BACKGROUND: Frailty is a prevalent yet reversible condition in older adults. While exercise is a cornerstone intervention, the optimal protocols tailored to varying functional levels remain underdefined. This study aimed to evaluate the feasibility and effectiveness of a Timed Up and Go (TUG) -based graded multi-component exercise (GME) program in reversing frailty among community-dwelling older adults. METHODS: This study was a multi-center, parallel-group, superiority randomized controlled trial conducted in community settings in Beijing, China. Participants were aged ≥ 60 years and diagnosed with pre-frailty or frailty according to the Fried phenotype. Participants were randomly assigned (1: 1) via a centralized computer-generated randomization tool (random. org) to either the GME group or the Medical Health Education (MHE) group. The GME group received a 5-month, twice-weekly exercise program (aerobic, resistance, balance, flexibility) graded by TUG performance (Levels A, B, C). The MHE comparator group received weekly health education. The primary outcome was the Fried frailty score. Data collectors and statistical analysts were blinded to group assignment, while participants and exercise instructors were not. RESULTS: Among 111 participants (GME: n = 66, MHE: n = 45), the GME group showed superior reduction in Fried frailty scores (P = 0. 008), with 21. 2% reversing to a Robust state. Improvements were significant for pre-frail individuals (P = 0. 016) and TUG Levels B/C, but not for the frail subgroup or Level A. GME participants also achieved better walking speed (Pₐdj = 0. 006) and PHQ-9 scores (Pₐdj < 0. 001). Significant within-group gains occurred in grip strength, TUG, and blood pressure (Pₐdj < 0. 05). However, no significant inter-group differences were found after FDR adjustment for FTSTT, SPPB, BMI, SMI, muscle mass, calf circumference, WHR, VFA, BADL, IADL, MNA-SF, GAD-7, PFS, and MoCA. No adverse events were reported. CONCLUSION: The TUG-based graded multi-component exercise program is a safe and effective strategy for reversing frailty in community-dwelling older adults. It significantly enhances physical function, optimizes body composition and improves mood. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400081175. Registered 26 February 2024. Retrospective Registration.
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