A structured hybrid exercise programme for pre-frail older adults in primary care: A feasibility and pilot study

Pre-frailty is prevalent and linked to diminished physical function and heightened healthcare needs. This study explored feasibility and preliminary effects of a structured 12-week exercise programme for pre-frail older adults and its impact on physical performance.

A multi-centre, prospective quasi-experimental study with single-arm pre-post design was conducted from April 2022 to September 2023 across four regional primary care clinics in Singapore. Participants aged ≥65 years, with Clinical Frailty Scale (CFS) score of 3 or 4, were enrolled in a 12-week program consisting of nine supervised in-person and three asynchronous remote exercise sessions (via pre-recorded videos). Each session lasted one hour and targeted functional strength, balance, mobility, and endurance. Primary feasibility outcomes included recruitment, retention, adherence, fidelity, satisfaction, and safety; clinical outcomes were considered secondary. Physical performance was assessed using Short Physical Performance Battery (SPPB), 30-Seconds Sit-to-Stand (30CST), and handgrip dynamometry at baseline and at 3 months (post-intervention). Changes in physical activity levels were evaluated using interviewer-administered International Physical Activity Questionnaire-Short Form (IPAQ-SF) at baseline, 6 months, and 12 months.

Of 227 eligible participants, 162 started the programme (attended ≥1 session), and 139 completed the 3-month follow-up. The recruitment rate was 71.4%, and the retention rate was 85.8% (139/162) among those who started. The program achieved overall 81.9% average attendance rate across 12 sessions, with 64% of participants attending at least 10 sessions. Participants demonstrated an increase in SPPB scores (mean: +0.76 points; 95% CI: 0.48-1.04; p < 0.001) and in 30CST repetitions (mean: +2.82; 95% CI: 2.27-3.41; p < 0.001) from pre- to post- intervention. Female participants showed improved right-hand grip strength (mean: +0.65 kg; 95% CI: 0.16-1.14; p = 0.010), although male grip strength did not significantly change. No significant increase in total physical activity was observed at 6 or 12 months (IPAQ category shifts: p = 0.136 and 0.050 respectively), despite a positive trend towards higher activity levels. All respondents expressed satisfaction with the overall programme, and 93% were satisfied with the remote sessions. No exercise-related adverse events occurred. Qualitative feedback highlighted improved confidence and social engagement as added benefits.

The structured hybrid exercise program was feasible in a primary care setting and associated with improvements in physical function among community-dwelling pre-frail older adults. Feasibility was demonstrated through strong attendance, completion rates and participant satisfaction. Despite no significant change in self-reported physical activity, the combination of in-person supervision and home-based exercise appears promising for scalable pre-frailty management. This pilot study's positive findings support further evaluation in a controlled trial and suggest that such hybrid models can be implemented to engage pre-frail seniors in regular exercise.