Effects of Assessment and Verbal Feedback on Physical Function and Exercise Adherence in Healthy Older Adults

This study is a pilot RCT that included healthy adults aged 65 years and older, with active registration in the Senior Citizens' Centers (KAPI) of the Municipality of Nikaia-Agios Ioannis Rentis, Athens, Greece. Ethical approval for the study was obtained from the Ethics Committee of the University of West Attica (Protocol No. 107620/24-10-2025) before study initiation.

Prior to participation, all eligible candidates received written information about the study and their voluntary participation, and provided written informed consent in accordance with the Declaration of Helsinki. Candidates who confirmed their willingness to participate were subsequently screened for eligibility based on the inclusion and exclusion criteria and they were allocated into two groups using a randomized procedure. Group allocation was known to the participants; however, the physiotherapist delivering the exercise program was blind to group assignment (intervention or control).

All participants followed the same structured and supervised exercise program, delivered by a municipal physiotherapist, with a duration of 12 weeks and a frequency of two sessions per week and a 48-hour interval between sessions. Each session lasted approximately 50 minutes and included warm-up, main exercise, and cool-down components. Exercise intensity was moderate, individually adapted based on perceived exertion, and progressively increased over time.

At baseline assessment, all participants completed the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2) to assess exercise motivation, the Activities-specific Balance Confidence (ABC) Scale to evaluate self-reported balance confidence during activities of daily living, and the Self-Efficacy for Exercise (SEE) Scale. Physical performance and functional mobility were assessed using the Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG) test. Exercise adherence was monitored throughout the intervention period by means of attendance records completed at each session.

Participants allocated to the intervention group underwent three additional assessments at weeks 3, 6, and 9 using the TUG test and the ABC Scale, conducted under conditions consistent with baseline assessments by the same evaluator. Following each assessment, participants in the intervention group received brief, individualized, and encouraging verbal feedback regarding their performance and progress. The control group did not receive additional periodic assessments or feedback.

After completion of the 12-week intervention, all participants underwent post-intervention assessments identical to baseline, conducted under comparable conditions to ensure data consistency and reliability.

Inclusion criteria

• Healthy adults of any gender, aged 65 years and older
• Actively registered at the Senior Citizens' Clubs (KAPI) of the Municipality of Nikaia - Agios Ioannis Rentis, Athens, Greece
• Required to live independently in their own homes
• Able to stand, move, and perform activities of daily living without assistance

Exclusion criteria

• Explicit recommendation from the participant's physician not to participate in an exercise program
• Serious underlying medical conditions, neurological disorders, or any contraindications to physical exercise (e.g., severe heart disease or uncontrolled hypertension)
• Significant limitations in mobility or functional capacity
• Inability to complete the Short Physical Performance Battery tests
• Hypotension or orthostatic hypotension
• Psychiatric disorders
• Cognitive impairment (Mini-Mental State Examination score <24/30)
• Visual or hearing impairments limiting the ability to participate in exercise
• Use of medications restricting the ability to engage in physical activity