Bridging loneliness and mobility: an integrated community-based rehabilitation model for older adults

Abstract

Background

As populations age, older adults increasingly experience challenges that extend beyond physical changes to include loneliness, reduced social connections, and lower life satisfaction. Although physical rehabilitation and social participation initiatives have been widely examined, they are commonly addressed as separate domains. Consequently, evidence on integrated community-based rehabilitation (CBR) programmes that simultaneously support physical functioning and psychosocial well-being remains limited. This study examined the effects of a structured, multidimensional CBR programme delivered within a university-based lifelong learning initiative for older adults in Türkiye.

Methods

A quasi-experimental pre-test/post-test design with a control group was employed. Both groups attended routine Refreshment University lessons. In addition to these standard lessons, the experimental group received a 12-week structured CBR programme consisting of organized physical exercise sessions and facilitated social participation modules. The control group did not receive this additional structured CBR intervention and participated only in the standard Refreshment University lessons. Outcomes were assessed using validated measures of loneliness, life satisfaction, physical self-perception, functional mobility, and muscular strength.

Results

Participants in the intervention group demonstrated significant improvements across all assessed physical and psychosocial outcomes, including reduced loneliness, increased life satisfaction, enhanced physical self-worth, improved functional mobility, and greater muscular strength. Although the control group also showed modest improvements, the magnitude of change was consistently greater in the intervention group. Post-intervention correlation analyses conducted within the intervention group revealed significant associations between functional mobility, psychosocial well-being, and dimensions of physical self-perception.

Conclusions

Integrated community-based rehabilitation programs that combine physical activity with intentional social participation, when delivered alongside existing formal lifelong learning programs, offer multidimensional benefits for older adults and may promote more inclusive and participatory approaches to aging.

Introduction

Global demographic ageing represents one of the most significant social transformations of the twenty-first century, raising increasing scholarly and policy concern about how longer lives can be accompanied by a meaningful quality of life in later adulthood [12]. Although advances in healthcare, nutrition, and living conditions have substantially extended life expectancy, these gains have not been matched by equivalent improvements in physical functioning, social integration, or subjective well-being among older adults [39]. Many older individuals experience declining mobility, reduced engagement in meaningful social roles, heightened vulnerability to loneliness, and diminished life satisfaction, highlighting persistent inequalities in ageing experiences despite demographic progress [22]. These patterns highlight the limitations of approaches that conceptualize ageing primarily through biomedical or individualized frameworks, underscoring the need for integrated perspectives that address the physical, psychological, and social dimensions of later life [24].

From a sociological perspective, ageing is not solely a biological process but a socially constructed and relational experience shaped by social roles, institutional arrangements, and opportunities for participation across the life course [14]. As individuals age, they often renegotiate identity and social belonging within socio-economic systems that privilege productivity and autonomy. Within such contexts, later life is frequently associated with dependency, decline, and withdrawal from communal life [26]. This symbolic marginalization can undermine older adults’ social agency and contribute to loneliness, disengagement, and diminished self-worth [37]. Despite growing recognition of relational ageing, many policy and intervention frameworks continue to position older adults as passive recipients of care rather than as active social actors. At the same time, a growing body of literature emphasizes that later life can also be characterized by resilience, adaptation, and continued social contribution, particularly when older adults are supported by enabling social and institutional environments [14].

In response, paradigms such as active ageing, healthy ageing, and social participation models have sought to reframe later life as a period of continued engagement and contribution [25]. Within this context, community-based rehabilitation (CBR) has emerged as a promising framework. Although traditionally viewed as a health-oriented intervention focused on physical functioning, CBR is increasingly recognized as a socially transformative practice grounded in participation, empowerment, and inclusion [6, 16]. By embedding rehabilitation within community settings, CBR creates environments that support social connection, collective activity, and sustained participation in meaningful roles [23]. However, the empirical literature on CBR among older adults remains fragmented. Most studies have examined physical rehabilitation outcomes and psychosocial dimensions separately, with limited attention to integrated interventions that simultaneously address functional mobility, bodily self-perception, and social well-being [20, 36, 41]. Systematic reviews show that programmes combining physical rehabilitation with psychosocial outcomes, such as loneliness, life satisfaction, and embodied self-concept, remain relatively scarce among community-dwelling older adults [35, 41]. This gap is significant given evidence that physical functioning, bodily self-concept, and psychosocial well-being are closely interconnected in later life [35]. Despite this growing recognition, it remains unclear whether integrated community-based rehabilitation programmes delivered within university-based lifelong learning contexts can simultaneously improve physical functioning and psychosocial well-being among community-dwelling older adults.

Moreover, little attention has been paid to the institutional contexts in which integrated CBR interventions are delivered. While community centers and healthcare settings dominate existing research, university-based lifelong learning initiatives remain underexplored, despite evidence linking participation in such programmes to improved psychological well-being, reduced depressive symptoms, enhanced self-esteem, and greater life satisfaction among older adults [4, 5, 7, 28]. As socially embedded environments, universities offer distinctive opportunities to integrate physical rehabilitation with meaningful social participation and learning, closely aligning with the participatory principles of CBR. Against this background, the present study examines the effects of an integrated CBR programme delivered within the “Refreshment University,” a university-affiliated lifelong learning initiative for adults aged 60 years and older in Türkiye. The programme combines supervised, group-based physical exercise with structured social participation activities, and conceptualizes functional capacity as an embodied resource supporting autonomy and engagement in later life. Guided by a sociological perspective that views ageing as a socially embedded process, this study treats physical functioning, psychosocial well-being, and physical self-perception as interdependent dimensions of later-life experience. Accordingly, the study aims to assess the impact of the integrated CBR programme on functional mobility, muscular strength, loneliness, life satisfaction, and physical self-perception, and to examine the relationships between changes in physical functioning and psychosocial outcomes. Grounded in community-based rehabilitation frameworks that conceptualise physical functioning, social participation, and psychosocial well-being as interrelated dimensions of later-life experience, the present study formulated the following a priori hypotheses.

• H1: Older adults who participated in the integrated community-based rehabilitation programme will demonstrate significantly greater improvements in functional mobility, muscular strength, loneliness, life satisfaction, and physical self-perception compared with those in the control group.

• H2: Within the intervention group, post-intervention functional mobility will be significantly associated with psychosocial outcomes, including loneliness, life satisfaction, and dimensions of physical self-perception.

Methods

Study design

This study employed a quasi-experimental design with a pre-test/post-test control group structure to evaluate the effects of a twelve-week CBR programme on older adults’ physical functioning, social participation, and psychosocial well-being. Baseline (pre-intervention) assessments were conducted in person for all participants immediately prior to the start of the intervention and before allocation to the groups. Assessments were conducted at the Refreshment University facilities and were scheduled to coincide with participants’ routine attendance at the program; therefore, no additional visits to the study site were required. Following completion of baseline assessments, participants were allocated to either the experimental or control group based on voluntary participation in the structured CBR programme.

Post-intervention assessments were conducted in person at the exact location immediately after completion of the twelve-week intervention period, using identical instruments and standardized procedures for both groups. Physical performance assessments were administered by trained personnel according to standardized testing protocols, and psychosocial questionnaires were administered under the supervision of the research team to ensure consistency and completeness of data collection. The structured CBR programme was delivered entirely in person through face-to-face sessions. It consisted of two components: a supervised physical exercise module and a structured social participation module.

Study setting

The Refreshment University is a university-affiliated continuing education and lifelong learning programme designed for adults aged 60 years and older. The programme offers non-formal educational, cultural, and social activities, including lectures, discussion-based classes, and opportunities for informal social interaction. Its primary aim is to promote lifelong learning, social engagement, and active participation in later life, rather than to deliver structured health or rehabilitation interventions. Activities are offered on a regular weekly basis and typically involve several hours of engagement per week, depending on the academic term. The study was conducted in 2025, with no COVID-19–related restrictions affecting recruitment, intervention delivery, or outcome assessment.

In the present study, all participants attended the Refreshment University programme, which served as a common educational and social context across groups. The structured community-based rehabilitation (CBR) programme was delivered as an additional intervention only to the experimental group, while the control group continued to participate solely in the standard Refreshment University activities.

Participants and sampling

Participants were recruited from a pool of 70 older adults enrolled in the Refreshment University programme. In the first stage, 70 eligible individuals were identified, and all were invited to participate in the study. Of these, 64 individuals provided written informed consent and constituted the study sample. Participation was therefore voluntary, in accordance with ethical requirements for research involving older adults.

After informed consent was obtained, participants were allocated to the experimental or control group based on their voluntary participation in the structured community-based rehabilitation programme. Individuals who agreed to participate in the intervention were assigned to the experimental group. In contrast, those who chose not to participate and continued with the standard Refreshment University activities were assigned to the control group. This self-selection–based allocation reflects the quasi-experimental design of the study and was implemented in accordance with the programme's voluntary participation framework, rather than through random assignment [33]. The inclusion criteria for participation in the study required individuals to be 60 years or older, currently enrolled in the Refreshment University programme, and possess sufficient physical and cognitive capacity to participate in regular face-to-face group-based activities. Participants were excluded from the study if they had acute or uncontrolled medical conditions, such as unstable cardiovascular disease or severe musculoskeletal disorders, that could contraindicate safe participation in physical exercise. Individuals with diagnosed neurological or psychiatric conditions associated with significant cognitive impairment were also excluded. Enrolment in the Refreshment University Programme preceded study recruitment and was independent of the research; only individuals already registered in the programme were eligible for study participation. Additionally, individuals with severe sensory impairments that would limit their meaningful engagement in group-based activities, as well as those who were unable or unwilling to provide informed consent or attend the intervention sessions regularly, were not eligible for participation.

An a priori power analysis was conducted using GPower (version 3.9.7.1) to determine the required sample size. Based on effect sizes reported in previous community-based rehabilitation and integrated physical–psychosocial intervention studies involving older adults, a moderate effect size (Cohen’s d = 0.50) was assumed. With the significance level (α) set at 0.05 and statistical power (1–β) set at 0.90, the analysis indicated that a minimum total sample size of 50 participants (25 per group) would be sufficient to detect between-group differences [41]. To account for potential attrition, a larger sample was recruited, and only participants who completed both pre- and post-intervention assessments were included in the final analysis. The final sample size exceeded the minimum required by the power analysis.

Intervention

The structured CBR programme was delivered over twelve weeks and consisted of two complementary modules: a physical exercise module and a social participation module. Each module was implemented twice per week, with sessions lasting approximately 30 min. The physical exercise and social participation modules were delivered concurrently over the same 12-week intervention period; however, they were scheduled in non-overlapping sessions on different days or at different times to ensure that each component was delivered independently.

Physical exercise module

The physical exercise component of the intervention was designed to enhance muscular strength, mobility, balance, and overall physical functioning, all of which are critical for maintaining independence in later life. The module was delivered twice weekly over the 12-week intervention period, with each session lasting approximately 30 min. Sessions were conducted face-to-face in the campus sports hall and supervised by a licensed physiotherapist with experience in geriatric rehabilitation [40].

Exercises were implemented in a group-based format following a standardized protocol. Although participants exercised collectively, the supervising physiotherapist continuously monitored each participant and provided tailored modifications (e.g., adjustments in posture, resistance level, repetitions, or range of motion) according to each participant’s functional capacity. These adaptations were implemented within the standardized programme to ensure safety and appropriateness, rather than as individualized one-to-one personal training.

The exercise programme included progressive Theraband-based resistance exercises targeting major muscle groups (e.g., quadriceps, hamstrings, biceps, triceps, and shoulder girdle) to improve muscular endurance and joint stability. Resistance levels were increased every three weeks by progressing through tan, yellow, red, and green bands. Exercises were performed in seated or standing positions depending on individual ability levels, determined through baseline physical performance assessments, participants’ self-reported limitations, and ongoing clinical observation during sessions.

The programme also incorporated balance training exercises (e.g., tandem stance, heel-to-toe walking, and single-leg stands) to enhance postural control and reduce fall risk, as well as flexibility exercises involving dynamic and static stretching of major muscle groups at the beginning and end of each session. Participant progress was monitored weekly, and exercises were modified as needed within the standardized protocol by the supervising physiotherapist [41].

Social participation module

The module consisted of facilitated, face-to-face group activities designed to promote social interaction, emotional expression, and community engagement. It was implemented during the same 12-week intervention period as the physical exercise component but delivered in separate sessions. Participants attended twice weekly, with each session lasting approximately 30 min. Sessions were facilitated by the programme coordinator, who guided structured group discussions, moderated interactions, and ensured consistency of implementation across meetings. Activities were informed by established models of active ageing and social inclusion [19].

The module included guided group discussions centred on shared life experiences, intergenerational relationships, health narratives, and cultural values [15]. Discussions were semi-structured to allow both spontaneous expression and thematic continuity, fostering reflection, mutual support, and conversational reciprocity among participants. Participants also engaged in art-based workshops, including collaborative drawing, painting, storytelling, and music sessions. These creative activities served as mediums for non-verbal expression, self-affirmation, and the activation of personal and collective memory. They were adapted to participants’ sensory and cognitive capacities to ensure inclusivity [17]. Finally, cultural and community-based activities, such as local intergenerational events, were organised to foster a sense of belonging and civic engagement, thereby reinforcing participants’ roles as active contributors to their communities.

Both the experimental and control groups were enrolled in and continued to attend the Refreshment University programme throughout the study period. Participation in this programme provided a shared educational and social context for all participants. In addition to routine Refreshment University lessons, the experimental group received a structured CBR programme consisting of organized physical exercise and facilitated social participation modules. The control group did not receive this additional structured CBR intervention and participated only in the standard Refreshment University lessons. Thus, the primary distinction between the experimental and control conditions was the addition of the structured CBR programme to the existing Refreshment University activities. Following the completion of all post-intervention assessments, the physical exercise programme was offered to control group participants voluntarily for ethical reasons. Twelve participants from the control group who expressed interest elected to participate in this post-study program. This activity was not part of the formal study design, and no data related to this post-study provision were collected or included in the analyses.

Attendance and adherence

Attendance and adherence to the intervention were monitored throughout the 12-week programme. In the experimental group, attendance was recorded for both the physical exercise and social participation modules at each session. Overall, participants in the experimental group demonstrated high adherence, with the majority attending most scheduled sessions. Attendance rates were comparable across the physical exercise and social participation components, and no serious adverse events or intervention-related withdrawals were reported. Participants in the control group continued to attend the routine Refreshment University activities during the study period. While formal attendance records for standard programme activities were collected, continued participation was confirmed through regular programme enrolment and presence during scheduled assessments. These data indicate that both groups maintained engagement with their respective activities throughout the intervention period.

Data collection instruments

All instruments used in this study were administered exclusively for research purposes and were not part of the routine assessment procedures of the Refreshment University programme. Pre- and post-intervention data were collected through validated and culturally adapted measurement tools:

UCLA Loneliness Scale (UCLA-LS)

Russell, Peplau, and Ferguson originally developed the scale to measure individuals' levels of loneliness [31]. The Turkish adaptation, including the validity and reliability study, was conducted by Demir [9]. The scale comprises 20 items, half positively worded and the other half negatively worded. Each item represents a situation reflecting a feeling or thought related to social relationships. Respondents indicate how frequently they experience these situations using a 4-point Likert scale ("Never" = 4, "Rarely" = 3, "Sometimes" = 2, "Often" = 1). The total score ranges from 20 to 80, with higher scores indicating greater loneliness.

Life satisfaction scale for the elderly (LIS)

Evaluates general life satisfaction. Altay and Çalmaz developed the scale to assess life satisfaction among older adults [1]. It consists of 14 items across three sub-dimensions, focusing on the extent to which elderly individuals participate in and perceive life satisfaction. The scale employs a 5-point Likert format, with response options ranging from “Strongly Disagree” to “Strongly Agree.” Each item is scored from 1 to 5, yielding a total score between 14 and 70. Higher scores indicate greater life satisfaction [1].

The physical self-perception profile (PSPP)

PSPP was administered to assess participants' perceptions of their physical competence and self-image. Initially developed by Fox in 1989, the instrument is designed to evaluate how individuals perceive their physical self [10]. Aşçı conducted the Turkish adaptation and inventory validation, confirming its reliability and cultural appropriateness for use with Turkish populations [2].The inventory consists of 30 items and evaluates five distinct sub-dimensions: sport competence, physical condition, body attractiveness, strength, and general physical self-worth. Items are scored on a 4-point structured alternative format, with higher scores indicating more positive physical self-perceptions. The inventory structure allows for assessing global and domain-specific perceptions of the physical self, making it particularly relevant for evaluating the psychosocial outcomes of rehabilitation interventions in older adult populations.

Timed up and go (TUG) test

The TUG test is a practical and reliable assessment of functional mobility, reflecting the ability to perform basic movement tasks required for independent daily functioning (e.g., standing up, walking, turning, and sitting down). It measures the time (in seconds) required to rise from a chair, walk 3 m, turn, walk back, and sit down again. Shorter completion times indicate better functional mobility [27].

Hand grip strength test

The Hand Grip Strength Test measures the isometric muscle strength of the hand and forearm muscles. Hand grip strength was assessed using the electronic hand dynamometer [Electronic Hand Dynamometer (HS-005), China], which was used for handgrip strength assessment, and was assessed in “kg”. Handgrip strength measures were taken while the participant was in the sitting position, with the arm in adduction, forearm in 90° flexion, and in the neutral position. The hand and wrist were in 0°−30° extension and 0°−15° ulnar abduction positions. The participants were required to grip as tightly as possible. Grip strength was measured separately for the dominant and non-dominant hands. For each hand, participants performed three maximal voluntary contractions, with a short rest period between trials to minimize fatigue. The mean value of the three trials for each hand was calculated and used for statistical analysis. Grip strength values for the dominant and non-dominant sides were treated as separate outcome measures. Conducted using a dynamometer, this test is widely regarded as an indicator of overall muscular strength [21].

Demographic data were collected, including age, gender, height, weight, educational background, employment status, smoking status, use of assistive devices, marital status, and preferred hand or dominant side. Hand grip strength was recorded for both the dominant and non-dominant sides. The history of falls was assessed by self-report and defined as the number of falls experienced during the previous 12 months.

Ethical considerations

Ethical approval was obtained from University Research Ethics Committee (Meeting No: 05, Decision No: 05, Date: 27.03.2025). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants provided informed consent and were assured of the confidentiality of their involvement and its voluntary nature. No identifying personal information was used in the dissemination of results. The control group was given access to the intervention after the study’s conclusion, which was consistent with ethical research practice involving older adult populations.

Data analysis

All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 22.0 for Windows. The normality of the data was assessed using skewness and kurtosis values, with values between − 2 and + 2 considered indicative of a normal distribution [11]. Descriptive statistics were reported as means ± standard deviations for continuous variables and frequencies and percentages for categorical variables. Independent samples t-tests were conducted to examine between-group differences in intervention-related changes using change scores (Δ), calculated as the difference between post-intervention and baseline values. Within-group changes were assessed using paired samples t-tests, depending on the data distribution. Relationships between continuous variables were examined using Pearson correlation coefficients. Comparisons between categorical variables were conducted using chi-square (χ²) tests. Correlation analyses were conducted to examine the associations between physical, psychosocial, and self-perceptual variables at baseline and post-intervention, in order to explore how these domains were interrelated and whether these relationships differed following participation in the integrated community-based rehabilitation programme. Baseline correlation analyses were conducted for descriptive and exploratory purposes to characterise pre-intervention relationships among key study variables.

Results

Participant characteristics

The average age of participants in the experimental group was 66.38 ± 4.51. When examined by gender, the mean age of female participants was 65.58 ± 4.37, whereas male participants were slightly older, with a mean age of 68.75 ± 4.10. In the control group, the overall mean age was 65.75 ± 4.13. Female participants in this group had a mean age of 64.70 ± 4.17, while the average age of male participants was 68.78 ± 3.15. Sixty-four older adults participated, evenly distributed between the experimental and control groups (n = 32 per group). The demographic profiles of the two groups were broadly comparable. Most participants were female (75.0% in the experimental group; 71.9% in the control group). Educational attainment varied, though most participants had at least basic literacy. A substantial proportion were retired (53.1% in the experimental group; 62.5% in the control group). Additionally, most reported being non-smokers and not using assistive mobility devices. Most participants identified their dominant hand as the right (96.9% in the experimental group; 87.5% in the control group). Baseline equivalence between the experimental and control groups was examined using chi-square (χ²) tests for categorical demographic variables, including gender, educational level, employment status, smoking status, assistive device use, marital status, and dominant side. The analyses revealed no statistically significant differences between the groups across any baseline demographic characteristic (all p > 0.05), indicating initial group equivalence (Table 1).

Table 1.

Demographic Characteristics of Participants in the Experimental and Control Groups

Variable	Experimental Group (n = 32), (%)	Control Group (n = 32), (%)	χ2	p-value
Gender
Female	24 (75.0)	23 (71.9)	0.01	1.000
Male	8 (25.0)	9 (28.1)
Education Level			2.49	0.870
Illiterate	4 (12.5)	3 (9.4)
Literate	8 (25.0)	8 (25.0)
Primary School	2 (6.3)	3 (9.4)
High School	9 (28.1)	6 (18.8)
Associate Degree	4 (12.5)	3 (9.4)
Bachelor’s Degree	4 (12.5)	6 (18.8)
Master’s Degree	1 (3.1)	3 (9.4)
Employment status			0.26	0.613
Homemaker	15 (46.9)	12 (37.5)
Retired	17 (53.1)	20 (62.5)
Smoking Status			1.29	0.257
Smoker	2 (6.3)	6 (18.8)
Non-smoker	30 (93.8)	26 (81.3)
Assistive Device Use			0.01	1.000
Uses device	2 (6.3)	1 (3.1)
Does not use	30 (93.8)	31 (96.9)
Marital Status			1.40	0.497
Married	26 (81.3)	22 (68.8)
Single	4 (12.5)	6 (18.8)
Widowed	2 (6.3)	4 (12.5)
Dominant Side			0.87	0.352
Right	31 (96.9)	28 (87.5)
Left	1 (3.1)	4 (12.5)

Physical and psychosocial outcomes

Following the 12-week intervention, participants in the experimental group demonstrated statistically significant improvements across a range of physical and psychosocial measures. BMI decreased significantly (p = 0.001), whereas changes in number of falls were not statistically significant (p = 0.103). Hand grip strength showed modest but significant gains in both the dominant (p = 0.001) and non-dominant (p = 0.005) hands. As measured by the TUG test, mobility improved significantly (p = 0.001). Psychosocial gains were particularly marked. Loneliness levels, assessed via the UCLA LS scale, decreased dramatically from 56.19 ± 4.78 to 31.38 ± 3.22 (p = 0.001), while LIS scale rose significantly from 25.91 ± 5.37 to 59.63 ± 8.02 (p = 0.001). All five subdimensions of the PSPP also showed statistically significant improvements, including sports skill, physical condition, body attractiveness, strength, and general physical competence (all p < 0.001).

In the control group, changes were generally modest and mixed. BMI decreased slightly but non-significantly (p = 0.163), and hand grip strength remained statistically unchanged for both dominant (p = 0.348) and non-dominant hands (p = 0.684). A small but significant improvement was observed in mobility (TUG: p = 0.002). Despite not receiving the structured intervention, control group participants also reported significant reductions in loneliness and improved life satisfaction (p = 0.001). However, the magnitude of change was smaller than that observed in the experimental group. Among the self-perception subscales, body attractiveness (p = 0.005) and general physical competence (p = 0.007) showed statistically significant gains, while changes in physical condition (p = 0.073) and strength (p = 0.051) were not significant. These findings underscore the effectiveness of the structured community-based rehabilitation programme in producing more comprehensive and robust improvements in older adults' physical function and psychosocial well-being (Table 2). Independent samples t-tests on change scores (Δ) demonstrated significantly greater improvements in physical performance, physical self-perception, and loneliness outcomes in the experimental group compared with the control group (p < 0.05; Table 2).

Table 2.

Comparison of Pre-Test and Post-Test Outcomes Between Experimental and Control Groups Across Physical and Functional Measures

Measure	Experimental N = 32			Control N = 32			Experimental Group Δ (Mean)	Control Group Δ (Mean)	p-value (Δ)
	Pre-Test Mean ± SD	Post-Test Mean ± SD	p-value	Pre-Test Mean ± SD	Post-Test Mean ± SD	p-value
BMI	29.95 ± 4.77	29.31 ± 4.53	0.001	27.79 ± 4.24	27.61 ± 4.35	0.163	− 0.64	− 0.18	0.016
Dominant Hand Grip	17.61 ± 7.76	18.17 ± 7.73	0.001	19.44 ± 8.85	19.38 ± 8.77	0.348	+ 0.56	− 0.06	0.001
Non-Dominant Hand Grip	15.43 ± 8.89	15.78 ± 8.61	0.005	16.02 ± 9.61	16.00 ± 9.50	0.684	+ 0.35	− 0.02	0.005
Number of Falls	0.63 ± 0.94	0.50 ± 0.67	0.103	0.41 ± 0.88	0.41 ± 0.88	1	− 0.13	0.00	0.103
TUG	10.37 ± 3.28	9.59 ± 2.90	0.001	10.71 ± 2.33	10.44 ± 2.28	0.002	− 0.78	− 0.27	0.001
UCLA-LS	56.19 ± 4.78	31.38 ± 3.22	0.001	57.00 ± 3.65	41.56 ± 5.54	0.001	− 24.81	− 15.44	0.001
LIS	25.91 ± 5.37	59.63 ± 8.02	0.001	26.06 ± 3.76	56.03 ± 8.09	0.001	+ 33.72	+ 29.97	0.109
Sports Skill	10.53 ± 2.12	12.44 ± 2.33	0.001	9.56 ± 1.58	9.69 ± 1.47	0.044	+ 2.38	+ 0.13	0.001
Physical Condition	10.28 ± 2.41	12.66 ± 2.61	0.001	10.53 ± 2.54	10.78 ± 2.76	0.073	+ 2.38	+ 0.25	0.001
Body Attractiveness	10.19 ± 2.75	12.19 ± 2.87	0.001	9.19 ± 1.38	9.47 ± 1.44	0.005	+ 2.00	+ 0.28	0.001
Strength	10.97 ± 2.67	13.44 ± 2.29	0.001	8.94 ± 1.27	9.16 ± 1.11	0.051	+ 2.47	+ 0.22	0.001
General Physical Competence	9.81 ± 2.02	13.38 ± 2.21	0.001	9.84 ± 1.22	10.63 ± 1.96	0.007	+ 3.56	+ 0.78	0.001

SD Standard Deviation, BMI Body Mass Index, TUG Timed Up and Go test, UCLA-LS UCLA Loneliness Scale, LIS Life Satisfaction Scale for the Elderly

Pearson correlation analyses were conducted separately at baseline (pre-test) and post-intervention (post-test); therefore, all reported correlations represent associations between variables measured at the same assessment point. Correlation analyses within the experimental group revealed statistically significant associations between functional mobility, psychosocial well-being, and physical self-perception following the intervention (Table 3).

Table 3.

Correlations between functional mobility, psychosocial well-being, and physical self-perception measures in pre- and post-intervention assessmensts

Variables	TUG (Pre)	TUG (Post)	UCLA (Pre)	UCLA (Post)	LIS (Pre)	LIS (Post)	SA (Pre)	SA (Post)	PC (Pre)	PC (Post)	BA (Pre)	BA (Post)	STR (Pre)	STR (Post)	GPA (Pre)	GPA (Post)
TUG(Pre)	1	0.992	−0.148	0.026	−0.185	−0.400	−0.701	−0.562	−0.788	−0.577	−0.131	−0.121	−0.010	−0.013	−0.278	−0.278
		0.01/*	0.418	0.889	0.311	0.023*	0.01**	0.01**	0.01**	0.01**	0.476	0.511	0.957	0.942	0.123	0.124
TUG(Post)	0.992	1	−0.136	0.028	−0.178	−0.384	−0.717	−0.566	−0.795	−0.591	−0.132	−0.108	−0.023	0.006	−0.281	−0.282
	0.01**		0.459	0.879	0.328	0.030*	0.01**	0.01**	0.01**	0.01**	0.473	0.556	0.899	0.972	0.119	0.117
UCLA(Pre)	−0.148	−0.136	1	0.343	−0.581	−0.132	0.269	0.253	0.322	0.235	−0.346	−0.348	0.091	0.078	0.374	0.277
	0.418	0.459		0.055	0.01**	0.472	0.136	0.162	0.072	0.195	0.053	0.051	0.619	0.672	0.035*	0.125
UCLA(Post)	0.026	0.028	0.343	1	−0.435	−0.425	0.248	0.206	0.310	0.476	0.207	0.027	0.091	0.236	0.249	0.324
	0.889	0.879	0.055		0.013*	0.015*	0.171	0.259	0.084	0.006**	0.257	0.883	0.619	0.194	0.170	0.070
LIS(Pre)	−0.185	−0.178	−0.581	−0.435	1	0.178	−0.055	−0.134	−0.095	−0.118	0.134	0.123	−0.014	−0.025	−0.441	−0.274
	0.311	0.328	0.01**	0.013*		0.331	0.765	0.466	0.605	0.522	0.463	0.503	0.941	0.890	0.011*	0.129
LIS(Post)	−0.400	−0.384	−0.132	−0.425	0.178	1	0.207	0.134	0.169	0.094	0.014	0.021	0.022	0.113	0.033	0.116
	0.023*	0.030*	0.472	0.015*	0.331		0.256	0.466	0.355	0.610	0.941	0.907	0.905	0.538	0.856	0.529
SA (Pre)	−0.701	−0.717	0.269	0.248	−0.055	0.207	1	0.884	0.895	0.808	0.021	−0.054	−0.139	−0.109	0.369	0.409
	0.01**	0.01**	0.136	0.171	0.765	0.256		0.01**	0.01**	0.01**	0.909	0.769	0.448	0.552	0.038*	0.020
SA (Post)	−0.562	−0.566	0.253	0.206	−0.134	0.134	0.884	1	0.856	0.817	−0.003	−0.061	−0.065	0.005	0.450	0.400
	0.01**	0.01**	0.162	0.259	0.466	0.466	0.01**		0.01**	0.01**	0.986	0.740	0.723	0.977	0.010*	0.023*
PC (Pre)	−0.788	−0.795	0.322	0.310	−0.095	0.169	0.895	0.856	1	0.897	0.060	−0.013	0.026	0.071	0.500	0.463
	0.01**	0.01**	0.072	0.084	0.605	0.355	0.01**	0.01**		0.01**	0.745	0.946	0.886	0.701	0.004	0.008**
PC (Post)	−0.577	−0.591	0.235	0.476	−0.118	0.094	0.808	0.817	0.897	1	0.104	0.005	0.100	0.199	0.501	0.476
	0.01**	0.01**	0.195	0.006**	0.522	0.610	0.01**	0.01**	0.01**		0.573	0.980	0.585	0.275	0.004	0.006**
BA (Pre)	−0.131	−0.132	−0.346	0.207	0.134	0.014	0.021	−0.003	0.060	0.104	1	0.907	−0.004	0.058	0.041	0.152
	0.476	0.473	0.053	0.257	0.463	0.941	0.909	0.986	0.745	0.573		0.01**	0.985	0.751	0.823	0.405
BA (Post)	−0.121	−0.108	−0.348	0.027	0.123	0.021	−0.054	−0.061	−0.013	0.005	0.907	1	−0.121	−0.052	0.129	0.146
	0.511	0.556	0.051	0.883	0.503	0.907	0.769	0.740	0.946	0.980	0.000		0.508	0.776	0.483	0.424
STR (Pre)	−0.010	−0.023	0.091	0.091	−0.014	0.022	−0.139	−0.065	0.026	0.100	−0.004	−0.121	1	0.885	0.202	0.204
	0.957	0.899	0.619	0.619	0.941	0.905	0.448	0.723	0.886	0.585	0.985	0.508		0.01**	0.268	0.262
STR (Post)	−0.013	0.006	0.078	0.236	−0.025	0.113	−0.109	0.005	0.071	0.199	0.058	−0.052	0.885	1	0.221	0.235
	0.942	0.972	0.672	0.194	0.890	0.538	0.552	0.977	0.701	0.275	0.751	0.776	0.01**		0.225	0.196
GPA (Pre)	−0.278	−0.281	0.374	0.249	−0.441	0.033	0.369	0.450	0.500	0.501	0.041	0.129	0.202	0.221	1	0.875
	0.123	0.119	0.035*	0.170	0.011**	0.856	0.038*	0.010	0.004**	0.004**	0.823	0.483	0.268	0.225		0.01**
GPA (Post)	−0.278	−0.282	0.277	0.324	−0.274	0.116	0.409	0.400	0.463	0.476	0.152	0.146	0.204	0.235	0.875	1
	0.124	0.117	0.125	0.070	0.129	0.529	0.020	0.023	0.008**	0.006**	0.405	0.424	0.262	0.196	0.000

TUG Timed Up and Go, UCLA UCLA Loneliness Scale, LIS Life Satisfaction Scale for the Elderly, SA Sports Ability, PC Physical Condition, BA Body Attractiveness, STR Strength, GPAs General Physical Ability

Post-test TUG scores were significantly and negatively correlated with sports ability (r = −0.566, p < 0.01), physical condition (r = –0.795, p < 0.01), and general physical ability (r = –0.282, p < 0.05), indicating that better functional mobility was associated with higher self-perceived physical competence. Similar significant inverse correlations were observed at the pre-test stage, particularly between TUG and sports ability (r = –0.701, p < 0.01) and physical condition (r = –0.788, p < 0.01), reinforcing the robustness of these relationships across time points.

Psychosocial variables also showed meaningful associations. Post-test loneliness scores (UCLA-LS) were negatively correlated with life satisfaction (r = –0.425, p = 0.015) and physical condition (r = –0.476, p = 0.006), suggesting that reductions in loneliness were closely linked to improved perceptions of both life satisfaction and physical competence. Pre-test life satisfaction demonstrated a significant negative correlation with loneliness (r = –0.581, p < 0.01) and general physical ability (r = –0.441, p = 0.011), suggesting that higher life satisfaction was associated with lower loneliness and more positive perceptions of physical competence. In addition, strong positive intercorrelations were observed between subdimensions of physical self-perception. For instance, pre-test correlations between sports ability and physical condition (r = 0.895, p < 0.01), and between physical condition and general physical ability (r = 0.500, p = 0.004), highlight the internal consistency of the self-perception construct.

Discussion

The findings of this study suggest that a structured community-based rehabilitation (CBR) programme may contribute to enhancements in physical functioning and psychosocial well-being, including physical self-worth, among older adults. In line with the existing literature, improvements were observed across both objective performance measures (e.g., TUG, grip strength) and subjective indicators (e.g., loneliness, life satisfaction, and physical self-worth), lending support to the potential relevance of integrative interventions that address both the physical and social dimensions of ageing [18, 35].

The demographic analysis revealed that the experimental and control groups were broadly comparable at baseline, supporting the internal validity of the study’s findings. The average age and gender distribution were similar across groups, with a predominance of female participants, reflecting general demographic trends in voluntary ageing-related programmes [38]. Notably, the absence of statistically significant differences in key demographic variables such as age, education, smoking status, use of assistive devices, and hand dominance suggests that the two groups were equivalent before the intervention. This comparability strengthens, though does not definitively establish, the attribution of observed post-intervention changes to the structured and intentional community-based rehabilitation programme rather than to pre-existing group disparities. Moreover, the high proportion of retired and right-handed individuals aligns with typical characteristics of older adult populations in similar settings. The balanced distribution and homogeneity of baseline characteristics thus provide a reasonably robust foundation for interpreting the effectiveness of the intervention in improving physical and psychosocial outcomes among older adults.

The findings of this study indicate that the 12-week structured CBR programme was associated with significant improvements in physical health outcomes among older adults in the experimental group. Reductions in BMI were observed; however, no statistically significant differences were found in the frequency of falls. Therefore, improvements in mobility, as measured by the TUG test, provide the primary evidence of enhanced dynamic balance and lower-extremity function. The observed gains in hand grip strength for both dominant and non-dominant hands further underscore improvements in upper body muscular function, a key predictor of overall strength, mobility, and mortality in older populations [3]. Additionally, the statistically significant enhancement in mobility, as measured by the TUG test, indicates improvements in dynamic balance and lower-extremity function, which are directly associated with reduced fall risk and better quality of life. These findings suggest that structured rehabilitation programmes may represent a promising preventive approach; however, further randomized and longitudinal research is required before firm policy implications can be drawn [8, 35].

The intervention yielded statistically significant psychosocial improvements, as evidenced by significant reductions in perceived loneliness and notable improvements in life satisfaction and physical self-perception. The marked decline in UCLA LS scores highlights the potential capacity of community-based interventions to counteract one of the most pervasive and detrimental experiences in later life, social isolation. Social engagement, facilitated through structured group activities and shared experiences, may have contributed to fostering a sense of belonging and emotional connection, consistent with prior literature [29, 34].These findings are also consistent with evidence suggesting that engagement in productive and socially meaningful activities, such as education and community participation, is associated with reduced loneliness and enhanced quality of life among older adults [32], which may help explain the significant increase in life satisfaction observed in the present study, consistent with findings linking purposeful social interaction and physical activity to greater life satisfaction in older populations [40]. Furthermore, the comprehensive improvement across all five subdimensions of the PSPP indicates an enhanced sense of embodied competence and physical self-worth [41]. This is particularly significant, as positive physical self-worth is associated with improved mental health and sustained participation in health-promoting behaviors. Importantly, these gains were not limited to performance metrics but may also reflect changes in how older participants perceived and valued their bodies. These findings are consistent with the potential value of integrative rehabilitation models that address the physical and psychosocial dimensions of ageing, ultimately promoting more holistic well-being in older adulthood [30].

In the literature, engagement in lifelong learning initiatives for older adults, including Universities of the Third Age, has been associated with enhanced psychological well-being [4, 7, 28]. The Refreshment University initiative examined in this study does not represent formal university education but rather a community-based lifelong learning programme, designed to promote social participation, personal development, and active engagement in later life. For instance, a study conducted in Portugal found that seniors attending a university program experienced significant improvements in life satisfaction and health self-efficacy compared to non-participants [28]. Similarly, research from Brazil highlighted that older adults who participated in a University of the Third Age program reported higher levels of psychological adjustment and life satisfaction, particularly after attending the program for six months or longer [5]. A study in Spain found that older adults who participated in a senior university program showed statistically significant improvements in anxiety, depression, and overall quality of life after completing a yearly educational cycle [4]. Another study in Poland revealed that participants in a Third Age University program exhibited lower levels of mild depression and anxiety symptoms, suggesting that such programs can serve as a protective factor against these mental health challenges [7].

In our study, significant improvements were observed in the TUG, UCLA-LS, and LIS scores among participants in the control group, who attended only the Refreshment University courses.

These changes may be attributable, at least in part, to incidental social interaction and engagement within the university-based learning environment. However, the magnitude and consistency of improvements observed in the experimental group underscore the added value of structured and intentional programming beyond incidental participation alone. Rather than characterizing control group participants as “passive,” which may inadequately capture the nature of their engagement, it is more appropriate to describe them as participants engaged in the standard university curriculum without exposure to the additional structured CBR components. This distinction emphasizes differences in programme structure rather than levels of participant engagement.

Correlation analyses between functional mobility, psychosocial well-being, and physical self-perception revealed important patterns that underscore the multidimensional impact of the intervention. As presented in Table 3, significant associations were observed between functional mobility and dimensions of physical self-perception, as well as between loneliness, life satisfaction, and perceived physical condition. These findings support prior research showing that improvements in physical performance are associated with enhanced self-perception and confidence among older adults [41]. Similarly, the observed associations indicate that psychosocial gains are interconnected with physical vitality. Detailed correlation coefficients are provided in Table 3 to avoid redundancy within the text. These findings align with the literature on embodied aging, which views the body as both a site of functional change and a medium through which identity, competence, and agency are rearticulated in later life [13, 25, 30].

Limitations

The findings of this study should be interpreted in light of several limitations. Participants were recruited from a single university-based continuing education program, which may limit the generalizability of the results to the broader population of older adults, particularly those experiencing structural disadvantages, such as lower socioeconomic status, limited access to educational opportunities, or restricted availability of health and community resources. The voluntary nature of participation and the reliance on self-reported measures may also have introduced selection and social desirability biases, as individuals who are more motivated, healthier, or socially engaged may have been more likely to participate and report favorable outcomes. Moreover, reliance on self-reported outcomes may not fully capture objective functional change or clinically meaningful improvement, and the absence of complementary performance-based assessments may have constrained measurement precision. In addition, the quasi-experimental design, which did not include random allocation or blinding, constrains causal inference and raises the possibility that unmeasured confounding factors may have influenced the observed outcomes. Accordingly, the observed associations should not be interpreted as definitive evidence of causality, and alternative explanations cannot be fully excluded. The study also did not incorporate long-term follow-up assessments, limiting conclusions regarding the sustainability and durability of the intervention effects over time. It therefore remains unclear whether the reported improvements in mobility and loneliness were maintained beyond the immediate post-intervention period. Furthermore, given the multidimensional structure of the CBR programme, the relative contribution of its individual components could not be disentangled. As such, it is not possible to determine which specific elements were primarily responsible for the observed changes. At the same time, the university-based continuing education context constitutes a defining strength of the study. Beyond the observed intervention effects, the successful implementation of the structured CBR programme within the Refreshment University highlights the potential of lifelong learning initiatives for older adults as effective platforms for integrated health-promoting interventions. The Refreshment University provided an established institutional infrastructure, regular attendance patterns, and a socially enriched learning environment, which likely facilitated engagement, adherence, and sustained participation in the CBR programme. Embedding a structured rehabilitation intervention within a lifelong learning setting may enhance feasibility and acceptability compared with standalone community or clinical programmes. Such settings inherently promote active ageing, social participation, and cognitive engagement, thereby complementing the physical and psychosocial objectives of community-based rehabilitation. From this perspective, continuing education programmes for older adults may function not only as educational and social resources but also as scalable and sustainable delivery contexts for multidimensional rehabilitation interventions in later life. Nevertheless, participants in this study represented an educationally engaged and relatively active subgroup of older adults, which may reflect higher baseline functional capacity and motivation than the broader ageing population. This characteristic may have amplified intervention responsiveness and should be considered when interpreting effect magnitude. Future research should build on these findings by incorporating more socioeconomically and culturally diverse samples, employing fully randomized or hybrid effectiveness–implementation designs where feasible, and adopting longitudinal approaches that attend to the intersecting social inequalities shaping older adults’ engagement with community-based interventions.

Conclusion

This study sheds light on the sociocultural and embodied aspects of ageing by showing that participation in a structured community-based rehabilitation programme was linked to improvements in physical functioning, psychosocial outcomes, and physical self-worth among older adults. Within a community setting, the combination of physical activity and facilitated social interaction supported mobility, life satisfaction, and reduced loneliness. Although the study did not directly explore how feelings of belonging or agency develop, the observed changes suggest that structured and intentional programmes may create supportive environments that encourage positive engagement in later life. As populations continue to age, these findings point to the potential value of integrated, community-based approaches in supporting both physical and psychosocial well-being. Future research should further explore the pathways through which such programmes influence participation, belonging, and engagement, and examine how they can be adapted across different sociocultural contexts.

Authors’ contributions

All authors contributed equally to the conception, design, data collection, analysis, and interpretation of the study, as well as to the drafting and critical revision of the manuscript. All authors read and approved the final version of the manuscript.

Funding

Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK).

Data availability

The data are available from the authors upon reasonable request.

Declarations

Ethical approval and consent to participate

This research received ethical clearance from the Ethical Review Committee of Erzurum Technical University. Written informed consen, t was obtained from all participants before their involvement.

Consent for publication

Not applicable.

Competing Interests

The authors declare no competing interests.