Exploring how exercise frequency impacts muscle strength and balance in institutionalized older adults: Protocol for a randomized controlled trial

This protocol for a randomized controlled trial aims to evaluate the impact of exercise frequency on muscle strength, balance, and fall risk among institutionalized older adults. Recognizing the unique physical and functional limitations of this population, the study will test whether two or three weekly sessions of multicomponent exercise yield differential outcomes. Sixty participants residing in nursing homes will be randomly assigned to one of two groups: a control group performing exercise twice weekly and an experimental group training three times weekly, over a 12-week intervention period. All sessions will follow international guidelines for older adults, incorporating aerobic, strength, balance, and flexibility training at light-to-moderate intensity. Primary outcomes include lower- and upper-body strength and dynamic balance; secondary outcomes comprise waist circumference, body mass index, and fall incidence. The program is designed with progressive adaptation and safety in mind, employing the Talk Test to regulate intensity and standardized measures to monitor physiological responses. The rationale stems from the gap in existing literature regarding optimal exercise frequency for institutionalized populations. While two sessions per week have been associated with functional improvements, it remains unclear whether an additional weekly session provides significant incremental benefits. By isolating frequency as the primary variable, the trial addresses the need to define the minimum effective dose of structured exercise for enhancing physical activity, functional capacity, and reducing fall risk. Results are expected to inform tailored physical activity guidelines and implementation strategies in long-term care settings, balancing clinical efficacy with feasibility and safety constraints typical of institutional environments. • This multicomponent exercise protocol tests the effect of two versus three sessions per week to define the minimum effective dose for institutionalized older adults. • The study utilizes a pragmatic, low-cost design that maximizes feasibility for sustainable implementation in resource-constrained nursing homes. • Primary analysis will use Intention-to-Treat and a per-protocol analysis to ensure the clinical relevance of changes in muscle strength and balance. • The findings are critical for establishing evidence-based exercise frequency guidelines and institutional policies for sedentary, frail older adults in long-term care.