 38–42 . The new sports program used in this study requires body weight shifting, such as side steps, and back steps with forehand and backhand movements 25,43–46 . We found that BBS increased by 58.3% in the RE group compared with 77% in the NS+RE group at 24 weeks of the intervention. A previous study also reported that BBS increased by 21% in elderly people with stroke after 4 weeks of exercise training with weight shifting and multidirectional stepping 17 . These results suggest that the combination of new sports and resistance exercises synergistically improves balance ability more effectively than resistance exercise alone. The multidirectional exercises activate muscles and improve proprioception and overall stability, all of which may contribute to a more comprehensive enhancement of balance ability 17,47 . FGA and IADL improved in the NS+RE and RE groups, suggesting that the combined program and resistance exercise is effective in terms of maintaining and improving functional walking and instrumental daily living. This finding also supports the notion that resistance exercise is recommended for elderly people with hemiplegia to improve their activities of daily living. We used several assessments to evaluate the changes in mental health after the exercise program. It was reported that racquet sports improve athletic ability as well as executive capacity 48 . In particular, tennis and badminton were helpful in terms of improving and sustaining cognition in elderly individuals 49 . Furthermore, participation in a new sports activity (a bowling game) was shown to improve hand coordination during everyday activities such as using a spoon and dressing 50 . The NS+RE group in our study demonstrated a sustained decrease in GPT at 16 and 24 weeks compared with the RE group, which is consistent with a prior study 51 . These findings suggest that a combined exercise program can improve the cognitive abilities of elderly people with hemiplegia. The change in GDS in this study is particularly noteworthy. In the RE group, the GDS score improved from 22.10 points at 0 weeks to 19.60 points at 24 weeks, corresponding to a change from “severe depression” to “moderate depression”. By contrast, the NS+RE group showed a much greater improvement, decreasing from 22.50 points at 0 weeks to 16.50 points at 24 weeks, a shift from “severe depression” to “mild depression.” This change was noticeable from 16 weeks onwards. This suggests that the combined exercise program may effectively reduce depressive symptoms of elderly people with hemiplegia. People affected by chronic stroke often exhibit poor self-esteem, and active participation in rehabilitation can improve self-esteem and QOL 52 . Additionally, self-efficacy plays a crucial role in the rehabilitation and recovery of elderly people affected by chronic stroke because higher levels of self-efficacy are linked to setting and achieving more ambitious self-goals 53 . A study showed that intensive nursing care improved the RSES by 14% in elderly people with depression 54 , while another study reported that 8 weeks of exercise increased RSES in stroke patients by 15% 55 . In this study, the RSES of the RE group increased by 14% after 8 weeks of program, consistent with prior studies 54,55 , whereas the RSES of the NS+RE group increased by 29% at 8 weeks. The measured improvement in self-esteem is likely to have resulted from active participation in an exercise program. This suggests that active participation in a structured program led to an improvement in self-esteem. The SS-QOL score must increase by >7 points to confirm the effect of a treatment or intervention 56 . In this study, the SS-QOL increased by 6.8 points at 8 weeks in the RE group, and by 10 points in the NS+RE group, indicating that the combined exercise program was more effective in terms of improving QOL. Taken together, our findings indicate that the combined exercise program significantly improved cognitive function, depressive symptoms, self-efficacy, and QOL, and these improvements in mental health could be attributed to the improvement in physical health. Limitations Our study has several limitations. The sample size of the study may be limited although it is difficult to recruit a large number of people with hemiplegia. An extensive and diverse sample size could provide greater insights into the generalizability of the results. In this study, we did not collect information regarding the participants’ medication usage or lifestyle, and it is unclear whether external factors may have influenced the results. Conclusion The improvements in shoulder and hip joint ROM, balance, cognition, depression, self-esteem, and SS-QOL were notably more effective in the NS+RE group than in the RE and CON groups in this study of elderly people with post-stroke hemiparesis. These results imply that a combined new sports and resistance exercise program is more effective than resistance exercise alone in terms of improving physical and mental health. Future studies should consider broadening the scope to encompass a wider range of disability types and age groups among elderly people with post-stroke hemiplegia. Methods Study design This clinical trial (KCT0008524) was conducted at the Health and Welfare Center in Dangjin City, Republic of Korea, from April 2023 to October 2023. It was approved by the ethics committee at Dankook University (IRB number: DKU-2021-05-046) and adhered to the principles outlined in the Declaration of Helsinki and its subsequent amendments or comparable ethical standards. All participants provided informed consent through signed agreements. Although our institution’s ethics committee did not initially require clinical trial registration, we retrospectively registered the study with the Clinical Research Information Service (CRIS) of the Republic of Korea, an entity approved by the World Health Organization (registration number KCT0008524). We initiated the registration process in April 2023 and successfully completed retroactive registration in June 2023. Throughout the study, we strictly adhered to the protocol without any deviations in methodology. Participants This study included 30 elderly people, aged 65–74, with a diagnosis of stroke, who were registered at a public health and welfare center located in D City. Participants were eligible if they were diagnosed with stroke ≥ 12 months ago, could walk independently for ≥ 10 m, and their Korean Mini-Mental State Examination score (MMSE-K) was ≥ 24. People with mental disabilities, visual or hearing impairment, or a risk of tumor or infection were excluded. The participants were randomly assigned to the NS + RE ( n = 10), resistance exercise (RE, n = 10), or control (CON, n = 10) groups for 24 weeks. The control group did not perform any sports or resistance exercises. Interventions New sports Details of the new sports program are provided in Table 4 . The NS + RE group performed new sports once weekly for 60 min per session for 24 weeks. The new sports program consists of a 10-min warm-up, 40 min of playing the new sport, and a 10-min cool-down. The program comprised eight sports, which considered limits in the participants’ motor function resulting from stroke-related hemiplegia. The sports were hangung, speedminton, bowling, big ball, hook ball, yutnori, bolo ball, and soft tennis. The participants were educated about fall prevention prior to beginning the exercises, and a team comprising a physical therapist, an occupational therapist, and an assistant was assigned to prevent falls and accidents. The new sports are described in Table 5 . Table 4 New sports program. RPE rating of perceived exertion. Order Contents and timing Time Intensity Warm-up Stretching 10 min RPE 9 Main exercise 1, 9, 17 weeks Hangung 40 min RPE 11–13 2, 10, 18 weeks Speedminton 3, 11, 19 weeks Bowling 4, 12, 20 weeks Big Ball 5, 13, 21 weeks Hookball 6, 14, 22 weeks Yutnori 7, 15, 23 weeks Bolo ball 8, 16, 24 weeks Soft tennis Cool-down Stretching 10 min RPE 9 Table 5 Description of the new sports. Name Description Hangung Using each hand in turn to throw a dart (diameter 8 mm, length 81 mm, weight 4 g; Hangung Globalization Research Institute, Republic of Korea) at a target (diameter 39.5 cm; Hangung Globalization Research Institute, Republic of Korea) located 3 m away. Speedminton Bouncing a rubber ball (diameter 6 cm, weight 8 g; Speedminton GmbH, Berlin, Germany) on a lightweight racquet (63 cm × 29 cm × 9 cm, weight 170 g; Speedminton GmbH, Berlin, Germany). Bowling Using a rubber bowling ball (diameter 17 cm, weight 700 g; New Sports Industry, Seoul, Republic of Korea) to knock down bowling pins (height 38 cm, diameter 12 cm, weight 500 g; New Sports Industry, Seoul, Republic of Korea) located 3 m away. Big ball Rolling a large cube (diameter 50 cm, weight 1.5 kg; New Sports Industry, Seoul, Republic of Korea) made of sturdy nylon fabric. Hook ball Throwing a velcro ball (diameter 9 cm, weight 50 g; Kumwoosports, Paju, Republic of Korea) at a target on a wall (120 cm × 160 cm; Kumwoosports, Paju, Republic of Korea) located 5 m away. Yutnori A variation of the traditional Korean board game Yutnori that employs four wooden sticks that serve a similar purpose to dice, being thrown to determine how far a player can advance their game piece on the board. Four giant sponge sticks (yut sticks) (60 cm × 15 cm; Worldtoy, Siheung, Republic of Korea) are thrown with both hands, and the game piece (diameter 3.5 cm; Worldtoy, Siheung, Republic of Korea) is advanced on a yut board (50 cm × 45 cm; Worldtoy, Siheung, Republic of Korea) according to the way the sticks land. Bolo ball Throwing a bolo (two balls joined by a string; diameter of each ball 5 cm, weight 50 g, string length 35 cm; New Sports Industry, Seoul, Republic of Korea) at a ladder-shaped target (width 62 cm × depth 122 cm × height 100 cm; New Sports Industry, Seoul, Republic of Korea) located 5 m away with the goal of suspending the bolo from the ladder rungs. Soft tennis Using a short racquet (59.5 cm × 25 cm; New Sports Industry, Republic of Korea) to hit a sponge ball (diameter 9 cm; New Sports Industry, Seoul, Republic of Korea) back and forth between two players. Resistance exercise Details of the resistance exercise program are provided in Table 6 . The NS + RE and RE groups performed resistance training three times per week for 75 min per session for 24 weeks. The exercise program consisted of a 10-min warm-up, 50 min of resistance exercise, a 5-min break, and a 10-min cool-down. The participants rested for 10 s between sets and between each exercise. Upper and lower limb exercise equipment (Orthopedic Passive Exercise Equipment, Shin Gwang, Paju, Republic of Korea) was used for upper and lower limb active training, and isokinetic strength equipment (Milon Circuit Training System, Milon, Emersacker, Germany) was used for leg extensions, leg curls, pull-ups, pull-downs, abdominal crunches, and back extensions. Table 6 Resistance exercise program. RPE rating of perceived exertion Order Content Time Intensity Warm-up Stretching 10 min RPE 9 Main exercise Upper and lower limb active exercise 15 min RPE 11–12 Rest 5 min Leg extension 3 s, 10 repetitions, 3 sets Rest between sets: 10 s Rest between exercise: 30 s 35 min RPE 11–13 Leg curl Pull up Pull down Abdominal crunch Back extension Cool-down Stretching 10 min RPE 9 Outcome measures Physical health The range of motion (ROM), Berg Balance Scale (BBS), Functional Gait Assessment (FGA), and Instrumental Activities of Daily Living (IADL) were determined before (0 weeks) and at 8, 16, and 24 weeks during the study period. A goniometer (Saehan Corporation, Changwon, Republic of Korea) was used to measure the ROM of the shoulder and knee joints. The active ROM was measured for shoulder flexion (SF), shoulder extension (SE), hip flexion (HF), hip extension (HE), knee flexion (KF), ankle dorsiflexion (DF), and ankle plantarflexion (PF). The measurements were performed three times, and the average value was used. The reliability is 0.89 26 . BBS is an assessment of independent functional movements, consisting of 14 items rated on a 5-point scale (scale: 0–4), with a total score of 56 points 27 . The assessment evaluates various tasks, including rising from a seated position, standing unsupported, sitting down without backrest assistance, sitting to standing, transitioning, standing with eyes closed, bringing both feet together while standing, reaching forward with arms while standing, picking up objects from the floor while standing, turning both shoulders around while standing, making a 360-degree turn, placing both feet alternately on a step while standing, standing on one foot, and standing on one foot without support. The reliability is 0.98 27 . FGA was developed by Wrisley et al. to evaluate gait 28 . It comprises 10 items scored on a scale of 0–3 points with a total score of 30 points. The specific items are walking on a level surface, changing walking speed, turning the head to the side while walking, moving the head up and down while walking, walking with one foot as an axis, walking around obstacles, gait with a narrow base of support, walking with eyes closed, walking backward, and climbing stairs. The reliability is 0.93 28 . IADL is a tool developed by Won et al. that comprises 10 items scored on a scale of 1–3 29 . Ten items cover grooming, chores, preparing meals, washing clothes, going out a short distance, using transport, buying goods, managing money, using a phone, and taking medicine. Higher scores indicate lower dependence in performing activities of daily living. The reliability is 0.93 29 . Mental health The Grooved Pegboard Test (GPT), Geriatric Depression Scale (GDS), Rosenberg Self-Esteem Scale (RSES), and Stroke-Specific Quality of Life (SS-QOL) were evaluated before and at 8, 16, and 24 weeks during the study period. GPT is a neuropsychological test in which the participant places pegs into a grooved pegboard (Sammons Preston, Bolingbrook, USA) that contains 25 key-shaped holes 30 . The holes are 25 irregularly oriented grooves aligned in a 5 × 5 layout. The time it takes to insert every key-shaped peg into an irregularly oriented groove in a single direction was measured in seconds. Slower completion times are indicative of impaired cognitive abilities. The reliability is 0.74 31 . GDS is a self-report instrument that uses yes/no responses to evaluate overall depression in elderly people 32 . It comprises 30 questions about the person’s interest in and contentment with activities and daily life, excluding physical symptoms. The total score is 30 points. Scores between 14 and 18 indicate mild depression, scores between 19 and 21 indicate moderate depression, and scores of ≥ 22 indicate severe depression. The reliability is 0.88 33 . RSES is a self-report tool consisting of 10 items for evaluating self-esteem on a 4-point scale (scale 1–4), based on self-centered positivity, preciousness, success, and value 34 . The total score is 40 points. The tool comprises 5 positive and 5 negative items, and the negative items are reverse-scored. Scores of 10–19 indicate low self-esteem, scores of 20–29 indicate moderate self-esteem, and scores of ≥ 30 indicate a healthy level of self-esteem. The reliability is 0.73 35 . SS-QOL is composed of 12 domains with 49 items rated on a 5-point scale (scale 1–5), with a maximum score of 245 points 36 . The 12 domains cover energy, family role, language use, mobility, mood, personal characteristics, self-help activities, social roles, thinking, arm and hand function, vision, and occupation-productivity activities. The reliability is 0.88 36 . Sample size and statistical analysis For repeated-measures analysis of variance (ANOVA) involving three groups, the appropriate sample size was estimated using G*Power software (version 3.1.9.7, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany). The calculation included an effect size of 0.25, an alpha level of 0.05, a power of 0.80, three groups, four measurements, and a correlation of 0.5 between repeated measurements 37 . Based on the analysis, the recommended sample size was 30 participants. Data were analyzed using SPSS 23.0 software (SPSS, Chicago, IL, USA). The general characteristics of the participants, prior to starting the interventions, were examined using descriptive statistics and one-way ANOVA. Differences between groups and timepoints were examined by two-way repeated-measures ANOVA. Pairwise differences between groups were evaluated using Tukey’s honestly significant difference post-hoc test. Values of p < 0.05 were considered statistically significant. Declarations Acknowledgments This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2022S1A5B5A17043949). Author Contributions J.E.L. and H.S.L. conceived of and designed the study. J.E.L. conducted the experiment. J.E.L. and T.A. performed data analysis. J.E.L. and T.A. wrote the manuscript. All authors participated in the manuscript review. All authors approved the final manuscript. Competing Interests The authors declare that there are no conflicts of interest regarding the publication of this paper. Data Availability The data supporting the findings of this study are openly available on Figshare (https://doi.org/10.6084/m9.figshare.24847521). References Lee, H.-J. et al. Analysis of medical service utilization for post-stroke sequelae in Korea between 2016 and 2018: a cross-sectional study. Sci. Rep. 12 , 20501 (2022). Feigin, V. L. et al. World Stroke Organization (WSO): global stroke fact sheet 2022. Int. 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Stroke 30 , 1362–1369 (1999). Faul, F., Erdfelder, E., Lang, A.-G. & Buchner, A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav. Res. Methods 39 , 175–191 (2007). Snijders, T., Leenders, M., de Groot, L., van Loon, L. J. C. & Verdijk, L. B. Muscle mass and strength gains following 6 months of resistance type exercise training are only partly preserved within one year with autonomous exercise continuation in older adults. Exp. Gerontol. 121 , 71–78 (2019). Reid, K. F. et al. Comparative effects of light or heavy resistance power training for improving lower extremity power and physical performance in mobility-limited older adults. J. Gerontol. Ser. A Biomed. Sci. Med. Sci. 70 , 374–380 (2015). Park, G.-D., Choi, J.-U. & Kim, Y.-M. The effects of multidirectional stepping training on balance, gait ability, and falls efficacy following stroke. J. Phys. Ther. Sci. 28 , 82–86 (2016). Khumsapsiri, N., Siriphorn, A., Pooranawatthanakul, K. & Oungphalachai, T. Training using a new multidirectional reach tool improves balance in individuals with stroke. Physiother. Res. Int. 23 , e1704 (2018). Ahmed, U., Karimi, H., Amir, S. & Ahmed, A. Effects of intensive multiplanar trunk training coupled with dual-task exercises on balance, mobility, and fall risk in patients with stroke: a randomized controlled trial. J. Int. Med. Res. 49 , 03000605211059413 (2021). Li, Y. & Jiang, S. Application of gait recognition technology in badminton action analysis. J. Phys. Conf. Series 1345 , 52008 (2019). Banerjee, J. & McPhee, J. A volumetric contact model to study the effect of lane friction and the radii of gyration on the “hook shot” in indoor bowling. Procedia Eng. 72 , 429–434 (2014). Fuss, F. K. Design of an instrumented bowling ball and its application to performance analysis in tenpin bowling. Sport. Technol. 2 , 97–110 (2009). Blenkinsop, G. M., Gallimore, N. J. & Hiley, M. J. Weight transfer changes during golf shots from different lies. ISBS Proc. Arch. 35 , 77 (2017). Ahmad, I., Verma, S., Noohu, M. M., Shareef, M. Y. & Hussain, M. E. Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: A randomized control trial. J. Musculoskelet. Neuronal Interact. 20 , 234 (2020). Pan, C.-Y. et al. A racket-sport intervention improves behavioral and cognitive performance in children with attention-deficit/hyperactivity disorder. Res. Dev. Disabil. 57 , 1–10 (2016). Yamasaki, T. Preventive strategies for cognitive decline and dementia: benefits of aerobic physical activity, especially open-skill exercise. Brain Sci. 13 , 521 (2023). Hsu, J. K. et al. A “Wii” bit of fun: The effects of adding Nintendo Wii® Bowling to a standard exercise regimen for residents of long-term care with upper extremity dysfunction. Physiother. Theory Pract. 27 , 185–193 (2011). Bergqvist, M., Möller, M. C., Björklund, M., Borg, J. & Palmcrantz, S. The impact of visuospatial and executive function on activity performance and outcome after robotic or conventional gait training, long-term after stroke—as part of a randomized controlled trial. PLoS One 18 , e0281212 (2023). Zheng, L. et al. Gender specific factors contributing to cognitive resilience in APOE ɛ4 positive older adults in a population-based sample. Sci. Rep. 13 , 8037 (2023). Szczepańska-Gieracha, J. & Mazurek, J. The role of self-efficacy in the recovery process of stroke survivors. Psychol. Res. Behav. Manag. 897–906 (2020). Li, Z., Shang, N., Fan, G., Li, M. & Zang, Z. Effect of nursing based on the hopeless self-esteem theory plus multi-dimensional intensive nursing for elderly patients with acute cerebral infarction complicated with depression. Am. J. Transl. Res. 13 , 8450 (2021). Abd El-Kader, S. M. & Al-Jiffri, O. H. Aerobic exercise improves quality of life, psychological well-being and systemic inflammation in subjects with Alzheimer’s disease. Afr. Health Sci. 16 , 1045–1055 (2016). Fong, T. C. T., Lo, T. L. T. & Ho, R. T. H. Psychometric properties of the 12-item Stroke-Specific Quality of Life Scale among stroke survivors in Hong Kong. Sci. Rep. 13 , 1510 (2023). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3794487","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":263198096,"identity":"0aeed1b9-4ee7-4a43-9006-3a809ca644cd","order_by":0,"name":"Ji-Eun Lee","email":"","orcid":"","institution":"Dankook University","correspondingAuthor":false,"prefix":"","firstName":"Ji-Eun","middleName":"","lastName":"Lee","suffix":""},{"id":263198097,"identity":"7b2a63cc-ec1f-4ca7-bb10-afd85fc2134e","order_by":1,"name":"Takayuki Akimoto","email":"","orcid":"","institution":"Waseda University","correspondingAuthor":false,"prefix":"","firstName":"Takayuki","middleName":"","lastName":"Akimoto","suffix":""},{"id":263198098,"identity":"45da73fa-bc24-44f2-9315-70eb32eba329","order_by":2,"name":"Ho-Seong Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIie3OMYvCMBTA8ScBb0nPtYdQv0LLA+WgHyahkC7xcOwoCO1yONdvcR+hkqHLE9eucsMtDoKjIIa78STq5pA/hMCDX/IAfL4nLLaHQZFG0NgbQMDv4DYhhQ+SXmnk/G4yeal237O+ypftxsSHQsGgahgWDvL+SYg1T6cr+shkTRpCEkySa7FO94c8VNOvRqMJSvt8B2w9d5L858Rjk8fb/R8Z3SZizLgwwn6HWVBqOwEmnYQIh7xRyarbY1KT4gnJReIkbbU7Bud09LrVGB6KLIpaY95c5F8coPcQ8Pl8Pt+VLmkbTzAD3VFCAAAAAElFTkSuQmCC","orcid":"","institution":"Dankook University","correspondingAuthor":true,"prefix":"","firstName":"Ho-Seong","middleName":"","lastName":"Lee","suffix":""}],"badges":[],"createdAt":"2023-12-23 02:29:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3794487/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3794487/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49075311,"identity":"f1ceb99a-4558-455c-b7fd-fb59fdb1983a","added_by":"auto","created_at":"2024-01-02 18:28:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":703377,"visible":true,"origin":"","legend":"\u003cp\u003eResults of mental health outcomes before and during the exercise program. (A) Grooved Pegboard Test (GPT), (B) Geriatric Depression Scale (GDS), (C) Rosenberg Self-Esteem Scale (RSES), and (D) Stroke-Specific Quality of Life (SS-QOL). *p \u0026lt; 0.05 vs. week 0; \u003csup\u003e†\u003c/sup\u003ep \u0026lt; 0.05 vs. CON; \u003csup\u003e‡\u003c/sup\u003ep \u0026lt; 0.05 vs. RE. \u003cem\u003eCON\u003c/em\u003e control, \u003cem\u003eNS\u003c/em\u003e new sports, \u003cem\u003eRE\u003c/em\u003e resistance exercise.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3794487/v1/d0d6783c9c16f212b89250d2.png"},{"id":56672618,"identity":"3fd36b7b-231c-4faf-9b3f-c8cba87994f2","added_by":"auto","created_at":"2024-05-17 15:16:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1512175,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3794487/v1/b5ae7d21-afb9-4220-afca-c80cb2de8b46.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Long-term combined “new sports” and resistance exercise improves the physical and mental health of elderly people with stroke-associated hemiplegia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHemiplegia is one of the most common disabling sequelae of stroke\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, affecting one in four older adults\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Elderly people with hemiplegia exhibit difficulties in daily life due to decreased muscle and postural control\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e, reduced balance and walking function\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, muscle weakness and stiffness, and reduced joint movements\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. These impairments in physical health also have a negative impact on the person\u0026rsquo;s mental health, such as depression and quality of life (QOL)\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eResistance exercise efficiently increases muscle mass and muscular endurance\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. It is also beneficial for elderly people with hemiplegia by increasing their muscle strength\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. In particular, long-term resistance exercise training improves muscle strength by inducing skeletal muscle hypertrophy\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and improves the physical health of elderly people after stroke\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. However, most exercise intervention studies in elderly people with hemiplegia are limited to relatively short-term interventions (within 8 weeks)\u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA variety of exercise programs have shown beneficial effects on the mental health of elderly people with hemiplegia\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Most previous studies examined the effect of individualized exercise programs rather than group-based exercise programs on cognition and depression\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Individualized exercise is goal-oriented, whereas group exercise focuses on fun, and reduces anxiety and depression\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Group exercise has positive effects on mental health, regardless of the person\u0026rsquo;s age and disease, suggesting that such programs are more effective in promoting exercise participation and persistence than individualized exercise programs\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe idea of \u0026ldquo;new sports\u0026rdquo; has gained popularity after its inception in Europe, following the \u0026ldquo;Sport for All\u0026rdquo; movement, which highlights the benefits of impromptu physical activity in daily life for improving and preserving physical well-being\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. New sports are participant-centered sports that can involve various exercises in a complex manner. New sports have a positive impact on physical activity and fitness\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e and improve interactions and social skills because \u0026ldquo;participation is open to even inexperienced exercisers who are not physically active\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. For instance, the new sport \u0026ldquo;speedminton\u0026rdquo; is a lightweight hybrid of badminton and tennis that is easy to play without a net, and is suitable for people with less physical prowess or lower fitness levels\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Shin et al. introduced \u0026ldquo;new sports tennis\u0026rdquo; as a sport that combines circuit training and tennis skills, including side steps, back steps, and backhand movements, and found that it had positive effects on physical health of postmenopausal women\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Meanwhile \u0026ldquo;new sports softball,\u0026rdquo; which combines the grip movements and manipulation techniques of badminton and tennis, improved physical and mental health of patients with Parkinson\u0026rsquo;s disease\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Nevertheless, few studies have investigated the effects of new sports in elderly people with hemiplegia.\u003c/p\u003e \u003cp\u003eThe aim of this study was to examine the effects of a long-term combined exercise program (new sports\u0026thinsp;+\u0026thinsp;resistance exercise [NS\u0026thinsp;+\u0026thinsp;RE]) on the physical and mental health of elderly people with hemiplegia. We hypothesized that the combined exercise program would improve the participants\u0026rsquo; physical and mental health better than resistance exercise alone.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eThe general characteristics of the subjects are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Sex, age, affected side, time since onset, and MMSE-K scores were not significantly different among the NS\u0026thinsp;+\u0026thinsp;RE, RE, and CON groups. No dropouts or adverse events were reported during the course of the study.\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\u003eParticipant characteristics. Values are means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or number of participants. \u003cem\u003eNS\u003c/em\u003e new sports, \u003cem\u003eRE\u003c/em\u003e resistance exercise, \u003cem\u003eCON\u003c/em\u003e control, \u003cem\u003eMMSE-K\u003c/em\u003e Korean Mini-Mental State Examination.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRE (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCON (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\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\u003e4/6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3/7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.873\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\u003e69.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffected side (right/left)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3/7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime since onset (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.90\u0026thinsp;\u0026plusmn;\u0026thinsp;5.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE-K score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePhysical health\u003c/h2\u003e \u003cp\u003eThe changes in the physical health outcomes are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for ROM and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for BBS, FGA, and IADL. SE and HE increased significantly in the NS\u0026thinsp;+\u0026thinsp;RE group at 8, 16, and 24 weeks of the exercise program compared with the RE and CON groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, SE and HE increased significantly in the RE group at 8, 16, and 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). KF, KF, DF, and PF increased significantly in the NS\u0026thinsp;+\u0026thinsp;RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Within the NS\u0026thinsp;+\u0026thinsp;RE group, SF, SE, HF, HE, KF, DF, and PF were significantly increased at 8, 16, and 24 weeks compared with the pre-exercise (0 weeks) values (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Within the RE group, SF, SE, HE, KF, DF, and PF were significantly increased at 8, 16, and 24 weeks, and HF was significantly increased at 16 and 24 weeks compared with the pre-exercise values (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eROM before and during the exercise program in the NS\u0026thinsp;+\u0026thinsp;RE, RE, and CON groups. Values are means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. pre-exercise (week 0); \u003csup\u003e\u0026dagger;\u003c/sup\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. CON; \u003csup\u003e\u0026Dagger;\u003c/sup\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. RE. \u003cem\u003eROM\u003c/em\u003e range of motion, \u003cem\u003eNS\u003c/em\u003e new sports, \u003cem\u003eRE\u003c/em\u003e resistance exercise, \u003cem\u003eCON\u003c/em\u003e control, \u003cem\u003eSF\u003c/em\u003e shoulder flexion, \u003cem\u003eSE\u003c/em\u003e shoulder extension, \u003cem\u003eHF\u003c/em\u003e hip flexion, \u003cem\u003eHE\u003c/em\u003e hip extension, \u003cem\u003eKF\u003c/em\u003e knee flexion, \u003cem\u003eDF\u003c/em\u003e ankle dorsiflexion, \u003cem\u003ePF\u003c/em\u003e ankle plantarflexion, \u003cem\u003eG\u003c/em\u003e group, \u003cem\u003eT\u003c/em\u003e timepoint.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-exercise\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 weeks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 weeks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 weeks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF\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\u003eSF (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e119.80\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e122.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e123.70\u0026thinsp;\u0026plusmn;\u0026thinsp;5.44*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e125.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;2.866\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;5.571*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;6.775*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e121.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e123.40\u0026thinsp;\u0026plusmn;\u0026thinsp;5.21*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e123.90\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e125.70\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e119.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e119.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e119.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e116.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSE (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e38.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98*\u003csup\u003e\u0026dagger;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e39.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50*\u003csup\u003e\u0026dagger;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e39.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;33.251*\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;22.016*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;7.994*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e35.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e36.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e37.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e31.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e32.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e31.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHF (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e84.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e86.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e88.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e89.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;1.149\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;11.356*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;2.882*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e87.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e88.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e89.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e89.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.30*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e87.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e87.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e87.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e87.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHE (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58*\u003csup\u003e\u0026dagger;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e16.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66*\u003csup\u003e\u0026dagger;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e16.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42*\u003csup\u003e\u0026dagger;\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;10.894*\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;29.525*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;10.160*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e12.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e13.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e10.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eKF (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e104.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e109.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.91*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e111.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e116.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;3.881*\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;15.907*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;10.356*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e105.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e110.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e111.70\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e114.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e105.90\u0026thinsp;\u0026plusmn;\u0026thinsp;7.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e104.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e104.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e102.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDF (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e12.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e13.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;17.382*\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;74.115*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;20.176*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e11.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e13.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e6.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e7.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e6.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePF (\u0026deg;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e14.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e14.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;46.689*\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;60.870*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;16.803*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e13.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e14.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11*\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e7.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e6.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e7.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\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 \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\u003eBBS, FGA, and IADL before and during the exercise program in the NS\u0026thinsp;+\u0026thinsp;RE, RE, and CON groups. Values are means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. pre-exercise (week 0); \u003csup\u003e\u0026dagger;\u003c/sup\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. CON; \u003csup\u003e\u0026Dagger;\u003c/sup\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. RE. \u003cem\u003eBBS\u003c/em\u003e Berg Balance Scale, \u003cem\u003eFGA\u003c/em\u003e Functional Gait Assessment, \u003cem\u003eIADL\u003c/em\u003e Instrumental Activities of Daily Living, \u003cem\u003eNS\u003c/em\u003e new sports, \u003cem\u003eRE\u003c/em\u003e resistance exercise, \u003cem\u003eCON\u003c/em\u003e control, \u003cem\u003eG\u003c/em\u003e group, \u003cem\u003eT\u003c/em\u003e timepoint.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-exercise\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 weeks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 weeks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 weeks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF\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\u003eBBS (score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e31.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e40.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27*\u0026dagger;\u0026Dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;30.166*\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;111.700*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;32.810*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.83*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e30.70\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e36.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e23.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e23.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e23.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFGA (score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e21.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e21.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;4.077*\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;37.843*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;8.162*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e20.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e20.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e16.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIADL (score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNS\u0026thinsp;+\u0026thinsp;RE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e18.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e18.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eG\u0026thinsp;=\u0026thinsp;99.260*\u003c/p\u003e \u003cp\u003eT\u0026thinsp;=\u0026thinsp;102.479*\u003c/p\u003e \u003cp\u003eG \u0026times; T\u0026thinsp;=\u0026thinsp;27.080*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e18.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e18.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42*\u0026dagger;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e24.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e24.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e25.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\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\u003eBBS increased significantly in the NS\u0026thinsp;+\u0026thinsp;RE group at 24 weeks compared with the RE and CON groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, BBS increased significantly in the NS\u0026thinsp;+\u0026thinsp;RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). FGA increased significantly in the NS\u0026thinsp;+\u0026thinsp;RE and RE groups at 16 and 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). IADL decreased significantly in the NS\u0026thinsp;+\u0026thinsp;RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Within the NS\u0026thinsp;+\u0026thinsp;RE and RE groups, BBS, FGA, and IADL were significantly improved at 8, 16, and 24 weeks compared with the pre-exercise values (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMental health\u003c/h2\u003e \u003cp\u003eThe changes in mental health are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. GPT significantly decreased in the NS\u0026thinsp;+\u0026thinsp;RE group compared with both the RE and CON groups at 16 and 24 weeks of the exercise program (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, GPT decreased significantly in the NS\u0026thinsp;+\u0026thinsp;RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). GDS decreased significantly in the NS\u0026thinsp;+\u0026thinsp;RE group at 24 weeks compared with the RE and CON groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, GDS decreased significantly in the NS\u0026thinsp;+\u0026thinsp;RE and RE groups at 8, 16, and 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). RSES increased significantly in the NS\u0026thinsp;+\u0026thinsp;RE group at 8, 16, and 24 weeks compared with the RE and CON groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, RSES increased significantly in the RE group at 8, 16, and 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). SS-QOL increased significantly in the NS\u0026thinsp;+\u0026thinsp;RE group at 8, 16, and 24 weeks compared with the RE and CON groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, SS-QOL increased significantly in the RE group at 24 weeks compared with the CON group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Within the NS\u0026thinsp;+\u0026thinsp;RE and RE groups, GPT, GDS, RSES, and SS-QOL were significantly improved at 8, 16, and 24 weeks compared with the pre-exercise values (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe hypothesized that a combined new sports and resistance exercise program would achieve greater improvements in physical and mental health compared with resistance exercise alone. Our findings support our hypothesis about the gains in physical and mental health outcomes: the NS+RE group showed greater improvements in ROM, RSES, and SS-QOL from 8 weeks, GPT from 16 weeks, and BBS and GDS from 24 weeks of the program compared with the RE group.\u003c/p\u003e\n\u003cp\u003eExercise programs for elderly people with post-stroke hemiplegia have only been evaluated over a short period of time, generally 4\u0026ndash;8 weeks\u003csup\u003e11\u0026ndash;13\u003c/sup\u003e, and there has not been any extensive research examining the effects of long-term exercise in this setting. We designed the present study to determine the long-term effect of the\u0026nbsp;combined exercise program on the physical health of elderly people with post-stroke hemiplegia because Snijders et al. suggested that a long-term, consistent exercise program was needed for elderly people to experience the full benefits of resistance training\u003csup\u003e38\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eShrestha et al. suggested that multidirectional step exercises, which include weight shifting, are more effective for improving balance and gait than a single-mode exercise\u003csup\u003e17\u003c/sup\u003e. Previous studies also revealed that exercise on an unstable surface and weight shifting training can improve the balance ability of chronic stroke patients\u003csup\u003e38\u0026ndash;42\u003c/sup\u003e. The new sports program used in this study requires body weight shifting, such as side steps, and back steps with forehand and backhand movements\u003csup\u003e25,43\u0026ndash;46\u003c/sup\u003e. We found that BBS increased by 58.3% in the RE group compared with 77% in the NS+RE group at 24 weeks of the intervention.\u0026nbsp;A previous\u0026nbsp;study\u0026nbsp;also reported that BBS increased by 21% in elderly people with stroke after 4 weeks of\u0026nbsp;exercise training with\u0026nbsp;weight shifting and multidirectional stepping\u003csup\u003e17\u003c/sup\u003e. These results suggest that the combination of new sports and resistance exercises synergistically improves balance ability more effectively than resistance exercise alone. The multidirectional exercises activate muscles and improve proprioception and overall stability, all of which may contribute to a more comprehensive enhancement of balance ability\u003csup\u003e17,47\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eFGA and IADL improved in the NS+RE and RE groups, suggesting that the combined program and resistance exercise is effective in terms of maintaining and improving functional walking and instrumental daily living. This finding also supports the notion that resistance exercise is recommended for elderly people with hemiplegia to improve their activities of daily living.\u003c/p\u003e\n\u003cp\u003eWe used several assessments to evaluate the changes in mental health after the exercise program. It was reported that racquet sports improve athletic ability as well as executive capacity\u003csup\u003e48\u003c/sup\u003e. In particular, tennis and badminton were helpful in terms of improving and sustaining cognition in elderly individuals\u003csup\u003e49\u003c/sup\u003e. Furthermore, participation in a new sports activity (a bowling game) was shown to improve hand coordination during everyday activities such as using a spoon and dressing\u003csup\u003e50\u003c/sup\u003e. The NS+RE group in our study demonstrated a sustained decrease in GPT at 16 and 24 weeks compared with the RE group, which is consistent with a prior study\u003csup\u003e51\u003c/sup\u003e. These findings suggest that a combined exercise program can improve the cognitive abilities of elderly people with hemiplegia.\u003c/p\u003e\n\u003cp\u003eThe change in GDS in this study is particularly noteworthy. In the RE group, the GDS score improved from 22.10 points at 0 weeks to 19.60 points at 24 weeks, corresponding to a change from \u0026ldquo;severe depression\u0026rdquo; to \u0026ldquo;moderate depression\u0026rdquo;. By contrast, the NS+RE group showed a much greater improvement, decreasing from 22.50 points at 0 weeks to 16.50 points at 24 weeks, a shift from \u0026ldquo;severe depression\u0026rdquo; to \u0026ldquo;mild depression.\u0026rdquo; This change was noticeable from 16 weeks onwards. This suggests that the combined exercise program may effectively reduce depressive symptoms\u0026nbsp;of elderly people with\u0026nbsp;hemiplegia.\u003c/p\u003e\n\u003cp\u003ePeople affected by chronic stroke often exhibit poor self-esteem, and active participation in rehabilitation can improve self-esteem and QOL\u003csup\u003e52\u003c/sup\u003e.\u0026nbsp;Additionally, self-efficacy plays a crucial role in the rehabilitation and recovery of elderly people affected by chronic stroke because higher levels of self-efficacy are linked to setting and achieving more ambitious self-goals\u003csup\u003e53\u003c/sup\u003e. A study showed that intensive nursing care improved the RSES by 14% in elderly people with depression\u003csup\u003e54\u003c/sup\u003e, while another study reported that 8 weeks of exercise increased RSES in stroke patients by 15%\u003csup\u003e55\u003c/sup\u003e. In this study, the RSES of the RE group increased by 14% after 8 weeks of program, consistent with prior studies\u003csup\u003e54,55\u003c/sup\u003e, whereas the RSES of the NS+RE group increased by 29% at 8 weeks. The measured improvement in self-esteem is likely to have resulted from active participation in an exercise program. This suggests that active participation in a structured program led to an improvement in self-esteem.\u003c/p\u003e\n\u003cp\u003eThe SS-QOL score must increase by\u0026nbsp;\u0026gt;7 points to confirm the effect of a treatment or intervention\u003csup\u003e56\u003c/sup\u003e. In this study, the SS-QOL increased by 6.8 points at 8 weeks in the RE group, and by 10 points in the NS+RE group, indicating that the combined exercise program was more effective in terms of improving QOL. Taken together, our findings indicate that the combined exercise program significantly improved cognitive function, depressive symptoms, self-efficacy, and QOL, and these improvements in mental health could be attributed to the improvement in physical health.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eLimitations\u003c/h2\u003e\n\u003cp\u003eOur study has several limitations. The sample size of the study may be limited although it is difficult to recruit a large number of people with hemiplegia. An extensive and diverse sample size could provide greater insights into the generalizability of the results. In this study, we did not collect information regarding the participants\u0026rsquo; medication usage or lifestyle, and it is unclear whether external factors may have influenced the results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe improvements in shoulder and hip joint ROM, balance, cognition, depression, self-esteem, and SS-QOL were notably more effective in the NS+RE group than in the RE and CON groups in this study of elderly people with post-stroke hemiparesis. These results imply that a combined new sports and resistance exercise program is more effective than resistance exercise alone in terms of improving physical and mental health. Future studies should consider broadening the scope to encompass a wider range of disability types and age groups among elderly people with post-stroke hemiplegia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis clinical trial (KCT0008524) was conducted at the Health and Welfare Center in Dangjin City, Republic of Korea, from April 2023 to October 2023. It was approved by the ethics committee at Dankook University (IRB number: DKU-2021-05-046) and adhered to the principles outlined in the Declaration of Helsinki and its subsequent amendments or comparable ethical standards. All participants provided informed consent through signed agreements.\u003c/p\u003e \u003cp\u003e Although our institution\u0026rsquo;s ethics committee did not initially require clinical trial registration, we retrospectively registered the study with the Clinical Research Information Service (CRIS) of the Republic of Korea, an entity approved by the World Health Organization (registration number KCT0008524). We initiated the registration process in April 2023 and successfully completed retroactive registration in June 2023. Throughout the study, we strictly adhered to the protocol without any deviations in methodology.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis study included 30 elderly people, aged 65\u0026ndash;74, with a diagnosis of stroke, who were registered at a public health and welfare center located in D City. Participants were eligible if they were diagnosed with stroke\u0026thinsp;\u0026ge;\u0026thinsp;12 months ago, could walk independently for \u0026ge;\u0026thinsp;10 m, and their Korean Mini-Mental State Examination score (MMSE-K) was \u0026ge;\u0026thinsp;24. People with mental disabilities, visual or hearing impairment, or a risk of tumor or infection were excluded. The participants were randomly assigned to the NS\u0026thinsp;+\u0026thinsp;RE (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10), resistance exercise (RE, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10), or control (CON, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10) groups for 24 weeks. The control group did not perform any sports or resistance exercises.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eInterventions\u003c/h2\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003eNew sports\u003c/h2\u003e \u003cp\u003eDetails of the new sports program are provided in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The NS\u0026thinsp;+\u0026thinsp;RE group performed new sports once weekly for 60 min per session for 24 weeks. The new sports program consists of a 10-min warm-up, 40 min of playing the new sport, and a 10-min cool-down. The program comprised eight sports, which considered limits in the participants\u0026rsquo; motor function resulting from stroke-related hemiplegia. The sports were hangung, speedminton, bowling, big ball, hook ball, yutnori, bolo ball, and soft tennis. The participants were educated about fall prevention prior to beginning the exercises, and a team comprising a physical therapist, an occupational therapist, and an assistant was assigned to prevent falls and accidents. The new sports are described in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\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\u003eNew sports program. \u003cem\u003eRPE\u003c/em\u003e rating of perceived exertion.\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\u003eOrder\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eContents and timing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntensity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWarm-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStretching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRPE 9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eMain exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1, 9, 17 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHangung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e40 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eRPE 11\u0026ndash;13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2, 10, 18 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpeedminton\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3, 11, 19 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBowling\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4, 12, 20 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBig Ball\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5, 13, 21 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHookball\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6, 14, 22 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYutnori\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7, 15, 23 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBolo ball\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8, 16, 24 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSoft tennis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCool-down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStretching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRPE 9\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 \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of the new sports.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eName\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHangung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsing each hand in turn to throw a dart (diameter 8 mm, length 81 mm, weight 4 g; Hangung Globalization Research Institute, Republic of Korea) at a target (diameter 39.5 cm; Hangung Globalization Research Institute, Republic of Korea) located 3 m away.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpeedminton\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBouncing a rubber ball (diameter 6 cm, weight 8 g; Speedminton GmbH, Berlin, Germany) on a lightweight racquet (63 cm \u0026times; 29 cm \u0026times; 9 cm, weight 170 g; Speedminton GmbH, Berlin, Germany).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBowling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsing a rubber bowling ball (diameter 17 cm, weight 700 g; New Sports Industry, Seoul, Republic of Korea) to knock down bowling pins (height 38 cm, diameter 12 cm, weight 500 g; New Sports Industry, Seoul, Republic of Korea) located 3 m away.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBig ball\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRolling a large cube (diameter 50 cm, weight 1.5 kg; New Sports Industry, Seoul, Republic of Korea) made of sturdy nylon fabric.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHook ball\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThrowing a velcro ball (diameter 9 cm, weight 50 g; Kumwoosports, Paju, Republic of Korea) at a target on a wall (120 cm \u0026times; 160 cm; Kumwoosports, Paju, Republic of Korea) located 5 m away.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYutnori\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA variation of the traditional Korean board game Yutnori that employs four wooden sticks that serve a similar purpose to dice, being thrown to determine how far a player can advance their game piece on the board.\u003c/p\u003e \u003cp\u003eFour giant sponge sticks (yut sticks) (60 cm \u0026times; 15 cm; Worldtoy, Siheung, Republic of Korea) are thrown with both hands, and the game piece (diameter 3.5 cm; Worldtoy, Siheung, Republic of Korea) is advanced on a yut board (50 cm \u0026times; 45 cm; Worldtoy, Siheung, Republic of Korea) according to the way the sticks land.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBolo ball\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThrowing a bolo (two balls joined by a string; diameter of each ball 5 cm, weight 50 g, string length 35 cm; New Sports Industry, Seoul, Republic of Korea) at a ladder-shaped target (width 62 cm \u0026times; depth 122 cm \u0026times; height 100 cm; New Sports Industry, Seoul, Republic of Korea) located 5 m away with the goal of suspending the bolo from the ladder rungs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft tennis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsing a short racquet (59.5 cm \u0026times; 25 cm; New Sports Industry, Republic of Korea) to hit a sponge ball (diameter 9 cm; New Sports Industry, Seoul, Republic of Korea) back and forth between two players.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eResistance exercise\u003c/h2\u003e \u003cp\u003eDetails of the resistance exercise program are provided in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. The NS\u0026thinsp;+\u0026thinsp;RE and RE groups performed resistance training three times per week for 75 min per session for 24 weeks. The exercise program consisted of a 10-min warm-up, 50 min of resistance exercise, a 5-min break, and a 10-min cool-down. The participants rested for 10 s between sets and between each exercise. Upper and lower limb exercise equipment (Orthopedic Passive Exercise Equipment, Shin Gwang, Paju, Republic of Korea) was used for upper and lower limb active training, and isokinetic strength equipment (Milon Circuit Training System, Milon, Emersacker, Germany) was used for leg extensions, leg curls, pull-ups, pull-downs, abdominal crunches, and back extensions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResistance exercise program. \u003cem\u003eRPE\u003c/em\u003e rating of perceived exertion\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\u003eOrder\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eContent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntensity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWarm-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStretching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRPE 9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eMain exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper and lower limb active exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRPE 11\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeg extension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e3 s, 10 repetitions, 3 sets\u003c/p\u003e \u003cp\u003eRest between sets: 10 s\u003c/p\u003e \u003cp\u003eRest between exercise: 30 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e35 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eRPE 11\u0026ndash;13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeg curl\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePull up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePull down\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal crunch\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBack extension\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCool-down\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStretching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRPE 9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003ePhysical health\u003c/h2\u003e \u003cp\u003eThe range of motion (ROM), Berg Balance Scale (BBS), Functional Gait Assessment (FGA), and Instrumental Activities of Daily Living (IADL) were determined before (0 weeks) and at 8, 16, and 24 weeks during the study period.\u003c/p\u003e \u003cp\u003eA goniometer (Saehan Corporation, Changwon, Republic of Korea) was used to measure the ROM of the shoulder and knee joints. The active ROM was measured for shoulder flexion (SF), shoulder extension (SE), hip flexion (HF), hip extension (HE), knee flexion (KF), ankle dorsiflexion (DF), and ankle plantarflexion (PF). The measurements were performed three times, and the average value was used. The reliability is 0.89\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBBS is an assessment of independent functional movements, consisting of 14 items rated on a 5-point scale (scale: 0\u0026ndash;4), with a total score of 56 points\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. The assessment evaluates various tasks, including rising from a seated position, standing unsupported, sitting down without backrest assistance, sitting to standing, transitioning, standing with eyes closed, bringing both feet together while standing, reaching forward with arms while standing, picking up objects from the floor while standing, turning both shoulders around while standing, making a 360-degree turn, placing both feet alternately on a step while standing, standing on one foot, and standing on one foot without support. The reliability is 0.98\u003csup\u003e27\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFGA was developed by Wrisley et al. to evaluate gait\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. It comprises 10 items scored on a scale of 0\u0026ndash;3 points with a total score of 30 points. The specific items are walking on a level surface, changing walking speed, turning the head to the side while walking, moving the head up and down while walking, walking with one foot as an axis, walking around obstacles, gait with a narrow base of support, walking with eyes closed, walking backward, and climbing stairs. The reliability is 0.93\u003csup\u003e28\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIADL is a tool developed by Won et al. that comprises 10 items scored on a scale of 1\u0026ndash;3\u003csup\u003e29\u003c/sup\u003e. Ten items cover grooming, chores, preparing meals, washing clothes, going out a short distance, using transport, buying goods, managing money, using a phone, and taking medicine. Higher scores indicate lower dependence in performing activities of daily living. The reliability is 0.93\u003csup\u003e29\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMental health\u003c/h2\u003e \u003cp\u003eThe Grooved Pegboard Test (GPT), Geriatric Depression Scale (GDS), Rosenberg Self-Esteem Scale (RSES), and Stroke-Specific Quality of Life (SS-QOL) were evaluated before and at 8, 16, and 24 weeks during the study period.\u003c/p\u003e \u003cp\u003eGPT is a neuropsychological test in which the participant places pegs into a grooved pegboard (Sammons Preston, Bolingbrook, USA) that contains 25 key-shaped holes\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. The holes are 25 irregularly oriented grooves aligned in a 5 \u0026times; 5 layout. The time it takes to insert every key-shaped peg into an irregularly oriented groove in a single direction was measured in seconds. Slower completion times are indicative of impaired cognitive abilities. The reliability is 0.74\u003csup\u003e31\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGDS is a self-report instrument that uses yes/no responses to evaluate overall depression in elderly people\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. It comprises 30 questions about the person\u0026rsquo;s interest in and contentment with activities and daily life, excluding physical symptoms. The total score is 30 points. Scores between 14 and 18 indicate mild depression, scores between 19 and 21 indicate moderate depression, and scores of \u0026ge;\u0026thinsp;22 indicate severe depression. The reliability is 0.88\u003csup\u003e33\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRSES is a self-report tool consisting of 10 items for evaluating self-esteem on a 4-point scale (scale 1\u0026ndash;4), based on self-centered positivity, preciousness, success, and value\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. The total score is 40 points. The tool comprises 5 positive and 5 negative items, and the negative items are reverse-scored. Scores of 10\u0026ndash;19 indicate low self-esteem, scores of 20\u0026ndash;29 indicate moderate self-esteem, and scores of \u0026ge;\u0026thinsp;30 indicate a healthy level of self-esteem. The reliability is 0.73\u003csup\u003e35\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSS-QOL is composed of 12 domains with 49 items rated on a 5-point scale (scale 1\u0026ndash;5), with a maximum score of 245 points\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. The 12 domains cover energy, family role, language use, mobility, mood, personal characteristics, self-help activities, social roles, thinking, arm and hand function, vision, and occupation-productivity activities. The reliability is 0.88\u003csup\u003e36\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSample size and statistical analysis\u003c/h2\u003e \u003cp\u003eFor repeated-measures analysis of variance (ANOVA) involving three groups, the appropriate sample size was estimated using G*Power software (version 3.1.9.7, Heinrich-Heine-Universit\u0026auml;t D\u0026uuml;sseldorf, D\u0026uuml;sseldorf, Germany). The calculation included an effect size of 0.25, an alpha level of 0.05, a power of 0.80, three groups, four measurements, and a correlation of 0.5 between repeated measurements\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Based on the analysis, the recommended sample size was 30 participants.\u003c/p\u003e \u003cp\u003eData were analyzed using SPSS 23.0 software (SPSS, Chicago, IL, USA). The general characteristics of the participants, prior to starting the interventions, were examined using descriptive statistics and one-way ANOVA. Differences between groups and timepoints were examined by two-way repeated-measures ANOVA. Pairwise differences between groups were evaluated using Tukey\u0026rsquo;s honestly significant difference post-hoc test. Values of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2022S1A5B5A17043949).\u003c/p\u003e\n\u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003eJ.E.L. and H.S.L. conceived of and designed the study. J.E.L. conducted the experiment. J.E.L. and T.A. performed data analysis. J.E.L. and T.A. wrote the manuscript. All authors participated in the manuscript review. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest regarding the publication of this paper.\u003c/p\u003e\n\u003cp\u003eData Availability\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are openly available on Figshare (https://doi.org/10.6084/m9.figshare.24847521).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLee, H.-J. \u003cem\u003eet al.\u003c/em\u003e Analysis of medical service utilization for post-stroke sequelae in Korea between 2016 and 2018: a cross-sectional study. \u003cem\u003eSci. Rep.\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 20501 (2022).\u003c/li\u003e\n\u003cli\u003eFeigin, V. L. \u003cem\u003eet al.\u003c/em\u003e World Stroke Organization (WSO): global stroke fact sheet 2022. \u003cem\u003eInt. J. 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Rep.\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 1510 (2023).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3794487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3794487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"In this study, we examined the effects of 24 weeks of a combined “new sports” and resistance exercise program on the physical and mental health of elderly people with hemiplegia. Thirty elderly people aged 65–74 years with hemiplegia were randomly divided into combined new sports and resistance exercise (NS+RE), resistance exercise (RE), and control groups. Indicators of physical health (range of motion [ROM], Berg Balance Scale [BBS], Functional Gait Assessment, and Instrumental Activities of Daily Living) and mental health (Grooved Pegboard Test [GPT], Geriatric Depression Scale [GDS], Rosenberg Self-Esteem Scale [RSES], and Stroke-Specific Quality of Life [SS-QOL]) were measured before and at 8, 16, and 24 weeks of exercise training. Compared with the RE and control groups, the NS+RE group showed significant improvements in ROM, RSES, and SS-QOL starting at 8 weeks, GPT starting at 16 weeks, and BBS and GDS at 24 weeks. We conclude that combined new sports and resistance exercise was more effective than resistance exercise alone in terms of improving the physical and mental health of elderly people with hemiplegia. Our findings highlight the importance of integrating new sports into rehabilitation strategies and sustaining long-term exercise for lasting benefits.","manuscriptTitle":"Long-term combined “new sports” and resistance exercise improves the physical and mental health of elderly people with stroke-associated hemiplegia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-02 18:28:46","doi":"10.21203/rs.3.rs-3794487/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9537d20a-e3d7-493d-95ff-53010f490321","owner":[],"postedDate":"January 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":27768211,"name":"Health sciences/Health care"},{"id":27768212,"name":"Health sciences/Health care/Geriatrics"},{"id":27768213,"name":"Health sciences/Neurology/Neurological disorders/Stroke"}],"tags":[],"updatedAt":"2024-05-17T15:08:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-02 18:28:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3794487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3794487","identity":"rs-3794487","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}