Abstract The purpose of this quasi-experimental study is to compare the fitness levels of older adults before and after taking part in the Exercise Program for Strong and Active Elderly (E75EPSAE) and to examine its effects and participant satisfaction with the program. The study was performed in Nong Tong Subdistrict, Hang Dong District, Chiang Mai Province, Thailand. Participants A total of 37 old adult participants aged 60 years or older were purposively selected from the Nong Tong Elderly Club. Subjects completed the E75EPSAE program that lasted for 8 weeks and consisted of 15 exercise stations provided in a circuit training sequence. Tested methods of physical fitness measurements before and after the intervention included muscle strength, strength-endurance, flexibility, and cardio-respiratory fitness. Data were described by descriptive statistics and analyzed using paired samples t-tests. Results Chair stand performance (P<0.001), knee lift capacity (P<0.001), and right-hand back scratch flexibility (P=0.008) were all shown to improve following the intervention. Participants were very satisfied with the program in its various physical, psychological, and social aspects. The results indicate that The E75EPSAE program is effective in improving physical fitness and wellness in elderly individuals. This program may be applicable to community settings for older adults for active and healthy aging. Larger and more diverse samples are warranted to conduct long-term follow-up studies on the effectiveness and sustainability of the program.

Keywords: Exercise program, Physical fitness, Older adults    

Citation: Paknapa, S., Yanawong, K., and Wungrath, J. 2025. Effectiveness of the E75 exercise program for strong and active elderly in improving physical fitness among older adults in Chiang Mai province, Thailand: A quasi-experimental study. Natural and Life Sciences Communications. 24(3): e2025054.

INTRODUCTION

Aging is a demographic shift that the world has never seen before. The latest estimates of older persons (aged 60 years or older) are 1 billion globally in 2022, or 16.8% of the total world population. This figure is expected to increase to 2.1 billion by 2050 (United Nations, 2022). In Thailand, recent data from the Department of Older Persons (2023) shows that there are approximately 13.2 million people aged 60 and above, accounting for 20% of the total population, marking Thailand's status as a completely aged society. This ratio is projected to reach 28% in 2033, transforming Thailand into a super-aged society (Department of Older Persons, 2023). The elderly population figures were derived from the most recent Health Data Center (HDC) as of December 2023 and Thailand had the number of elderly as 12,987,435 (19.73%) and Chiang Mai Province had 421,556 elderly residents (25.1%). This indicates Chiang Mai has entered a completely aged society, with over 20% of its population being elderly. In Nong Tong Subdistrict specifically, there are 2,177 elderly residents (28.9%), making it one of the highest proportions in Chiang Mai Province (Health Data Center, 2023).

Aging is characterized by a decline in the function of most organ systems and physical units. These alterations compromised bone and muscle strength and flexibility, resulting in declining ability to perform daily tasks, poor agility, slower reaction time, decreased learning and memory, and possible cognitive decline (Guo et al., 2022). It is important, therefore, to maintain appropriate physical activity and exercise for the elderly population in order to improve muscle strength and prevent physical decline aiding them in the retention of strength and an active life of quality (Szychowska and Drygas, 2022). Furthermore, there is evidence that tailored in-home exercise interventions may slow the progression of cognitive decline and improve general psychological well-being in older adults (Taheri, 2023). A 2020 survey of desired health behaviors among the elderly in the Northern region of Thailand found that only 22.82% of older adults met the desired health behavior criteria. The lowest-scoring (Health Data Center, 2023) behavior was physical activity, with only 31.22% of the elderly engaging in at least 30 minutes of physical activity for more than 5 days per week (Health Promotion Center Region 1 Chiang Mai, 2023). This indicates declining physical fitness, which affects daily activities. Elderly individuals who require caregivers need to be aware of frailty and receive proper support. Those who receive appropriate preventive care have better health prospects, while those who neglect prevention may require caregiver assistance (Chamnankit et al., 2020; Wungrath et al., 2022).

E75 Exercise Program Strong Active Elderly (E75EPSAE) The E75EPSAE was established by the Department of Health, Ministry of Public Health of Thailand, emphasizing the strategic direction toward achieving a Health Adjusted Life Expectancy (HALE) of 75 years among the elderly (Ministry of Public Health of Thailand, 2019). The focus of the E75DES EP is on this goal, of preserving as much, and as high quality," of longevity, as is possible, for the vast majority. The programs were developed to prevent muscle deterioration and improve cognitive abilities in older adults, to reduce the risks of frailty and inactivity that can affect quality of life. It Is about building muscle strength and endurance through the use of your own body resistance exercises, targeting upper body muscles (chest, shoulder, upper back, deltoids, and arms), core muscles (abdomen, trunk, and lower back) and lower body muscles (hips, thighs, and calves). It is composed of 15 exercises on circuit, working arteries and veins and at the same time addressing the cardiorespiratory capacity (Department of Health of Thailand, 2019). Although it is practical to use E75EPSAE, little is known of its efficacy in improving PE among rural Thai elderly. Although program design is encouraging, formal assessment of its establisment in communities is needed. Thus, the purpose of this study was to examine the influence of the E75EPSAE on physical fitness parameters of the elderly and to evaluate participant satisfaction with the program. Such results would offer support to clinicians and policy makers for an effective exercise intervention for elderly individuals.

RESEARCH METHODOLOGY

Study design

This quasi-experimental research employed a one-group pretest-posttest design to compare physical fitness before and after participation in the E75 program and to evaluate program effects and satisfaction. The study was conducted between March and May 2021.

Population and sample

In this population-based cross-sectional study, participants were adults aged 60 years and older from the Nong Tong Elderly Club who were both men and women of the Nong Tong Subdistrict, Chiang Mai Province. Sample size was determined from previous similar intervention studies with reference to the work of (Kariuki et al., 2019). The formula applied was the following, to compare means in a single group (Pretest-Posttest design):

n = (Zα + Zβ)² × SD² / d²

Where Zα = 1.96 (95% confidence level), Zβ = 0.84 (80% power), SD = 4.5 (standard deviation of difference in physical function scores), and d = 2.5 (expected mean difference in physical function scores). Based on these calculations and accounting for a 10% attrition rate, the final sample size was set at 37 participants.

Sample selection

The research used purposive sampling, a selective sampling procedure which focused on participants who should offer indepth information on the E75 activity program. Pilot recruitment started with initial researcher communication with the Nong Tong Elderly Club administrators to find suitable participants who frequently participated in club activities. The elderly members were then pre-screened by health managers from the health promotion hospital in the community, and the status of their basic health and physical condition were evaluated. The following were the criteria for the eligibility judgment:

Inclusion criteria

1. Male and female elderly age 60 and older will be enrolled.

2. Capable of independent ambulation and ambulatory activities.

3. No fractures or joint dislocations present at the time of diagnosis.

4. No contraindicated medical conditions such as chronic heart failure, myocardial ischemia within the past year, or emphysema.

5. Able to take part in the study.

Exclusion criteria

•   Unable to participate in activities for at least 4 weeks

Research tools

1. The E75EPSAE Program from the Department of Physical Activity for Health, Department of Health consists of 15 exercise stations as shown in Table 1:

Table 1. E75EPSAE program components and descriptions.

2. Physical Fitness Test for Aging consists of 6 standardized items based on the 2019 physical fitness test and standards for ages 60-89 years from the Sports Science Office, Department of Physical Education, Ministry of Tourism and Sports. The test evaluates vital components of physical fitness, including body composition (BMI), upper body flexibility (Back Scratch Test), lower body strength (30-second Chair Stand), agility and dynamic balance (8-foot Up-and-Go), aerobic endurance (2-Minute Knee Lift), and static balance (Balance Stance Test). Each test is administered according to uniform instructions, including designated break times between test items, and uses predefined scoring norms based on sex and age.

3. The form of satisfaction assessment, which was originally published in Nattaphon Prapharat,52 had a reliability coefficient of 0.837. It contains 17 items in three domains: 1) Physical (6 subscales) – better physical condition, muscular strength, cardiovascular functioning, physical appearance, body composition, and resistance to disease; 2) Psychological (6 subscales) – better mood, less anxiety, greater enjoyment, better health, less negative feelings, and better relations with others; 3) Social (5 subscales) – increased chances for meeting people, sharing ideas/thoughts, self-confidence, expressing self and forgiving deficiencies in social interaction. Each of them is scored on a 5-point Likert scale (1 = lowest, 5 = highest satisfaction). Satisfaction Rated previously on a 10-point scale at or after completion of 8 week exercise program to assess global satisfaction.

Research procedure

The study process took 10 weeks, that was divided into the phase for preparation and execution. Each session consisted of the same structure: a 5-min warm-up, 35–40 min of circuit-based exercise at the 15 stations, and a 5-min cool-down, and included a safe guard and recording, as illustrated in Table 2.

Table 2. Weekly research activities and procedures.

The statistical methods were processed in two major data analyses. Frequency distributions, percentages, and means and standard deviations were obtained to describe the participants' demographic characteristics and satisfaction scores. The normality of the data distribution was examined with the Kolmogorov-Smirnov test. The differences of physical fitness parameters between pre-and post- intervention were statistically tested by paired-sample t-test for inferential statistics. The data analysis comprised checking of assumptions for tests, calculation of 95% confidence intervals for mean differences in peak forces, and calculation of effect sizes, Cohen's d was used with statistical significance at P < 0.05. The missing data was addressed by complete case analysis. Statistical analyses were conducted in SPSS version 26.0.

Ethical consideration

The Health Promotion Center Region 1 Chiang Mai Ethics Research Committee reviewed and approved this study, assigning it the approval code 40/2563.

RESULTS

Demographic characteristics

Demographic Characteristics of the Study Participants (n=37) are listed in Table 3. The age distribution was nearly even between 60 and 64 years (48.6%) and 65 and 69 years (51.4%). The sample was predominantly female (54.05%) versus male (45.95%). In terms of occupation, most were working as labourers (56.8%) followed next by unemployed persons (21.6%), garden workers (13.5%), traders (5.4%) and finally farmers (2.7%). The majority of participants (67.6%) were free of chronic diseases (n=93) while they were (32.4%) pre-existing with chronic diseases (n=47).

Table 3. Demographic characteristics of the sample.

Physical fitness outcomes

Significant differences emerged in physical fitness parameters following implementation of the 8-week E75EPSAE Program and significant improvements were observed in the three main fitness outcomes. Significant differences in the chair stand function were observed when comparing the baseline (17.00 ± 3.15) to the post-intervention (21.16 ± 6.07) (95% CI: -5.97 to -2.36, P<0.001), suggesting improved strength of the lower extremities. Also, knee lift capacity significantly increased from pre-intervention (86.90 ± 20.37) to post-intervention (104.02 ± 17.67) (95% CI: -24.90 to -9.33, P<0.001) indicating improved aerobic endurance. From baseline to post-intervention increase in flexibility in upper body as evaluated by the right hand back scratch test was significantly higher (95% CI: 0.53 to 3.31, P=0.008) from 23.08 ± 6.81 to 21.16 ± 6.04 respectively. But some indexes of fitness didn’t change by statistically significant amount. Body Mass Index 7807798Stays the same between pre- (24.07 ± 3.51) and post-intervention (24.14 ± 3.60) (95% 95%CI: -10.70 to 0.55, P=0.808). Performances on left-hand back scratch (24.70 ± 7.71 to 23.78 ± 7.73, 95% CI -0.95 to 2.80, P=0.326) and agility (14.96 ± 1.78 to 15.39 ± 2.11, 95% CI -1.18 to 0.30, P=0.237) tests did not significantly change.

Table 4. Effects of the E75EPSAE program on physical fitness.

Satisfaction survey results

Satisfaction with the E75EPSAE Program Participants reported high satisfaction throughout the E75EPSAE Program. In the physical domain improved physical structure was the factor rated for second with highest satisfaction level (4.16 ± 0.61) among patients, the factors that were rated even higher than the mean were increased muscle strength (4.33 ± 0.70), transformed physical health (4.27 ± 0.57) and improved cardiovascular function (4.20 ± 0.60). All items in physical domain were rated consistently very satisfactory, with scores above 4.0. In the psychological section, the most positive ratings were reported with respect to interpersonal relations (4.47 ± 0.62), cheerfulness (4.43 ± 0.56), mental-health (4.43 ± 0.62), and anxiety (4.43 ± 0.62). The social domain, though still highly rated (4.07 ± 0.70), was relatively less satisfied with overall compared to other domains. Opportunities to exchange ideas and greater self-confidence were the two highest-rated items (both 4.13), and opportunities to make new friends was the lowest (although still high) rated item (3.97 ± 0.71).

Table 5. Satisfaction with the E75EPSAE program.

DISCUSSION

The results of the present quasi-experimentally demonstrate a number of significant effects of the E75EPSAE Program on physical fitness outcomes in older adults. Significant improvement in CS test was observed (17.00 ± 3.15 to 21.16 ± 6.07, P<0.001) to measure lower limbs strength and endurance. This enhancement is likely due to the program's emphasis on lower extremity muscle exercises (e.g., chair stands, wall squats, knee lifts) targeting major muscle groups (quadriceps, hamstrings, gluteals) (Panton and Artese, 2024). Because the bodyweight exercises are used in these interventions, it is possible to achieve progressive overload as participants become stronger, which results in adaptation throughout the 8-week duration. Moreover, the circuit training method that incorporates short rest periods between exercise may lead to an increase in muscular endurance by encouraging repetitive contractions against fatigue (Staniszewski et al., 2004; Grgic et al., 2018). This evidence is consistent with the specificity principle of exercise training, since the exercises included in the program are very similar to the movement patterns and to the requirements of the chair stand test. These results are consistent with previous findings that have reported marked gains in lower limb strength in response to resistance exercise programmes in older individuals (O’Bryan et al., 2022; Marzuca-Nassr et al., 2023; Leadbetter et al., 2024)

The significant 19.7% increase in knee lift volume (86.90 ± 20.37 vs 104.02 ± 17.67, P<0.001) (Figure 1) reflects increase in cardiovascular fitness. It is probable that this improvement is due to the 'metabolic demand' imposed by circuit training, characterized by a progressive pattern of exercise and an overall increased heart rate during the whole session. With alternating lower and upper body patterns, and short rest periods, a cardiovascular stimulus is provided that may promote changes in the functioning of the heart, stroke volume and extent of oxygen usage. Furthermore, the introduction of dynamic, large-muscle-group actions such as knee up and marching in machine possibly have led to increased improvement of aerobic capacity and endurance. These results encourage the administration of multicomponent training programs that simultaneously combine resistance and aerobic exercise for holistic fitness promotion among old adults. Studies by Wu et al. (2024) and An et al. (2024) supports these findings and report that exercise interventions that combined both aerobic and resistance training could result in a significant improvement in CRF in the older adults (An et al., 2024; Wu et al., 2024; Mauluddin et al., 2024).

The lack of symmetry in flexibility improvements (with only the right hand back scratch test showing significant changes) may indicate that the E75EPSAE Program might not address flexibility in a balanced way. The favourable results of the one-side procedure may reflect that all of the subjects were right handed and contributed to the conclusion that the major ROM occurred on their dominant side. Further, the interventional exercises might not have been as balanced for stretching and mobility exercises for both sides upper extremities. This lack of symmetry underscores the importance of including specific flexibility training, where equal attention is given to bilateral action and variation in ROM (Wang et al., 2024). The program, in future, could be enhanced by incorporating a variety of stretching exercises, teaching proper form and technique and by encouraging participants to perform stretches on both the left and right sides of the body in order to develop symmetrical flexibility gains (Nagai et al., 2023). As in the study of Rodrigues et al. (2023) emphasised that a diversity of stretching exercises and correct form should be incorporated to facilitate symmetrical improvement in flexibility among older adults (Rodrigues et al., 2023).

Although the E75EPSAE Program appears to have potential in its ability to address fall risk factors related to lower body strength and balance deficits, it is important to note that falls are multi-factorial in origin and a multi-component approach to prevention is necessary. The emphasis of the program on strength training and functional movements might enhance the capacity of the participants to recover from unpredicted loss of stability, hence reducing the risk of falls. Nevertheless, the absence of improvements in agility and dynamic balance scores indicates that the program may require an increased focus on specialized balance training exercises, such as one leg stance, tandem walking and reactive balance circuits (Munoz Martel, 2024). In addition to exercise interventions, fall prevention interventions should also focus on extrinsic risk factors such as environmental hazards, medication management and vision impairments (Giovannini et al., 2022; Smith and Ory, 2023). Jurisdictions need to work with healthcare and older adults to undertake a multi-level approach to addressing both intrinsic and extrinsic risk factors to prevent falls. Our results were consistent with those of the study by Sadaqa et al. (2019) and Chamnankit et al. (2020) have highlighted the importance of multifactorial fall prevention programmes which combine balance, strength and functional exercises that are effective for multiple risk factors (Chamnankit et al., 2020; Sadaqa et al., 2023).

The generally high degree of satisfaction across all the domains; in particular for the psychological domain; indicates the potential of the program to improve wellbeing and quality of life for this senior population. The psychological mechanisms may involve a sense of achievement and control gained through consistent exercise attendance, the social support and camaraderie forged with group members, and the psychological benefits of exercise upon mood and stress regulation (Baron and Bogosian, 2024). The release of endorphin and the alteration in neurotransmitter that exercise provide may also result in a decrease in anxiety, an enhanced quality of sleep, an increased cerebral blood flow, and enhancement of cognitive function (7) (Pahlavani, 2024). It is also shown that person-alized exercise interventions can delay cognitive decay and maintain gen-eral a sense of psychological well-being in older subjects (Taheri, 2023). In addition, the group aspect of the program facilitates socialization, which helps to mitigate the feeling of being lonely that older adults often experience (Hoang et al., 2022). These data suggest the need for the psychosocial aspects of exercise interventions to be taken into account and programs developed to ensure that the environment is supportive and stimulating for participants. Consistent with the findings from the systematic review of Liu and colleagues (2021) and Steckhanfurther  et al. (2023) confirm these findings and suggested that positive psychosocial aspects are more likely to be influenced by a group-based exercise program in older adults (Wungrath and Mongkol, 2020; Liu and Lachman, 2021; Steckhan et al., 2022).

The effectiveness and feasibility of the E75EPSAE Program supports the potential for broad implementation within communities; however, attention should be given to facilitate successful translation. The program’s need for relatively few materials and body weight exercises render it accessible and transferable across differing community environments, of which may include senior centers, park settings and retirement apartments. Nonetheless, the requirement for trained instructors and long-term supervision can be problematic, particularly in low-resource settings. To multiply the program on a wide scale, investment would be necessary to train instructors and institute measures to control quality and evaluate fidelity and effectiveness. Furthermore, incentives, peer support networks and community partnerships for the enhancement of long-term adherence and program sustainability also need to be considered to effectively maintain the program impact. Partnerships are the key to leveraging resources and advocating for policies and environmental change to support physical activity in older age through collaboration between public health, health care, and the community.

RESEARCH LIMITATIONS

Several limitations should be considered when interpreting the results of this study. First, the absence of a control group or comparison to alternative interventions limits the ability to determine the unique benefits and relative effectiveness of the E75EPSAE Program. Future studies should consider employing randomized controlled trial designs or comparisons with existing exercise programs to provide a more rigorous evaluation of the program's impact.Second, the relatively small sample size and specific geographic location may limit the generalizability of the findings to broader populations. Third, 8 weeks may be too short a time to reflect long-term adaptations and compliance with the diet and exercise regimen. Long term follows up is required to determine compliance and to evaluate the maintenance of gains in physical fitness and quality of life. Furthermore, satisfaction was self-reported, which presents factors of social desirability. Quantification of the impact of the program on well-being and quality of life would offer an enhanced understanding of its psychosocial effects. In addition, it could be that by using only structured, quantitative satisfaction questionnaires, we may have had a poorer understanding of participant psychological and social experiences. Qualitative methods, such as in-depth interviews or open-ended questions, should be used in future research to obtain more detailed and nuanced accounts of the program’s influence on emotional well-being, motivation, social connectedness, and perceived value.

CONCLUSION

Interesting effects of the E75EPSAE Program on health and fitness in the elderly. The considerable gains in lower body strength, cardiovascular PT, flexibility, and psychological well-being suggest the ability of this multicomponent exercise programme to foster active and healthy ageing, to decrease fall risk and to improve quality of life. The efficacy, feasibility, and high participant satisfaction with the program suggest potential for community-based dissemination. However, additional work is required to overcome the limitations of this study to determine long-term effectiveness and sustainability of the program, and mechanisms for successful translation into practice. Futures by extending these findings, as well as through interdisciplinary collaboration (among researchers and public and private sectors) could include developing and disseminating scalable, evidence-based interventions to promote healthy and active aging in ways that also lower health care expenditures and improve the quality of life of the increasing number of older adults in the world. Larger, more diverse populations should be recruited in further studies in order to improve the applicability of the findings. Prolonging the follow-up period would also enable assessment of long-term benefits and compliance. In addition, including a control group and improving the methodological issues would increase the reliability and validity of the results.

RECOMMENDATIONS

The following recommendations for future practice and research can be deducted from the findings of the study. The E75EPSAE should be implemented into the community to increase physical activity and social interaction in the older adult by inservicing exercise instructors. Additional studies are necessary to determine the effectiveness and generalizability of the program, including randomized control trials with larger, more diverse samples and longer-term follow-up. Studying the program's efficacy in older adults with certain chronic illnesses or functional impairments will result in more targeted adaptations. Long-term adherence and sustainability strategies (e.g. peer support, incentives, community partnerships) need to be considered. Objective assessments of QOL, wellbeing, and fall risk may offer a more global perspective on the program’s effects. Further, a longer follow-up over and above the present 8 weeks period is suggested to establish the maintenance of improvements in physical fitness and well-being. Follow-up monitoring of participants for an extended period of time might generate essential knowledge about the lasting value of the program, both in terms of sustained benefits and the possible requirement of booster sessions or ongoing support. The addition of such longitudinal evaluations would strengthen the evidential basis for the E75EPSAE as well as help shape future implementation programs. Lastly, cost-effectiveness analyses can provide data to guide decisions around the allocation of resources and policy decisions for the implementation and dissemination of the program.

ACKNOWLEDGMENTS

The authors would like to express their gratitude to the Health Promotion Center Region 1 Chiang Mai, the Faculty of Public Health at Chiang Mai University, and the Nong Tong Subdistrict community for their support and collaboration throughout this research project. We also thank the participants for their time and dedication to the E75EPSAE Program.

AUTHOR CONTRIBUTIONS

S.P. and K.Y. conceptualized the research idea, conducted the intervention, collected and analyzed data. J.W. provided guidance throughout the research process, wrote the manuscript, reviewed for accuracy, made revisions, and coordinated the publication process.

CONFLICT OF INTEREST

The authors declare that they hold no competing interests.

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