Effectiveness of Smart-Assisted Rehabilitation Exercise Training on the Physical and Mental Health of Older Adults in Long-Term Care Facilities

This clinical trial aims to evaluate the effectiveness of a 12-week exercise intervention using an intelligent rehabilitation assistance system (KNEESUP) in improving the physical and mental health of institutionalized older adults with sarcopenia in long-term care facilities.

With the rapid aging of the population, long-term care institutions have become crucial in supporting the quality of life for older adults. Residents in these settings often face compounded challenges, including chronic illnesses, reduced physical function, cognitive decline, and psychosocial issues such as loneliness and depression. These conditions increase the burden on healthcare systems and care staff. While exercise interventions are known to be effective in promoting physical and mental well-being in older adults, traditional standardized programs may lack individualization and precision.

This study introduces a smart rehabilitation system that combines wearable technology and personalized exercise prescriptions designed by a physical medicine and rehabilitation physician. The system allows real-time monitoring and feedback, which enhances safety, motivation, and adherence. The intervention aligns with trends in post-pandemic digital health solutions and aims to integrate medical technology into routine elder care.

Study Design A randomized controlled trial will be conducted. Eligible participants (aged ≥65 with sarcopenia, able to stand with assistance or walk with/without aid, and cognitively intact) will be randomly assigned to either an intervention or control group in a 1:1 ratio. The sample size was calculated using G*Power, estimating 42 participants to account for a 20% dropout rate.

Intervention group: Receives a 12-week progressive resistance training program using the KNEESUP smart rehabilitation system. Training will occur 3 times per week, twice per day, totaling 72 sessions. Exercises include lower-limb strengthening through progressive stages (bed, seated, and standing), designed by a team of multidisciplinary experts and monitored via wearable sensors.

Control group: Continues routine care and usual physical activity without additional intervention.

Outcome Measures

Participants will be assessed pre- and post-intervention on the following variables:

Sarcopenia indicators: Grip strength, limb circumference

Joint range of motion: Measured with goniometer (upper limbs) and the KNEESUP system (lower limbs)

Cognitive function: Short Portable Mental Status Questionnaire (SPMSQ)

Daily living function: Barthel Index

Functional status: Comprehensive Geriatric Assessment (CGA)

Quality of life: WHOQOL-BREF (Taiwan version)

Emotional state: Geriatric Depression Scale (GDS-15)

Basic demographic and lifestyle data: Age, sex, education, comorbidities, social support, and physical activity habits

Statistical Analysis Data will be analyzed using SPSS. Descriptive statistics (mean, SD, percentage) and inferential statistics (independent t-tests, chi-square tests, ANOVA, and generalized estimating equations [GEE]) will be used to assess within-group and between-group differences, and group × time interaction effects. Significance is set at α = 0.05.

Data Management and Confidentiality All data will be anonymized. Paper and electronic data will be securely stored and encrypted. Data will be destroyed 5 years after study completion. Only authorized personnel will have access.

Ethical Considerations The study has IRB approval and informed consent will be obtained from all participants or their legal guardians. Risks (e.g., muscle soreness or fatigue) will be mitigated with one-on-one supervision. Emergency procedures and referral systems are in place if adverse events occur.

Expected Impact This study is expected to provide evidence supporting the feasibility and effectiveness of smart rehabilitation systems in long-term care. It may serve as a model for future eldercare strategies, inform policy, and contribute to the development of precision geriatric rehabilitation approaches.

Inclusion criteria

• Adults aged 65 years or older residing in long-term care facilities and diagnosed with sarcopenia, defined as:

• Handgrip strength: <28 kg for males or <18 kg for females, or
• Calf circumference (10 cm below the knee): <34 cm for males or <33 cm for females.
• Able to stand with assistive devices (e.g., walker), transfer from bed to chair using a wheelchair, or ambulate independently.
• Clear consciousness, able to communicate, and able to provide informed consent.
• Willing to participate and comply with the exercise intervention.

Exclusion criteria

• Impaired consciousness.
• Unsuitable for wearing the device due to any leg-related medical condition.
• Unable to perform aerobic or resistance training due to neurological or musculoskeletal disorders.
• History of head injury resulting in cognitive impairments such as memory or attention deficits.
• Assessed by a rehabilitation specialist as having absolute or relative contraindications to exercise training, such as:

• Severe myocardial ischemia
• Myocardial infarction within the past 6 months
• Unstable angina
• Uncontrolled arrhythmias causing symptoms or hemodynamic instability
• Severe aortic valve stenosis
• Deemed unsuitable to participate in the study by a rehabilitation specialist due to conditions such as end-stage renal disease requiring dialysis, terminal cancer, or ongoing chemotherapy/radiation therapy.
• Diagnosed with depression or experienced major life events in the past six months.
• Fracture, sports injury of the limbs, stroke, dementia, or other major illness within the past six months.
• Individuals with infectious disease risks.