The relationship between effort tolerance, functional fitness, age, and rehabilitation training in women over 60 living in Polish nursing homes

Abstract

Decline in physical activity is believed to contribute to reduced exercise tolerance and diminished functional fitness. This underscores the importance of rehabilitation training in maintaining adequate levels of both. The aim of this study was to evaluate the relationship between exercise tolerance, functional fitness, age, and participation in rehabilitation training among women over the age of 60. The study included 106 women aged 60 to 89, of whom 60 participated in rehabilitation training and 46 did not. To assess exercise tolerance and functional fitness, researchers employed the 6-min Walk Test and the Short Physical Performance Battery. No significant relationship was found between age and either functional fitness or exercise tolerance among physically active women. Similarly, no association was observed between age and exercise tolerance in the group of inactive women. However, a significant correlation was identified between age and functional fitness in inactive women (p = 0.001). A notable difference in exercise tolerance between active and inactive participants was observed only in the subgroup of women aged 75 to 89, with those engaged in rehabilitation activities achieving significantly better results (p = 0.008). The level of physical activity among female nursing home residents from the western region of Poland is too low and poorly balanced. Rehabilitation training should be individually selected to bring benefits to the elderly.

The projected increase in the proportion of people aged 65 and older—from 19% in 2020 to 33% in 2050 poses challenges to the effectiveness of long-term care in Poland. This issue also affects the availability of long-term care through well-functioning social care homes. It is essential to implement public policy measures to ensure that older people have access to appropriate and personalized services¹.

The number of people residing in social care homes in Poland is increasing, largely due to the aging of society. However, the availability of caregivers and geriatricians remains a challenge, as there are currently too few professionals employed to meet future demand. Most existing studies focus on the functional fitness, exercise tolerance, and health status of older adults living independently^2–4. In contrast, significantly less research has been conducted on older adults living in social care homes^5,6, especially in Poland^7,8. In nursing homes, older individuals are provided with structured care and activation programs within their place of residence. Further research is needed to develop optimal conditions for dignified aging among older adults, who increasingly reside in social care facilities.

Lifestyle, including regular engagement in appropriately selected physical activity, is a key factor in preventing lifestyle-related diseases and slowing down age-related changes. Numerous studies have confirmed that insufficient physical activity contributes to a decline in physiological parameters. Aging is associated with reduced daily mobility and diminished functional abilities⁹. Researchers emphasize that improving functional fitness and physical endurance is a crucial preventive factor for many diseases and significantly enhances quality of life. This conclusion applies to all age groups, particularly as age-related regression affects various bodily systems, leading to reduced efficiency^7,10,11. The American College of Sports Medicine and the American Heart Association have developed guidelines concerning exercise load, duration, and intensity, which promote health benefits and lead to noticeable adaptive changes in the body. A well designed training regimen balanced in terms of intensity and volume produces the desired adaptations, based on the simple principle that too little is ineffective and too much may be harmful¹¹. The most noticeable beneficial adaptive changes are closely linked to the volume and intensity of physical activity performed. Especially in older adults, physical activity should be purposefully tailored to maximize these adaptations while promoting optimal functional fitness and physical endurance. This approach supports greater autonomy and contributes to dignified aging. Research by various authors has shown that high-intensity interval training (HIIT) induces positive changes in cardiovascular and respiratory fitness, functional capacity, and muscle strength in older individuals, helping to maintain aerobic fitness and slow the progression of sarcopenia¹⁰. Physical activity reduces overall morbidity and mortality among older adults¹². It also lowers the risk of falls, which pose serious threats to the health and even lives of seniors¹³. Older individuals should be encouraged to minimize sedentary behavior and avoid prolonged periods of physical inactivity¹⁴. The decline in physical activity and exercise tolerance with age is a natural physiological process. However, the rate of this decline varies among individuals depending on their age and level of physical activity. Researchers have found that older adults who engage in regular physical activity and maintain an active family and social life experience a slower rate of decline¹⁵.

Accordingly, the following research question was formulated: Do exercise tolerance and functional fitness among women residing in social welfare homes differ depending on age and participation in rehabilitation training?

Aim of the study

The aim of this study was to evaluate the relationship between exercise tolerance, functional fitness, age, and rehabilitation training in women over the age of 60 residing in social welfare homes in Poland.

Materials and methods

Research design and participants

The study involved 106 women, including 60 who participated in rehabilitation training and 46 who did not, aged between 60 and 89 years. All participants were residents of social welfare homes located in the south-western region of Poland. The research was conducted in 13 cities across Poland and took place between 2020 and 2023.

The division into groups A1, A2, B1, and B2 was introduced to enable clear and methodologically consistent comparisons across age categories and levels of physical activity.

The active group (Group A) consisted of younger individuals who regularly participated in rehabilitation training. The inactive group (Group B) included individuals who did not attend any physical activity sessions. Both the active and inactive groups were further divided into two age categories. Groups A1 and B1 included participants aged 60 to 74, while Groups A2 and B2 included those aged 75 to 89. Within the active group, subgroups A1 and A2 were formed, and within the inactive group, subgroups B1 and B2 were established.

Participants in the active groups reported that they had been attending both types of sessions described below for at least six months. Individuals in this group took part in rehabilitation classes regularly, twice a week. Each session lasted between one hour and one hour and twenty minutes, depending on the individual adaptive capacity of the residents. The sessions took place in a rehabilitation room adapted for exercise. The facility was equipped with devices designed to activate both upper and lower limbs, with adjustable resistance settings to suit the level of exertion. The program consisted of individualized and progressive strength exercises, balance training, and aerobic conditioning. Each session began with a warm-up lasting up to 10 min, focused on increasing the range of motion in various joints. The strength training segment, lasting up to 25 min, included exercises targeting both upper and lower body muscle groups using external weights. The balance training, lasting up to 10 min, involved progressively challenging exercises. It began with transitioning from a seated to a standing position. While standing, the number of support points was gradually reduced: starting with both hands, then one hand, followed by both feet, and finally standing on one leg only. The final part of the session, lasting up to 30 min, focused on improving aerobic endurance and was conducted on a stationary bicycle. Each session concluded with breathing and relaxation exercises. Each training session lasted between one hour and one hour and twenty minutes. Additionally, once a week, group classes were held in the exercise room, focusing primarily on physical activities related to everyday functionality. These exercises included: repeated full-range joint movements of the upper and lower limbs, bends in all planes, rotational movements of the torso, standing up from a chair with various arm positions, static and dynamic balance exercises, and fine motor tasks involving small manipulative movements. Most of the exercises were performed in a seated position. These sessions lasted one hour. The physical exercise program for the residents included in the active group maintained the same overall structure throughout the study.

Inclusion criteria for study participants:

1. Age between 60 and 89 years.

2. Women residing in residential care homes in Poland.

3. Independent mobility and ability to perform daily activities unaided.

4. No medical contraindications to participation in functional fitness assessments.

5. No issues with verbal communication.

6. No physical or cognitive impairments.

7. Absence of obesity.

Exclusion criteria included cancer, acute injuries and infections, recent myocardial infarction, other medical contraindications, and lack of consent to participate in the study. These inclusion and exclusion criteria were designed to minimize potential confounding factors, such as cognitive impairment, mobility limitations, obesity, or medical conditions that could influence functional performance. All participants who agreed to take part signed a voluntary informed consent form prior to the commencement of the study. The study received ethical approval from the Senate Committee for Scientific Research Ethics at the University of Opole (approval number KB/202/FI/2019) and was conducted in accordance with the principles of the Declaration of Helsinki.

Methods

The assessment of each participant lasted approximately 30 min and was conducted within a single day. Measurements including the 6-min walk test (6MWT) and the Short Physical Performance Battery (SPPB) were carried out in residential care homes. The 6-min walk test was conducted as the final assessment¹⁶. The study was carried out in 13 cities across Poland and spanned the years 2020 to 2023.

Methods and procedures of functional fitness tests

Physical fitness was assessed using the Short Physical Performance Battery (SPPB). Physical endurance was evaluated with the 6-min walk test. The SPPB provides information about physical capabilities, which are reflected in the ability to perform basic activities of daily living. The SPPB test assessed physical fitness in three areas: lower limb strength, static balance, and walking speed. To evaluate lower limb endurance and strength, the participant was asked to rise from a chair with arms crossed over the chest. If the individual successfully completed a single sit-to-stand repetition, they were then instructed to perform five consecutive repetitions as quickly as possible. The total time taken to complete the task was used for result interpretation. To assess static balance, the participant attempted to maintain stability for ten seconds in three different positions:

• Standing with feet placed parallel to each other.

• Semi-tandem stance, with the side of one heel touching the big toe of the opposite foot.

• Full tandem stance, with one foot placed directly behind the other so that the heel of the front foot touched the toes of the back foot. The participant proceeded to the next position only if the previous one was completed without difficulty and could be maintained for ten seconds.

• To assess walking speed, the participant walked a straight four-metre distance as quickly as possible. The recorded time to cover the distance was used for result interpretation.

SPPB test results were interpreted using a scoring table based on performance in each individual trial. In each domain of the SPPB test, participants could score from zero to four points, where zero indicated inability to perform the task and four represented the highest level of functional ability. The total score ranged from zero to twelve points and was used to define the overall level of physical fitness^17,18.

Physical endurance was assessed using the 6-min walk test

The 6-min walk test was used to indirectly assess aerobic capacity¹⁹. Participants were instructed to cover the longest possible distance within 6 min. The distance was recorded in metres. The test was conducted on a flat, non-slippery surface. The walking route was marked around a rectangle measuring twenty metres by five metres.

Somatic measurements

Body height and weight were measured using the SECA model 764 device. Based on these measurements, the Body Mass Index (BMI) was calculated. The following categories were adopted:

• Underweight: < 18.5 kg/m².

• Normal weight: 18.5–24.9 kg/m².

• Overweight: 25–29.9 kg/m².

• Obesity: > 30 kg/m² in accordance with the criteria defined by the World Health Organization (WHO)²⁰.

Statistical analysis

Statistical calculations were performed using the Statistica v.14 software. After computing basic descriptive statistics, the distribution of the analysed variables was examined for normality. The Shapiro–Wilk W test was used to assess the conformity of the data distribution with the theoretical normal distribution. The Mann–Whitney U test was applied for variables that did not follow a normal distribution. For between-group comparisons, the independent samples Student’s t-test was used. Variables with normal distributions in the analysed groups included:

• A1—points.

• A2—distance.

• B1—distance.

• B2—distance.

• B1—points.

• B2—points.

A comparison was made between the results of this study and those reported by Ignasiak et al., 2020²¹. The data obtained from the 6-min walk test in the present study were compared with established norms for the older adult population in Poland. In the first step of the analysis, weighted mean values were calculated based on the data presented in the source article by Ignasiak et al., 2020²¹. The data from two age groups were simplified for comparison purposes. Calculations were based on data from Table 1 (means and standard deviations of the variables) and Table 6 (sample sizes within age categories). The weighted mean was calculated using the following formula:

Table 1.

The general statistical characteristic.

Variable M SD	Age range (60–74) A1	Age range (75–89) A2	Age range (60–74) B1	Age range (75–89) B2
Age [years]	66,8 5,7	87,3 2,6	62,2 2,6	85,3 3,2
Weight [kg]	62,7 11,1	61,1 7,9	60,3 6,1	61,3 7,6
BMI [kg/m2]	24,7 3,4	24,6 2,6	24,5 2,3	26,6 2,1
SPPB points	7,8 3	6,5 2,5	7,4 2,2	5,1 2,1
6-min walk test (m)	266,4 118	213,5 85,8	214,7 105	161,6 61,8

where:

• x = value of the variable.

• w = weight of the variable (in this case, the number of individuals in each age category).

Weighted mean values were calculated for the age categories based on the source material by Ignasiak et al., 2020²¹: – Group A = 471.6 (SD 105.8) – Group B = 382.2 (SD 117.7).

An analysis of the significance of differences in mean values of the distance covered in the 6-min walk test was conducted (own research versus the study by Ignasiak et al., 2020). A mean difference test (equivalent to Student’s t-test) was applied. The results were processed using Statistica software in accordance with generally accepted standards. A significance threshold of p ≤ 0.05 was adopted. No correction for multiple comparisons was applied, as only single, predefined pairwise comparisons were conducted rather than sets of simultaneous tests. Therefore, p-value adjustment was not required.

Additionally, a power analysis of the statistical tests was conducted using the calculated effect sizes (Cohen’s d, Hedges’ g, r, and Cliff’s δ). In many comparisons, the effect sizes were very small or small (e.g., d = 0.14; r = 0.07–0.24), which translated into low statistical power (1 − β ≈ 0.05–0.45). This indicates that the study may not have had sufficient power to detect subtle differences between groups, particularly after stratification into age subgroups. At the same time, in analyses where the effect sizes were moderate or large (e.g., Hedges’ g = 0.67; r = 0.48), the statistical power was high (0.90–0.97), confirming the reliability of these results.

Results

The general characteristics of the presented somatic features across different age groups of active and inactive women do not indicate significant variation in terms of BMI. The examined female residents do not show signs of underweight or obesity (Table 1).

With increasing age, there is a tendency toward lower average values of the distance covered in the 6-min Walk Test, as well as lower average scores on the SPPB among women participating in rehabilitation training (Table 1).

The Mann–Whitney U test was applied (due to distributions differing from the standard normal distribution). Differences in mean distances covered and mean scores obtained in the defined age groups of active individuals are statistically insignificant (Table 2). The difference in mean distance covered in the 6-min walk test among the defined groups of inactive individuals is also statistically insignificant. However, the mean SPPB scores in the younger inactive women group (B1) are significantly higher compared to the older inactive women group (B2) (Table 2).

Table 2.

The general statistical characteristic. 6-min Walk Test [m] and SPPB Test for active group. The analysis of variance of 6-min Walk Test and the analysis of variance of SPPB Test [m] for active group.

Variables	Group	M ± SD	Me	Min - Max	p
SPPB points	A1	7,8 ± 2,9	8	3–12	0,0703
	A2	6,5 ± 2,5	5	2–11
SPPB points	B1	7,4 ± 2,2	8	3–11	0,0010
	B2	5,1 ± 2,1	5	1–10
Distance 6 min walk (m)	A1	266,4 ± 118	299	85–432	0,0844
	A2	213,5 ± 85,8	202	65–410
Distance 6 min walk (m)	B1	214,7 ± 105	220	30–366	0,0550
	B2	161,6 ± 61,8	161	37–317

M—mean; SD—standard deviation; Me—median; Min—minimum value, Max—maximum value; *p < 0.05.

With aging, the examined groups show a tendency toward lower average values of the distance covered in the 6-min Walk Test and lower average total scores in the SPPB Test among women not participating in rehabilitation training (Table 2).

An independent samples Student’s t-test was performed to compare the mean results of active and inactive groups within the same age range. SPPB test scores were compared between groups A1 and B1, and walking distance was compared between groups A2 and B2 (Table 3).

Table 3.

Comparison of mean results between active and inactive groups within the same age range.

Variables	Group	M ± SD	Me	Min - Max	p
SPPB points	A1	7,8 ± 2,9	8	3–12	0,2024
	B1	7,4 ± 2,2	8	3–11
SPPB points	A2	6,5 ± 2,5	5	2–11	0,0527
	B2	5,1 ± 2,1	5	1–10
Distance 6 min walk (m)	A1	266,4 ± 118	299	85–432	0,0843
	B1	214,7 ± 105	220	30–366
Distance 6 min walk (m)	A2	213,5 ± 85,8	202	65–410	0,0010
	B2	161,6 ± 61,8	161	37–317

M—mean; SD—standard deviation; Me—median; Min—minimum value, Max—maximum value; *p < 0.05.

The Mann–Whitney U test was applied (due to distributions differing from the standard normal distribution). The distance covered in the 6-min walk test was compared between groups A1 and B1, and the SPPB scores were compared between older active and inactive women (A2 vs. B2) (Table 3).

The mean distance covered does not differ significantly depending on participation in training when comparing the same age range among younger women aged 60–74 (comparison between A1 and B1) (Table 3). However, the difference in distance covered is statistically significant among older women aged 75−89 (comparison between A2 and B2) (Table 3). Women participating in training achieved greater walking distances. The mean SPPB scores do not differ significantly depending on participation in rehabilitation training within comparable age ranges among the examined women (Table 3).

The results of the distance covered in the 6-min walk test across all examined groups are significantly lower than the established norms for seniors in Poland (Table 4).

Table 4.

Reference to existing nationwide norms for the distance covered in the 6-min walk test for older people.

Variables	Group	M ± SD	p
Distance 6 min walk (m)	A1	266,4 ± 118	p < 0,001
	Normy	471,6 ± 105,8
Distance 6 min walk (m)	A2	213,5 ± 85,8	p < 0,001
	Normy	382,2 ±117,7
Distance 6 min walk (m)	B1	214,7 ± 105	p < 0,001
	Normy	471,6 ± 105,8
Distance 6 min walk (m)	B2	161,6 ± 61,8	p < 0,001
	Normy	382,2 ± 117,7

M—mean; SD—standard deviation; Me—median; Min—minimum value, Max - maximum value; *p < 0.05.

Discussion

The interpretation of the findings was deliberately limited to the empirical data obtained in this study, without extending conclusions beyond the scope of the results.

Many studies report that the aging process contributes to a decline in functional fitness and aerobic endurance. As a result, this leads to difficulties in performing daily activities and in the normal functioning of older adults. There is a trend in aging associated with a reduction in muscle mass and the efficiency of the cardiovascular and respiratory systems. Muscle mass and strength decrease by 30−50% between the ages of 30 and 80. Muscle strength declines by approximately 12–14% per decade after the age of 50. Resistance training is considered a promising intervention that may slow down the loss of muscle function and mass associated with aging. The ability of older adults to engage in aerobic activities such as walking and running declines with age. This is largely due to a decrease in maximal oxygen uptake by approximately 0.5–1.0% per year²². Differences in the average walking distance achieved in the test across various age groups both among inactive and active individuals examined in this study are not statistically significan. A downward trend associated with aging is evident in both groups (inactive and active). Comparison of the 6-min walk test results between active and inactive individuals within the same age groups mostly did not reveal statistically significant differences. Statistically significant differences in walking distance were observed only in the group of older women (aged 75–89). Women participating in training (group A2) achieved greater walking distances. This group demonstrated a higher level of exercise tolerance. Most likely, only in this age range was a more effective activation applied—though still insufficient. The active women in the study engaged in aerobic capacity-enhancing activities twice a week for up to 30 min. This was dependent on the adaptation process. The training program was based on stationary cycling. Aerobic exercises for older adults may include various forms such as: walking with changes in pace and direction, treadmill walking, step-ups, stair climbing, and dancing. The choice should depend on individual preferences, availability, coexisting cognitive and physical conditions, and specific musculoskeletal issues, in order to achieve the best adaptive effects. According to the International Consensus on Exercise for Older Adults (ICFSR), endurance training may begin with 5–10 min during the initial weeks, progressing to 15–30 min for the remainder of the program, with a frequency of 3 to 7 days per week²². It can be assumed that the training program conducted among the examined female residents was insufficient, with too few sessions per week. Therefore, the expected adaptive changes were not achieved. No significant differences in the distance covered during the 6-min walk test were observed between active and inactive women in the younger age group.

Moreover, when comparing the results of the 6-min walk test for senior women in Poland living independently (not hospitalized, not residing in nursing homes, etc.), significantly lower scores were observed among women living in nursing homes across all age groups. This conclusion is based on a comparison of the values obtained in this study with normative data for Polish older people²¹. This applies to all compared age groups of women. Nursing home residents achieved significantly lower values. It can be assumed that activation programs and rehabilitation are still applied too infrequently and with insufficient intensity relative to the needs of senior women living in nursing homes in Poland. Aerobic capacity is an important component of physical fitness, and aerobic training should be part of the exercise routine for both fit and frail older adults. Good exercise tolerance is associated with reduced mortality risk and many other chronic diseases, and it determines autonomy²².

Walking ability is a strong predictor of survival in older adults, and its maintenance should be a priority in the oldest age groups²³. It can be assumed that the activation programs implemented for older women in Polish nursing homes are insufficient.

In Poland, nursing homes operate based on the Regulation of the Minister of Labour and Social Policy on nursing homes from 2012, with amendments introduced in 2017 and final revisions in 2018²⁴. According to this regulation, a nursing home, in addition to providing services related to basic living needs and caregiving, should also offer therapeutic services. These include improving residents’ physical fitness, activating them, and enabling participation in occupational therapy. However, it is often the case that the number of occupational therapists and physiotherapists employed in nursing homes is insufficient relative to the number of residents. Physiotherapists also do not always sufficiently encourage residents to engage in physical activity, often focusing instead on physical treatments. Older residents of nursing homes frequently refuse to participate in activation activities. They do not see the point, are unwilling to make the effort, exhibit passive attitudes, and spend most of the day sitting^25,26. Insufficient exercise and excessive sedentary behavior are strong risk factors for mortality and other chronic age-related diseases. Therapists should be able to effectively activate nursing home residents. The more actively an older person participates in therapy, the less assistance they require with self-care and the lower the financial costs needed to maintain their health and independence. Occupational therapy and physical rehabilitation activities for older people living in nursing homes should be intensified in order to improve physical fitness, resilience, and health, allowing people to age with dignity²⁴.

Research results show that physical fitness declines with age among seniors¹⁴. Using the Short Physical Performance Battery (SPPB) to assess fitness in older adults, residents can be categorized based on their initial total SPPB score into groups of low performance (LP; 0–6 points), moderate performance (MP; 7–9 points), and high performance (HP; 10–12 points)^17,27. The present study shows that female residents aged 60–74 (groups A1, B1) belong to the moderate performance group, while those aged 75–89 (groups A2, B2) exhibit low performance. The older group of women (A2), despite participating in activation programs, falls within the category of low functional fitness. Based on the present study, no significant difference in functional fitness was observed between active and inactive groups of female residents. A significant difference was found only between the younger and older groups of inactive women. The older group showed significantly lower functional fitness, which seems understandable due to the progressive aging of the body. Regular physical activity slows down the process of physical decline. However, this effect was not observed in the studied group of active women. A comparison of SPPB test results between younger and older active women showed no significant differences.

The absence of significant differences in some analyses should be interpreted in light of the high risk of Type II error. The low statistical power observed in many comparisons (1 − β ≈ 0.05–0.40) indicates that non-significant results may stem from insufficient subgroup sample sizes rather than from a true lack of effect. This suggests that several analyses may not have had adequate sensitivity to detect very small effects, which is a typical limitation of studies conducted in populations of nursing home residents.

The results of this study indicate an unsatisfactory level of physical fitness among female nursing home residents in Poland. Studies by other authors confirm a strong relationship between intentional activation of seniors and the resulting improvement in physical fitness levels. Research findings emphasize a close link between physical fitness and the later development of preclinical disability in the aging process¹⁴. Most likely, exercise tolerance declines more slowly than physical fitness during the aging process. This may explain why no statistical differences in exercise tolerance were observed between age groups, while differences in physical fitness were evident particularly when comparing younger and older inactive women. Even basic selfcare requires a certain level of functional fitness. However, among nursing home residents, regular long-distance movement is not necessary, which means that aerobic endurance is neither maintained nor strengthened through adaptive changes. Insufficient activation of residents likely due to a lack of encouragement to take regular walks may lead to a decline in exercise tolerance.

With age, the drive for physical activity tends to diminish. The physical fitness assessment results of the examined nursing home residents, based on comparisons with standard results in Poland, are relatively low²². Scientific research shows that regular physical activity has a comprehensive effect on the entire body. It improves functional fitness as well as cardiovascular and respiratory efficiency, which is associated with enhanced aerobic capacity²⁸. Some changes described as part of the aging process are, in fact, caused by a lack or deficiency of physical activity. Implementing regular, appropriately tailored physical exercises may help reduce these changes. Developing optimal yet simple rehabilitation protocols aimed at maintaining autonomy for as long as possible is valuable for aging with dignity.

This study presents the level of physical fitness and endurance among female residents aged 60 − 89 living in nursing homes in Poland. The findings point to a problem of accelerated decline in physical fitness and endurance during aging, despite the fact that some participants were engaged in regular activation programs. Analyzing the results in light of the cited literature suggests that activation efforts for seniors in Polish nursing homes may be inadequate, insufficient, or entirely lacking. Identifying this issue highlights the need for intervention and support through the implementation of tailored activation programs. Such efforts could extend seniors’ independence, reduce the incidence of falls, and help prevent premature disability.

Strengths and Limitations of the Study

A major strength of this research is the use of proven and robust methodological approaches. The results have significant clinical relevance for the development and implementation of effective health prevention programs focused on physical activity among nursing home residents. The aim of this initiative is successful aging—maintaining independence for as long as possible while reducing the economic impact of treatment and hospitalization. This study included only female participants. For future research, it would be advisable to expand the analysis to include male residents, which would also increase the overall sample size.

• The operating conditions of nursing homes differ across regions of Poland, and even more substantially across countries,

• The level of activation, access to rehabilitation, and the health profiles of residents may vary considerably,

• Therefore, the findings should be interpreted with caution and regarded as characteristic of the studied population rather than representative of all older adults.

At the same time, it should be emphasized that this population is of significant research value, as it is rarely examined, and the needs of older adults living in institutional care settings are often underestimated. The generalizability of the results to nursing home populations in other countries is limited. Within different regions of Poland, however, these limitations are considerably smaller.

It is also important to note that the power analysis demonstrated limited sensitivity of the statistical tests to detect small effects in many comparisons, which resulted from the relatively small subgroup sizes and very small differences between them. This means that the lack of statistical significance in some analyses may reflect insufficient statistical power rather than the absence of a true effect. Conversely, in cases where the effect size was moderate or large and statistical power was high, the results can be considered reliable.

Conclusions

The studied population of female nursing home residents from the western region of Poland, taking into account the activation efforts in these facilities, provided valuable insights. Based on these findings, it can be assumed that the level of physical activity among residents is too low and poorly balanced. This is reflected in the low scores for physical fitness and exercise tolerance across all age groups. It highlights the issue of inadequately designed exercise protocols or even a complete lack of activation. These results serve as a reference point for the need to implement well-developed exercise and rehabilitation programs for seniors living in nursing homes in Poland.

The individualization of a rehabilitation program should take into account a range of clinical and functional factors, including:

• The current level of functional performance (SPPB results, ability to ambulate independently),

• Exercise tolerance (6MWT results),

• Coexisting chronic conditions (e.g., cardiovascular diseases, degenerative joint diseases),

• Pain-related limitations,

• Fall risk,

• The older adult’s preferences and motivation,

• Equipment availability and facility conditions,

• The individual adaptive response to physical exertion.

Insufficient training intensity may fail to produce meaningful benefits, whereas excessively high intensity may pose safety risks—hence the necessity of personalized programming.

Author contributions

A.B. i C.D. napisali główny tekst rękopisu, a A.B i C.D. przygotowali ryciny. Wszyscy autorzy recenzowali manuskrypt. D wykonał obliczenia statystyczne. Wszyscy autorzy interpretowali obliczenia statystyczne. A.B. przeprowadzali badania. Wszyscy autorzy porządkowali dane.

Funding

The authors received no funding for this work.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author upon reasonable request.

Declarations

Competing interests

The authors declare no competing interests.