Impact of frailty level on the effectiveness of exercise interventions in community-dwelling older adults with(pre)frailty:a subgroup analysis of a stepped-wedge design trial
QIAO Xiaoxia
ZHU Ruifang
ZHOU Wendie
WANG Cuili
Abstract：Objective:To explore the impact of frailty level on the effectiveness of exercise interventions in community-dwelling older adults with(pre)frailty,and to provide a reference for developing stage-matched intervention strategies.Methods:A stepped-wedge design trial was conducted in three steps,involving 149(pre)frail older adults from six communities in Jinzhong city,Shanxi province.A 12-week exercise intervention was implemented,and multilevel models were used to analyze the immediate effects(at the end of the intervention)and sustained effects(12 and 24 weeks after the intervention)of baseline(pre)frailty level on the outcomes.Primary outcomes included frailty and frailty-related indicators(muscle mass,muscle strength,and physical performance).Secondary outcomes included physical health indicators(disability and fear of falling),mental health indicators(cognitive function and depressive symptom),and comprehensive social health indicators(social support and quality of life).Results:The exercise intervention was effective for most primary outcomes in the pre-frailty subgroup at baseline.Specifically,it reduced(pre)frailty scores(β=-0.640,-0.284,P<0.05),increased muscle mass(β=4.174,P=0.001)and grip strength(β=3.898,5.329,P<0.05),improved balance(β=0.204,0.236,P<0.05),and shortened the timed"Up&Go"test duration(β=-1.556,P=0.018).In the(pre)frailty subgroup at baseline,the intervention improved(pre)frailty(β=-1.163 to-1.100,P<0.001),muscle mass(β=2.413,5.049,P<0.05),grip strength(β=5.957,P=0.027),and 4-meter gait speed(β=0.439,P=0.042),but had no significant effects on short physical performance battery,balance,five-times sit-to-stand test,or timed"up&go"test(P>0.05).For secondary outcomes,the exercise intervention improved basic activities of daily living(β=1.809,P=0.022)and instrumental activities of daily living(β=2.612,P=0.004),enhanced social support(β=6.106-11.467,P<0.05),and improved the mental health domain of quality of life(β=5.007-10.966,P<0.05)in the pre-frailty subgroup.In the frailty subgroup,in addition to improving basic activities of daily living(β=1.688,2.424,P<0.05),instrumental activities of daily living(β=3.201,P=0.017),social support(β=7.421-16.094,P<0.01),and the mental health domain(β=11.103-16.726,P<0.05),it also alleviated depressive symptoms(β=-0.807--0.594,P<0.05)and enhanced the physical health domain of quality of life(β=8.923-17.129,P<0.05).Conclusions:Frailty level influences both the breadth and intensity of the effectiveness of exercise interventions in community-dwelling older adults with(pre)frailty.Future research should develop frailty-level-adapted interventions to promote precision nursing and enhance intervention efficacy.
Keywords：the aged(pre)frailtyexercise interventionbalance abilityactivities of daily livingquality of lifesocial supportstepped-wedge trial
Publication Date：2025-11-10
Online Publishing Date：2025-11-13(First online date of this platform, not the publication date of the document)
Pages：8( 3559-3566 )