Physical and motor fitness tests for older adults living in nursing homes: a systematic review

Citation: Galhardas, L.; Raimundo, A.; Del Pozo-Cruz, J.; Marmeleira, J. Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review. Int. J. Environ. Res. Public Health 2022,19, 5058. https://doi.org/10.3390/ ijerph19095058 Academic Editor: Timothy A. Brusseau Received: 9 March 2022 Accepted: 19 April 2022 Published: 21 April 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). International Journal of Environmental Research and Public Health Systematic Review Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review Luis Galhardas 1,2,* , Armando Raimundo 1,2 , Jesús Del Pozo-Cruz 3,4 and JoséMarmeleira 1,2 1Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais, 7000-727 Évora, Portugal; [email protected] (A.R.); [email protected] (J.M.) 2Comprehensive Health Research Centre (CHRC), Palácio do Vimioso, Gabinete 256, Largo Marquês de Marialva, Apart. 94, 7002-554 Évora, Portugal 3Department of Physical Education and Sports, University of Seville, 41013 Sevilla, Spain; [email protected] 4 Epidemiology of Physical Activity and Fitness across Lifespan Research Group (EPAFit), University of Seville, 41013 Sevilla, Spain *Correspondence: galhar[email protected] Abstract: This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives. Keywords: assessment; long-term care facilities; measure; older adults; performance-based testing 1. Introduction Currently, most people can expect to live to over 70 years old [ 1 ]. Thus, the increase in average life expectancy combined with the sharp decline in fertility rates is leading to the rapid ageing of populations worldwide [2]. An important question related to the increase in longevity is the relationship between older ages and the person’s general health. With advancing age, there is a progressive deterioration in the physical and mental health of the elderly and a consequent increase in the need for greater medical and social assistance [ 3 ]. When talking about health throughout the natural ageing process, it is assumed to be multifactorial, resulting from a continuous interaction between genetic and environmental influences, which makes the group of older people quite heterogeneous [ 3 , 4 ]. The ageing process leads to inevitable life changes and is characterized by a progressive decline in physiological functions [ 5 ]. Older adults often show low aerobic capacity, low muscle strength, balance limitations, and other physical/motor limitations [ 6 , 7 ]. Regular physical activity and/or physical exercise are essential for healthy ageing and contribute to better mental health [ 6 ]. It can help prevent, delay, or manage many costly and challenging chronic diseases handled by older adults, especially those living in nursing homes. It can Int. J. Environ. Res. Public Health 2022,19, 5058. https://doi.org/10.3390/ijerph19095058 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2022,19, 5058 2 of 29 also decrease the risk of moderate or severe functional limitations in older adults and the risk of premature death [8]. Assessment methods are needed to assess these capabilities. In this review, we focused on older adults living in nursing homes, a group of the population that was characterized by a high proportion of very much older adults, most of them with marked levels of frailty [ 9 , 10 ]. The assessment of the physical and motor capacities of nursing home residents is of importance for health personnel to design proper (and individualized) intervention programs, monitor a person’s progress, and evaluate the effects of the interventions carried out [ 11 ]. To the best of our knowledge, in recent years, no literature review has focused on physical/motor assessment methods for people living in long-term facilities. From our perspective, knowledge of the most used assessment tests and the physical parameters most screened could be very pertinent to health professionals and researchers. The principal aim of this systematic literature review is to highlight and categorize the most common tests used in recent years for assessing the physical function and motor skills of older adults living in institutionalized contexts. This study also intends to examine the psychometric properties of the tests. This information could help researchers and technicians to select the methods that best suit their objectives, whether to analyze the effects of treatments or to characterize the person’s abilities. 2. Materials and Methods A systematic literature review of studies involving older adults, residents of nursing homes, or similar, and to which physical or motor assessment methods were applied, was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement [ 12 ] was applied to improve the report of this systematic review. We registered the review in the PROSPERO International prospective register of systematic reviews (registration number CRD42020212338), and it is available at the following link: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020212338 (accessed on 1 November 2020). 2.1. Data Sources and Search Strategy Electronic databases (PubMed, Scopus, and ScienceDirect) were initially searched for articles published between January 2005 and 31 December 2020. Subsequently, a new search was conducted for articles published until 31 October 2021. Using MeSh terms and relevant keywords the following semantic categories were entered: ‘nursing homes’, ‘institutionalized’, ‘residential care facility’, ‘long-term facility’, ‘aged, 65 and over’, ‘older’, ‘elderly’, ‘older adults’, ‘physical’, ‘motor’ ‘physical’, ‘tests’, ‘physical assessment’, ‘motor tests’, and ‘motor assessment’. We also screened the reference lists of review articles. The review was conducted using the DistillerSR (Evidence Partners Incorporated, Ottawa, Canada), an online specialized systematic review software. All identified citations were uploaded to DistillerSR, and duplicates were identified and removed. 2.2. Inclusion and Exclusion Criteria Studies were eligible if they met the following inclusion criteria: (1) the participants were institutionalized (nursing homes or similar); (2) the participants were on average older than 65 years; (3) physical or motor tests (assessment methods) were used to measure specific abilities/skills; and (4) written in English. Studies were excluded if (1) the publication was a systematic review, abstract, study protocol, letter, commentary, a study reporting only qualitative data, dissertation, or poster abstract; (2) the work was published before 2005; or (3) they just applied scales or questionnaires, with indirect evaluation or by interview, very common, for example, in activities of daily living (ADL) assessment. It should be noted that we only consider methods/assessments that directly assess performance in pre-established activities. Int. J. Environ. Res. Public Health 2022,19, 5058 3 of 29 2.3. Selecion Process After the literature search, an initial selection of studies was performed according to their titles, followed by a selection after reading the abstracts. One reviewer (LG) performed both steps to identify those studies that met the inclusion criteria. After that, another reviewer (JM) checked whether all was in accordance. Disagreement was solved with full-text screening by all the research team. In the next step, a full-text analysis was performed to check whether the studies identified previously matched with the inclusion criteria. Subsequently, all the research team hand-searched for other studies that were not already found in the initial literature search. Finally, full-text analysis and data extraction from the final selected studies were performed. 2.4. Data Extraction The data extracted from the selected studies included: year of publication; type of study; mean age of population sampled; sample size; assessment methods (physical or motor); and abilities/skills that were measured. We also collected, when studies mentioned them, which psychometric characteristics were analyzed and the respective statistics. 2.5. Study Quality We evaluated the quality of the studies that examined the psychometric properties. To the best of our knowledge, only one tool—the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist [ 13 – 15 ] (www.cosmin. nl/, accessed on 1 November 2021)—is proper for assessing the methodological quality of outcome measurement instrument [ 16 ]. From this tool, we selected and applied, adjusting to the individuality of each study, the items’ content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, and responsiveness. For the other studies, as our interest was only to understand what tests the scientific community uses most to assess physical or motor abilities/skills in nursing home residents, we did not evaluate their quality. For these studies, we did not collect any outcomes (tests scores), only the tests that were used. This is in line with previous studies, e.g., [ 17 , 18 ], that focused on the health benefits of sports and physical activity for older adults and on mental health. To comprehensively review the physical/motor fitness tests for nursing home residents, we included studies with various designs (e.g., observational, randomized controlled trial and controlled non-randomized). One should note that this search was carried out in the most reputable databases, assuming the quality of the studies. 3. Results 3.1. Selection Process Of the total of 4196 studies, 3794 were excluded based on title or because they were duplicates. Of the remaining 402, 120 were excluded based on title and abstracts. For the remaining 282 articles, the full text was analyzed. In this phase, 41 additional articles were excluded, resulting in a total of 241 articles (involving 27,646 older people) to include in the review. The process and outcome of the literature selection are presented in detail in Figure 1. Int. J. Environ. Res. Public Health 2022,19, 5058 4 of 29 Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 4 of 35 Figure 1. Flow diagram of database search. 3.2. Categorization of the Physical and Motor Assessment Methods To frame each identified assessment method into categories, we use the following definitions. • Muscular Strength—the ability to exert a force on an external object/target or resistance [19]. • Balance—maintaining the position of the body’s center of gravity vertically over the base of support. Relies on rapid, continuous feedback from visual, vestibular, and somatosensory structures [20]. • Agility—rapid whole-body movement with a change of velocity and/or direction [21]. • Gait—walking patterns as a combination of different joints and muscles active simultaneously to maintain an upright posture and to produce forward propulsion of the whole-body [22]. • Aerobic capacity—ability to use large muscles (muscle groups) in dynamic and moderate-to-high-intensity exercise for prolonged periods. Depends on the functional state of respiratory, cardiovascular and muscular systems [23]. Figure 1. Flow diagram of database search. 3.2. Categorization of the Physical and Motor Assessment Methods To frame each identified assessment method into categories, we use the following definitions. • Muscular Strength—the ability to exert a force on an external object/target or resistance [19]. • Balance—maintaining the position of the body’s center of gravity vertically over the base of support. Relies on rapid, continuous feedback from visual, vestibular, and somatosensory structures [20]. • Agility—rapid whole-body movement with a change of velocity and/or direction [ 21 ]. • Gait—walking patterns as a combination of different joints and muscles active simultaneously to maintain an upright posture and to produce forward propulsion of the whole-body [22]. Int. J. Environ. Res. Public Health 2022,19, 5058 5 of 29 • Aerobic capacity—ability to use large muscles (muscle groups) in dynamic and moderate-to-high-intensity exercise for prolonged periods. Depends on the functional state of respiratory, cardiovascular and muscular systems [23]. • Flexibility—static flexibility is the degree to which a joint can be passively moved to the end-points in the range of motion; dynamic flexibility is the degree to which a joint can be moved as a consequence of a muscle contraction [24]. • Reaction time—simple reaction time is the time needed to react to a single stimulus, whereas choice reaction time refers to the time needed to make a choice and respond to one of a number of possible stimuli [25]. • Activities of Daily Living (ADL)—refers to a large scope of daily activities required to complete a day. ADL can include self-care tasks and more complex instrumental tasks such as shopping and food preparation [26]. • Dexterity—voluntary movements, with the hands, used to manipulate small objects during a specific task [27]. • Proprioception—the sense of the position of the body and body parts in the space, including body segment static position, displacement, acceleration, velocity, and muscle sense of tension/effort [11]. • Paratonia—an external stimulus-dependent increase in muscle tone that is absent at rest [28]. The most common physical/motor component assessed was muscular strength (174 studies); of the 241 articles included in this review, 72.2% included methods that assess this component. Balance, agility, and gait were also frequently assessed in the target population. In Table 1, it is possible to verify which physical/motor components we identified in the review studies, evaluated in recent years, as well as their frequency of use. Table 1. Physical/motor components that were identified in the reviewed studies. Components Number of Studies % of the Total References Strength 174 72.2% [6,10,29–200] Balance 138 57.3% [10,11,29,32,33,36,38,40,43,46,47,49–52,58–60,62– 64,66,70,71,74,77–79,82,84–87,90–94,96–98,100,101,103–105,107– 111,117,126,130,131,135,136,138,140–142,145– 157,167,168,171,175,179–185,188,189,192,194,198,201–248] Agility 102 42.3% [6,11,29,31,32,35,45,46,49,52,55,57,62,64– 66,70,73,74,76,78,79,81,86,87,90,92,93,96,97,102,105,107– 109,115,117,121,136,140,145–147,150,151,153,155,158,159,161– 163,165,167,171,178,182,183,185,191,192,194,196,198,202– 205,208–211,214–216,219–221,223– 230,233,235,237,241,243,246,248–257] Gait 96 39.8% [10,29,30,32,33,35–40,43,47–51,53,54,57–60,62–65,68,71,73,74,77– 80,82,84,86,94,96,98,103–107,110–112,126,129– 133,135,136,141,142,144,145,147,149– 151,153,155,156,158,163,166,171,175,177,180–182,184,187,192, 195,198,216,217,219,227,228,230,239,241,246,248,249,258–260] Aerobic capacity 41 17.0% [6,31,43,46,55,79–81,87,93,95,116,117,119,120,125,136,146– 148,150,151,161– 165,167,173,178,181,182,186,189,191,193,202,243,259,261,262] Flexibility 33 13.7% [43,55,61,65,73,79,81,82,90,100,101,108,109,111,138,147,159– 162,165,168,170,178,179,188,191,194,213,226,246,263,264] Reaction Time 5 2.1% [6,43,100,109,147] Dexterity 4 1.7% [100,138,157,179] Proprioception 3 1.3% [11,108,194] ADL 1 0.4% [84] Paratonia 1 0.4% [265] Notes: ADL: activities of daily living. Int. J. Environ. Res. Public Health 2022,19, 5058 6 of 29 Table 2describes the test batteries identified in the reviewed studies and their frequency of use. We found that the Short Physical Performance Battery, the Berg balance scale, and the Tinetti test are the three most popular test batteries. Table 2. Batteries of physical and motor tests applied in the reviewed studies. Test Battery Assesses N (Studies) Sample (Females/Males) Mean Age References Short physical performance battery Gait speed, chair stand and balance 37 6469 (4541/1928) 83.7 [10,29,32,33,36,38,40,47, 50,51,58,59,71,78,79,86,94, 98,103,104,107,126,130, 131,136,141,142,145,151, 155,156,171,175,180,182, 184,198] Berg balance scale Balance 36 3284 (2225/1059) 81.0 [40,46,63,79,87,93,108– 110,135,136,138,149,152, 167,179,182,183,189,194, 198,201–203,205,207,208, 212,217,221,227,233,235, 239,245,247] Tinetti test Static and dynamic balance 35 4895 (3541/1332) 81.5 [32,74,77,78,85,86,90,92, 97,101,107,145,148,154, 168,204,206,211,214,215, 218–220,222–225,229,231, 234,236,238,240,243,248] Senior Fitness Test * Physical fitness, specifically; strength, flexibility, agility and aerobic fitness 18 1643 (1003/412) 80.8 [6,55,70,73,79,81,109,125, 136,151,161,162,165,167, 168,178,182,191] Physical Performance Test (9 items) ADL, balance, and gait 4 301 (267/34) 83.6 [80,195,227,259] Frailty and injuries: cooperative studies of intervention techniques (FICSIT-4) Balance 4 263 (195/68) 89.1 [147,150,153,192] Four Test Balance Scale (FTBS) Balance 2 52 (47/5) 84.5 [91,146] Groningen Fitness Test for the Elderly (GFE) Strength, flexibility, agility, balance, dexterity, reaction time and aerobic fitness. 2 335 (266/69) 83.6 [43,147] Elderly Mobility Scale ADL, balance, and gait 2 92 (62/30) 82.5 [60,77] Nursing Home Physical Performance Test (NHPPT) ADL, strength, and gait 1 178 (115/63) 78.0 [84] Balance Evaluation Systems Test Balance 1 49 (30/19) 77.8 [207] Mini-Balance Evaluation Systems Test (14-item test) Balance 1 49 (30/19) 77.8 [207] Brief-Balance Evaluation Systems Test (14-item test) Balance 1 49 (30/19) 77.8 [207] Fullerton Advanced Balance (FAB) Scale Static and dynamic balance 1 36 (19/17) No data [209] Notes: * In 9 studies, the test battery was partially applied; ADL, activities of daily living. Table 3shows all the tests found in this literature review, organized by components. To analyze the tests individually, the batteries that assessed different physical and/or motor components (e.g., balance and strength) were separated ‘test-by-test’. The batteries dedicated to one component (e.g., Berg balance scale) were considered as an individual test. Based on this criterion, we identified 97 different tests, involving the various physical and motor characteristics of older nursing home residents. For each category, the tests are presented in descending order of the number of studies in which they were used. Int. J. Environ. Res. Public Health 2022,19, 5058 7 of 29 Table 3. Physical and motor tests applied in the reviewed studies. Test N (Females/ Males) Mean Age Type of Studies References Strength tests Hand grip strength test 13,981 (9720/4112) 82.5 RCT (35) Cross-sectional (45) Pilot study (5) Cohort study (4) Quasi-experimental (5) Prospective study (3) [29,30,32,35,38,41,43–45,47– 50,53,57,64,65,69,70,72–74,76– 80,83,85–88,90,98,101,104,106, 107,112,113,115–123,126– 128,130,132,133,135,137,138, 140,143,144,147,148,150,152, 153,155–158,160,164,166– 177,179–184,186,187,189,190, 192,197,200] Five Times Sit to Stand Test 7083 (4927/2129) 83.2 Cross-sectional (17) RCT (16) Cohort study (10) Pilot study (4) [10,29,32,33,35,36,38,40,46,47, 50,51,58,59,62,65,70,71,73,78, 79,86,92,94,96,98,103,104,107, 126,130,131,136,141,142,145, 150,151,155,156,158,171,175, 180,182,184,198] 30 s sit to stand test 3251 (2314/937) 84.5 RCT (14) Cross-sectional (15) Cohort study (2) Pilot study (2) [31,33,37,52,54,57,63,93,95,97, 102,110,116,118,120,122,125, 135,143,146,147,149,153,159, 163,164,170,173,181,185,187, 193,196] Handheld dynamometer tests 3685 (2774/884) 82.8 Cross-sectional (14) RCT (8) Cohort study (6) Pilot study (3) Quasi-experimental (1) [32,34,42–44,66– 68,78,82,86,89,93,96,99,100,105, 107,111,123,124,129,134,145, 147,152–154,163,183,188,192] Arm Curl test 2937 (1915/803) 81.6 RCT (14) Cross-sectional (10) Quasi-experimental (4) Cohort study (4) [6,55,59,70,73,79,81,91,95,97, 109,116,122,125,136,138,143, 148,151,160–162,165,167,168, 170,178,179,181,182,191,196] Isokinetic Dynamometer (different models) 663 (601/62) 79.9 RCT (6) Cross-sectional (4) [31,56,61,75,80,90,95,181,186, 195,199] 1 RM test (all protocols) 591 (378/213) 86.5 Cross-sectional (4) RCT (3) [39,83,88,120,153,192,193] Peak Flow Meter analysis 482 (279/203) 82.1 RCT (3) Cohort study (1) [160,170,172,179] Back/leg dynamometer evaluation 158 (89/69) 77.8 RCT (1) Cross-sectional (1) [108,194] Leg extension test (GFE) 335 (266/69) 83.6 RCT (1) Cross-sectional (1) [43,147] 10 RM test 10 (10/0) 86.2 RCT (1) [114] Seated Medicine Ball Throw test 31 (17/14) 78.9 Cross-over study (1) [83] Lower limb power test 41 (17/24) 69.8 Cohort study (1) [115] Cyklotren device 20 (6/14) 76.7 RCT (1) [97] Fatigue test–Grip Work 662 (484/178) 83.2 Cohort study (1) [86] Test of toe grip strength 35 (23/12) 82.1 Cross-sectional (1) [139] Countermovement jump test 31 (17/14) 78.9 Cross-sectional (1) [83] 11-step stair-climbing test 45 (33/12) 83.8 Pilot study (1) [57] 8 RM test 15 (9/6) 84.0 Pilot study (1) [60] Sitting-rising test 38 (18/20) 73.4 Cross-sectional (1) [140] Sit-to-stand (one time) test 178 (115/63) 78.0 RCT (1) [84] Balance Tests Tandem test 6239 (4495/1744) 82.8 Cross-sectional (18) RCT (15) Cohort Study (10) Pilot study (2) [10,29,32,33,36,38,40,43,47,49– 51,58,59,71,74,78,79,86,94,98, 100,103,104,107,108,126,130, 131,136,140– 142,145,151,155,171,175,180, 182,184,198,224,233,237] Semi-Tandem test 6600 (4631/1969) 83.5 Cross-sectional (18) RCT (12) Cohort study (7) Pilot study (2) Quasi-experimental study (1) [10,29,32,33,36,38,40,47,50,51, 58,59,71,78,79,86,94,98,103,104, 107,126,130,131,136,140– 142,145,151,155,156,171,175, 180,182,184,198,224,237] Int. J. Environ. Res. Public Health 2022,19, 5058 8 of 29 Table 3. Cont. Test N (Females/ Males) Mean Age Type of Studies References Feet Together test 6536 (4572/1954) 83.5 Cross-sectional (17) RCT (12) Cohort study (7) Pilot study (2) Quasi-experimental study (1) [10,29,32,33,36,38,40,47,50,51, 58,59,71,78,79,86,94,98,103,104, 107,126,130,131,136,140– 142,145,151,155,156,171,175, 180,182,184,198,237] Berg balance scale 2922 (1966/956) 81.1 RCT (17) Cross-sectional (9) Pilot study (6) Exploratory study (1) Cohort study (2) Quasi-experimental (1) [40,46,63,79,87,93,108– 110,135,136,138,149,152,167, 179,182,183,189,194,198,201– 203,205,207,208,212,217,221, 227,233,235,239,245,247] Tinetti test 4895 (3541/1332) 81.5 RCT (13) Cross-sectional (10) Longitudinal study (6) Exploratory study (3) Observational study (2) Pilot study (1) [32,74,77,78,85,86,90,92,97,101, 107,145,148,154,168,204,206, 211,214,215,218–220,222– 225,229,231,234,236,238,240, 243,248] Functional Reach Test -FRT 971 (688/283) 82.7 Cross-sectional (6) Pilot study (4) RCT (6) Cohort study (2) Quantitative study (1) [11,60,62,64,66,77,96,105,109, 157,181,188,209,213,216,225, 229,230,237] One-leg stance 937 (632/305) 81.3 RCT (8) Cross-sectional (4) Quasi experimental (3) Pilot study (3) [64,70,82,91,96,105,108,111, 117,209,210,213,226,230,233, 241,243,246] Postural Sway (force platform or similar) 461 (312/133) 82.9 RCT (3) Cross-sectional (4) Exploratory study (2) [52,111,138,185,213,230,232, 242,244] FICSIT-4 263 (195/68) 89.1 RCT (3) Cross-sectional (1) [147,150,153,192] Turn 360 degrees test 301 (267/34) 83.6 Cross-sectional (3) RCT (1) [80,195,227,259] Progressive Romberg test 256 (222/34) 83.2 Cross-sectional (3) [80,195,259] 4-Stage Balance Test 52 (47/5) 84.5 Cross-sectional (1) Pilot study (1) [91,146] Balance board (platform) test (GFE) 335(266/69) 83.6 RCT (1) Cross-sectional (1) [43,147] Four Square Step Test 34 (30/4) 83.0 Quasi-experimental (1) [91] Balance Evaluation Systems Test 49 (30/19) 77.8 Cross-sectional (1) [207] Brief-Balance Evaluation Systems Test 49 (30/19) 77.8 Cross-sectional (1) [207] Mini-Balance Evaluation Systems Test 49 (30/19) 77.8 Cross-sectional (1) [207] Parallel walk test 117 (76/41) 82.5 RCT (1) [228] Fullerton Advanced Balance Scale 36 (19/17) No data RCT (1) [209] Dynamic Gait Index 22 (no data) 88.2 Cross-sectional (1) [214] Agility tests Timed Up and Go test 7212 (4777/2376) 82.2 RCT (35) Cross-sectional (30) Pilot study (8) Cohort study (8) Quantitative study (1) [6,11,29,31,32,35,45,46,52,57, 62,64–66,73,76,78,86,87,90,92, 93,96,102,105,107,108,115,117, 121,136,140,145– 147,150,151,153,155,158,163, 182,183,185,192,194,198,202– 205,208–211,214–216,219– 221,223,225–230,233,235,237, 241,243,246,248,249,251–256] 8 foot up and go test 1720 (1185/316) 82.5 RCT (8) Cross-sectional (8) Pilot study (1) Quasi-experimental (1) [49,55,70,74,79,81,97,109,159, 161,162,165,167,171,178,191, 196,224,257] Int. J. Environ. Res. Public Health 2022,19, 5058 9 of 29 Table 3. Cont. Test N (Females/ Males) Mean Age Type of Studies References Gait tests Gait speed test- SPPB 6469 (4541/1928) 83.7 Cross-sectional (17) RCT (11) Cohort study (6) Pilot study (2) Quasi-experimental study (1) [10,29,32,33,36,38,40,47,50,51, 58,59,71,78,79,86,94,98,103,104, 107,126,130,131,136,141,142, 145,151,155,156,171,175,180, 182,184,198] 4 m walking test 2554 (1728/789) 83.0 RCT (6) Cross-sectional (6) Cohort-studies (3) Case-control (1) Pilot study (2) [30,38,53,65,73,79,112,129,131– 133,136,155,158,166,182,184, 239] 6 m walking test 1704 (1220/484) 84.0 RCT (7) Cross-sectional (4) Cohort study (4) Pilot study (2) Quasi-experimental (1) [29,33,37,40,48,54,60,62,63,77, 82,84,110,147,149,163,181,241] 10 m walking test 1562 (1171/391) 83.2 RCT (5) Cross-sectional (5) Pilot study (2) Exploratory study (1) [36,57,68,105,135,187,198,216, 217,228,246,249,258] 5 m walking test 1185 (709/476) 86.0 Cross-sectional (4) RCT (2) Exploratory study (1) [96,106,111,153,177,192,230] 50-foot walk test 301 (267/34) 83.6 Cross-sectional (3) RCT (1) [80,195,227,259] Climb One flight of stairs test 301 (267/34) 83.6 Cross-sectional (3) RCT (1) [80,195,227,259] Climb Four Flights of stairs test 301 (267/34) 83.6 Cross-sectional (3) RCT (1) [80,195,227,259] 4.6 m Walking Test 700 (621/79) 81.7 Cross-sectional (2) RCT (1) [49,74,144] GAITRite system 81 (56/25) 82.7 RCT (1) Cohort study (1) [156,260] Locometrix®gait analysis system 124 (94/30) 83.2 RCT (2) [219,248] 7 m walking test 24 (18/6) 93.1 Cross-sectional (1) [39] 3 m Walking Test 70 (42/28) 83.2 Cross-sectional (1) [35] 7.5 m Walking Test 60 (47/13) 85.5 Pilot study (1) [259] 8 m Walking test 226 (184/42) 81.6 Cross-sectional (1) [43] Figure of 8 walk test 87 (67/20) 87.0 RCT (1) [150] 10 m Maximal Walking Speed test 31 (25/6) 89.0 Cross-sectional (1) [250] Stepping test (repetitive side-stepping tester-TKK5301 TAKEI Co) 40 (36/4) 83.8 Cross-over study (1) [105] Step test (BOOMER protocol) 46 (28/18) 82.4 Pilot study (1) [64] Aerobic capacity tests 6 Min walking test 2486 (1638/629) 82.9 RCT (16) Cross-sectional (10) Pilot study (4) [6,31,46,55,79–81,87,93,95,116, 117,119,136,147,150,151,161, 163,164,173,181,182,186,189, 191,202,259,261,262] 2-Min Step Test 553 (429/124) 81.5 RCT (1) Cross-sectional (5) Quasi-experimental (1) Walking endurance test (GFE) 335 (266/69) 83.6 RCT (1) Cross-sectional (1) [43,147] 10-min walk (weellchair) distance test 418 (246/172) 78.3 Cohort study (1) RCT (1) [120,193] Cooper test 42 (29/13) 83.21 RCT (1) [243] Flexibility tests Back-Scratch test 2111 (1307/585) 80.2 RCT (8) Cross-sectional (8) Quasi-experimental (2) [43,55,73,79,81,90,100,109,138, 160– 162,165,168,170,178,179,191] Chair–Sit and Reach test 1703 (970/514) 80.1 RCT (8) Cross-sectional (6) Quasi-experimental (1) Cohort (1) [55,73,79,81,90,109,138,160– 162,165,170,178,179,191,246] Int. J. Environ. Res. Public Health 2022,19, 5058 16 of 29 components; and (iii) the psychometric-related data. Taken together, the data presented here can be very useful for clinicians and researchers. 6. Conclusions This review included 241 studies, involved 27,646 older nursing home residents, and mapped the large heterogeneity in motor and physical functioning assessment methods applied. We identified 97 different tests, involving the different physical and motor characteristics. According to the data collected, we found that the most common physical/motor component assessed was muscular strength. We identified five stand-out tests to assess strength: the handgrip strength, the five times sit-to-stand, the 30 s sit to stand and the arm curl test. Additionally, balance, agility and gait were commonly assessed in the target population. For these components, the most used methods were the tandem test, semi-tandem test, and feet together test (balance); the timed up and go test (agility); and the gait speed test-SPPB (gait). We suggest that more attention should be paid to other physical and motor aspects (e.g., reaction time and proprioception), as they also contribute to a better quality of life, better autonomy, and a healthy and active ageing. Furthermore, since information on the tests’ psychometric quality seems to be, in several cases, insufficient or absent, more related studies are needed in the near future. This review provides valuable information to researchers and/or health-care professionals regarding the physical/motor tests that are common in nursing home residences, helping them select the screening tools that could most closely fit their study objectives. Author Contributions: Conceptualization, L.G., A.R., J.D.P.-C. and J.M.; methodology, L.G., A.R., J.D.P.-C. and J.M.; validation, L.G., A.R., J.D.P.-C. and J.M.; investigation, L.G., A.R. and J.M.; data curation, L.G., A.R., J.D.P.-C. and J.M.; writing—original draft preparation, L.G. and J.M.; writing— review and editing, L.G., A.R. and J.M.; supervision, A.R. and J.M.; funding acquisition, L.G. and A.R. All authors have read and agreed to the published version of the manuscript. Funding: This research was funded by the National Funds through Portuguese Foundation for Science and Technology, grant number SFRH/BD/140669/2018; and the European Fund for regional development (FEDER). The sponsors had no role in the preparation of this manuscript. Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable. Data Availability Statement: This is a review paper, data are presented throughout the text. Conflicts of Interest: The authors declare no conflict of interest. References 1. Dicker, D.; Nguyen, G.; Abate, D.; Abate, K.H.; Abay, S.M.; Abbafati, C.; Abbasi, N.; Abbastabar, H.; Abd-Allah, F.; Abdela, J.; et al. Global, Regional, and National Age-Sex-Specific Mortality and Life Expectancy, 1950–2017: A Systematic Analysis for the Global Burden of Disease Study 2017. Lancet 2018,392, 1684–1735. [CrossRef] 2. Da Saúde, O.M. Relatório Mundial de Envelhecimento e Saúde. Estados Unidos 2015,30, 12. 3. Grande, G.; Qiu, C.; Fratiglioni, L. Prevention of dementia in an ageing world: Evidence and biological rationale. Aging Res. Rev. 2020,64, 101045. [CrossRef] [PubMed] 4. Calderón-Larrañaga, A.; Vetrano, D.L.; Ferrucci, L.; Mercer, S.; Marengoni, A.; Onder, G.; Eriksdotter, M.; Fratiglioni, L. Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways. J. Intern. Med. 2019 , 285, 255–271. [CrossRef] [PubMed] 5. Harridge, S.D.R.; Lazarus, N.R. Physical Activity, Aging, and Physiological Function. Physiology 2017,32, 152–161. [CrossRef] 6. Marmeleira, J.; Galhardas, L.; Raimundo, A. Exercise merging physical and cognitive stimulation improves physical fitness and cognitive functioning in older nursing home residents: A pilot study. Geriatr. Nurs. 2018,39, 303–309. [CrossRef] 7. Germain, C.M.; Vasquez, E.; Batsis, J.A.; McQuoid, D.R. Sex, race and age differences in muscle strength and limitations in community dwelling older adults: Data from the Health and Retirement Survey (HRS). Arch. Gerontol. Geriatr. 2016 ,65, 98–103. [CrossRef] 8. Mora, J.C.; Valencia, W.M. Exercise and Older Adults. Clin. Geriatr. Med. 2018,34, 145–162. [CrossRef] Int. J. Environ. Res. Public Health 2022,19, 5058 17 of 29 9. Tabue-Teguo, M.; Kelaiditi, E.; Demougeot, L.; Dartigues, J.-F.; Vellas, B.; Cesari, M. Frailty Index and Mortality in Nursing Home Residents in France: Results From the INCUR Study. J. Am. Med. Dir. Assoc. 2015,16, 603–606. [CrossRef] 10. Vaca, J.G.; de la Rica, M.; Silva-Iglesias, M.; Arjonilla-García, M.D.; Varela-Pérez, R.; Oliver-Carbonell, J.L.; Abizanda, P. Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: Rationale, design, methodology, prevalence and attributes. Maturitas 2014,77, 78–84. [CrossRef] 11. Galhardas, L.; Raimundo, A.; Marmeleira, J. Test-retest reliability of upper-limb proprioception and balance tests in older nursing home residents. Arch. Gerontol. Geriatr. 2020,89, 104079. [CrossRef] [PubMed] 12. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021 ,372, 105906. [CrossRef] 13. Mokkink, L.B.; Prinsen, C.A.C.; Bouter, L.M.; de Vet, H.C.W.; Terwee, C.B. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz. J. Phys. Ther. 2016 , 20, 105–113. [CrossRef] [PubMed] 14. Mokkink, L.B.; De Vet, H.C.W.; Prinsen, C.A.C.; Patrick, D.L.; Alonso, J.; Bouter, L.; Terwee, C.B. COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures. Qual. Life Res. 2018,27, 1171–1179. [CrossRef] [PubMed] 15. Prinsen, C.A.C.; Mokkink, L.B.; Bouter, L.M.; Alonso, J.; Patrick, D.L.; De Vet, H.C.W.; Terwee, C.B. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual. Life Res. 2018,27, 1147–1157. [CrossRef] [PubMed] 16. Ma, L.-L.; Wang, X.; Yang, Z.-H.; Huang, D.; Weng, H.; Zeng, X.-T. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better? Mil. Med. Res. 2020,7, 7. [CrossRef] 17. Guo, Y.; Shi, H.; Yu, D.; Qiu, P. Health benefits of traditional Chinese sports and physical activity for older adults: A systematic review of evidence. J. Sport Health Sci. 2016,5, 270–280. [CrossRef] 18. Lee, C.; Kuhn, I.; McGrath, M.; Remes, O.; Cowan, A.; Duncan, F.; Baskin, C.; Oliver, E.J.; Osborn, D.P.J.; Dykxhoorn, J.; et al. A systematic scoping review of community-based interventions for the prevention of mental ill-health and the promotion of mental health in older adults in the UK. Health Soc. Care Community 2022,30, 27–57. [CrossRef] 19. Siff, M. Biomechanical Foundations of Strength and Power Training. Biomechanics in Sport; Blackwell Scientific Ltd.: London, UK, 2001; pp. 103–139. 20. Hrysomallis, C. Balance Ability and Athletic Performance. Sports Med. 2011,41, 221–232. [CrossRef] 21. Sheppard, J.M.; Young, W.B. Agility literature review: Classifications, training and testing. J. Sports Sci. 2006 ,24, 919–932. [CrossRef] 22. Nutakki, C.; Mathew, R.J.; Suresh, A.; Vijay, A.R.; Krishna, S.; Babu, A.S.; Diwakar, S. Classification and Kinetic Analysis of Healthy Gait using Multiple Accelerometer Sensors. Procedia Comput. Sci. 2020,171, 395–402. [CrossRef] 23. Hsieh, L.-F.; Wei, J.C.-C.; Lee, H.-Y.; Chuang, C.-C.; Jiang, J.-S.; Chang, K.-C. Aerobic capacity and its correlates in patients with ankylosing spondylitis. Int. J. Rheum. Dis. 2016,19, 490–499. [CrossRef] [PubMed] 24. Shellock, F.G.; Prentice, W.E. Warming-Up and Stretching for Improved Physical Performance and Prevention of Sports-Related Injuries. Sports Med. 1985,2, 267–278. [CrossRef] 25. Nissan, J.; Liewald, D.; Deary, I.J. Reaction time and intelligence: Comparing associations based on two response modes. Intelligence 2013,41, 622–630. [CrossRef] 26. Cox, J.L. Elderly Drivers’ Perceptions of Their Driving Abilities Compared to Their Functional Motor Skills and Their Actual Driving Performance. Phys. Occup. Ther. Geriatr. 1989,7, 51–82. [CrossRef] 27. Desrosiers, J.; Bravo, G.; Hébert, R.; Dutil, É.; Mercier, L. Validation of the Box and Block Test as a measure of dexterity of elderly people: Reliability, validity, and norms studies. Arch. Phys. Med. Rehabil. 1994,75, 751–755. [CrossRef] 28. Vahia, I.; Cohen, C.I.; Prehogan, A.; Memon, Z. Prevalence and Impact of Paratonia in Alzheimer Disease in a Multiracial Sample. Am. J. Geriatr. Psychiatry 2007,15, 351–353. [CrossRef] 29. Courel-Ibáñez, J.; Buendía-Romero, Á.; Pallarés, J.G.; García-Conesa, S.; Martínez-Cava, A.; Izquierdo, M. Impact of Tailored Multicomponent Exercise for Preventing Weakness and Falls on Nursing Home Residents’ Functional Capacity. J. Am. Med. Dir. Assoc. 2021,23, 98–104.e3. [CrossRef] 30. Landi, F.; Liperoti, R.; Fusco, D.; Mastropaolo, S.; Quattrociocchi, D.; Proia, A.; Tosato, M.; Bernabei, R.; Onder, G. Sarcopenia and Mortality among Older Nursing Home Residents. J. Am. Med. Dir. Assoc. 2011,13, 121–126. [CrossRef] 31. Zarzeczny, R.; Nawrat-Szołtysik, A.; Polak, A.; Maliszewski, J.; Kiełtyka, A.; Matyja, B.; Dudek, M.; Zborowska, J.; Wajdman, A. Aging effect on the instrumented Timed-Up-and-Go test variables in nursing home women aged 80–93 years. Biogerontology 2017 , 18, 651–663. [CrossRef] 32. Buckinx, F.; Bruyère, O.; Lengelé, L.; Reginster, J.-Y.; Marchal, Q.; Hurtrez, P.; Mouton, A. The effects of GAMotion (a giant exercising board game) on physical capacity, motivation and quality of life among nursing home residents: A pilot interventional study. Exp. Gerontol. 2020,138, 110983. [CrossRef] [PubMed] 33. Millor, N.; Cadore, E.L.; Gómez, M.; Martínez, A.; Lecumberri, P.; Martirikorena, J.; Idoate, F.; Izquierdo, M. High density muscle size and muscle power are associated with both gait and sit-to-stand kinematic parameters in frail nonagenarians. J. Biomech. 2020,105, 109766. [CrossRef] [PubMed] Int. J. Environ. Res. Public Health 2022,19, 5058 18 of 29 34. Buckinx, F.; Croisier, J.-L.; Reginster, J.-Y.; Dardenne, N.; Beaudart, C.; Slomian, J.; Leonard, S.; Bruyere, O. Reliability of muscle strength measures obtained with a hand-held dynamometer in an elderly population. Clin. Physiol. Funct. Imaging 2017 ,37, 332–340. [CrossRef] [PubMed] 35. Silva, A.G.; Cerqueira, M.; Santos, A.R.; Ferreira, C.; Alvarelhão, J.; Queirós, A. Inter-rater reliability, standard error of measurement and minimal detectable change of the 12-item WHODAS 2.0 and four performance tests in institutionalized ambulatory older adults. Disabil. Rehabil. 2019,41, 366–373. [CrossRef] 36. Jansen, C.-P.; Diegelmann, M.M.; Schilling, O.K.; Werner, C.; Schnabel, M.E.-L.; Wahl, H.-W.; Hauer, K. Pushing the Boundaries: A Physical Activity Intervention Extends Sensor-Assessed Life-Space in Nursing Home Residents. Gerontologist 2018 ,58, 979–988. [CrossRef] 37. Telenius, E.W.; Engedal, K.; Bergland, A. Physical Performance and Quality of Life of Nursing-Home Residents with Mild and Moderate Dementia. Int. J. Environ. Res. Public Health 2013,10, 6672–6686. [CrossRef] 38. Iranzo, M.A.C.I.; Arnal-Gómez, A.; Tortosa-Chuliá, M.A.; Balasch-Bernat, M.; Forcano, S.; Sentandreu-Mañó, T.; Tomas, J.M.; Cezón-Serrano, N. Functional and Clinical Characteristics for Predicting Sarcopenia in Institutionalised Older Adults: Identifying Tools for Clinical Screening. Int. J. Environ. Res. Public Health 2020,17, 4483. [CrossRef] 39. Martinikorena, I.; Ramírez, A.M.; Gómez, M.; Lecumberri, P.; Casas-Herrero, A.; Cadore, E.; Millor, N.; Zambom-Ferraresi, F.; Idoate, F.; Izquierdo, M. Gait Variability Related to Muscle Quality and Muscle Power Output in Frail Nonagenarian Older Adults. J. Am. Med. Dir. Assoc. 2015,17, 162–167. [CrossRef] 40. González-Bernal, J.; Jahouh, M.; González-Santos, J.; Mielgo-Ayuso, J.; Fernández-Lázaro, D.; Soto-Cámara, R. Influence of the Use of Wii Games on Physical Frailty Components in Institutionalized Older Adults. Int. J. Environ. Res. Public Health 2021 , 18, 2723. [CrossRef] 41. Bahat, G.; Tufan, A.; Ozkaya, H.; Tufan, F.; Akpinar, T.S.; Akin, S.; Bahat, Z.; Kaya, Z.; Kiyan, E.; Erten, N.; et al. Relation between hand grip strength, respiratory muscle strength and spirometric measures in male nursing home residents. Aging Male 2014 ,17, 136–140. [CrossRef] 42. Suzuki, M.; Yamamoto, R.; Ishiguro, Y.; Sasaki, H.; Kotaki, H. Deep learning prediction of falls among nursing home residents with Alzheimer’s disease. Geriatr. Gerontol. Int. 2020,20, 589–594. [CrossRef] [PubMed] 43. Singh, A.S.; A Paw, M.J.M.C.; Bosscher, R.J.; Van Mechelen, W. Cross-sectional relationship between physical fitness components and functional performance in older persons living in long-term care facilities. BMC Geriatr. 2006,6, 4. [CrossRef] 44. Iranzo, M.A.C.I.; Bernat, M.B.I.; Tortosa-Chuliá, M.Á.; Balasch-Parisi, S. Effects of Resistance Training of Peripheral Muscles Versus Respiratory Muscles in Older Adults With Sarcopenia Who are Institutionalized: A Randomized Controlled Trial. J. Aging Phys. Act. 2018,26, 637–646. [CrossRef] [PubMed] 45. Diekmann, R.; Winning, K.; Bauer, J.; Uter, W.; Stehle, P.; Lesser, S.; Bertsch, T.; Sieber, C.C.; Volkert, D. Vitamin D status and physical function in nursing home residents: A 1-year observational study. Z. Gerontol. Geriatr. 2013 ,46, 403–409. [CrossRef] [PubMed] 46. Lam, F.M.; Chan, P.F.; Liao, L.R.; Woo, J.; Hui, E.; Lai, C.W.; Kwok, T.C.; Pang, M.Y.C. Effects of whole-body vibration on balance and mobility in institutionalized older adults: A randomized controlled trial. Clin. Rehabil. 2018,32, 462–472. [CrossRef] 47. Urzi, F.; Šimuniˇc, B.; Buzan, E. Basis for Sarcopenia Screening with the SARC-CalF in Nursing Homes. J. Am. Med. Dir. Assoc. 2017,18, 991.e5–991.e10. [CrossRef] [PubMed] 48. Yardimci, B.; Aran, S.N.; Ozkaya, I.; Aksoy, S.M.; Demir, T.; Tezcan, G.; Kaptanoglu, A.Y. The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents. Saudi Med. J. 2016 ,37, 1101–1108. [CrossRef] 49. Furtado, G.E.; Carvalho, H.M.; Loureiro, M.; Patrício, M.; Uba-Chupel, M.; Colado, J.C.; Hogervorst, E.; Ferreira, J.P.; Teixeira, A.M. Chair-based exercise programs in institutionalized older women: Salivary steroid hormones, disabilities and frailty changes. Exp. Gerontol. 2019,130, 110790. [CrossRef] 50. Keogh, J.W.; Senior, H.; Beller, E.M.; Henwood, T. Prevalence and Risk Factors for Low Habitual Walking Speed in Nursing Home Residents: An Observational Study. Arch. Phys. Med. Rehabil. 2015,96, 1993–1999. [CrossRef] 51. Damanti, S.; Barreto, P.D.S.; Rolland, Y.; Astrone, P.; Cesari, M. Malnutrition and physical performance in nursing home residents: Results from the INCUR study. Aging Clin. Exp. Res. 2021,33, 2299–2303. [CrossRef] 52. Álvarez-Barbosa, F.; del Pozo-Cruz, J.; del Pozo-Cruz, B.; Rosa, R.M.A.; Rogers, M.E.; Zhang, Y. Effects of supervised whole body vibration exercise on fall risk factors, functional dependence and health-related quality of life in nursing home residents aged 80+. Maturitas 2014,79, 456–463. [CrossRef] [PubMed] 53. De la Rica, M.; Vaca, J.G.; Varela-Pérez, R.; Arjonilla-García, M.D.; Silva-Iglesias, M.; Oliver-Carbonell, J.L.; Abizanda, P. Frailty and mortality or incident disability in institutionalized older adults: The FINAL Study. Maturitas 2014 ,78, 329–334. [CrossRef] [PubMed] 54. Telenius, E.W.; Engedal, K.; Bergland, A. Effect of a High-Intensity Exercise Program on Physical Function and Mental Health in Nursing Home Residents with Dementia: An Assessor Blinded Randomized Controlled Trial. PLoS ONE 2015 ,10, e0126102. [CrossRef] [PubMed] 55. Arrieta, H.; Hervás, G.; Rezola-Pardo, C.; Ruiz-Litago, F.; Iturburu, M.; Yanguas, J.J.; Gil, S.M.; Rodriguez-Larrad, A.; Irazusta, J. Serum Myostatin Levels Are Higher in Fitter, More Active, and Non-Frail Long-Term Nursing Home Residents and Increase after a Physical Exercise Intervention. Gerontology 2018,65, 229–239. [CrossRef] Int. J. Environ. Res. Public Health 2022,19, 5058 19 of 29 56. Gusi, N.; Adsuar, J.C.; Corzo, H.; Del Pozo-Cruz, B.; Olivares, P.R.; Parraca, J.A. Balance training reduces fear of falling and improves dynamic balance and isometric strength in institutionalised older people: A randomised trial. J. Physiother. 2012 ,58, 97–104. [CrossRef] 57. Johnen, B.; Schott, N. Feasibility of a machine vs free weight strength training program and its effects on physical performance in nursing home residents: A pilot study. Aging Clin. Exp. Res. 2018,30, 819–828. [CrossRef] 58. Valiani, V.; Lauzé, M.; Martel, D.; Pahor, M.; Manini, T.; Anton, S.; Aubertin-Leheudre, M. A new adaptive home-based exercise technology among older adults living in nursing home: A pilot study on feasibility, acceptability and physical performance. J. Nutr. Health Aging 2016,21, 819–824. [CrossRef] 59. Charles, A.; Girard, A.; Buckinx, F.; Mouton, A.; Reginster, J.-Y.; Bruyère, O. Senior physical activity contests in nursing homes: A feasibility study. Aging Clin. Exp. Res. 2020,32, 869–876. [CrossRef] 60. Krist, L.; Keil, T.; Dimeo, F. Can progressive resistance training twice a week improve mobility, muscle strength, and quality of life in very elderly nursing-home residents with impaired mobility? A pilot study. Clin. Interv. Aging 2013 ,8, 443–448. [CrossRef] 61. Gallon, D.; Rodacki, A.; Hernandez, S.G.; Drabovski, B.; Outi, T.; Bittencourt, L.R.; Gomes, A. The effects of stretching on the flexibility, muscle performance and functionality of institutionalized older women. Braz. J. Med. Biol. Res. Rev. Bras. Pesqui. Med. Biol. 2011,44, 229–235. [CrossRef] 62. Brett, L.; Stapley, P.; Meedya, S.; Traynor, V. Effect of physical exercise on physical performance and fall incidents of individuals living with dementia in nursing homes: A randomized controlled trial. Physiother. Theory Pract. 2019 ,37, 38–51. [CrossRef] [PubMed] 63. Telenius, E.W.; Engedal, K.; Bergland, A. Inter-rater reliability of the Berg Balance Scale, 30 s chair stand test and 6 m walking test, and construct validity of the Berg Balance Scale in nursing home residents with mild-to-moderate dementia. BMJ Open 2015 , 5, e008321. [CrossRef] [PubMed] 64. Henwood, T.; Neville, C.; Baguley, C.; Beattie, E. Aquatic exercise for residential aged care adults with dementia: Benefits and barriers to participation. Int. Psychogeriatr. 2017,29, 1439–1449. [CrossRef] [PubMed] 65. Moyer, H.S.; Gale, J.; Severe, S.; Braden, H.J.; Hasson, S. Outcome measures correlated with falls in nursing home residents—A pilot study. Physiother. Theory Pract. 2017,33, 725–732. [CrossRef] 66. Ribeiro, F.; Teixeira, F.; Brochado, G.; Oliveira, J. Impact of low cost strength training of dorsi- and plantar flexors on balance and functional mobility in institutionalized elderly people. Geriatr. Gerontol. Int. 2009,9, 75–80. [CrossRef] 67. Pilz, S.; Meinitzer, A.; Tomaschitz, A.; Kienreich, K.; Dobnig, H.; Schwarz, M.; Wagner, D.; Drechsler, C.; Piswanger-Sölkner, C.; März, W.; et al. Associations of homoarginine with bone metabolism and density, muscle strength and mortality: Cross-sectional and prospective data from 506 female nursing home patients. Osteoporos. Int. 2013,24, 377–381. [CrossRef] 68. Suzuki, M.; Yamada, S.; Inamura, A.; Omori, Y.; Kirimoto, H.; Sugimura, S.; Miyamoto, M. Reliability and Validity of Measurements of Knee Extension Strength Obtained from Nursing Home Residents with Dementia. Am. J. Phys. Med. Rehabil. 2009 ,88, 924–933. [CrossRef] 69. Mateos-Angulo, A.; Galán-Mercant, A.; Cuesta-Vargas, A.I. Muscle thickness contribution to sit-to-stand ability in institutionalized older adults. Aging Clin. Exp. Res. 2020,32, 1477–1483. [CrossRef] 70. Chang, S.-F.; Lin, P.-C.; Yang, R.-S.; Yang, R.-J. The preliminary effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life among older people with sarcopenia. BMC Geriatr. 2018 ,18, 17. [CrossRef] 71. Tabue-Teguo, M.; Dartigues, J.-F.; Simo, N.; Kuate-Tegueu, C.; Vellas, B.; Cesari, M. Physical status and frailty index in nursing home residents: Results from the INCUR study. Arch. Gerontol. Geriatr. 2017,74, 72–76. [CrossRef] 72. Chang, S.-F.; Chiu, S.-C. Effect of resistance training on quality of life in older people with sarcopenic obesity living in long-term care institutions: A quasi-experimental study. J. Clin. Nurs. 2020,29, 2544–2556. [CrossRef] [PubMed] 73. Lopes, P.B.; Rodacki, A.L.F.; Wolf, R.; Fisher, K.; Bento, P.C.B.; Pereira, G. Can Age Influence Functional Tests Differently to Predict Falls in Nursing Home and Community-Dwelling Older Adults? Exp. Aging Res. 2021,47, 192–202. [CrossRef] [PubMed] 74. Furtado, G.E.; Letieri, R.; Caldo, A.; Patricio, M.; Loureiro, M.; Hogervorst, E.; Ferreira, J.P.; Teixeira, A.M. The Role of Physical Frailty Independent Components on Increased Disabilities in Institutionalized Older Women. Transl. Med. UniSa 2019 ,19, 17–26. [PubMed] 75. Rinaldi, I.; Setiati, S.; Oemardi, M.; Aries, W.; Tamin, T.Z. Correlation between serum vitamin D (25(OH)D) concentration and quadriceps femoris muscle strength in Indonesian elderly women living in three nursing homes. Acta Med. Indones. 2007 ,39, 107–111. [PubMed] 76. Halil, M.; Ulger, Z.; Varli, M.; Doventas, A.; Oztürk, G.B.; Kuyumcu, M.E.; Yavuz, B.B.D.; Yesil, Y.; Tufan, F.; Cankurtaran, M.; et al. Sarcopenia assessment project in the nursing homes in Turkey. Eur. J. Clin. Nutr. 2014,68, 690–694. [CrossRef] 77. Bautmans, I.; Njemini, R.; Predom, H.; Lemper, J.-C.; Mets, T. Muscle Endurance in Elderly Nursing Home Residents Is Related to Fatigue Perception, Mobility, and Circulating Tumor Necrosis Factor-Alpha, Interleukin-6, and Heat Shock Protein 70. J. Am. Geriatr. Soc. 2007,56, 389–396. [CrossRef] 78. Buckinx, F.; Croisier, J.-L.; Reginster, J.-Y.; Lenaerts, C.; Brunois, T.; Rygaert, X.; Petermans, J.; Bruyere, O. Prediction of the Incidence of Falls and Deaths Among Elderly Nursing Home Residents: The SENIOR Study. J. Am. Med. Dir. Assoc. 2018 ,19, 18–24. [CrossRef] Int. J. Environ. Res. Public Health 2022,19, 5058 20 of 29 79. Arrieta, H.; Rezola-Pardo, C.; Zarrazquin, I.; Echeverria, I.; Yanguas, J.J.; Iturburu, M.; Gil, S.M.; Rodriguez-Larrad, A.; Irazusta, J. A multicomponent exercise program improves physical function in long-term nursing home residents: A randomized controlled trial. Exp. Gerontol. 2018,103, 94–100. [CrossRef] 80. Martien, S.; Delecluse, C.; Boen, F.; Seghers, J.; Pelssers, J.; Van Hoecke, A.-S.; Van Roie, E. Is knee extension strength a better predictor of functional performance than handgrip strength among older adults in three different settings? Arch. Gerontol. Geriatr. 2015,60, 252–258. [CrossRef] 81. Sousa, N.; Mendes, R. Effects of Resistance Versus Multicomponent Training on Body Composition and Functional Fitness in Institutionalized Elderly Women. J. Am. Geriatr. Soc. 2013,61, 1815–1817. [CrossRef] 82. Choi, J.H.; Moon, J.-S.; Song, R. Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults. J. Adv. Nurs. 2005,51, 150–157. [CrossRef] [PubMed] 83. Marques, D.L.; Neiva, H.P.; Faíl, L.B.; Gil, M.H.; Marques, M.C. Acute effects of low and high-volume resistance training on hemodynamic, metabolic and neuromuscular parameters in older adults. Exp. Gerontol. 2019 ,125, 110685. [CrossRef] [PubMed] 84. Nijs, K.A.N.D.; De Graaf, C.; Kok, F.J.; Van Staveren, W.A. Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: Cluster randomised controlled trial. BMJ 2006 ,332, 1180–1184. [CrossRef] [PubMed] 85. Resnick, B.; Gruber-Baldini, A.L.; Zimmerman, S.; Galik, E.; Pretzer-Aboff, I.; Russ, K.; Hebel, J.R. Nursing Home Resident Outcomes from the Res-Care Intervention. J. Am. Geriatr. Soc. 2009,57, 1156–1165. [CrossRef] [PubMed] 86. Buckinx, F.; Reginster, J.Y.; Petermans, J.; Croisier, J.L.; Beaudart, C.; Brunois, T.; Bruyère, O. Relationship between frailty, physical performance and quality of life among nursing home residents: The SENIOR cohort. Aging Clin. Exp. Res. 2016 ,28, 1149–1157. [CrossRef] 87. Benavent-Caballer, V.; Rosado-Calatayud, P.; Segura-Ortí, E.; Amer-Cuenca, J.J.; Lisón, J.F. Effects of three different low-intensity exercise interventions on physical performance, muscle CSA and activities of daily living: A randomized controlled trial. Exp. Gerontol. 2014,58, 159–165. [CrossRef] 88. Rexach, J.A.S.; Ruiz, J.R.; Bustamante-Ara, N.; Villarán, M.H.; Gil, P.G.; Ibáñez, M.J.S.; Sanz, N.B.; Santamaría, V.O.; Sanz, N.G.; Prada, A.B.M.; et al. Health enhancing strength training in nonagenarians (STRONG): Rationale, design and methods. BMC Public Health 2009,9, 152. [CrossRef] 89. Buckinx, F.; Croisier, J.-L.; Charles, A.; Petermans, J.; Reginster, J.-Y.; Rygaert, X.; Bruyere, O. Normative data for isometric strength of 8 different muscle groups and their usefulness as a predictor of loss of autonomy among physically active nursing home residents: The SENIOR cohort. J. Musculoskelet. Neuronal Interact. 2019,19, 258–265. 90. Bautmans, I.; Van Hees, E.; Lemper, J.-C.; Mets, T. The feasibility of whole body vibration in institutionalised elderly persons and its influence on muscle performance, balance and mobility: A randomised controlled trial [ISRCTN62535013]. BMC Geriatr. 2005 , 5, 17. [CrossRef] 91. Keogh, J.; Power, N.; Wooller, L.; Lucas, P.; Whatman, C. Physical and Psychosocial Function in Residential Aged-Care Elders: Effect of Nintendo Wii Sports Games. J. Aging Phys. Act. 2014,22, 235–244. [CrossRef] 92. Sitjà-Rabert, M.; Martínez-Zapata, M.J.; Vanmeerhaeghe, A.F.; Abella, F.R.; Romero-Rodríguez, D.; Bonfill, X. Effects of a Whole Body Vibration (WBV) Exercise Intervention for Institutionalized Older People: A Randomized, Multicentre, Parallel, Clinical Trial. J. Am. Med. Dir. Assoc. 2015,16, 125–131. [CrossRef] [PubMed] 93. Candan, S.A.; Ako˘glu, A.S.; Bü˘gü¸san, S.; Yüksel, F. Effects of neuromuscular electrical stimulation of quadriceps on the quadriceps strength and functional performance in nursing home residents: A comparison of short and long stimulation periods. Geriatr. Gerontol. Int. 2019,19, 409–413. [CrossRef] [PubMed] 94. Sverdrup, K.; Bergh, S.; Selbæk, G.; Benth, J.Š.; Røen, I.M.; Husebo, B.; Tangen, G.G. Trajectories of physical performance in nursing home residents with dementia. Aging Clin. Exp. Res. 2020,32, 2603–2610. [CrossRef] [PubMed] 95. Strasser, E.-M.; Hofmann, M.; Franzke, B.; Schober-Halper, B.; Oesen, S.; Jandrasits, W.; Graf, A.; Praschak, M.; Horvath-Mechtler, B.; Krammer, C.; et al. Strength training increases skeletal muscle quality but not muscle mass in old institutionalized adults: A randomized, multi-arm parallel and controlled intervention study. Eur. J. Phys. Rehabil. Med. 2018 ,54, 921–933. [CrossRef] [PubMed] 96. Masaki, M.; Ikezoe, T.; Kamiya, M.; Araki, K.; Isono, R.; Kato, T.; Kusano, K.; Tanaka, M.; Sato, S.; Hirono, T.; et al. Association of Activities of Daily Living With Load During Step Ascent Motion in Nursing Home–Residing Elderly Individuals: An Observational Study. Am. J. Phys. Med. Rehabil. 2018,97, 715–720. [CrossRef] 97. Naczk, M.; Marszalek, S.; Naczk, A. Inertial Training Improves Strength, Balance, and Gait Speed in Elderly Nursing Home Residents. Clin. Interv. Aging 2020,15, 177–184. [CrossRef] 98. Urzi, F.; Marusic, U.; Liˇcen, S.; Buzan, E. Effects of Elastic Resistance Training on Functional Performance and Myokines in Older Women—A Randomized Controlled Trial. J. Am. Med. Dir. Assoc. 2019,20, 830–834.e2. [CrossRef] 99. Suzuki, M.; Kirimoto, H.; Inamura, A.; Yagi, M.; Omori, Y.; Yamada, S. The relationship between knee extension strength and lower extremity functions in nursing home residents with dementia. Disabil. Rehabil. 2012,34, 202–209. [CrossRef] 100. Paw, M.J.C.A.; van Poppel, M.N.M.; Twisk, J.W.R.; van Mechelen, W. Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities [ISRCTN87177281]. Patient Educ. Couns. 2006 ,63, 205–214. [CrossRef] 101. Sabol, V.K.; Resnick, B.; Galik, E.; Gruber-Baldini, A.L.; Morton, P.G.; Hicks, G.E. Exploring the Factors That Influence Functional Performance Among Nursing Home Residents. J. Aging Health 2011,23, 112–134. [CrossRef] Int. J. Environ. Res. Public Health 2022,19, 5058 21 of 29 102. Le Berre, M.; Apap, D.; Babcock, J.; Bray, S.; Gareau, E.; Chassé, K.; Lévesque, N.; Robbins, S.M. The Psychometric Properties of a Modified Sit-to-Stand Test With Use of the Upper Extremities in Institutionalized Older Adults. Percept. Mot. Ski. 2016 ,123, 138–152. [CrossRef] [PubMed] 103. Arrieta, H.; Rezola-Pardo, C.; Gil, S.M.; Virgala, J.; Iturburu, M.; Antón, I.; González-Templado, V.; Irazusta, J.; Rodriguez-Larrad, A. Effects of Multicomponent Exercise on Frailty in Long-Term Nursing Homes: A Randomized Controlled Trial. J. Am. Geriatr. Soc. 2019,67, 1145–1151. [CrossRef] [PubMed] 104. Reid, N.; Keogh, J.W.; Swinton, P.; Gardiner, P.A.; Henwood, T.R. The Association of Sitting Time With Sarcopenia Status and Physical Performance at Baseline and 18-Month Follow-Up in the Residential Aged Care Setting. J. Aging Phys. Act. 2018 ,26, 445–450. [CrossRef] [PubMed] 105. Nagai, K.; Inoue, T.; Yamada, Y.; Tateuchi, H.; Ikezoe, T.; Ichihashi, N.; Tsuboyama, T. Effects of toe and ankle training in older people: A cross-over study. Geriatr. Gerontol. Int. 2011,11, 246–255. [CrossRef] 106. Liu, W.; Chen, S.; Jiang, F.; Zhou, C.; Tang, S. Malnutrition and Physical Frailty among Nursing Home Residents: A Cross-Sectional Study in China. J. Nutr. Health Aging 2020,24, 500–506. [CrossRef] 107. Buckinx, F.; Mouton, A.; Reginster, J.Y.; Croisier, J.L.; Dardenne, N.; Beaudart, C.; Nelis, J.; Lambert, E.; Appelboom, G.; Bruyere, O. Relationship between ambulatory physical activity assessed by activity trackers and physical frailty among nursing home residents. Gait Posture 2017,54, 56–61. [CrossRef] 108. Donat, H.; Özcan, A. Comparison of the effectiveness of two programmes on older adults at risk of falling: Unsupervised home exercise and supervised group exercise. Clin. Rehabil. 2007,21, 273–283. [CrossRef] 109. Marmeleira, J.; Ferreira, S.; Raimundo, A. Physical activity and physical fitness of nursing home residents with cognitive impairment: A pilot study. Exp. Gerontol. 2017,100, 63–69. [CrossRef] 110. Telenius, E.W.; Engedal, K.; Bergland, A. Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: A single blinded randomized controlled trial. BMC Geriatr. 2015,15, 158. [CrossRef] 111. Ikezoe, T.; Asakawa, Y.; Shima, H.; Kishibuchi, K.; Ichihashi, N. Daytime physical activity patterns and physical fitness in institutionalized elderly women: An exploratory study. Arch. Gerontol. Geriatr. 2013,57, 221–225. [CrossRef] 112. Yalcin, A.; Aras, S.; Atmis, V.; Cengiz, O.K.; Cinar, E.; Atli, T.; Varli, M. Sarcopenia and mortality in older people living in a nursing home in Turkey. Geriatr. Gerontol. Int. 2017,17, 1118–1124. [CrossRef] [PubMed] 113. Norman, K.; Smoliner, C.; Valentini, L.; Lochs, H.; Pirlich, M. Is bioelectrical impedance vector analysis of value in the elderly with malnutrition and impaired functionality? Nutrition 2007,23, 564–569. [CrossRef] [PubMed] 114. Coelho-Júnior, H.J.; Aguiar, S.D.S.; Calvani, R.; Picca, A.; Carvalho, D.D.A.; Zwarg-Sá, J.D.C.; Audiffren, M.; Marzetti, E.; Uchida, M.C. Acute Effects of Low- and High-Speed Resistance Exercise on Cognitive Function in Frail Older Nursing-Home Residents: A Randomized Crossover Study. J. Aging Res. 2021,2021, 9912339. [CrossRef] [PubMed] 115. Kozicka, I.; Kostka, T. Handgrip strength, quadriceps muscle power, and optimal shortening velocity roles in maintaining functional abilities in older adults living in a long-term care home: A 1-year follow-up study. Clin. Interv. Aging 2016 ,11, 739–747. [CrossRef] 116. Schober-Halper, B.; Hofmann, M.; Oesen, S.; Franzke, B.; Wolf, T.; Strasser, E.-M.; Bachl, N.; Quittan, M.; Wagner, K.-H.; Wessner, B. Elastic band resistance training influences transforming growth factor-ß receptor I mRNA expression in peripheral mononuclear cells of institutionalised older adults: The Vienna Active Ageing Study (VAAS). Immun. Ageing 2016,13, 22. [CrossRef] 117. Meng, G.; Wang, H.; Pei, Y.; Li, Y.; Wu, H.; Song, Y.; Guo, Q.; Guo, H.; Fukushima, S.; Tatefuji, T.; et al. Effects of protease-treated royal jelly on muscle strength in elderly nursing home residents: A randomized, double-blind, placebo-controlled, dose-response study. Sci. Rep. 2017,7, 11416. [CrossRef] 118. Hofmann, M.; Schober-Halper, B.; Oesen, S.; Franzke, B.; Tschan, H.; Bachl, N.; Strasser, E.-M.; Quittan, M.; Wagner, K.-H.; Wessner, B. Effects of elastic band resistance training and nutritional supplementation on muscle quality and circulating muscle growth and degradation factors of institutionalized elderly women: The Vienna Active Ageing Study (VAAS). Graefe’s Arch. Eur. J. Appl. Physiol. 2016,116, 885–897. [CrossRef] 119. Franzke, B.; Halper, B.; Hofmann, M.; Oesen, S.; Jandrasits, W.; Baierl, A.; Tosevska, A.; Strasser, E.-M.; Wessner, B.; Wagner, K.-H.; et al. The impact of six months strength training, nutritional supplementation or cognitive training on DNA damage in institutionalised elderly. Mutagenesis 2015,30, 147–153. [CrossRef] 120. Binder, E.F.; White, H.K.; Resnick, B.; McClellan, W.M.; Lei, L.; Ouslander, J.G. A Prospective Study of Outcomes of Nursing Home Residents with Chronic Kidney Disease with and without Anemia. J. Am. Geriatr. Soc. 2012,60, 877–883. [CrossRef] 121. Kaiser, R.; Winning, K.; Uter, W.; Volkert, D.; Lesser, S.; Stehle, P.; Kaiser, M.J.; Sieber, C.C.; Bauer, J.M. Functionality and Mortality in Obese Nursing Home Residents: An Example of ‘Risk Factor Paradox’? J. Am. Med. Dir. Assoc. 2010,11, 428–435. [CrossRef] 122. Pedrero-Chamizo, R.; Albers, U.; Palacios, G.; Pietrzik, K.; Meléndez, A.; González-Gross, M. Health Risk, Functional Markers and Cognitive Status in Institutionalized Older Adults: A Longitudinal Study. Int. J. Environ. Res. Public Health 2020 ,17, 7303. [CrossRef] [PubMed] 123. Bjorkman, M.P.; Finnesoveri, H.; Pilvi, T.K.; Tilvis, R.S. Bioimpedance spectroscopy as a measure of physical functioning in nursing home residents. Aging Clin. Exp. Res. 2012,24, 612–618. [CrossRef] [PubMed] Int. J. Environ. Res. Public Health 2022,19, 5058 22 of 29 124. Moreira-Pfrimer, L.D.; Pedrosa, M.A.; Teixeira, L.; Lazaretti-Castro, M. Treatment of Vitamin D Deficiency Increases Lower Limb Muscle Strength in Institutionalized Older People Independently of Regular Physical Activity: A Randomized Double-Blind Controlled Trial. Ann. Nutr. Metab. 2009,54, 291–300. [CrossRef] [PubMed] 125. Monteiro-Junior, R.S.; Oliveira, T.R.; Leão, L.L.; Baldo, M.P.; de Paula, A.M.; Laks, J. Poor physical fitness is associated with impaired memory, executive function, and depression in institutionalized older adults: A cross-sectional study. Rev. Bras. Psiquiatr. 2022,44, 41–45. [CrossRef] 126. Cervantes, J.M.D.C.; Cervantes, M.H.M.; Torres, R.M. Effect of a Resistance Training Program on Sarcopenia and Functionality of the Older Adults Living in a Nursing Home. J. Nutr. Health Aging 2019,23, 829–836. [CrossRef] 127. Chiu, S.-C.; Yang, R.-S.; Yang, R.-J.; Chang, S.-F. Effects of resistance training on body composition and functional capacity among sarcopenic obese residents in long-term care facilities: A preliminary study. BMC Geriatr. 2018,18, 21. [CrossRef] 128. Martínez-Arnau, F.M.; Fonfría-Vivas, R.F.; Buigues, C.; Castillo, Y.; Molina, P.; Hoogland, A.J.; Van Doesburg, F.; Pruimboom, L.; Fernández-Garrido, J.; Cauli, O. Effects of Leucine Administration in Sarcopenia: A Randomized and Placebo-controlled Clinical Trial. Nutrients 2020,12, 932. [CrossRef] 129. Yalcin, A.; Aras, S.; Atmis, V.; Cengiz, O.K.; Varli, M.; Cinar, E.; Atli, T. Sarcopenia prevalence and factors associated with sarcopenia in older people living in a nursing home in Ankara Turkey. Geriatr. Gerontol. Int. 2016,16, 903–910. [CrossRef] 130. Thalmann, M.; Tröster, T.; Fischer, K.; Bieri-Brüning, G.; Patrick, B.; Bischoff-Ferrari, H.; Gagesch, M. Do older adults benefit from post-acute care following hospitalisation? A prospective cohort study at three Swiss nursing homes. Swiss Med. Wkly. 2020 , 150, w20198. [CrossRef] 131. Barreto, P.D.S.; Cesari, M.; Denormandie, P.; Armaingaud, D.; Vellas, B.; Rolland, Y. Exercise or Social Intervention for Nursing Home Residents with Dementia: A Pilot Randomized, Controlled Trial. J. Am. Geriatr. Soc. 2017,65, E123–E129. [CrossRef] 132. Yang, L.-J.; Wu, G.-H.; Yang, Y.-L.; Wu, Y.-H.; Zhang, L.; Wang, M.-H.; Mo, L.-Y.; Xue, G.; Wang, C.-Z.; Weng, X.-F. Nutrition, Physical Exercise, and the Prevalence of Sarcopenia in Elderly Residents in Nursing Homes in China. Med. Sci. Monit. 2019 ,25, 4390–4399. [CrossRef] [PubMed] 133. Rodriguez-Rejon, A.I.; Artacho, R.; Puerta, A.; Zuñiga, A.; Ruiz-Lopez, M.D. Diagnosis of Sarcopenia in Long-Term Care Homes for the Elderly: The Sensitivity and Specificity of Two Simplified Algorithms with Respect to the EWGSOP Consensus. J. Nutr. Health Aging 2018,22, 796–801. [CrossRef] [PubMed] 134. Wearing, J.; Stokes, M.; De Bruin, E.D. Quadriceps muscle strength is a discriminant predictor of dependence in daily activities in nursing home residents. PLoS ONE 2019,14, e0223016. [CrossRef] [PubMed] 135. Grönstedt, H.; Hellström, K.; Bergland, A.; Helbostad, J.L.; Puggaard, L.; Andresen, M.; Granbo, R.; Frändin, K. Functional level, physical activity and wellbeing in nursing home residents in three Nordic countries. Aging Clin. Exp. Res. 2011 ,23, 413–420. [CrossRef] 136. Rezola-Pardo, C.; Rodriguez-Larrad, A.; Gomez-Diaz, J.; Real, G.L.; Mugica-Errazquin, I.; Patiño, M.J.; Bidaurrazaga-Letona, I.; Irazusta, J.; Gil, S.M. Comparison Between Multicomponent Exercise and Walking Interventions in Long-Term Nursing Homes: A Randomized Controlled Trial. Gerontologist 2019,60, 1364–1373. [CrossRef] 137. Arrieta, H.; Rezola-Pardo, C.; Echeverria, I.; Iturburu, M.; Gil, S.M.; Yanguas, J.J.; Irazusta, J.; Rodriguez-Larrad, A. Physical activity and fitness are associated with verbal memory, quality of life and depression among nursing home residents: Preliminary data of a randomized controlled trial. BMC Geriatr. 2018,18, 80. [CrossRef] 138. Wołoszyn, N.; Grzegorczyk, J.; Wi´sniowska-Szurlej, A.; Kilian, J.; Kwolek, A. Psychophysical Health Factors and Its Correlations in Elderly Wheelchair Users Who Live in Nursing Homes. Int. J. Environ. Res. Public Health 2020,17, 1706. [CrossRef] 139. Tsuyuguchi, R.; Kurose, S.; Seto, T.; Takao, N.; Fujii, A.; Tsutsumi, H.; Otsuki, S.; Kimura, Y. The effects of toe grip training on physical performance and cognitive function of nursing home residents. J. Physiol. Anthr. 2019,38, 11. [CrossRef] 140. Damascena, K.G.; Ferreira, C.B.; Teixeira, P.D.S.; Madrid, B.; Gonçalves, A.; Córdova, C.; Nóbrega, O.d.T.; Ferreira, A.P. Functional capacity and obesity reflect the cognitive performance of older adults living in long-term care facilities. Psychogeriatrics 2017 ,17, 439–445. [CrossRef] 141. Hewitt, J.; Goodall, S.; Clemson, L.; Henwood, T.; Refshauge, K. Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. J. Am. Med. Dir. Assoc. 2018 ,19, 361–369. [CrossRef] 142. Sverdrup, K.; Bergh, S.; Selbæk, G.; Røen, I.; Kirkevold, Ø.; Tangen, G.G. Mobility and cognition at admission to the nursing home—a cross-sectional study. BMC Geriatr. 2018,18, 30. [CrossRef] [PubMed] 143. Pedrero-Chamizo, R.; Albers, U.; Tobaruela, J.L.; Meléndez, A.; Castillo, M.J.; González-Gross, M. Physical strength is associated with Mini-Mental State Examination scores in Spanish institutionalized elderly. Geriatr. Gerontol. Int. 2013 ,13, 1026–1034. [CrossRef] [PubMed] 144. De Andrade, F.L.J.P.; Jerez-Roig, J.; Belém, L.N.M.; De Lima, K.C. Frailty among institutionalized older people: A cross-sectional study in Natal (Brazil). J. Frailty Sarcopenia Falls 2019,4, 51–60. [CrossRef] 145. Mouton, A.; Gillet, N.; Mouton, F.; Van Kann, D.; Bruyere, O.; Cloes, M.; Buckinx, F. Effects of a giant exercising board game intervention on ambulatory physical activity among nursing home residents: A preliminary study. Clin. Interv. Aging 2017 ,12, 847–858. [CrossRef] [PubMed] 146. Feng, H.; Zou, Z.; Zhang, Q.; Wang, L.; Ouyang, Y.-Q.; Chen, Z.; Ni, Z. The effect of the group-based Otago exercise program on frailty among nursing home older adults with cognitive impairment. Geriatr. Nurs. 2021,42, 479–483. [CrossRef] Int. J. Environ. Res. Public Health 2022,19, 5058 23 of 29 147. Bossers, W.J.; van der Woude, L.; Boersma, F.; Hortobágyi, T.; Scherder, E.J.; van Heuvelen, M.J. A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial. Am. J. Geriatr. Psychiatry 2015,23, 1106–1116. [CrossRef] [PubMed] 148. Furtado, G.E.; Patrício, M.; Loureiro, M.; Hogervorst, E.; Theou, O.; Ferreira, J.P.; Teixeira, A. Physical frailty and health outcomes of fitness, hormones, psychological and disability in institutionalized older women: An exploratory association study. Women Health 2020,60, 140–155. [CrossRef] [PubMed] 149. Kvæl, L.A.H.; Bergland, A.; Telenius, E.W. Associations between physical function and depression in nursing home residents with mild and moderate dementia: A cross-sectional study. BMJ Open 2017,7, e016875. [CrossRef] 150. Henskens, M.; Nauta, I.M.; Van Eekeren, M.C.; Scherder, E.J. Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial. Dement. Geriatr. Cogn. Disord. 2018,46, 60–80. [CrossRef] 151. Pardo, C.R.; Arrieta, H.; Gil, S.M.; Zarrazquin, I.; Yanguas, J.J.; López, M.A.; Irazusta, J.; Rodriguez-Larrad, A. Comparison between multicomponent and simultaneous dual-task exercise interventions in long-term nursing home residents: The Ageing- ONDUAL-TASK randomized controlled study. Age Ageing 2019,48, 817–823. [CrossRef] 152. Dechamps, A.; Alban, R.; Jen, J.; Traissac, T.; Dehail, P. Individualized Cognition-Action intervention to prevent behavioral disturbances and functional decline in institutionalized older adults: A randomized pilot trial. Int. J. Geriatr. Psychiatry 2010 ,25, 850–860. [CrossRef] [PubMed] 153. Casas-Herrero, A.; Cadore, E.; Zambom-Ferraresi, F.; Idoate, F.; Millor, N.; Ramírez, A.M.; Gómez, M.; Rodríguez-Mañas, L.; Marcellán, T.; De Gordoa, A.R.; et al. Functional Capacity, Muscle Fat Infiltration, Power Output, and Cognitive Impairment in Institutionalized Frail Oldest Old. Rejuvenation Res. 2013,16, 396–403. [CrossRef] [PubMed] 154. Huang, T.-T.; Chung, M.-L.; Chen, F.-R.; Chin, Y.-F.; Wang, B.-H. Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes. Aging Ment. Health 2016 ,20, 2–12. [CrossRef] [PubMed] 155. Sievänen, H.; Karinkanta, S.; Moisio-Vilenius, P.; Ripsaluoma, J. Feasibility of whole-body vibration training in nursing home residents with low physical function: A pilot study. Aging Clin. Exp. Res. 2014,26, 511–517. [CrossRef] [PubMed] 156. Bischoff, L.L.; Cordes, T.; Meixner, C.; Schoene, D.; Voelcker-Rehage, C.; Wollesen, B. Can cognitive-motor training improve physical functioning and psychosocial wellbeing in nursing home residents? A randomized controlled feasibility study as part of the PROCARE project. Aging Clin. Exp. Res. 2020,33, 943–956. [CrossRef] [PubMed] 157. Cordes, T.; Zwingmann, K.; Rudisch, J.; Voelcker-Rehage, C.; Wollesen, B. Multicomponent exercise to improve motor functions, cognition and well-being for nursing home residents who are unable to walk—A randomized controlled trial. Exp. Gerontol. 2021 , 153, 111484. [CrossRef] 158. Ferreira, C.B.; Teixeira, P.D.S.; Dos Santos, G.A.; Maya, A.T.D.; Brasil, P.A.D.; Souza, V.C.; Córdova, C.; Ferreira, A.P.; Lima, R.M.; Nóbrega, O.T. Effects of a 12-Week Exercise Training Program on Physical Function in Institutionalized Frail Elderly. J. Aging Res. 2018,2018, 7218102. [CrossRef] 159. Rica, R.L.; Shimojo, G.L.; Gomes, M.C.; Alonso, A.C.; Pitta, R.M.; Santa-Rosa, F.A.; Pontes, F.L., Jr.; Ceschini, F.; Gobbo, S.; Bergamin, M.; et al. Effects of a Kinect-based physical training program on body composition, functional fitness and depression in institutionalized older adults. Geriatr. Gerontol. Int. 2020,20, 195–200. [CrossRef] 160. Chen, M.-C.; Chen, K.-M.; Chang, C.-L.; Chang, Y.-H.; Cheng, Y.-Y.; Huang, H.-T. Elastic Band Exercises Improved Activities of Daily Living and Functional Fitness of Wheelchair-bound Older Adults with Cognitive Impairment: A Cluster Randomized Controlled Trial. Am. J. Phys. Med. Rehabil. 2016,95, 789–799. [CrossRef] 161. Pereira, C.; Fernandes, J.; Raimundo, A.; Biehl-Printes, C.; Marmeleira, J.; Tomas-Carus, P. Increased Physical Activity and Fitness above the 50th Percentile Avoid the Threat of Older Adults Becoming Institutionalized: A Cross-sectional Pilot Study. Rejuvenation Res. 2016,19, 13–20. [CrossRef] 162. Sampaio, A.; Marques-Aleixo, I.; Seabra, A.; Mota, J.; Marques, E.; Carvalho, M.J. Physical fitness in institutionalized older adults with dementia: Association with cognition, functional capacity and quality of life. Aging Clin. Exp. Res. 2020 ,32, 2329–2338. [CrossRef] [PubMed] 163. Bossers, W.J.R.; Scherder, E.J.A.; Boersma, F.; Hortobágyi, T.; van der Woude, L.; Van Heuvelen, M.J.G. Feasibility of a Combined Aerobic and Strength Training Program and Its Effects on Cognitive and Physical Function in Institutionalized Dementia Patients. A Pilot Study. PLoS ONE 2014,9, e97577. [CrossRef] [PubMed] 164. Vedovelli, K.; Giacobbo, B.L.; Corrêa, M.S.; Wieck, A.; Argimon, I.I.D.L.; Bromberg, E. Multimodal physical activity increases brain-derived neurotrophic factor levels and improves cognition in institutionalized older women. GeroScience 2017 ,39, 407–417. [CrossRef] [PubMed] 165. Sampaio, A.; Marques, E.; Mota, J.; Carvalho, M.J. Effects of a multicomponent exercise program in institutionalized elders with Alzheimer’s disease. Dementia 2019,18, 417–431. [CrossRef] [PubMed] 166. Zeng, Y.; Hu, X.; Xie, L.; Han, Z.; Zuo, Y.; Yang, M. The Prevalence of Sarcopenia in Chinese Elderly Nursing Home Residents: A Comparison of 4 Diagnostic Criteria. J. Am. Med. Dir. Assoc. 2018,19, 690–695. [CrossRef] 167. Beck, A.M.; Damkjær, K.; Beyer, N. Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function. Nutrition 2008,24, 1073–1080. [CrossRef] 168. Magistro, D.; Carlevaro, F.; Magno, F.; Simon, M.; Camp, N.; Kinrade, N.; Zecca, M.; Musella, G. Effects of 1 Year of Lifestyle Intervention on Institutionalized Older Adults. Int. J. Environ. Res. Public Health 2021,18, 7612. [CrossRef] Int. J. Environ. Res. Public Health 2022,19, 5058 24 of 29 169. Rondanelli, M.; Opizzi, A.; Antoniello, N.; Boschi, F.; Iadarola, P.; Pasini, E.; Aquilani, R.; Dioguardi, F.S. Effect of essential amino acid supplementation on quality of life, Amino acid profile and strength in institutionalized elderly patients. Clin. Nutr. 2011 ,30, 571–577. [CrossRef] 170. Chen, K.-M.; Li, C.-H.; Huang, H.-T.; Cheng, Y.-Y. Feasible modalities and long-term effects of elastic band exercises in nursing home older adults in wheelchairs: A cluster randomized controlled trial. Int. J. Nurs. Stud. 2015,55, 4–14. [CrossRef] 171. Senior, H.E.; Henwood, T.R.; Beller, E.M.; Mitchell, G.K.; Keogh, J.W. Prevalence and risk factors of sarcopenia among adults living in nursing homes. Maturitas 2015,82, 418–423. [CrossRef] 172. Smoliner, C.; Norman, K.; Scheufele, R.; Hartig, W.; Pirlich, M.; Lochs, H. Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition. Nutrition 2008,24, 1139–1144. [CrossRef] [PubMed] 173. Franzke, B.; Schober-Halper, B.; Hofmann, M.; Oesen, S.; Tosevska, A.; Henriksen, T.; Poulsen, H.E.; Strasser, E.-M.; Wessner, B.; Wagner, K.-H. Age and the effect of exercise, nutrition and cognitive training on oxidative stress—The Vienna Active Aging Study (VAAS), a randomized controlled trial. Free Radic. Biol. Med. 2018,121, 69–77. [CrossRef] [PubMed] 174. Franzke, B.; Halper, B.; Hofmann, M.; Oesen, S.; Pierson, B.; Cremer, A.; Bacher, E.; Fuchs, B.; Baierl, A.; Tosevska, A.; et al. The effect of six months of elastic band resistance training, nutritional supplementation or cognitive training on chromosomal damage in institutionalized elderly. Exp. Gerontol. 2015,65, 16–22. [CrossRef] [PubMed] 175. Henwood, T.; Hassan, B.; Swinton, P.; Senior, H.; Keogh, J. Consequences of sarcopenia among nursing home residents at long-term follow-up. Geriatr. Nurs. 2017,38, 406–411. [CrossRef] 176. Lee, L.-C.; Tsai, A.C.; Wang, J.-Y. Need-based nutritional intervention is effective in improving handgrip strength and Barthel Index scores of older people living in a nursing home: A randomized controlled trial. Int. J. Nurs. Stud. 2015 ,52, 904–912. [CrossRef] 177. Lardiés-Sánchez, B.; Sanz-París, A.; Pérez-Nogueras, J.; Serrano-Oliver, A.; Torres-Anoro, M.E.; Cruz-Jentoft, A.J. Influence of nutritional status in the diagnosis of sarcopenia in nursing home residents. Nutrition 2017,41, 51–57. [CrossRef] 178. Kazoglu, M.; Yuruk, Z.O. Comparison of the physical fitness levels in nursing home residents and community-dwelling older adults. Arch. Gerontol. Geriatr. 2020,89, 104106. [CrossRef] 179. Wołoszyn, N.; Wi´sniowska-Szurlej, A.; Grzegorczyk, J.; Kwolek, A. The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes—a randomized control trial. BMC Geriatr. 2021,21, 423. [CrossRef] 180. Abizanda, P.; López, M.D.; García, V.P.; Estrella, J.D.D.; González, Á.D.S.; Vilardell, N.B.; Torres, K.A. Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status, and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study. J. Am. Med. Dir. Assoc. 2015,16, 439.e9–439.e16. [CrossRef] 181. Oesen, S.; Halper, B.; Hofmann, M.; Jandrasits, W.; Franzke, B.; Strasser, E.-M.; Graf, A.; Tschan, H.; Bachl, N.; Quittan, M.; et al. Effects of elastic band resistance training and nutritional supplementation on physical performance of institutionalised elderly—A randomized controlled trial. Exp. Gerontol. 2015,72, 99–108. [CrossRef] 182. Rezola-Pardo, C.; Hervás, G.; Arrieta, H.; Diego, A.H.-D.; Ruiz-Litago, F.; Gil, S.M.; Rodriguez-Larrad, A.; Irazusta, J. Physical exercise interventions have no effect on serum BDNF concentration in older adults living in long-term nursing homes. Exp. Gerontol. 2020,139, 111024. [CrossRef] [PubMed] 183. Rydwik, E.; Kerstin, F.; Akner, G. Physical training in institutionalized elderly people with multiple diagnoses—A controlled pilot study. Arch. Gerontol. Geriatr. 2005,40, 29–44. [CrossRef] [PubMed] 184. Kamo, T.; Ishii, H.; Suzuki, K.; Nishida, Y. Prevalence of sarcopenia and its association with activities of daily living among japanese nursing home residents. Geriatr. Nurs. 2018,39, 528–533. [CrossRef] [PubMed] 185. Barbosa, F.Á.; del Pozo-Cruz, B.; del Pozo-Cruz, J.; Alfonso-Rosa, R.M.; Corrales, B.S.; Rogers, M.E. Factors Associated with the Risk of Falls of Nursing Home Residents Aged 80 or Older. Rehabil. Nurs. 2016,41, 16–25. [CrossRef] 186. Cancela, J.M.; Perez, C.A.; Rodrigues, L.P.; Bezerra, P. The Long-Term Benefits of a Multicomponent Physical Activity Program to Body Composition, Muscle Strength, Cardiorespiratory Capacity, and Bone Mineral Density in a Group of Nonagenarians. Rejuvenation Res. 2020,23, 217–223. [CrossRef] [PubMed] 187. Grönstedt, H.; Frändin, K.; Bergland, A.; Helbostad, J.L.; Granbo, R.; Puggaard, L.; Andresen, M.; Hellström, K. Effects of Individually Tailored Physical and Daily Activities in Nursing Home Residents on Activities of Daily Living, Physical Performance and Physical Activity Level: A Randomized Controlled Trial. Gerontology 2013,59, 220–229. [CrossRef] 188. Netz, Y.; Argov, E.; Burstin, A.; Brown, R.; Heyman, S.N.; Dunsky, A.; Alexander, N.B. Use of a device to support standing during a physical activity program to improve function of individuals with disabilities who reside in a nursing home. Disabil. Rehabil. Assist. Technol. 2007,2, 43–49. [CrossRef] 189. Najafi, Z.; Kooshyar, H.; Mazloom, R.; Azhari, A. The Effect of Fun Physical Activities on Sarcopenia Progression among Elderly Residents in Nursing Homes: A Randomized Controlled Trial. J. Caring Sci. 2018,7, 137–142. [CrossRef] 190. Rizka, A.; Indrarespati, A.; Dwimartutie, N.; Muhadi, M. Frailty among Older Adults Living in Nursing Homes in Indonesia: Prevalence and Associated Factors. Ann. Geriatr. Med. Res. 2021,25, 93–97. [CrossRef] 191. Lobo, A.; Carvalho, M.J.; Santos, M.P. Effects of Training and Detraining on Physical Fitness, Physical Activity Patterns, Cardiovascular Variables, and HRQoL after 3 Health-Promotion Interventions in Institutionalized Elders. Int. J. Fam. Med. 2010 , 2010, 486097. [CrossRef] Int. J. Environ. Res. Public Health 2022,19, 5058 25 of 29 192. Cadore, E.L.; Casas-Herrero, A.; Zambom-Ferraresi, F.; Idoate, F.; Millor, N.; Gómez, M.; Rodríguez-Mañas, L.; Izquierdo, M. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age 2014,36, 773–785. [CrossRef] [PubMed] 193. Ouslander, J.G.; Griffiths, P.C.; McConnell, E.; Riolo, L.; Kutner, M.; Schnelle, J. Functional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing Homes. J. Am. Geriatr. Soc. 2005,53, 1091–1100. [CrossRef] [PubMed] 194. Ozcan, A.; Donat, H.; Gelecek, N.; Ozdirenc, M.; Karadibak, D. The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health 2005,5, 90. [CrossRef] [PubMed] 195. Van Roie, E.; Verschueren, S.; Boonen, S.; Bogaerts, A.; Kennis, E.; Coudyzer, W.; Delecluse, C. Force-Velocity Characteristics of the Knee Extensors: An Indication of the Risk for Physical Frailty in Elderly Women. Arch. Phys. Med. Rehabil. 2011 ,92, 1827–1832. [CrossRef] 196. Monteiro-Junior, R.; Figueiredo, L.F.; Maciel-Pinheiro, P.D.T.; Abud, E.L.R.; Engedal, K.; Barca, M.L.; Nascimento, O.J.; Laks, J.; Deslandes, A. Virtual Reality–Based Physical Exercise With Exergames (PhysEx) Improves Mental and Physical Health of Institutionalized Older Adults. J. Am. Med. Dir. Assoc. 2017,18, 454.e1–454.e9. [CrossRef] 197. Coelho, F.M.; Narciso, F.M.S.; Oliveira, D.M.G.; Pereira, D.S.; Teixeira, A.L.; Teixeira, M.M.; Souza, D.G.; Pereira, L.S.M. sTNFR-1 is an early inflammatory marker in community versus institutionalized elderly women. Agents Actions 2009 ,59, 129–134. [CrossRef] 198. Pereira, N.M.; Araya, M.J.P.M.; Scheicher, M.E. Effectiveness of a Treadmill Training Programme in Improving the Postural Balance on Institutionalized Older Adults. J. Aging Res. 2020,2020, 4980618. [CrossRef] 199. Verschueren, S.M.P.; Bogaerts, A.; Delecluse, C.; Claessens, A.L.; Haentjens, P.; Vanderschueren, D.; Boonen, S. The effects of wholebody vibration training and vitamin D supplementation on muscle strength, muscle mass, and bone density in institutionalized elderly women: A 6-month randomized, controlled trial. J. Bone Miner. Res. 2011,26, 42–49. [CrossRef] 200. Masciocchi, E.; Maltais, M.; El Haddad, K.; Giudici, K.V.; Rolland, Y.; Vellas, B.; Barreto, P.D.S. Defining Vitality Using Physical and Mental Well-Being Measures in Nursing Homes: A Prospective Study. J. Nutr. Health Aging 2020,24, 37–42. [CrossRef] 201. Toots, A.; Littbrand, H.; Boström, G.; Hörnsten, C.; Holmberg, H.; Lundin-Olsson, L.; Lindelöf, N.; Nordström, P.; Gustafson, Y.; Rosendahl, E. Effects of Exercise on Cognitive Function in Older People with Dementia: A Randomized Controlled Trial. J. Alzheimer’s Dis. 2017,60, 323–332. [CrossRef] 202. Elsner, V.R.; Fraga, I.; Weber, C.; Galiano, W.B.; Iraci, L.; Wohlgemuth, M.; Morales, G.; Cercato, C.; Rodriguez, J.; Pochmann, D.; et al. Effects of a multimodal exercise protocol on functional outcomes, epigenetic modulation and brain-derived neurotrophic factor levels in institutionalized older adults: A quasi-experimental pilot study. Neural Regen. Res. 2021 ,16, 2479–2485. [CrossRef] [PubMed] 203. Kocic, M.; Stojanovic, Z.; Lazovic, M.; Nikolic, D.; Zivkovic, V.; Milenkovic, M.; Lazarevic, K. Relationship between fear of falling and functional status in nursing home residents aged older than 65 years. Geriatr. Gerontol. Int. 2017 ,17, 1470–1476. [CrossRef] [PubMed] 204. Delbroek, T.; Vermeylen, W.; Spildooren, J. The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: A randomized controlled trial. J. Phys. Ther. Sci. 2017,29, 1137–1143. [CrossRef] [PubMed] 205. Kose, N.; Cuvalci, S.; Ekici, G.; Otman, A.S.; Karakaya, M.G. The Risk Factors of Fall and Their Correlation with Balance, Depression, Cognitive Impairment and Mobility Skills in Elderly Nursing Home Residents. Saudi Med. J. 2005 ,26, 978–981. [PubMed] 206. Verrusio, W.; Renzi, A.; Cecchetti, F.; Gaj, F.; Coi, M.; Ripani, M.; Cacciafesta, M. The Effect of a Physical Training with the Use of an Exoskeleton on Depression Levels in Institutionalized Elderly Patients: A Pilot Study. J. Nutr. Health Aging 2018 ,22, 934–937. [CrossRef] 207. Viveiro, L.A.P.; Gomes, G.C.V.; Bacha, J.M.R.; Junior, N.C.; Kallas, M.E.; Reis, M.; Filho, W.J.; Pompeu, J.E. Reliability, Validity, and Ability to Identity Fall Status of the Berg Balance Scale, Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in Older Adults Who Live in Nursing Homes. J. Geriatr. Phys. Ther. 2019,42, E45–E54. [CrossRef] 208. Christofoletti, G.; Oliani, M.M.; Gobbi, S.; Stella, F.; Gobbi, L.; Canineu, P.R. A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia. Clin. Rehabil. 2008 ,22, 618–626. [CrossRef] 209. Babadi, S.Y.; Daneshmandi, H. Effects of virtual reality versus conventional balance training on balance of the elderly. Exp. Gerontol. 2021,153, 111498. [CrossRef] 210. Deschamps, A.; Onifade, C.; Bourdel-Marchasson, I. Health-Related Quality of Life in Frail Institutionalized Elderly: Effects of a Cognition-Action Intervention and Tai Chi. J. Aging Phys. Act. 2009,17, 236–248. [CrossRef] 211. Vermeulen, J.; Neyens, J.C.; Spreeuwenberg, M.D.; Van Rossum, E.; Hewson, D.J.; Duchêne, J.; de Witte, L. Construct Validity of a Modified Bathroom Scale That Can Measure Balance in Elderly People. J. Am. Med. Dir. Assoc. 2012 ,13, 665.e1–665.e5. [CrossRef] 212. Saravanakumar, P.; Higgins, I.J.; Van Der Riet, P.J.; Marquez, J.; Sibbritt, D. The influence of tai chi and yoga on balance and falls in a residential care setting: A randomised controlled trial. Contemp. Nurse 2014,48, 76–87. [CrossRef] [PubMed] 213. Yamagata, M.; Ikezoe, T.; Kamiya, M.; Masaki, M.; Ichihashi, N. Correlation between movement complexity during static standing and balance function in institutionalized older adults. Clin. Interv. Aging 2017,12, 499–503. [CrossRef] [PubMed]