TY - JOUR AU - Tang, Jennifer Yee Man AU - Luo, Hao AU - Tse, Michael AU - Kwan, Joseph AU - Leung, Angela Yee Man AU - Tsien Wong, Teresa Bik-kwan AU - Lum, Terry Yat Sang AU - Wong, Gloria Hoi Yan PY - 2025 DA - 2025/5/14 TI - Frailty, Fitness, and Quality of Life Outcomes of a Healthy and Productive Aging Program (GrandMove) for Older Adults With Frailty or Prefrailty: Cluster Randomized Controlled Trial JO - JMIR Aging SP - e65636 VL - 8 KW - physical activity KW - physical exercise KW - exercising KW - gerontology KW - geriatric KW - older adult KW - older person KW - older people KW - active aging KW - postretirement work KW - cluster randomized controlled trial KW - RCT AB - Background: Exercise interventions can reverse frailty. However, their scalability and sustainability are limited by manpower, which is reducing due to population aging. GrandMove is a program that combines healthy and productive aging strategies to (1) train and employ robust older adults as exercise coaches and (2) improve fitness and motivate the adoption of an exercise habit in older adults with frailty and prefrailty. Objective: The aim of this study is to examine the effectiveness of GrandMove in improving frailty, fitness, and quality of life in older adults with frailty and prefrailty. Methods: This cluster randomized controlled trial recruited older adults with frailty and prefrailty (N=390) living in the community. The 18-month exercise program consisted of three 6-month phases of lifestyle education (E), resistance exercise (R), and aerobic exercise (A). Each group of participants was randomized into 3 intervention sequence arms: the E-R-A group, the A-R-E group, and the R-A-E group. Results: At 6, 12, and 18 months, 346, 305, and 264 participants completed the frailty assessment, respectively. At 6 months, 100 of 346 participants (28.9%) were robust. A-R-E and R-A-E were no better than E-R-A as the active control in addressing frailty over the first 6 months (A-R-E: interaction coefficient 0.07, 95% CI −0.35 to 0.49, P=.68; R-A-E: interaction coefficient −0.02, 95% CI −0.42 to 0.38, P=.90). Compared to lifestyle education, resistance training and aerobic training over the first 6 months were associated with greater improvement in fitness measures of grip strength for the left hand (A-R-E: interaction coefficient 2.99, 95% CI 0.76 to 5.23, P=.009; R-A-E: interaction coefficient 2.21, 95% CI 0.63 to 4.36, P=.04) and right hand (A-R-E: interaction coefficient 3.75, 95% CI 1.54 to 5.97, P=.001; R-A-E: interaction coefficient 2.29, 95% CI 0.16 to 4.42, P=.04) and arm curl test (A-R-E: interaction coefficient 1.42, 95% CI 0.39 to 2.46, P=.007; R-A-E: interaction coefficient 1.11, 95% CI 0.12 to 2.11, P=.03). The sequence of exercise interventions (R-A-E vs A-R-E) did not make a difference in primary outcomes at 12 months, but the R-A-E group showed better quality of life (interaction coefficient 4.50, 95% CI 0.12 to 8.88, P=.008). Improved frailty outcomes were maintained by the end of the study, but the change in overall physical activity level was limited. Conclusions: Combining healthy and productive aging strategies is a scalable and sustainable way to improve frailty, fitness, and quality of life in older adults with frailty and prefrailty. Different combinations of lifestyle education and physical interventions improved frailty. Trial Registration: HKU Clinical Trials Registry HKUCTR-1964; https://www.hkuctr.com/Study/Show/75c5d2e6825c4b5498f0c65c82714c4b SN - 2561-7605 UR - https://aging.jmir.org/2025/1/e65636 UR - https://doi.org/10.2196/65636 DO - 10.2196/65636 ID - info:doi/10.2196/65636 ER -