Restricted accessResearch articleFirst published online 2026-1
Impacts of (Pre-)Social Frailty on the Effectiveness of a Theory-Driven Exercise Intervention Among Community-Dwelling (Pre-)Physically Frail Older Adults
(Pre-)frailty is a state of heightened multidimensional vulnerability. Therein, (pre-)social frailty and (pre-)physical frailty are common subtypes, often coexisting and synergistically increasing risks of adverse outcomes.
Objective:
We aimed to compare the effectiveness of an exercise intervention among community-dwelling (pre-)physically frail older adults by baseline (pre-)social frailty status.
Methods:
This was a secondary analysis of a stepped-wedge cluster randomized trial evaluating a 12-week exercise intervention among 149 community-dwelling (pre-)physically frail older adults, with 3 follow-up visits at the 0-week, 12-week, and 24-week postintervention. Intervention effectiveness was examined within subgroups by baseline (pre-)social frailty status (non-[pre-]social frailty: n = 47; [pre-]social frailty: n = 102) using multilevel linear regression.
Results:
The non-(pre-)social frailty group exhibited immediate and persistent treatment responses across most outcomes. The (pre-)social frailty group showed improvements in physical frailty (all time points), cognitive function (0-week postintervention), depressive symptoms (all time points), social frailty (score: 0-week and 12-week postintervention; status: all time points), and quality of life (physical: all time points, mental: 0-week and 12-week postintervention). The (pre-)social frailty group had greater immediate improvements in fear of falling, depressive symptoms, and social frailty scores and status than the non-(pre-)social frailty group, but their improvements in social frailty score were less persistent at the 24-week postintervention.
Conclusions:
Older adults with (pre-)physical frailty who had comorbid (pre-)social frailty experienced effective improvements in fewer outcomes and less persistent gains in certain outcomes than their counterparts. Interventions should incorporate social support components to ensure comprehensive and lasting effectiveness for this population.
Trial Registration:
Chinese Clinical Trial Registry (ChiCTR2100041981).
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