Journal of Clinical and Diagnostic Research. 2023 Aug, Vol-17(8): YK01-YK06 1 1 DOI: 10.7860/JCDR/2023/64028.18245 Physiotherapy Section Effect of Chair Suryanamaskar with Strength Training on Functional Fitness in Frail Older Adults: A Research Protocol for a Randomised Controlled Trial Research Protocol NITIN SUHAS NIKHADE 1 , VAISHALI DEEPAK PHALKE 2 INTRODUCTION Ageing is characterised by a gradual decrease in functional fitness, which serves as a significant and independent risk factor for premature mortality [1]. Reduced fitness among older adults is associated with a higher rate of lean mass decline, increased body fat, abnormal metabolic profile, elevated blood pressure, arterial stiffness, disruptions in autonomic function, and cardiac pressure overload. These factors significantly impact the individual's quality of life [2]. Therefore, muscle mass, muscular strength, muscular flexibility, muscular endurance, and cardiorespiratory fitness play crucial roles in functional fitness for older adults [3]. To assess these components, the SFT was developed by Rikli RE and Jones CJ at California State University. This test helps evaluate key aspects such as flexibility, strength, speed, endurance, and balance [4,5]. The SPPB test includes balance, walking, and rising from chair tasks, which have proven to be useful for predicting physical frailty in clinical practice. A cutoff score of ≤7 points is considered physical frailty in community dwelling older adults [6]. Frailty is associated with an increased risk of functional decline, institutionalisation, morbidity, and mortality [7]. Several studies have demonstrated that regular exercise can enhance functional fitness in older adults [8]. According to the American College of Sports Medicine (ACSM) guidelines, older adults should engage in 20-30 minutes of moderate-to-vigorous aerobic training at least three days a week, along with incorporating resistance training one or two days a week [9]. Some studies have suggested that practicing Suryanamaskar at different speeds can offer various benefits, and when performed rapidly, it can warm up the body and act as a cardiotonic [10]. The research provides compelling evidence that resistance training can help counteract the age-related decline in neuromuscular function and functional capacity. Different forms of resistance training show potential in improving muscle strength, mass, and power output [11,12]. In recent times, there has been a growing proposal to use increased physical activity or regular exercise training as a preventive measure for frailty and its adverse consequences [13]. Both aerobic and resistance exercises have demonstrated positive outcomes, targeting distinct features of frailty [14]. The potential benefits of an intervention that combines both exercise components for frail older adults have garnered recent interest. Consequently, this study aims to investigate the effects of chair Suryanamaskar with strength training on enhancing the functional fitness of frail older adults residing in the community. Keywords: Physical frailty, Senior fitness test, Short physical performance battery ABSTRACT Introduction: Physical frailty is a syndrome characterised by deterioration in multiple physiological domains, including muscle mass and strength, flexibility, balance, neuromuscular coordination, and cardiovascular function. Evidence suggests that regular exercise provides substantial health benefits, reducing the risk of many chronic diseases and medical costs, especially for frail older adults. However, the effect of exercise on functional status in this population is not well explored. Need of the study: Population aging in India is rapidly accelerating, and frailty is a significant clinical condition associated with aging. Frailty increases the risk of institutionalisation, morbidity, and mortality. Regular exercise has been shown to improve functional fitness in older adults, but exercises performed while standing unaided can be challenging for individuals with compromised balance and mobility. Chair Suryanamaskar, a form of exercise performed while seated, may be an alternative mode of exercise for this population. Although aerobic and resistance exercises have shown benefits, there is growing interest in exploring the potential benefits of a multicomponent intervention for frail older adults. Aim: The aim of this study is to investigate the effect of chair Suryanamaskar with strength training on functional fitness in community-dwelling frail older adults. Materials and Methods: The study will be conducted from March 2021 to March 2024. This two-group parallel single- blind randomised controlled trial will take place at MAEER's Physiotherapy College in TalegaonDabhade, Maharashtra, India. Approximately 400 older adults will be screened for frailty using the Short Physical Performance Battery (SPPB) test. Participants with an SPPB score ≤7 will be considered frail and a total of 108 participants aged 65-84 years will be recruited based on inclusion and exclusion criteria. The participants will be equally divided into two groups (54 participants in each group) using computer-generated random tables. The experimental group (group A) will receive a 45-minute Chair Suryanamaskar with strength training protocol three times a week for 12 weeks. Before the study begins, participants will have two practice sessions of 20 minutes each to become familiar with Chair Suryanamaskar. The control group (group B) will participate in two 20-minute health education program sessions and receive weekly telephonic follow-ups to monitor for adverse events. Additionally, a health education program booklet will be provided. The primary outcome of the study is the Senior Fitness Test (SFT). Assessments will be conducted at baseline (0 weeks) and post-intervention (12 weeks). Intention- to-treat analyses with mixed linear modeling will be used for statistical analysis.