EDITED BY
Ra ael Be na des,
Uni e sidade Ca ólica Po uguesa, Po ugal
REVIEWED BY
Luis Manuel Mo a de Sousa,
Uni e sidade A lân ica, Po ugal
Heni Pujias u i,
Sul an Ageng Ti ayasa Uni e si y, Indonesia
*CORRESPONDENCE
So aia Fe ei a
[email p o ec ed]
RECEIVED 12 June 2024
ACCEPTED 09 Decembe 2024
PUBLISHED 07 Janua y 2025
CITATION
Fe ei a S, Ma melei a J, Del Pozo C uz J,
Lei e N, Be na dino A, Mo adell A and
Raimundo A (2025) E ec s o an exe cise
p og am wi h augmen ed eali y on unc ional
fi ness and physical ac i i y o communi y-
dwelling olde adul s.
F on . Spo s Ac . Li ing 6:1447866.
doi: 10.3389/ spo .2024.1447866
COPYRIGHT
© 2025 Fe ei a, Ma melei a, Del Pozo C uz,
Lei e, Be na dino, Mo adell and Raimundo.
This is an open-access a icle dis ibu ed
unde he e ms o he C ea i e Commons
A ibu ion License (CC BY). The use,
dis ibu ion o ep oduc ion in o he o ums is
pe mi ed, p o ided he o iginal au ho (s) and
he copy igh owne (s) a e c edi ed and ha
he o iginal publica ion in his jou nal is ci ed,
in acco dance wi h accep ed academic
p ac ice. No use, dis ibu ion o ep oduc ion
is pe mi ed which does no comply wi h
hese e ms.
E ec s o an exe cise p og am
wi h augmen ed eali y on
unc ional fi ness and physical
ac i i y o communi y-dwelling
olde adul s
So aia Fe ei a1,2*, José Ma melei a1,2, Jesus Del Pozo C uz3,4,
Nil on Lei e1,2, Alexand e Be na dino5, Ana Mo adell6,7,8,9 and
A mando Raimundo1,2
1
Depa men o Spo and Heal h, School o Heal h and Human De elopmen , Uni e si y o E o a,
É o a, Po ugal,
2
Comp ehensi e Heal h Resea ch Cen e , New Uni e si y o Lisbon, Lisboa, Po ugal,
3
Depa men o Physical Educa ion and Spo s, Uni e si y o Se ille, Se ille, Spain,
4
Epidemiology o
Physical Ac i i y and Fi ness Ac oss Li espan Resea ch G oup (EPAFi ), Uni e si y o Se ille, Se ille, Spain,
5
Labo a o y o Robo ics and Enginee ing Sys ems (LARSyS), Ins i u o Supe io Técnico (ISR), Lisboa,
Po ugal,
6
G ow h, Exe cise, Nu i ion and De elopmen (EXER-GENUD) Resea ch G oup, Uni e sidad
de Za agoza, Za agoza, Spain,
7
Ins i u o de in es igación Sani a ia de A agón (IIS A agón), Za agoza,
Spain,
8
Ins i u o Ag oalimen a io de A agón-IA2 (Uni e sidad de Za agoza-CITA), Za agoza, Spain,
9
Depa men o Animal P oduc ion and Food Sciences, Facul y o Heal h and Spo Sciences, Uni e si y
o Za agoza, Za agoza, Spain
Backg ound: This s udy aims o in es iga e he e ec s o a mul imodal p og am
using augmen ed eali y on he unc ional fi ness and physical ac i i y o olde
adul s li ing in he communi y.
Me hod: Se en y-eigh olde adul s li ing in he communi y pa icipa ed in his
s udy. Pa icipan s we e di ided in o h ee g oups: a con ol g oup ha
main ained hei usual ac i i ies, and wo expe imen al g oups, one wi h
mul imodal aining (EG1) and he o he wi h mul imodal aining combined
wi h augmen ed eali y (EG2). Pa icipan s we e assessed a baseline and pos -
in e en ion, a e 12 weeks. Func ional fi ness was assessed using he Rikli
and Jones Senio Fi ness Tes , handg ip s eng h, he unc ional each es ,
and he Fulle on Ad anced Balance Scale. Physical ac i i y was measu ed
using accele ome y.
Resul s: In EG1, lowe limb flexibili y, agili y, ca dio espi a o y fi ness, and
balance imp o ed significan ly be ween baseline and he 12-week ou come
(p≤0.001 o all). In EG2, imp o emen s we e obse ed in uppe and lowe
limb s eng h, lowe limb flexibili y, agili y, ca dio espi a o y fi ness, handg ip
s eng h, and balance (p< 0.05 o all). Seden a y beha io inc eased in EG1
a e he in e en ion. The clinical e ec sizes o he in e en ions we e la ge
o balance (ES = 1.19) in EG1 and o uppe limb s eng h (ES = 1.24) in EG2,
and medium o ca dio espi a o y fi ness (ES = 0.74), agili y (ES = 0.50), and
lowe limb flexibili y (ES = 0.65) in EG1, and lowe limb s eng h (ES = 0.61) and
ca dio espi a o y fi ness (ES = 0.79) in EG2.
Conclusion: Bo h in e en ion p og ams led o imp o emen s in se e al unc ional
domains. Howe e , he mul imodal aining combined wi h augmen ed eali y
p og am showed imp o emen s ac oss mo e domains, esul ing in g ea e
changes. Physical ac i i y did no show significan imp o emen s.
KEYWORDS
physical unc ion, physical ac i i y, olde adul s, augmen ed eali y, mul imodal aining
TYPE O iginal Resea ch
PUBLISHED 07 Janua y 2025
|
DOI 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 01 on ie sin.o g
1 In oduc ion
In he con ex o aging, he e is a endency o unc ional
fi ness and physical ac i i y o dec ease (1). Func ional fi ness
(FF) plays a key ole in he daily li e o he popula ion, as i is
associa ed wi h he pe o mance o daily li ing asks and he
main enance o independence (2,3). The concep o FF is
associa ed wi h ca dio espi a o y fi ness, balance, s eng h, agili y,
flexibili y, and body composi ion (4). On he o he hand,
physical ac i i y allows people o gain se e al benefi s, no only
physically, bu also cogni i ely and psychologically (5–7).
O e he pas ew yea s, a ious s udies ha e been conduc ed o
in es iga e he e ec s o di e en exe cise p og ams on unc ional
fi ness and physical ac i i y in he elde ly. These exe cise p og ams
ha e included ae obic, mul imodal, balance, and aqua ic aining
(8,9). Recen ly, he e has been a g owing in e es in combining
new echnologies wi h physical ac i i y, leading o he
de elopmen o exe cise p og ams u ilizing i ual eali y (VR)
and exe games (10,11). Exe games ha e been shown o mo i a e
pa icipan s o be physically ac i e by p omo ing enjoymen and
un du ing exe cise. Howe e , mos exe games a e no specifically
designed o inc ease ecommended le els o physical ac i i y (12).
Vi ual eali y (VR) aining has demons a ed imp o emen s
in unc ional fi ness, balance, and cogni i e abili ies in olde
adul s (10,13,14), bu i also p esen s some challenges, such as
issues wi h ace- o- ace communica ion, simula ion sickness,
headaches, and sa e y conce ns (15,16). In addi ion, VR can be
an al e na i e o he use o exe games, bu no a subs i u e (17).
In pa allel wi h i ual eali y, augmen ed eali y (AR) has also
been explo ed in some con ex s, especially in balance aining (18).
One o he majo benefi s o AR is ha i p o ides use s wi h
i ual expe iences in he eal wo ld, allowing hem o ha e new
and sa e expe iences wi hou exposing olde people o
dange ous en i onmen s (19).
Recen ly, AR has been inc easingly associa ed wi h physical
ac i i y, and some exe cise p og ams ha e al eady been de eloped
using his echnology. The use o AR o olde adul s can o e
a ious benefi s, p omo ing a heal hy li es yle by enhancing he
pe o mance o daily asks and suppo ing ehabili a ion (20).
Gonçal es e al. (21) obse ed ha pa icipan s spen mo e ime in
mode a e o igo ous in ensi y physical ac i i y when exe cising
wi h AR han adi ional fi ness aining. Howe e , esea ch
linking AR and physical ac i i y is limi ed (19).
Recen s udies ha e epo ed high sel -e ficacy in exe cises
pe o med wi h AR, and imp o emen s in lowe limb s eng h,
ca dio espi a o y fi ness, mobili y, and maximal inspi a o y
p essu e (22,23). To ou knowledge, he e has been only one
s udy examining he e ec s o AR on unc ional fi ness in olde
adul s, which was conduc ed in a eal-wo ld se ing. The e o e,
his s udy eme ged om he need o be e unde s and he
e ec s o in e en ions ha combine exe cise and new
echnologies on physical fi ness in olde adul s. Thus, his s udy
aims o in es iga e he e ec s o an exe cise in e en ion using
mul imodal exe cise wi h augmen ed eali y and mul imodal
exe cise alone on he unc ional fi ness and physical ac i i y
beha io o olde adul s li ing in he communi y.
2 Me hod
2.1 S udy design and pa icipan s
Se en y-eigh communi y-dwelling olde adul s pa icipa ed in
his s udy. The esea ch p ojec was p omo ed h ough pos e s and
flye s dis ibu ed h oughou he egion. Indi iduals in e es ed in
pa icipa ing isi ed he Uni e si y gymnasium o egis e .
Pa icipan s we e eligible o he s udy i hey we e 60 yea s o
age o olde and had mo o independence (unassis ed). Exclusion
c i e ia included he p esence o a pacemake and cogni i e
impai men . The Mini-Men al S a e Examina ion (MMSE) was
used o assess cogni i e impai men . This es e alua es six
cogni i e domains, and we applied he cu o sco es om he
Po uguese e sion o he MMSE: ≤27 o indi iduals wi h mo e
han 11 yea s o educa ion, ≤22 o hose wi h 1–11 yea s o
educa ion, and ≤15 o illi e a e indi iduals (24). Table 1
con ains he cha ac e is ics o he pa icipan s.
Pa icipan s eligible o he s udy we e di ided in o g oups
based on hei a ailabili y, as andomizing he pa icipan s was
no easible (Figu e 1). The e we e h ee di e en g oups: a
con ol g oup (CG), an expe imen al g oup wi h mul imodal
aining (EG1) and an expe imen al g oup wi h mul imodal AR
aining (EG2). Twen y-eigh pa icipan s pa icipa ed in he CG,
26 in EG1 and 24 in EG2. All pa icipan s we e in o med o he
s udy’s aims and ga e in o med consen be o e pa icipa ion. The
s udy was app o ed by he Uni e si y o É o a’s E hics
Commi ee (GD/21849/2017) and was conduc ed in acco dance
wi h he Decla a ion o Helsinki. The p o ocol was egis e ed in
ClinicalT ials.go (NCT05727748).
2.2 Ou comes
Pa icipan s unde wen wo assessmen s, one a he beginning
and one a he end o he p og am. The pa icipan s unde wen
aining on some o he es s ha we e deemed necessa y
immedia ely be o e he e alua ion es ing session. The
TABLE 1 Desc ip i e analysis o all pa icipan s, by g oups. Resul s a e
exp essed as mean ± SD.
CG EG2 EG1 p
Age (yea s) 71.50 (3.9) 72.14 (6.1) 73.52 (7.4) 0.530*
Weigh (kg) 76.38 (12.1) 76.04 (10.5) 69.34 (13.3) 0.108*
Heigh (cm) 158.84 (8.4) 160.72 (8.1) 155.32 (9.8) 0.139*
BMI (kg/m
2
) 30.32 (4.6) 29.45 (3.5) 28.65 (4.1) 0.417*
Educa ion (yea s) 6.23 (4.7) 7.0 (3.6) 9.19 (5.0) 0.091*
SBP (mm Hg) 142.33 (15.7) 130.43 (19.3) 146.15 (17.3) 0.015*
,
**
DBP (mm Hg) 81.24 (12.1) 81.76 (16.2) 81.15 (10.6) 0.987*
Wais ci cum e ence (cm) 105.37 (18.8) 100.73 (11.2) 95.91 (11.2) 0.104*
Hip ci cum e ence (cm) 104.60 (13.4) 103.15 (6.6) 101.40 (7.3) 0.560*
CG, con ol g oup; EG2, expe imen al g oup wi h augmen ed eali y; EG1, expe imen al
g oup wi h mul imodal aining; BMI, body mass index; SBP, sys olic blood p essu e;
DBP, dias olic blood p essu e.
*Ano a es p- alue.
**p> 0.05.
Fe ei a e al. 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 02 on ie sin.o g
assessmen s we e conduc ed by an exe cise physiologis and las ed
app oxima ely one and a hal hou s.
Physical fi ness was assessed by he Senio Fi ness Tes , which
assessed lowe and uppe limb flexibili y, ca dio espi a o y
fi ness, uppe and lowe limb s eng h, and agili y. These
a iables we e espec i ely assessed by (1) chai si and each
(cm): he pa icipan sa on he edge o a chai wi h one leg
ex ended s aigh ou in on . They we e ins uc ed o each
o wa d wi h hei hands owa d he oes o he ex ended leg
whilekeeping heopposi elegben and he oo fla on he
floo . The dis ance be ween he finge ips and he oes was
measu ed. A posi i e alue was eco ded i he finge ips
passed he oes, and a nega i e alue i hey did no each he
oes; (2) back sc a ch (cm): he pa icipan eached one hand
o e hei shoulde and he o he hand up hei back,
a emp ing o make he finge s mee . The dis ance be ween he
finge ips was measu ed, wi h a posi i e sco e indica ing ha
he finge s o e lapped and a nega i e sco e indica ing ha hey
did no mee ; (3) 6 min walk (m): he pa icipan was
ins uc ed o walk as a as possible, wi hou unning, wi hin
6min in a p edefined a ea. The o al dis ance co e ed was
measu ed; (4) 30-s chai s and ( epe i ions): he pa icipan sa
in a chai wi h a ms c ossed o e he ches and was ins uc ed
o s and up ully and si down again as many imes as possible
wi hin 30 s. The numbe o comple e s ands was coun ed; (5)
a m cu l ( epe i ions): while sea ed, he pa icipan held a
weigh (5 pounds o women and 8 pounds o men) in hei
dominan hand and pe o med as many bicep cu ls as possible
wi hin 30 s; and (6) imed up and go (s): he pa icipan began
sea ed in a chai . On a signal, hey s ood up, walked 2.44 m,
u ned a ound, walked back o he chai , and sa down as
quicklyaspossible.The ime aken ocomple e heen i e
sequence was eco ded in seconds (25).
He e is he co ec ed and efined e sion o he ex :
Balance was assessed using he Func ional Reach Tes (FRT)
and he Fulle on Scale. The FRT is pe o med while he
pa icipan s ands up igh wi h a s able base. The ask equi es
he pa icipan o each o wa d wi h an ou s e ched a m
wi hou mo ing hei ee . The di e ence be ween he s a ing
and ending poin s (in cm) is measu ed. Each pa icipan
pe o ms he exe cise h ee imes, and he a e age is used o
s a is ical analysis (26). The Fulle on Scale was de eloped o
independen olde adul s and assesses bo h s a ic and dynamic
balance. I consis s o 10 ac i i ies: s anding wi h eyes closed and
ee oge he , u ning in a ci cle, walking up and down a s ep,
andem walking, one-legged balance, s anding wi h eyes closed
on a oam su ace, jumping a ho izon al dis ance, walking while
u ning he head, and egaining balance a e an unexpec ed loss.
Each ac i i y is sco ed om 0 o 4, wi h 0 indica ing he inabili y
o pe o m he ask and 4 ep esen ing he bes possible
pe o mance (27).
The handg ip dynamome e (HGD) was used o
measu e hand and o ea m muscle s eng h (in kilog ams)
(Baseline Smedley, model 12-0286, Whi e Plains, NY, USA).
The es was pe o med sea ed wi h he elbow flexed a
90° and he w is g ip indi idually adjus ed o each
pa icipan . Pa icipan s we e ins uc ed o each hei
maximum s eng h in 3 ials. The es was pe o med o
bo h he dominan (HGDH) and nondominan hand
(HGNDH). The a e age o he 3 ials o each hand was used
o s a is ical analysis (28).
Physical ac i i y was measu ed wi h an accele ome e
(Ac iG aph wGT3X- BT; Ac iG aph, LLC, Pensacola, Flo ida).
P e ious esea ch has shown ha accele ome e measu emen is
alid o quan i ying physical ac i i y in adul s (29). Pa icipan s
we e asked o wea he accele ome e 24 h a day o 7
consecu i e days. The accele ome e was emo ed o wa e
ac i i ies and ba hing. The de ice was wo n a he le el o he
FIGURE 1
Flow diag am o pa icipan ’s ec ui men .
Fe ei a e al. 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 03 on ie sin.o g
igh hip. Ac i a ion and downloading o accele ome e da a we e
pe o med ia Ac ili e so wa e. The esul s o pa icipan s who
used he accele ome e on a leas 3 alid days, including one
day du ing he weekend, we e conside ed. The a iables
measu ed wi h he accele ome e we e sleep du a ion, seden a y
ime, and physical ac i i y (ligh , mode a e, igo ous, mode a e-
igo ous, and o al). The c i e ia used o define PA we e:
seden a y: <100 coun s pe minu e; ligh : 100–2,019 coun s pe
minu e; mode a e: 2,020–5,998 coun s pe minu e; igo ous:
>5,999 coun s pe minu e (30).
2.3 In e en ion p og am
The in e en ion p og am las ed 12 weeks, wi h ini ial and
final assessmen s conduc ed o all pa icipan s. The con ol
g oup con inued hei daily ac i i ies wi hou any specific
physical ac i i y in e en ion. The expe imen al g oups
pa icipa ed in 60-min exe cise sessions h ee imes pe week.
Each session in bo h expe imen al g oups began wi h a 6-min
wa m-up and join mobiliza ion and ended wi h a 6-min cool-
down pe iod.
In EG1, sessions we e s uc u ed a ound ou s a ions: a
s eng h s a ion, a ca dio espi a o y fi ness s a ion, a dual- ask
eac ion ime s a ion, and a dual- ask agili y and coo dina ion
s a ion. Each pa icipan spen 12 min a each s a ion, comple ing
all ou s a ions du ing each session A he s eng h s a ion,
exe cises we e pe o med using body weigh , dumbbells, and
esis ance bands. Ini ially, pa icipan s began wi h bodyweigh
exe cises o lea n p ope echnique, and g adually p og essed o
using dumbbells and esis ance bands. The di ficul y was
p og essi ely inc eased by aising he numbe o epe i ions, he
weigh o he dumbbells, and he esis ance o he bands, wi h
he p og ession ailo ed o he indi idual cha ac e is ics o each
pa icipan . The ca dio espi a o y fi ness s a ion in ol ed walking
exe cises, whe e obs acles we e added o he cou se o e ime,
and pa icipan s ca ied an ex e nal load, such as 0.5 kg
dumbbells in each hand. S ai s we e also in oduced, and he
walking pace was g adually inc eased. The dual- ask eac ion
ime s a ion equi ed pa icipan s o comple e a ci cui ha
in ol ed pe o ming a mo o ask while simul aneously
esponding as quickly as possible o a s imulus. Meanwhile, a
he dual- ask agili y and coo dina ion s a ion, exe cises in ol ed
using a ball o e a 20-m cou se while engaging in a cogni i e
ask. Fo example, pa icipan s migh h ow a ball in he ai and
ap he g ound wice while coun ing backwa d om 50 by wos,
o bounce he ball once wi h he igh hand, hen h ee imes
wi h he le hand, while adding numbe s in inc emen s o h ee.
The ansi ion ime be ween s a ions se ed as es , and
pa icipan s we e also allowed o es whene e needed. The
aining sessions and hei espec i e s a ions we e indi idually
adap ed o sui he specific cha ac e is ics o each pa icipan .
EG2 sessions consis ed o six s a ions ocusing on aining
s eng h, ca dio espi a o y fi ness, dual- ask eac ion ime, and
dual- ask agili y and coo dina ion. Pa icipan s in his g oup
s ayed a each s a ion o 8 min. Fou o he s a ions we e he
same as hose used in EG1, wi h he addi ion o wo s a ions
inco po a ing augmen ed eali y (AR) echnology. The same
physical and cogni i e a iables we e a ge ed a hese AR
s a ions, bu wi h he enhancemen o AR ea u es.
A one o he AR s a ions, he aining was conduc ed using he
Po able Exe game Pla o m o Elde ly (PEPE) ( e e ed o as AR
S a ion 1), while he o he s a ion in ol ed ac i i ies p ojec ed on a
wall ( e e ed o as AR S a ion 2). The ac i i ies a bo h AR s a ions
we e specifically designed o he elde ly popula ion. PEPE is a
pla o m comp ising fi e exe games, and in his s udy, ou o
hese games we e u ilized: Exe pong, G ape S omping, Rabelos,
and Toboggan Games (Figu e 2). These games a ge ed
ca dio espi a o y fi ness, coo dina ion, s eng h, agili y, and
eac ion ime, wi h mos ac i i ies pe o med as dual asks. The
echnology implemen ed in PEPE is de ailed in he s udy by
Gonçal es (21), and he me hodology applied was consis en wi h
ha used in a p e iously published s udy by Fe ei a e al. (31,
32). The exe games we e designed o simul aneously ain
physical and cogni i e a iables, wi h a di e en exe game being
ea u ed in each session. A AR S a ion 2, he e we e ou
dis inc ac i i ies, including asks such as ouching a ci cle as
quickly as possible o make i disappea and ma ching on he
spo while esponding o a p edefined s imulus wi h he palm o
he hand.
A he end o he aining sessions, he Bo g CR10 scale was
used o moni o aining in ensi y, and he Nasa TLX was used
o con ol he men al and physical e o pe cei ed by he
pa icipan s, conside ing he en i e exe cise session.
2.4 Da a analysis
The sample size was de e mined u ilizing G*Powe , an
analy ical so wa e, wi h he aid o he RS udio pla o m,
inco po a ing he pw lib a y. The calcula ions we e based on an
e ec size o 0.573, an αle el o 0.05, and a s a is ical powe o
0.8. Consequen ly, a ecommended sample size o 11 olde adul s
was p oposed o each expe imen al g oup. The e ec size used
was based on esul s o me a-analyses conduc ed on he e ec s o
p og ams wi h augmen ed eali y o exe games on olde adul s.
No mali y analysis was calcula ed using he Shapi o-Wilk es .
Pa ame ic es s we e used o he no mally dis ibu ed a iables,
and nonpa ame ic es s we e used o he nonno mally
dis ibu ed a iables. Fo he no mally dis ibu ed a iables, he
ANOVA was used o compa ison be ween g oups, and pai ed
sample - es was used o compa e he p ein e en ion and
pos in e en ion pe iods wi hin he same g oup. Fo
nonpa ame ic a iables, he independen -samples - es was used
o compa e g oups, and he Wilcoxon es was used o compa e
he momen be o e and a e he in e en ion wi hin he
same g oup. Fo compa ison be ween g oups, he del a alue
(Δ: momen 1-momen 0) was used. Thei p opo ional change
alue (D%¼[(momen 1 momen 0)=momen 0] 100) was
calcula ed o all a iables be ween he p ein e en ion and
pos in e en ion pe iods.
Fe ei a e al. 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 04 on ie sin.o g
The e ec size (Cohen’s d) and 95% CI we e calcula ed o
de e mine he magni ude o he ea men e ec and he clinical
significance o he in e en ions. Cohen’s cu o alues we e used,
wi h 0.20, 0.50, and 0.80 indica ing a small, medium, and la ge
e ec , espec i ely (33).
Desc ip i e analysis was used o all a iables, conside ing he
mean and s anda d de ia ion. Analyses we e pe o med using
PASW S a is ical o Windows s a is ical so wa e ( e sion 22.0;
IBM SPSS Inc). Fo all s a is ical es s, significance was se a p<0.05.
3 Resul s
In his s udy, 78 pa icipan s we e assigned o he g oup ha
was mos con enien o hem. Wi hin he mul imodal aining
g oup, 5 pa icipan s wi hd ew om he s udy, while 21
success ully comple ed he in e en ion. Simila ly, 21 pa icipan s
comple ed he in e en ion wi hin he mul imodal aining g oup
wi h augmen ed eali y (AR), while 22 we e pa o he con ol
g oup. Among he ini ial 28 pa icipan s in he con ol g oup, 5
d opped ou , and 2 did no finish he final assessmen s. The
pa icipan s who d opped ou did so because hey had o a end
o amily ma e s and no longe had ime o pa icipa e in he
exe cise sessions. Desc ip i e cha ac e is ics such as weigh ,
heigh , age, educa ion le el, body mass index, and es ing hea
a e did no di e significan ly among he h ee g oups.
A o al o 36 exe cise sessions we e conduc ed, and pa icipan s
we e equi ed o a end a leas 80% o hese sessions o be included
in he s udy. All pa icipan s who began he in e en ion me his
a endance equi emen and comple ed bo h he ini ial and final
assessmen s. O e all, he exe cise sessions had high a endance
a es. In he EG2 g oup, 10 pa icipan s a ended o e 90% o
he sessions, while 11 a ended be ween 80% and 90%. In he
EG1 g oup, 17 pa icipan s a ended a leas 90% o he sessions,
and 4 we e p esen o mo e han 80%.
Ini ially, he physical fi ness o all pa icipan s was assessed o
de e mine hei baseline condi ion be o e s a ing he p og am. The
esul s we e hen compa ed wi h he e e ence alues p oposed by
Mendes e al. (2014), based on he age and sex o each pa icipan .
Ac oss all g oups, mo e han 70% o pa icipan s exceeded he
ecommended alues o uppe and lowe limb s eng h, agili y,
and ca dio espi a o y fi ness. In e ms o flexibili y, 50% o
pa icipan s in he con ol g oup (CG) had alues abo e he
e e ence, while in he mul imodal aining g oups (EG1 and
EG2), 60% o pa icipan s exceeded he ecommended le els o
hei age and sex.
Table 2 shows he esul s o he e ec s o he di e en
in e en ion p og ams on unc ional fi ness. A e he 12-week
in e en ion, CG showed wo se ou comes and mo e ime on
he TUG (Δ% = 4.78%) and inc eased back sc a ching dis ance
(Δ% = 18.73%) compa ed o he p e-in e en ion and pos -
in e en ion pe iods. EG2 showed be e esul s in uppe limb
s eng h (Δ% = 21.48%) and lowe limb s eng h (Δ% = 8.77%)
a e he 12-week o in e en ion. In he es o nondominan
handg ip, EG2 showed imp o emen in pe o mance a e he 12
weeks (Δ% = 9.13%). EG2 and EG1 showed be e esul s in
he chai si -and- each es (EG2, Δ%=−77.12%; EG1;
Δ%=−82.18%), in he TUG (EG2, Δ%=−6.60%; EG1, Δ%=−7.
FIGURE 2
Di e en games on he po able exe game pla o m o elde ly. (A) Exe pong; (B) oboggan games; (C) abelos; (D) g ape s omping.
Fe ei a e al. 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 05 on ie sin.o g
08%), in he ca dio espi a o y fi ness es (EG1, Δ% = 9.62%;
EG2, Δ% = 5.94%), and in he balance es (EG1, Δ% = 13.79%;
EG2, Δ% = 15.01%), wi h imp o ed pe o mance in all es s.
Finally, on FRT, EG2 (Δ% = 21.88%) showed significan
imp o emen s and inc eased ange.
When compa ing he 3 g oups ega ding unc ional fi ness, he e
a e significan di e ences in lowe (p= 0.020) and uppe limb
s eng h (p< 0.001), chai si -and- each (p= 0.035), 8 up-and-go
(p< 0.001), unc ional each es (p= 0.003), HGNDH (p= 0.020),
and balance (p< 0.001). CG and EG2 showed significan di e ences
in chai s ance (p= 0.032), a m flexion (p= 0.001), and TUG
(p= 0.002), wi h EG2 showing be e esul s han CG. The alues
in TUG (p<0.001), CSR (p= 0.013), FRT (p= 0.003) and balance
(p< 0.001) showed significan di e ences when compa ing CG and
EG1, wi h he expe imen al g oup showing be e esul s. When
compa ing he wo expe imen al g oups, EG2 showed be e sco es
on he HGNDH (p= 0.016) han EG1, and EG1 be e sco es han
EG2 on he Func ional Reach Tes (p=0.031).
Table 3 p esen s he esul s ela ed o physical ac i i y,
highligh ing significan di e ences be ween g oups in seden a y
TABLE 2 Impac o he augmen ed eali y and mul imodal exe cise p og ams on fi ness unc ion.
Baseline mean (SD) Pos -in e en ion mean (SD) p- alue E ec size Cohen’s d (95% CI) Δ%
30-s chai s and ( ep)
EG1 13.48 (3.1) 14.33 (3.6) 0.176** 0.26 (−0.36, 0.85) 6.31%
EG2 12.43 (1.6) 13.52 (1.9) 0.030**
,
*** 0.61 (−0.03, 1.19) 8.77%
CG 13.55 (3.5) 12.68 (3.6) 0.098** −0.25 (−0.87, 0.38) −6.42%
A m cu l ( ep)
EG1 15.70 (2.8) 16.52 (2.9) 0.120** 0.29 (−0.32, 0.94) 5.22%
EG2 14.90 (2.2) 18.10 (2.9) 0.001*
,
*** 1.24 (0.65, 1.75) 21.48%
CG 17.73 (3.6) 16.09 (4.5) 0.096** −0.40 (−0.99, 0.21) −9.25%
Back sc a ch (cm)
EG1 −13.59 (9.01) −12.09 (10.5) 1.00** 0.15 (−0.49, 0.76) −11.04%
EG2 −9.57 (10.8) −9.39 (11.4) 0.394** 0.02 (−0.62, 0.65) −1.88%
CG −15.38 (10.6) −18.26 (11.4) 0.028**
,
*** −0.26 (−0.84, 0.37) 18.73%
Chai si -and- each (cm)
EG1 −9.37 (11.9) −1.67 (11.5) 0.001*
,
*** 0.65 (0.02, 1.3) −82.18%
EG2 −4.59 (12.6) −1.05 (13.8) 0.042**
,
*** 0.27 (−0.37, 0.9) −77.12%
CG −6.45 (14.2) −6.05 (15.9) 0.776** 0.03 (−0.59, 0.63) −6.20%
8 up-and-go (s)
EG1 6.07 (0.86) 5.64 (0.86) 0.011**
,
*** −0.50 (−1.15, 0.176) −7.08%
EG2 6.36 (1.0) 5.94 (1.0) 0.006*
,
*** −0.41 (−0.99, 0.25) −6.60%
CG 6.28 (1.3) 6.58 (1.3) 0.033**
,
*** 0.23 (−0.38, 0.84) 4.78%
6-minu e walk (m)
EG1 472.26 (27.5) 500.33 (45.3) 0.001**
,
*** 0.74 (0.06, 1.43) 5.94%
EG2 440.55 (52.9) 482.93 (54.9) 0.007**
,
*** 0.79 (0.145, 1.39) 9.62%
CG 422.59 (161.7) 454.46 (131.6) 0.249* −0.03 (−0.623, 0.572) 7.54%
FRT (cm)
EG1 28.56 (5.3) 34.81 (5.2) <0.001**
,
*** 1.19 (0.43, 1.85) 21.88%
EG2 31.44 (5.9) 32.49 (5.8) 0.501** 0.18 (−0.46, 0.81) 3.34%
CG 30.61 (6.8) 30.16 (4.9) 0.733** −0.07 (−0.71, 0.52) −1.47%
HGDH (Kg)
EG1 25.6 (10.1) 24.00 (8.6) 0.185* 0.15 (−0.49, 0.77) −6.25%
EG2 27.04 (9.3) 28.36 (7.3) 0.256** 0.16 (−0.46, 0.81) 4.88%
CG 25.38 (6.7) 25.56 (6.2) 0.778** 0.03 (−0.58, 0.63) 0.71%
HGNDH (Kg)
EG1 23.32 (7.9) 22.61 (7.4) 0.357* −0.09 (−0.71, 0.53) −3.04%
EG2 23.55 (7.1) 25.70 (7.3) 0.011**
,
*** 0.29 (−0.34, 0.91) 9.13%
CG 23.22 (5.9) 23.85 (5.8) 0.581** 0.11 (−0.49, 0.72) 2.71%
Balance (poin s)
EG1 30.38 (4.9) 34.57 (3.9) <0.001**
,
*** 1.19 (0.53, 1.75) 13.79%
EG2 30.52 (4.7) 35.10 (2.7) <0.001*
,
*** −0.24 (−0.84, 0.36) 15.01%
CG 29.82 (4.7) 28.64 (5.1) 0.185** 0.94 (0.30, 1.63) −3.96%
EG2, expe imen al g oup wi h augmen ed eali y and mul imodal aining; EG1, expe imen al g oup wi h mul imodal aining; FRT, unc ional each es ; HGDH, hand g ip dominan hand;
HGNDH, hand g ip non-dominan hand.
*Wilcoxon es p- alue.
**Pai ed-samples - es p- alue.
***p≤0.05.
Fe ei a e al. 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 06 on ie sin.o g
beha io and sleep. Changes in physical ac i i y a iables, as shown
in Table 3, we e obse ed a e he 12-week in e en ion using
accele ome y. No ably, only EG1 exhibi ed significan di e ences
be ween he beginning and end o he in e en ion in he
seden a y beha io and sleep a iables. Howe e , a e 12 weeks,
seden a y beha io inc eased (Δ% = 7.02%) and sleep du a ion
dec eased (Δ%=−9.02%). When compa ing he 3 g oups, he e
a e significan di e ences in sleep (p= 0.05) and seden a y
beha io (p= 0.04). GE1 showed be e esul s as hey had less
seden a y beha io (p= 0.03) and mo e sleep ime (p= 0.05)
han GE2.
No significan di e ences we e obse ed be ween g oups o
uppe limb flexibili y, ca dio espi a o y fi ness, dominan
handg ip, o in he ligh , mode a e, igo ous, mode a e- o-
igo ous physical ac i i y (MVPA), and o al physical ac i i y le els.
4 Discussion
The fi s pu pose o his s udy was o in es iga e he e ec s o a
mul imodal exe cise p og am and a mul imodal exe cise p og am
wi h AR in FF and PA. As he popula ion ages, de eloping
s a egies ha p omo e heal h and quali y o li e is essen ial.
Nowadays, echnology is used in he daily li e o a la ge pa o
he gene al popula ion and has become an impo an aspec o
people’s li es. Mul imodal exe cise benefi s unc ional fi ness and
physical ac i i y in olde people, bu ew s udies use echnology
in conjunc ion wi h exe cise sessions. This s udy demons a ed
ha a mul imodal p og am inco po a ing AR can lead o
significan imp o emen s in unc ional fi ness among
communi y-dwelling olde adul s. Ou findings indica e no able
inc eases in a ious aspec s o unc ional fi ness, and bo h
in e en ion p og ams con ibu ed o enhancemen s in specific
unc ional skills, esul ing in clinically significan e ec s.
When compa ing he h ee g oups, di e ences we e ound in
uppe and lowe limb s eng h, lowe limb flexibili y, imed up
and go, unc ional each es , non-dominan hand g ip, and
balance. When we compa ed EG2 wi h CG, changes we e
obse ed in uppe and lowe limb s eng h, balance, and imed
up and go, indica ing ha an AR in e en ion has mul iple
benefi s in e ms o unc ional fi ness. When we compa ed EG1
wi h CG, we obse ed di e ences be ween he g oups in he
TABLE 3 Impac o he augmen ed eali y and mul imodal exe cise p og ams on physical ac i i y.
Baseline mean (SD) Pos -in e en ion mean (SD) p- alue E ec size Cohen’s d (95% CI) Δ%
Seden a y beha io (min/day)
EG1 806.75 (119.2) 863.36 (113.0) 0.024**
,
*** 0.49 (−0.18, 1.1) 7.02
EG2 843.2 (124.3) 802.67 (145.68) 0.178** −0.29 (−0.95, 0.34) −4.81
CG 847.02 (117.3) 865.11 (117.4) 0.678** 0.15 (−0.45, 0.81) 2.14
To al PA (min/day)
EG1 104.75 (43.2) 88.55 (39.3) 0.079** −0.39 (−1.02, 0.24) −15.47
EG2 121.02 (67.4) 138.1 (102.8) 0.566** 0.19 (−0.41, 0.75) 14.11
CG 82.39 (44.3) 76.71 (43.1) 0.236** −0.13 (−0.71, 0.49) −6.89
Ligh PA (min/day)
EG1 85.31 (37.2) 73.83 (33.4) 0.159** −0.33 (−0.95, 0.30) −13.46
EG2 98.36 (51.5) 111.99 (99.9) 0.627* 0.17 (−0.44, 0.77) 13.86
CG 68.41 (34.3) 68.81 (35.7) 0.322** 0.01 (−0.61, 0.61) 0.58
Mode a e PA (min/day)
EG1 19.43 (14.5) 14.72 (12.5) 0.058* −0.35 (−0.89, 0.35) −24.24
EG2 28.67 (30.6) 26.07 (28.4) 0.126* −0.09 (−0.73, 0.55) −9.07
CG 13.96 (14.8) 11.56 (15.1) 0.876* −0.16 (−0.76, 0.51) −17.19
MVPA (min/day)
EG1 19.44 (14.5) 14.72 (12.5) 0.058* −0.35 (−0.89, 0.35) −24.28
EG2 27.34 (30.5) 26.12 (28.5) 0.274* −0.04 (−0.66, 0.59) −4.46
CG 13.97 (14.8) 11.04 (14.9) 0.615* −0.19 (−0.82, 0.44) −20.97
Vigo ous PA (min/day)
EG1 0.001 (0.0) 0.001 (0.0) 1.00* 0.00
EG2 0.04 (0.1) 0.06 (0.2) 1.00* 0.11 (−0.61, 0.66) 50.00
CG 0.01 (0.0) 0.01 (0.0) 0.596* −0.09 (−0.65, 0.57) 0.00
Sleep ime (min/day)
EG1 478.61 (105.7) 435.42 (102.3) 0.030**
,
*** −0.42 (−1.03, 0.23) −9.02
EG2 425.93 (122.4) 454.59 (132.3) 0.126** 0.23 (−0.43, 0.87) 6.73
CG 455.71 (99.7) 446.78 (103.2) 0.821** −0.09 (−0.742, 0.502) −1.96
EG2, expe imen al g oup wi h augmen ed eali y and mul imodal aining; EG1, expe imen al g oup wi h mul imodal aining; PA, physical ac i i y; MVPA, mode a e- igo ous physical
ac i i y.
*Wilcoxon es p- alue.
**Pai ed-samples - es p- alue.
***p≤0.05.
Fe ei a e al. 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 07 on ie sin.o g
a iables o unc ional each es , lowe limb flexibili y, balance,
and imed up and go. When compa ing he expe imen al g oups
wi h he con ol g oup, significan di e ences we e ound in
some a iables. This can be a ibu ed o he ac ha he con ol
g oup did no unde go any specific in e en ion, while he
expe imen al g oups pa icipa ed in a 12-week exe cise
in e en ion. These findings align wi h p e ious s udies ha
u ilized a CG wi hou an in e en ion, highligh ing he posi i e
e ec s o s uc u ed exe cise p og ams on unc ional fi ness in
olde adul s (34,35). In con as , when compa ing EG2 and
EG1, EG1 pa icipan s showed be e esul s in he FRT. EG2
showed imp o emen s in non-dominan hand g ip (HGNDH)
compa ed o EG1. In EG1, pa icipan s showed a dec ease in
hand p essu e s eng h (Δ%=−3%), whe eas pa icipan s in EG2
inc eased i wi h exe cise (Δ% = 9%). This could be because
ac i i ies wi h AR equi e using bo h uppe limbs o pe o m he
ac i i ies success ully.
When compa ing he p e- and pos - aining assessmen s
wi hin each g oup in he p esen s udy, we iden ified significan
di e ences in unc ional fi ness ac oss all g oups. In he con ol
g oup (CG), pa icipan s exhibi ed declines in unc ional fi ness
a iables, pa icula ly in imed up and go (TUG) pe o mance
and uppe limb flexibili y. These findings align wi h o he s udies
ha indica e a dec ease in unc ional fi ness wi h ad ancing age.
When compa isons we e made be ween he p e- and pos -
aining momen wi hin each g oup in he p esen s udy, we
ound some significan di e ences in unc ional fi ness in all
g oups. In he CG, pa icipan s exhibi ed declines in unc ional
fi ness a iables, pa icula ly in imed up and go pe o mance
and uppe limb flexibili y. These findings align wi h o he s udies
ha indica e a dec ease in unc ional fi ness wi h ad ancing age
(36–38). EG2 demons a ed imp o emen s in uppe and lowe
limb s eng h, lowe limb flexibili y, imed up and go,
ca dio espi a o y fi ness, balance, and non-dominan hand g ip
s eng h. In con as , EG1 showed enhancemen s in lowe limb
flexibili y, imed up and go, balance, and ca dio espi a o y
fi ness. Al hough he e we e di e ences wi hin each g oup
be ween he p e- and pos -exe cise assessmen s, he e ec size
was ound o be g ea e in EG2. Clinically ele an e ec s we e
also mo e p onounced in EG2. Howe e , i is impo an o no e
ha he in e en ion wi h only mul imodal aining s ill showed
clinically ele an e ec s in ce ain a iables. Acco ding o ou
esul s, bo h in e en ions demons a ed clinically significan
imp o emen s ac oss di e en a eas. EG1 achie ed be e
ou comes in balance, ca dio espi a o y fi ness, and lowe limb
flexibili y, while EG2 excelled in s eng h and ca dio espi a o y
fi ness. An ea lie s udy by Pa k and Shin showed ha an AR
in e en ion imp o ed he imed up and go o olde women
li ing in he communi y (23). Howe e , i did no show
imp o emen s in he fi e imes si - o-s and and he 1-min si - o-
s and es , designed o measu e lowe limb unc ion. Acco ding
o he au ho s, his may be ela ed o he ac ha he exe cise
p og am de eloped did no consis o s eng h exe cises. In his
s udy, la ge muscle g oups we e used in he wo k o he g oup
ha used augmen ed eali y. All PEPE ac i i ies equi ed
pa icipan s o pe o m mo emen s wi h he lowe and uppe
limbs simul aneously, and some loading was added du ing he
sessions o inc ease he di ficul y. In con as o he esul s
ob ained in Pa k, we imp o ed lowe and uppe limb s eng h.
To ou knowledge, his is one o he ew s udies ha used an AR
exe cise pla o m ha allows pa icipan s o pe o m exe cises in
he eal wo ld wi h he addi ion o i ual elemen s.
This s udy shows ha al hough bo h expe imen al g oups
showed imp o emen s in se e al a iables EG2 p oduced mo e
esul s and had se e al clinically ele an e ec . The use o AR in
he aining sessions p o ided pa icipan s wi h cons an
s imula ion and immedia e eedback. Ou aining sessions used
4 PEPE ac i i ies ha ained agili y, ca dio espi a o y fi ness,
uppe and lowe limb muscle s eng h, and mo o skills. All
ac i i ies equi ed pa icipan s o pe o m mo emen s wi h hei
legs (la e al displacemen s, s a iona y walking, o squa s) and
wi h hei a ms ( o a ion, ex ension and flexion, adduc ion, and
abduc ion) while main aining a cons an mo emen . As he
aining sessions p og essed, he exe cises we e adap ed, and he
load o he exe cises inc eased. One o he ad an ages o using
PEPE is he cons an eedback p o ided o he pa icipan s
du ing he execu ion o he exe cises. A p e ious s udy by
Gonçal es e al. (21), which obse ed he e ec s o using PEPE
on physical ac i i y le els, concluded ha his pla o m p o ed o
be an e ec i e addi ion o exe cise sessions o ageing. They
demons a ed ha AR aining sessions could p omo e a highe
pe cen age o ime spen in mode a e- igo ous physical ac i i y
han adi ional aining sessions. The ac ha mo e mode a e-
igo ous physical ac i i y occu s leads o g ea e significan gains
among pa icipan s in his s udy (22,39,40).
Rega ding physical ac i i y, wi hin each g oup, he e we e
significan di e ences be ween baseline and end-line only a
EG1 in seden a y beha io and sleep du a ion. Howe e ,
pa icipan s had wo se esul s, inc easing seden a y beha io ime
(Δ%=−7%), and dec easing sleep ime (Δ%=−9%). When we
compa e he 3 g oups, di e ences a e obse ed in he same 2
a iables, wi h di e ences be ween EG2 and EG1. Al hough he e
we e no significan di e ences in EG2, he e was a end owa d
an inc ease in sleep ime (Δ% = 6%) and a dec ease in seden a y
ime (Δ%=−5%). To ou knowledge, no s udies ha e examined
he e ec s o an AR exe cise p og am on seden a y beha io and
sleep in communi y-dwelling olde adul s. Howe e , p e ious
s udies ha e shown ha a e an exe cise p og am, olde people
dec ease he amoun o ime spen in seden a y beha io (41)
beha io and imp o e hei sleep quali y (42). In he u u e, i
will be essen ial o assess sleep quali y and e ficiency o
unde s and wha impac a p og am a AR migh ha e on hese
a iables and o de elop s a egies o pa icipan s o emain
physically ac i e ou side o sessions.
The in eg a ion o mul imodal aining wi h AR p esen s
significan po en ial o inclusion in public heal h s a egies and
in e en ions ocused on enhancing unc ional fi ness and
educing seden a y beha io among olde adul s. AR can
coun e ac he ad e se e ec s o a seden a y li es yle by o e ing
in e ac i e and engaging exe cise expe iences. Public heal h
ini ia i es could le e age AR by inco po a ing i in o p og ams
designed o educe seden a y beha io in olde popula ions,
Fe ei a e al. 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 08 on ie sin.o g
especially h ough c ea i e implemen a ions in senio cen e s and
communi y spaces. The findings indica e ha echnology-enabled
fi ness p og ams can add ess mul iple ace s o unc ional fi ness,
making hem a aluable elemen o ac i e aging s a egies.
Policies ha encou age he use o AR echnologies in
communi y-based exe cise p og ams could lead o imp o emen s
in physical fi ness and, consequen ly, he o e all heal h and well-
being o olde adul s. This app oach has he po en ial o lowe
heal hca e cos s associa ed wi h physical decline and o suppo
aging in place.
This s udy has se e al limi a ions. Fi s ly, moni o ing
pa icipan s’hea a es h oughou he exe cise sessions would
ha e been c ucial o a mo e p ecise unde s anding o hei
physiological esponses. Fu u e esea ch should conside
inco po a ing hea a e moni o s o be e assess exe cise
in ensi y. Ano he limi a ion is ha he sample was no
andomly assigned; ins ead, g oup alloca ion was based on
pa icipan s’a ailabili y. Addi ionally, he conclusion o he
in e en ion coincided wi h he summe season, and high
empe a u es a he in e en ion si e may ha e educed
pa icipan s’mo i a ion o engage in physical ac i i y, po en ially
impac ing he s udy’s ou comes.
5 Conclusion
The esul s o his s udy indica e ha pa icipa ion in a
mul imodal exe cise p og am ha inco po a es augmen ed eali y
(AR) leads o significan unc ional imp o emen s in olde
adul s. The mul imodal exe cise p og am enhanced wi h AR
p o ed pa icula ly e ec i e, yielding b oade and mo e
subs an ial imp o emen s in se e al unc ional fi ness a iables
compa ed o a p og am ha did no u ilize his echnology.
Unde s anding he mo i a ions o olde adul s in communi y
se ings o engage in physical exe cise is c ucial o enhancing
he e ec i eness o hese p og ams. AR has shown p omise as a
ool o inc easing engagemen by allowing olde adul s o
in e ac wi h i ual objec s wi hin hei eal-wo ld en i onmen s,
he eby making exe cise mo e enjoyable and accessible.
In eg a ing AR in o exe cise p og ams o communi y-dwelling
olde adul s can esul in a a ie y o heal h benefi s, including
imp o ed physical unc ion, heigh ened mo i a ion, and
po en ially educed seden a y beha io .
Da a a ailabili y s a emen
The da a suppo ing he conclusions o his a icle is no eady
a ailable due o pa icipan confiden iali y. Reques s o access he
da a can be di ec ed o he co esponding au ho .
E hics s a emen
The s udies in ol ing humans we e app o ed by Comissão de
É ica da Uni e sidade de É o a. The s udies we e conduc ed in
acco dance wi h he local legisla ion and ins i u ional
equi emen s. The pa icipan s p o ided hei w i en in o med
consen o pa icipa e in his s udy.
Au ho con ibu ions
SF: W i ing –o iginal d a , W i ing – e iew & edi ing,
Concep ualiza ion, Da a cu a ion, In es iga ion, Me hodology,
P ojec adminis a ion. JM: Concep ualiza ion, In es iga ion,
Me hodology, Supe ision, W i ing – e iew & edi ing. JD:
Concep ualiza ion, Supe ision, Valida ion, W i ing – e iew &
edi ing. NL: Concep ualiza ion, In es iga ion, Me hodology,
W i ing – e iew & edi ing. AB: Concep ualiza ion, Resou ces,
So wa e, Valida ion, W i ing – e iew & edi ing. AM:
Concep ualiza ion, In es iga ion, Valida ion, W i ing – e iew &
edi ing. AR: Concep ualiza ion, Me hodology, Supe ision,
Valida ion, W i ing – e iew & edi ing.
Funding
The au ho (s) decla e financial suppo was ecei ed o he
esea ch, au ho ship, and/o publica ion o his a icle. This wo k
was suppo ed by he Na ional Funds h ough he Po uguese
Founda ion o Science and Technology (FCT), g an numbe
SFRH/BD 141448/2018. I was also suppo ed by Na ional Funds
h ough he Po uguese Founda ion o Science and Technology
unde he p ojec UIDB/04923/2020.
Conflic o in e es
The au ho s decla e ha he esea ch was conduc ed in he
absence o any comme cial o financial ela ionships ha could
be cons ued as a po en ial conflic o in e es .
Publishe ’s no e
All claims exp essed in his a icle a e solely hose o he
au ho s and do no necessa ily ep esen hose o hei a filia ed
o ganiza ions, o hose o he publishe , he edi o s and he
e iewe s. Any p oduc ha may be e alua ed in his a icle, o
claim ha may be made by i s manu ac u e , is no gua an eed
o endo sed by he publishe .
Fe ei a e al. 10.3389/ spo .2024.1447866
F on ie s in Spo s and Ac i e Li ing 09 on ie sin.o g
