As the global population continues to age at a rapid pace, supporting functional independence and promoting healthy aging among older adults has become a critical public health issue [1,2]. The rising prevalence of functional impairments in this demographic presents significant challenges for healthcare systems and society [3,4]. Declines in muscle strength, balance, and gait speed due to aging are key factors that hinder older adults’ ability to perform daily tasks, consequently raising their risk of falls [5]. Reduced physical function in this group is particularly linked to increased healthcare needs, loss of independence, and a lowered quality of life [6,7].

Numerous exercise intervention programs have been developed to enhance physical function in older adults; however, many existing approaches require external weights or complex movements, limiting their practicality [8,9]. Although traditional resistance training has proven effective, it often suffers from low adherence rates among older adults, largely due to perceived difficulties and safety concerns [10]. Especially for older adults living independently in the community, there is a need for exercise programs that prioritize both accessibility and safety without compromising effectiveness [11,12].

Ideal Movement Stabilizer (IMS) training presents a novel exercise methodology designed specifically for older adults’ functional improvement. This comprehensive system integrates three primary components-spinal lengthening, postural stabilization, and dynamic weight transfer patterns-into cohesive standing exercises, distinguishing it from traditional exercise methods that often treat these elements separately.

Unlike conventional strength training programs that typically isolate specific muscle groups, IMS emphasizes full-body coordination through controlled standing postures. The system views the body as an interconnected network where proper alignment in one area positively influences overall movement patterns. This integration is particularly relevant for older adults, as it mirrors the standing positions required for daily activities while maintaining safety through consistent vertical alignment.

Research evidence supports the effectiveness of such standing-based exercise programs in enhancing balance and mobility among older adults [13,14]. Studies have shown that integrated postural control exercises can potentially enhance functional performance, with some evidence suggesting effects on fall risk in elderly populations [15,16].

Despite this, there is still limited research investigating the impact of IMS training on physical function and muscle strength in community-dwelling older adults. This study, therefore, seeks to evaluate the effects of a 12-week IMS training program on physical performance and muscle strength within this group. The results are anticipated to offer valuable insights for the development of effective exercise interventions aimed at improving functional fitness in older adults.

Participants

Participants were recruited from community-dwelling adults aged 65 and older residing in G city. A total of 12 participants were recruited for this study. Eligibility criteria included independent walking ability without assistive devices [17,18] and no cognitive impairments, as determined by a Mini-Mental State Examination score of 24 or above, which ensured comprehension and adherence to exercise instructions [19,20]. Exclusion criteria included acute musculoskeletal conditions [21], severe cardiovascular disease [22], or neurological disorders affecting balance or mobility [23,24]. Furthermore, individuals who had engaged in regular exercise programs within the previous six months were excluded to control for potential effects of prior training [8]. All participants provided written informed consent before enrollment.

Study design

This research was a single-arm, prospective intervention study designed to assess the impact of a 12-week IMS training program on physical performance and muscle strength among older adults living in the community.

Study procedures

Ethical Considerations

The study adhered to the ethical guidelines of the Declaration of Helsinki. Participants received comprehensive information regarding the study’s purpose, methods, expected benefits, potential risks, and possible discomfort. Written informed consent was obtained from all participants, who were informed of their right to withdraw at any time, and their personal data were handled anonymously.

Intervention Program

The intervention consisted of supervised IMS training sessions delivered weekly over a 12-week period. Each 60-minute session incorporated a systematic three-phase approach. The first phase comprised a 10-minute preparatory warm-up focusing on joint mobility and progressive dynamic stretching. The core component was a 40-minute main exercise phase emphasizing bodyweight decompression techniques performed exclusively in standing positions. This main phase integrated three key elements: postural control exercises to enhance stability, balance-focused movements to improve equilibrium, and systematic gait training to refine walking patterns. Sessions concluded with a 10-minute cool-down phase dedicated to gentle stretching and controlled breathing exercises designed to promote recovery. Exercise specialists monitored all sessions to ensure proper execution and participant safety (Table 1).

Outcome measures

Physical performance was assessed using the Short Physical Performance Battery (SPPB), a validated and reliable tool for measuring lower extremity function in older adults [25]. The SPPB includes three tests: balance, gait speed, and the chair stand test. For the balance test, participants were required to hold three progressively challenging standing positions (side-by-side, semi-tandem, and tandem) for 10 seconds each. The gait speed test involved measuring the time taken to walk 4 meters at a comfortable pace, with the fastest of two attempts recorded. The chair stand test measured the time required to complete five consecutive sit-to-stand movements without using arm support. Each component is scored from 0 to 4, with a total score range of 0 to 12, where higher scores indicate better function. The SPPB has excellent test-retest reliability (ICC 0.87-0.92) and a minimal clinically = important difference (MCID) of 0.5points, along with a minimal detectable change (MDC) of 1.0points [26,27].

Grip strength was assessed using a calibrated digital hand dynamometer (TK-200, Takei Scientific Instruments, Japan) following standardized protocols [28]. Participants were seated with their elbow at a 90-degree angle, forearm neutral, and wrist slightly extended (0-30 degrees). They were instructed to grip the dynamometer with maximum effort for 3∼5seconds. Two trials were conducted for each hand, with a 60-second rest between trials, and the highest value recorded in kilograms. This test has shown high test-retest reliability (ICC>0.90) and a minimal detectable change of 5.0kg for older adults [29]. Ageand sex-specific normative values were referenced to interpret the results, with values below 27kg for men and 16kg for women indicating low muscle strength based on current sarcopenia criteria [30].

All assessments were administered by a trained physical therapist at baseline and after the 12-week program. To reduce variability, testing was conducted at the same time of day and in a consistent order for each participant. Verbal instructions were standardized across participants using a scripted guide.

Statistical Analysis

Data analysis was conducted using SPSS (version 25.0, IBM Corp., Armonk, NY, USA). Pre- and post- intervention data were compared using the Wilcoxon Signed-Rank Test, with statistical significance set at p<0.05. Additionally, effect sizes r were calculated to gauge the intervention’s effectiveness.

This study included ten community-dwelling older adults who completed the 12-week IMS training program. The participant group comprised six women (60%) and four men (40%), with a mean age of 71.82 (±4.35) years. Physical measurements revealed a mean height of 161.45 cm (±6.78) and weight of 62.83 kg (±7.92), resulting in a body mass index of 24.15 kg/m² (±2.53). Cognitive assessment using the mini-mental state examination yielded an average score of 26.90 (±1.85), indicating normal cognitive function across all participants. The physical activity scale for the elderly showed a mean score of 178.65 (±31.24), suggesting relatively high baseline physical activity levels compared to normative values for community-dwelling older adults. Program attendance averaged 92.50%, demonstrating high adherence, with no dropouts during the intervention period (Figure 1) (Table 2). The study included 10 community-dwelling older adults who completed the 12-week IMS training program. Following the intervention, significant improvements were observed in overall physical performance as measured by the SPPB total score (baseline: 9.90±0.99 vs. post-intervention: 11.30±0.82; Z=-2.456, p=0.014) with a large effect size (r=0.78) (Table 1).

Analysis of individual SPPB components revealed improvements across all measures, though these changes did not reach statistical significance. Balance scores increased from 3.60±0.70 to 3.90±0.32 (Z=-1.342, p=0.180) with a moderate effect size (r=0.42). Similar improvements were observed in gait speed scores (3.60±0.52 to 3.90±0.32; Z=-1.342, p=0.180; r=0.42). The sit-to-stand component showed the largest improvement among individual measures, increasing from 2.70±1.16 to 3.5±0.71 (Z=-1.613, p=0.107) with a large effect size (r=0.51) (Table 3).

Upper extremity strength, as measured by grip strength, showed a modest increase from 25.12±4.36 kg to 27.22±6.30 kg (Z=-0.968, p=0.333) with a moderate effect size (r=0.31) (Table 1). When comparing effect sizes across all functional measures, the SPPB total score demonstrated the largest improvement (r=0.78), followed by sit-to-stand (r=0.51), gait speed (r=0.42), balance (r=0.42), and grip strength (r=0.31) (Figure 2).

These results suggest that the 12-week IMS training program was most effective in improving overall functional performance, particularly in lower extremity function, while showing modest improvements in upper extremity strength.

This study explored the impact of a 12-week IMS training program on the physical capabilities of communitydwelling older adults, revealing an interesting pattern in functional performance outcomes. Analysis of the SPPB results unveiled a nuanced relationship between overall performance and its constituent elements. While the composite SPPB score demonstrated significant enhancement (p=0.014) with a substantial effect size (r=0.78), examination of individual components painted a more complex picture. The discrete improvements in balance (0.3 points, p=0.180, r=0.42), gait speed (0.3 points, p=0.180, r=0.42), and sit-to-stand performance (0.8 points, p=0.107, r=0.51), though not individually reaching statistical significance, collectively contributed to meaningful functional advancement. The aggregate improvement of 1.4 points in total SPPB score surpassed both the established minimal clinically important difference (0.5 points) and minimal detectable change (1.0points) thresholds [26,27], indicating genuine functional progress.

Individual SPPB component analysis revealed notable trends despite not reaching statistical significance. The sit-to-stand performance showed the largest improvement among the components (r=0.51), suggesting that IMS training may particularly benefit lower extremity strength and power. This finding aligns with previous research indicating that standing-based exercises can effectively improve lower body function in older adults [13,14]. The improvements in balance (r=0.42) and gait speed (r=0.42) components, while modest, demonstrate the potential of bodyweight decompression training in enhancing postural control and mobility.

The modest improvement in grip strength (2.1 kg increase, r=0.31) did not reach the established MDC of 5.0kg for older adults [29]. This finding is not unexpected given that IMS training primarily focuses on standing postural control and lower body function. However, the observed trend toward improvement suggests potential transfer effects of whole-body stabilization training on upper extremity function, although further investigation is warranted.

These results are particularly noteworthy considering the intervention’s relatively low frequency (once weekly) and absence of external loads. Traditional resistance training programs typically recommend 2∼3 sessions per week [8,9], yet our findings suggest that bodyweight- based IMS training, even at lower frequencies, may effectively improve functional performance. This characteristic could be particularly advantageous for older adults who may be hesitant to participate in conventional resistance training programs due to safety concerns or accessibility issues [10].

The effectiveness of IMS training may be attributed to several key mechanisms. First, the program’s focus on functional movements in a standing position directly challenges postural control systems through multiple sensorimotor pathways [15,16], enhancing both static and dynamic balance control essential for daily activities. This integration of postural control with functional movements has been shown to facilitate more effective neuromuscular adaptation than isolated muscle training [14,31]. Second, the bodyweight decompression approach uniquely emphasizes proper alignment and stabilization throughout movement patterns, potentially optimizing muscle recruitment patterns and motor control strategies [32,33]. This comprehensive approach to movement quality may explain the substantial improvements in overall physical performance, despite the relatively low training frequency. Furthermore, the standing-based nature of IMS training activates both local and global muscle systems simultaneously [34], promoting efficient force transfer and functional stability [35]. This integrated approach to movement training, combined with its inherent safety due to the absence of external loads, may provide a particularly effective and accessible alternative to traditional resistance training for older adults [36]. The emphasis on controlled, functional movements also aligns with current evidence suggesting that quality of movement patterns, rather than just strength alone, plays a crucial role in improving physical function in older adults [37,38].

Several limitations should be considered when interpreting these results. The single-arm design and small sample size limit the generalizability of our findings. Additionally, the lack of follow-up assessments prevents conclusions about the long-term retention of improvements. Future research should employ randomized controlled designs with larger sample sizes and include follow-up assessments to establish the long-term efficacy of IMS training.

The 12-week IMS training program demonstrated effectiveness in improving overall physical performance in community-dwelling older adults, with changes exceeding clinically meaningful thresholds. Despite the relatively low training frequency, the bodyweight decompression-based approach showed particular benefits for functional mobility and postural control. These findings suggest that IMS training may offer a safe and accessible alternative to traditional resistance training for maintaining and enhancing functional independence in older adults. Future randomized controlled trials with larger samples are warranted to further validate these promising results.

The authors of this study declare that there are no potential conflicts of interest with respect to the research, authorship, and publication.