Effects of a Smart Circuit Exercise Program on Health Outcomes in Community-Dwelling Older Adults

Intelligent Precision Exercise Integrated Health Management: Construction of Innovative Technology and Management Models and Clinical Evidence Research in Elderly Communities.

This study was conducted in collaboration with a community-based retirement facility to evaluate the clinical effectiveness of a smart, technology-assisted circuit exercise intervention for community-dwelling older adults. Traditional exercise prescriptions for older adults often lack real-time monitoring of individual physiological responses, which can increase the risk associated with exercise participation. This program integrated real-time physiological monitoring (including heart rate reserve, HRR) to guide individualized exercise intensity within a moderate-intensity range (50%-60% HRR).

The study was conducted in two stages with different allocation designs:

Stage 1 (Randomized Controlled Design): Participants were randomly assigned to either an intervention group or a control group. The intervention group received the smart circuit exercise program, while the control group did not receive the exercise intervention and underwent pre- and post-assessment only. This stage allowed for between-group comparison of intervention effects.

Stage 2 (Single-Group Extension): Following completion of Stage 1, the facility extended the exercise program to a broader group of community residents as part of a real-world implementation and scale-up initiative, in order to evaluate the program under routine practice conditions and to provide equitable access to the intervention across the community. A concurrent control group was not maintained during this stage, consistent with its focus on real-world effectiveness evaluation rather than efficacy comparison.

Participants in both stages received circuit-based exercise training three times per week (24 sessions total over approximately 8 weeks), with intensity controlled at 50%-60% heart rate reserve (HRR).

Outcome measures assessed before and after the intervention period included: cardiac autonomic activity and hemodynamic function (including blood pressure and heart rate variability), arterial stiffness, body composition (including skeletal muscle mass, body fat mass, and body fat percentage), functional fitness (including lower limb muscle strength and dynamic balance), clinical blood biochemistry indicators (including HbA1c), depressive symptoms (CESD-10), and sleep quality (Pittsburgh Sleep Quality Index, PSQI).

Statistical analyses varied by stage and publication. For Stage 1 between-group comparisons, linear mixed models (LMM) with participant as a random intercept were used to test Time × Group interactions, adjusting for age, sex, and height. For broader cohort analyses, two-way mixed-design analysis of variance and paired-samples t-tests were used. Statistical significance was set at alpha = .05 for all analyses.

Study Overview

• Status: Completed
• Conditions: Aging; Hemodynamics; Autonomic Nervous System
• Intervention / Treatment: Behavioral: Smart Circuit Exercise Program

Detailed Description

This study was conducted in collaboration with a community-based retirement facility to evaluate the clinical effectiveness of a smart, technology-assisted circuit exercise intervention for community-dwelling older adults. Traditional exercise prescriptions for older adults often lack real-time monitoring of individual physiological responses, which can increase the risk associated with exercise participation. This program integrated real-time physiological monitoring (including heart rate reserve, HRR) to guide individualized exercise intensity within a moderate-intensity range (50%-60% HRR).

The study was conducted in two stages with different allocation designs:

Stage 1 (Randomized Controlled Design): Participants were randomly assigned to either an intervention group or a control group. The intervention group received the smart circuit exercise program, while the control group did not receive the exercise intervention and underwent pre- and post-assessment only. This stage allowed for between-group comparison of intervention effects.

Stage 2 (Single-Group Extension): Following the completion and analysis of Stage 1, which demonstrated the safety and preliminary effectiveness of the smart circuit exercise program, the facility extended the program to a broader group of community residents as part of a real-world implementation and scale-up initiative, in order to evaluate the program's effectiveness under routine practice conditions and to provide equitable access to the intervention across the community. A concurrent control group was not maintained during this stage, consistent with its focus on real-world effectiveness evaluation rather than efficacy comparison.

Participants in both stages received circuit-based exercise training three times per week (24 sessions total across approximately 8 weeks), with intensity controlled at 50%-60% heart rate reserve (HRR).

Outcome measures assessed before and after the intervention period included: body composition (including skeletal muscle mass, body fat mass, and body fat percentage), blood pressure, functional fitness (lower limb muscle strength and dynamic balance), clinical blood biochemistry indicators (including HbA1c), depressive symptoms (CESD-10), and sleep quality (Pittsburgh Sleep Quality Index, PSQI).

Statistical analyses included two-way mixed-design analysis of variance and paired-samples t-tests, with statistical significance set at alpha = .05. Stage 1 data were analyzed as a between-group comparison. Stage 2 data were analyzed independently as a within-group pre-post comparison and were not statistically compared to the Stage 1 control group, given the non-concurrent recruitment timing between stages.

Note: This trial is being registered retrospectively. The study was conducted and closed under IRB approval prior to the decision to pursue publication in international peer-reviewed journals, at which point trial registration was completed.

• Study Type: Interventional
• Enrollment (Actual): 256
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Guishan
    • Taoyuan, Guishan, Taiwan, 33371
      • Chang Gung University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 65 to 85 years, community-dwelling
• Able to walk independently, without assistance
• Able to understand study procedures in Mandarin or Taiwanese and voluntarily provide informed consent
• Willing to undergo health examinations and testing, and to provide historical health examination records
• Completed a health status questionnaire covering medical history, medication use, and comorbidities
• Physical Activity Readiness Questionnaire Plus (PAR-Q+) results indicating suitability for exercise training (or written physician clearance obtained if any positive response)
• Completed the International Physical Activity Questionnaire (IPAQ), with results not meeting the criterion for regular exercise within the past 6 months (i.e., fewer than 2 sessions/week or less than 30 minutes/session of moderate-intensity aerobic exercise)

Exclusion Criteria:

• Cognitive impairment or dementia precluding understanding of study procedures or compliance with test instructions
• Lower-extremity fracture, joint surgery, or joint replacement within the past 3 months precluding safe completion of sit-to-stand or walking tasks
• Severe joint pain precluding safe completion of baseline test movements, as assessed by study personnel
• Unexplained syncope or fall history within the past 3 months, or safety concerns as assessed by study personnel
• Acute illness (e.g., fever, acute infection)
• Cardiac pacemaker or incompatible metal implants affecting bioelectrical impedance analysis (BIA) measurement safety
• Meeting the criterion for regular exercise within the past 6 months per the International Physical Activity Questionnaire (IPAQ) (≥2 sessions/week, ≥30 minutes/session of moderate-intensity aerobic exercise)
• Physical Activity Readiness Questionnaire Plus (PAR-Q+) screening results indicating unsuitability for exercise training, without written physician clearance
• Unstable cardiovascular disease, including unstable angina, uncontrolled atrial or ventricular arrhythmia, uncontrolled resting sinus tachycardia (>120 beats/min), decompensated congestive heart failure, third-degree atrioventricular block without a pacemaker, acute pericarditis or myocarditis, or recent thrombosis/thrombophlebitis
• Uncontrolled diabetes (HbA1c > 9%, resting blood glucose > 300 mg/dL, or > 250 mg/dL with ketosis) or poorly controlled hypertension (systolic blood pressure > 180 mmHg or diastolic blood pressure > 100 mmHg)
• Use of medications that may interfere with muscle metabolism (e.g., high-dose corticosteroids, immunosuppressants)
• Symptomatic orthostatic hypotension (blood pressure drop > 20 mmHg)
• Resting ST-segment depression > 2 mm
• Severe neurological or musculoskeletal disease precluding safe performance of study procedures, as assessed by study personnel
• Currently participating in another clinical trial involving an exercise intervention
• Severe anemia, acute infectious disease, or other physiological conditions deemed unsuitable for exercise training by the investigator

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm 1_Stage 1 - Intervention Group; Participants randomly assigned to receive the smart circuit exercise program during Stage 1. Sessions were held 3 times per week (24 sessions total over approximately 8 weeks), with exercise intensity controlled at 50%-60% heart rate reserve (HRR) using real-time physiological monitoring. (n=50 enrolled, n=50 completed)	Behavioral: Smart Circuit Exercise Program; A moderate-intensity circuit-based exercise program incorporating real-time physiological monitoring (including heart rate reserve, HRR) to guide individualized exercise intensity. Sessions were held 3 times per week (24 sessions total over approximately 8 weeks), with intensity controlled at 50%-60% HRR.
No Intervention: Arm 2_Stage 1 - Control Group; Participants randomly assigned to the control group during Stage 1. Participants did not receive the exercise intervention and underwent pre- and post-assessment only. (n=50 enrolled, n=46 completed)
Experimental: Arm 3_Stage 2 - Intervention Extension (Single-Group); Following completion and analysis of Stage 1, additional community residents were enrolled to receive the same smart circuit exercise program as part of a real-world implementation and scale-up initiative. No concurrent control group was maintained during this stage. (n=156 enrolled, n=142 completed)	Behavioral: Smart Circuit Exercise Program; A moderate-intensity circuit-based exercise program incorporating real-time physiological monitoring (including heart rate reserve, HRR) to guide individualized exercise intensity. Sessions were held 3 times per week (24 sessions total over approximately 8 weeks), with intensity controlled at 50%-60% HRR.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Time-Domain Heart Rate Variability	Standard deviation of NN intervals (SDNN) and root mean square of successive differences (RMSSD), derived from 4-minute seated ECG recording, reported in milliseconds.	Baseline and up to 12 weeks
Change in Frequency-Domain Heart Rate Variability	Normalized low-frequency (nLF) and high-frequency (nHF) power, derived from 4-minute seated ECG recording, reported in normalized units.	Baseline and up to 12 weeks
Change in Dynamic Heart Rate Variability Reactivity	E/I ratio (from 2-minute deep breathing), Valsalva ratio (from 2-minute Valsalva maneuver), and 30:15 ratio (from 2-minute standing), each reported as a ratio.	Baseline and up to 12 weeks
Change in Blood Pressure	Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP), measured via upper-arm automatic blood pressure monitor, average of 3 consecutive readings, reported in mmHg.	Baseline and up to 12 weeks
Change in Rate-Pressure Product	Cardiac load index calculated as heart rate multiplied by systolic blood pressure, reported in bpm·mmHg.	Baseline and up to 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Skeletal Muscle Mass and Body Fat Mass	Skeletal muscle mass (SMM) and body fat mass (BFM), reported in kg.	Baseline and up to 12 weeks
Change in Percent Body Fat	Percent body fat (PBF), reported as a percentage.	Baseline and up to 12 weeks
Change in Body Mass Index	Body mass index (BMI), calculated from body composition analysis, reported in kg/m^2.	Baseline and up to 12 weeks
Change in Waist-Hip Ratio	Waist-hip ratio (WHR), reported as a ratio.	Baseline and up to 12 weeks
Change in Visceral Fat Area	Visceral fat area (VFA), reported in cm^2.	Baseline and up to 12 weeks
Change in Digital Volume Pulse Stiffness Index	Stiffness Index (SI), derived from photoplethysmography-based digital volume pulse (DVP) pulse contour analysis, reported in m/s.	Baseline and up to 12 weeks
Change in Digital Volume Pulse Contour Reflection Index	Reflection Index (RI), derived from pulse contour analysis of the digital volume pulse (DVP) waveform, reported as a ratio.	Baseline and up to 12 weeks
Change in Second-Derivative Photoplethysmogram Amplitude Ratios	Second-derivative photoplethysmogram (SDPTG) amplitude ratios (b/a, c/a, d/a, e/a), derived from second-derivative analysis of the digital volume pulse (DVP) waveform, reported as a ratio.	Baseline and up to 12 weeks
Change in Augmentation Index	Augmentation Index (AIx) and heart-rate-normalized Augmentation Index (AIx@75), derived from DVP pulse contour analysis, reported as a percentage.	Baseline and up to 12 weeks
Change in Aging Index	Aging Index (AGI), derived from second-derivative photoplethysmogram (SDPTG) analysis, reported in arbitrary units.	Baseline and up to 12 weeks
Change in Lower- and Upper-Limb Muscular Strength	Lower-limb strength (LowerStr), assessed using the 30-Second Chair Stand Test, and upper-limb strength (UpperStr), assessed using the 30-Second Arm Curl Test, reported in repetitions.	Baseline and up to 12 weeks
Change in Lower- and Upper-Limb Flexibility	Lower-limb flexibility (LowerFlex), assessed using the Chair Sit-and-Reach Test, and upper-limb flexibility (UpperFlex), assessed using the Back Scratch Test, reported in cm.	Baseline and up to 12 weeks
Change in Cardiorespiratory Endurance	Cardiorespiratory endurance assessed using a 2-minute step test, reported in number of steps.	Baseline and up to 12 weeks
Change in Dynamic and Static Balance	Dynamic balance (DynBal), assessed using the Timed Up-and-Go Test, and static balance (StatBal), assessed using the Single-Leg Stance Test (eyes open), reported in seconds.	Baseline and up to 12 weeks
Change in HbA1c	Glycated hemoglobin (HbA1c), based on voluntary submission of participants' individual routine health examination reports. Assessment timing and laboratory were not standardized by the study protocol, as this measure relied on participant-provided documentation rather than investigator-administered blood collection. Reported as a percentage.	Baseline and up to 12 months following study completion
Change in Lipid Profile	Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), based on voluntary submission of participants' individual routine health examination reports at any point up to 12 months following study completion. Assessment timing and laboratory were not standardized by the study protocol, as this measure relied on participant-provided documentation rather than investigator-administered blood collection. Reported in mg/dL.	Baseline and up to 12 months following study completion

Collaborators and Investigators

• Sponsor: Chang Gung Memorial Hospital
• Investigators: Principal Investigator: Jong-Shyan WANG, Ph.D., Chang Gung University, Guishan, Taoyuan 333

Publications and helpful links

General Publications

• Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999 Sep;89(9):1322-7. doi: 10.2105/ajph.89.9.1322.
• Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010 Mar 30;55(13):1318-27. doi: 10.1016/j.jacc.2009.10.061.
• Jarczok MN, Weimer K, Braun C, Williams DP, Thayer JF, Gundel HO, Balint EM. Heart rate variability in the prediction of mortality: A systematic review and meta-analysis of healthy and patient populations. Neurosci Biobehav Rev. 2022 Dec;143:104907. doi: 10.1016/j.neubiorev.2022.104907. Epub 2022 Oct 13.
• Lim AY, Chiang CY, Lin YT, Hsu CC, Wang JS. Intelligent circuit exercise training improves platelet mitochondrial bioenergetic efficiency in sedentary men. Eur J Appl Physiol. 2026 Apr;126(4):2161-2174. doi: 10.1007/s00421-025-06014-7. Epub 2025 Dec 4.
• Mitchell GF. Arterial stiffness and hypertension. Hypertension. 2014 Jul;64(1):13-8. doi: 10.1161/HYPERTENSIONAHA.114.00921. Epub 2014 Apr 21.

Study record dates

Study Major Dates

• Study Start (Actual): May 10, 2024
• Primary Completion (Actual): February 27, 2026
• Study Completion (Actual): February 28, 2026

Study Registration Dates

• First Submitted: August 20, 2026
• First Submitted That Met QC Criteria: August 24, 2026
• First Posted (Actual): August 27, 2026

Study Record Updates

• Last Update Posted (Actual): August 27, 2026
• Last Update Submitted That Met QC Criteria: August 24, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Aerobic exercise; Arterial stiffness; Blood pressure; Older adults; Heart rate variability; Digital health; Circuit training
• Other Study ID Numbers: 202601236B0; FCRPD1P0021 (Other Grant/Funding Number: Wang Chang-Gung Charitable Trust Fund)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data that underlie the results reported in publications arising from this study may be made available to other researchers upon reasonable request to the corresponding author, subject to appropriate institutional and ethics committee approvals.
• IPD Sharing Time Frame: Beginning after publication, with no defined end date, upon reasonable request.
• IPD Sharing Access Criteria: Requests will be reviewed by the corresponding author and require institutional/ethics approval where applicable.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No