Effect of Baduanjin Exercise and Resistance Band Training on Sarcopenia in the Elderly: A Randomized Controlled Trial

Introduction

Sarcopenia, a condition marked by the progressive decline of skeletal muscle mass and strength, is strongly associated with aging [1] and has a high prevalence among the elderly worldwide, with estimated prevalence rates ranging from 10% to 16% [2]. This degenerative process, characterized by muscle atrophy and frailty, is accompanied by morphological and functional alterations, often coexisting with osteoporosis and increasing susceptibility to falls and fractures. In advanced stages, sarcopenia significantly compromises mobility and autonomy, potentially resulting in long-term disability [3,4].

Current therapeutic approaches for sarcopenia remain under investigation, yet exercise interventions continue to be the primary strategy for prevention and management [5,6]. Exercise regimens tailored for sarcopenic patients primarily include resistance and aerobic training [7,8]. Notably, resistance exercise demonstrates superior efficacy in enhancing muscle mass and strength [9,10]. Extensive research indicates that resistance training significantly increases handgrip strength (HGS) and skeletal muscle mass [11], while also promoting protein synthesis and neural adaptability in the elderly [12]. Among resistance modalities, resistance band training is widely used and has been shown to aid sarcopenia treatment due to its safety, accessibility, and graduated resistance, making it particularly suitable for elderly populations. Empirical evidence supports the role of resistance training in increasing muscle mass, improving muscle strength, optimizing body composition, and enhancing overall physical function in older adults, thereby contributing to sarcopenia prevention and treatment [13]. Furthermore, traditional Chinese exercise (TCE), rooted in traditional Chinese medicine with a history spanning approximately 3000 years, offers a cost-effective, accessible, and safe aerobic training option for elderly individuals [14]. Niu et al [15] reported significant improvements in limb function among sarcopenic patients after TCE, particularly in gait speed, balance, and strength. Research suggests that TCE exerts anti-inflammatory effects, mitigating sarcopenia through the modulation of inflammatory cytokines such as interleukin-6 and C-reactive protein [16]. As a key component of non-pharmacological Chinese medicine interventions, TCE includes practices like Baduanjin, Yijin Jing, Tai chi, and Five-Animal exercises. Preliminary studies indicate that Baduanjin exercise, in particular, markedly enhances muscle strength in sarcopenic patients [17,18].

Resistance band training and Baduanjin exercise offer accessible and practical options for elderly individuals to engage in community-based physical activity, requiring minimal equipment and space. Unlike high-intensity exercise, these modalities align with the physical capacities of older adults and are well-suited for widespread community implementation. While both have demonstrated beneficial effects in managing sarcopenia among the elderly, their comparative efficacy remains unclear. Existing research has yet to establish a definitive distinction between the therapeutic outcomes of resistance exercise and Baduanjin exercise for sarcopenic patients. We hypothesized that combining both modalities might produce synergistic effects by simultaneously addressing muscle mass through resistance training and functional balance through Baduanjin exercise. To bridge this gap, the present study used a randomized controlled trial (RCT) design to evaluate the effectiveness of 3 exercise interventions – Baduanjin exercise, resistance band training, and a combined regimen incorporating both – on muscle mass and physical function in elderly people with sarcopenia. Our comprehensive assessment of these interventions aimed to inform the development of optimized exercise prescriptions tailored to this population.

Material and Methods

A total of 556 elderly individuals aged 60 and above were recruited between November 2022 and April 2023 from Xianggang Xinsi Village, Xianggang Xinwu Village, Quanxintang Community, and Batang Village in Yuetang District, Xiangtan City, Hunan Province. A convenience sampling method was used, and data collection, including a questionnaire survey and physical assessments, was conducted in a quiet, open community space. The study protocol was approved by the Ethics Committee of Central Hospital of Xiangtan in October 2022 (Approval No. 2022-10-001) and was registered in the Chinese Clinical Trial Registry: ChiCTR2400089722 (13/09/2024). The study was conducted according to the principles of the Declaration of Helsinki. Written informed consent was obtained from all subjects.

Diagnosis followed the criteria established by the Asian Working Group for Sarcopenia (AWGS) in 2019 [19]: (1) Reduced muscle strength, indicated by HGS <28 kg in males and <18 kg in females; (2) Declined physical performance, defined as a 6-meter gait speed (GS) <1 m/s or short physical performance battery (SPPB) scores ≤9; (3) Low skeletal muscle mass, measured by the appendicular skeletal muscle index (ASMI) calculated as the sum of limb skeletal muscle mass (kg) divided by height squared (m2), with thresholds of <7 kg/m2 for males and <5.7 kg/m2 for females. Sarcopenia was diagnosed when both criterion 1 and criterion 3 were present. Severe sarcopenia was identified when all 3 criteria were met. The detailed screening process is illustrated in Figure 1.

Inclusion criteria were: (1) fulfillment of diagnostic criteria for sarcopenia; (2) voluntary engagement in exercise following the prescribed regimen; (3) comprehension of study protocols and provision of written informed consent.

Exclusion criteria were: (1) presence of hemiplegia or acute myocardial infarction; (2) diagnosis of cachexia; (3) prior systemic treatment relevant to the study; (4) active severe infection; (5) cognitive or motor impairments; (6) performing regular exercise within the past year, including weight-bearing activities and brisk walking.

Sample size calculation was conducted using Gpower software (version 3.1.9.7) to determine statistical power. The increase in ASMI was considered a primary outcome, with calculations referencing a similar study by Zhu et al [20]. In that study, ASMI changes exhibited significant intergroup differences, with mean values of −0.05 (control), 0.02 (exercise program alone), and 0.11 (combined-exercise program and nutrition supplement), and an SD of 0.14. Group sample sizes were 37, 40, and 36, respectively, yielding a calculated effect size of 0.46. Based on Zhu et al’s findings, assuming an SD of 0.14, one-way ANOVA comparing change scores between 4 groups was selected with a statistical power of 0.95, an α level of 0.05, and 4 groups. A minimum of 60 participants totaling across all groups was required. Accounting for an anticipated 20% dropout rate, the study aimed to recruit at least 72 participants.

A total of 87 sarcopenic patients were screened for eligibility, with 80 ultimately meeting the inclusion criteria and providing informed consent. We used a stratified randomization approach to ensure balanced distribution across key demographic characteristics. Participants were first stratified by age (≥75 years vs <75 years) and sex. Within each stratum, simple randomization was performed using a computer-generated random sequence created in Excel by LZY. Participants were then allocated in a 1: 1: 1: 1 ratio into 4 groups. The allocation information was concealed in sequentially numbered, sealed opaque envelopes, which were opened in sequential order at the time of participant enrollment by CJW. They were assigned to 3 intervention groups – Baduanjin (n=20), resistance band (n=20), and mixed exercise (n=20) – along with a control group (n=20). Ethics approval was obtained from the Ethics Committee of Central Hospital of Xiangtan (Approval No. 2022-10-001), and the study was conducted in Xianggang Xinsi Village, Xianggang Xinwu Village, Quanxintang Community, and Batang Village in Yuetang District, Xiangtan City. The methodology adhered to the CONSORT 2010 guidelines [21], with all procedures implemented according to the approved research protocol.

The Baduanjin group performed the Baduanjin exercise method, as supervised by the General Administration of Sport of China [17] (video source: https://www.bilibili.com/video/av85510564/). Sessions were 30 minutes, 3 times per week, over a 12-week intervention period. The exercise regimen included the following postures: (1) Two hands hold up the heavens, (2) Drawing the bow, (3) Separating heaven and earth, (4) Wise owl gazes backwards (or look back), (5) Sway the head and shake the tail to dispel Xin Huo, (6) Two hands hold the feet to strengthen the kidneys and waist, (7) Clenching fists with an angry gaze, and (8) Bouncing on the toes.

In the resistance band group, the Thera-Band resistance system, as referenced in previous studies [22], served as the primary modality for resistance band training. Each band color corresponds to a distinct level of elasticity, with resistance determined by the percentage of elongation. Participants selected appropriate resistance levels based on individualized needs. Sessions lasted 30 minutes, conducted 3 times per week over a 12-week period. Exercise intensity was prescribed according to the ICFSR Expert Consensus Guidelines [23], maintaining a range of 40% to 80% 1RM. A licensed intermediate rehabilitation therapist provided training and supervision throughout the intervention. The Rating of Perceived Exertion (RPE) scale was used to regulate exercise intensity throughout the training, with individual exercise load tolerance set within a specific range. The RPE score (12–16) aligned with the moderate-intensity exercise scale recommended by the American College of Sports Medicine [24]. Exercise selection followed prior research [13], incorporating 6 upper-limb strength exercises (pulldown, pullback, shoulder abduction, biceps curl, triceps extension, and upright rowing) and 6 lower-limb strength exercises (leg press, ankle eversion, ankle dorsiflexion, knee extension, knee flexion, and hip flexion). Participants initially trained with the lowest resistance band (yellow), progressively increasing resistance until failure to complete 10 repetitions (10 RM) at the next level. The final resistance band successfully completed at 10 RM was designated for the training program. Each session included 2 sets at an intensity corresponding to 40% to 80% of 10 RM, with a 1-minute rest interval between sets. Throughout the 12-week intervention, training volume for both upper and lower limbs remained constant, with 10 to 15 repetitions per set. Maximum strength (10 RM) was assessed using progressively higher resistance bands. If participants successfully completed 2 sets of 10 repetitions for all exercises in the protocol for 2 consecutive sessions, they advanced in color every 4 weeks; if progression was not feasible, band length was reduced by half to maintain intensity by increasing the effective resistance per unit length. This protocol was sustained through the 12-week intervention.

The mixed exercise group underwent a combined regimen of Baduanjin exercise and resistance band training, with each session comprising 15 minutes of each modality, totaling 30 minutes per session, performed 3 times per week over a 12-week period.

Participants in the control group received no specific intervention and were instructed to maintain their usual daily activities while refraining from engaging in any organized exercise (Table 1).

Exercise sessions were discontinued immediately if any of the following conditions arose: (1) respiratory distress, including shortness of breath or difficulty breathing, chest tightness, or related symptoms; (2) muscle spasms or joint pain; (3) abnormal physiological responses, such as blood pressure exceeding 180 mmHg, heart rate below 60 beats/min, or blood oxygen saturation falling below 88%; (4) signs of excessive physical exertion intolerance. In the event of these occurrences, exercise cessation was required, followed by rest or appropriate pharmacological intervention. If symptoms persisted despite medication, urgent referral to a specialized medical facility was made [17]. The complete trial process is illustrated in Figure 2.

The primary outcome was skeletal muscle mass evaluated using bioimpedance analysis (BIA) with a human body composition analyzer (InbodyS10), providing measurements of ASM. ASMI was derived using the formula: ASM (kg)/height2 (m2) [19].

The secondary outcome was handgrip strength (HGS) assessed using a handgrip strength meter (Sammons Preston, USA) with measurements recorded in kilograms. The test was conducted on the dominant hand while the patient remained seated, keeping the arm close to the body with an unsupported forearm, 90° elbow flexion, and a neutral wrist position. The handgrip strength meter handle was adjusted to ensure the middle phalanx of the third finger aligned perpendicularly to the handle’s long axis. Patients were instructed to exert maximal force for 3 to 5 seconds while verbal encouragement was provided. A 30-second interval was maintained between trials, and the average of 3 attempts was recorded as the final handgrip strength value [23]. Under resting conditions, normal HGS for the dominant hand is defined as >25 kg for males and >18 kg for females, with most individuals being right-handed [25].

The short physical performance battery (SPPB) is a comprehensive assessment tool used to evaluate the physical function and mobility of older adults. It consists of 3 subtests that measure different aspects of physical performance. (1) The balance test includes standing with feet together, in a semi-tandem position (one foot in front of the other with a small distance between them), and in a tandem position (one foot directly in front of the other). The testing followed a hierarchical protocol in which participants attempted to hold the side-by-side position for 10 seconds; if successful, they proceeded to the semi-tandem position for 10 seconds; if successful again, they attempted the tandem position for 10 seconds. Failure at any level prevented progression to more difficult positions. Each position could be held up to 10 seconds, with their time being recorded in seconds and subsequently scored. (2) The gait speed test was completed with the participant having both feet behind a marked line. Participants were asked to walk at their normal pace for accurate gait analysis. Timing began when participants made their first movement and ended when the trailing foot passed the marked line at the end of the course. (3) The sit-to-stand test was performed using an armless chair. Participants were seated in the chair with arms crossed over the chest. Participants stood 5 consecutive times, with time starting from the first movement and ending when the participant returned to the fully seated position after completing the fifth stand. The SPPB has a maximum possible score of 12 points. Scores of 10 to 12 indicate preserved muscle function, 7 to 9 reflects moderate impairment, and 0 to 6 signifies severe impairment [26]. The scale’s reliability is supported by a Cronbach’s alpha coefficient of 0.87 [27].

For the 6-meter gait speed test, a straight 6-meter walking track was marked on the floor using yellow tape. Participants were instructed to walk the distance at a normal pace, with completion time measured using a stopwatch. Gait speed was then calculated accordingly [28].

TUGT: During the assessment, patients remained in regular footwear and seated in a chair with armrests (seat height: approximately 45 cm; armrest height: approximately 20 cm), with the back resting against the chair and hands positioned on the armrests. If a walker was used, it was held during the test. A clearly visible marker, such as a colored strip or thick line, was placed on the floor 3 meters from the seat. Upon the tester’s “start” command, the patient stood up from the chair, maintained stability, and proceeded to walk 3 meters with a natural gait. After crossing the marker, patients turned, returned to the chair, turned again, and sat down with the back resting against the chair. No physical assistance was permitted during the test. Before the formal assessment, 1 to 2 practice trials were provided to ensure comprehension of the procedure [29]. The scale’s Cronbach’s alpha coefficient is 0.74 [30].

Blinding of the participants and intervention providers was not possible due to the nature of the intervention and the public health service context. To mitigate potential bias, however, the outcome assessors (trained therapists) were blinded to group assignment during all pre- and post-intervention assessments. Participants were instructed not to discuss their exercise program with assessors. To ensure that evaluators are blinded, we implemented the following specific procedures: (1) All participants were informed in writing and verbally before the assessors, and it was strictly forbidden to disclose their grouping or intervention content to the evaluator; (2) We evaluated the use of standardized scripts that avoided any suggestive questions related to exercise interventions. Data analysts were also blinded to group allocation during statistical analysis. When the data management analyst received the dataset for analysis, the group variables were replaced with anonymous codes (groups A, B, C, D). Blinding was not performed until all major analyses were completed and statistical reports were generated, and the codes were mapped to the actual groups. Blinding was maintained throughout the study period and verified through regular checks. This procedure was used to safeguard the reliability and validity of the outcome measures.

Data were analyzed using SPSS 21.0 (EASYBIO, China), while R 4.4.1. was used for image visualization. Continuity variables are presented as mean±standard deviation (χ̄±s). The Shapiro-Wilk test confirmed normal distribution of all outcome variables, and homogeneity of variances was verified using Levene’s test. For normally distributed data, paired t tests evaluated within-group differences before and after intervention. One-way ANOVA was used to compare change scores (post-intervention minus pre-intervention values) between the 4 groups. When one-way ANOVA revealed significant main effects, Tukey’s honestly significant difference (HSD) test was used for post hoc pairwise comparisons for multiple comparisons. For non-normally distributed data, the Wilcoxon test was used to evaluate within-group differences. The non-parametric Kruskal-Wallis test was used to evaluate between-group differences, followed by Dunn’s test. Categorical variables are expressed as case numbers (%), with comparisons performed via the chi-square test. Statistical significance was set at P<0.05 (2-tailed), with P<0.01 considered highly significant and P<0.001 extremely significant.

Results

After the 12-week intervention period, 4 participants withdrew from the control group (1 due to COVID-19 illness, 2 due to quarantine restrictions, and 1 due to personal reasons); 4 participants withdrew from the Baduanjin group (3 due to quarantine restrictions and 1 due to facility closure); 5 participants withdrew from the resistance band group (2 due to COVID-19 illness, 2 due to quarantine restrictions, and 1 due to personal reasons); and 5 participants withdrew from the mixed exercise group (3 due to quarantine restrictions and 2 were lost to follow-up). The detailed participant flow is presented in Figure 2.

Baseline demographic and clinical characteristic of the participants were not significantly different among the 4 groups (P>0.05), indicating comparability, as shown in Table 2.

Comparison of skeletal muscle mass and physical function across the 4 groups before and after intervention showed that no significant pre-intervention differences were observed among the 4 groups. After intervention, within-group comparisons revealed significant improvements in ASM and ASMI in the resistance band group and mixed exercise group (P<0.05) (Table 3). The between-group comparison indicated that the resistance band group had significantly greater changes than the control group (P<0.05) (Figure 3). Regarding physical function, post-intervention intra-group comparisons demonstrated significant improvements in HGS, gait speed, balance, and SPPB in the Baduanjin, resistance band, and mixed exercise groups (P<0.05) (Table 3). Between-group comparisons revealed that both the resistance band and mixed exercise groups showed greater improvements than the control group in HGS, GS, and TUGT(P<0.05). The resistance band group outperformed the control group in gait speed and SPPB (P<0.05), while the Baduanjin group showed greater gains than the control group in balance (P<0.05) (Figures 4, 5). No significant differences were observed among the three intervention groups across all indicators (P>0.05). No adverse events were reported.

Discussion

SKELETAL MUSCLE MASS:

After the intervention, both the resistance band group and the mixed exercise group showed significant improvements in the skeletal muscle mass of sarcopenic patients’ limbs, as indicated by increases in ASM and ASMI, compared to baseline measurements. In contrast, the Baduanjin group exhibited no significant changes. These findings align with previous research, which suggests that 12 weeks of resistance band training can notably enhance ASM and ASMI in elderly people with sarcopenia [22]. The lack of muscle mass improvement in the Baduanjin group is consistent with it being primarily an aerobic/balance exercise rather than a resistance-based intervention. Currently, few studies have investigated the effects of Baduanjin exercise on sarcopenia. A meta-analysis [31] revealed no significant difference in muscle mass improvement between the tai chi exercise group and the control group among frail and sarcopenic patients. Based on these results, it is hypothesized that resistance band training offered greater benefits in improving ALM than Baduanjin exercise, likely due to the higher load applied to limb muscles during resistance training. Herda et al [32] demonstrated in a RCT that 6 weeks of resistance band training can enhance ALM in older adults. A separate meta-analysis indicated that resistance band training (40–60 minutes per session, performed more than 3 times per week for 12 weeks) notably increased skeletal muscle mass in elderly sarcopenic patients. While the resistance band group showed significant improvements in ASM and ASMI compared to the control group, no substantial statistical differences were observed among the 3 exercise intervention groups. This may be due to the relatively short duration of the interventions – 12 weeks in total, with each session lasting only 30 minutes – less than the exercise duration used in other studies [33,34]. In the present study, the 30-minute session duration may have been insufficient for the mixed exercise group to show superior effects compared to 30 minutes of resistance training alone, as the combined regimen divided the time between 2 modalities. Consequently, no significant variations were observed across the 3 groups.

PHYSICAL FUNCTION:

Significant improvements in HGS were observed in the resistance band training and mixed exercise groups compared to the baseline and control group. This enhancement is likely due to the nature of resistance band training, where both hands must counteract the elastic retraction force of the bands. Similar results were reported by Seo et al [35], who found that resistance band training notably increased HGS in sarcopenic patients. Additionally, Liao et al [22] observed significant improvements in HGS among elderly women with sarcopenia after a 12-week regimen of resistance band training performed 3 times a week. Previous research has demonstrated that resistance exercise enhances skeletal muscle protein kinase B activity, which promotes GSK-3β phosphorylation and facilitates glucose uptake [36]. This mechanism may partially explain the improvements in HGS observed in our resistance band training group. In contrast, the Baduanjin group did not exhibit a significant improvement in HGS compared to the control group. This can be due to the specific nature of the Baduanjin exercise; aside from the “drawing the bow” and “clenching fists with an angry gaze” postures, the other 6 involve minimal finger engagement, with insufficient stimulation of the muscles responsible for HGS.

In the present study, resistance band training and mixed exercise regimens significantly enhance gait speed in individuals with sarcopenia. These findings align with previous studies. A RCT by Pablo et al [13] demonstrated that resistance band training performed 3 times per week over 12 weeks notably improved gait speed in sarcopenic patients. The instability inherent in resistance band training stimulates substantial muscle activation, thereby effectively targeting muscle groups during walking and posture maintenance. This mechanism is in line with the improved motor function observed in other elderly cohorts. Similarly, Villareal et al [37] reported that resistance training significantly enhanced gait speed among older adults. Conversely, a related study indicated that, compared to a non-exercise control group, TCE did not produce a significant improvement in gait speed in sarcopenic individuals [31], a result consistent with the gait speed performance observed in the Baduanjin group in the present study.

For the TUGT, the resistance band group had significantly greater improvement compared to the control group. This suggests that resistance band training exerts a stronger effect on lower-limb function. A detailed analysis of the movements reveals that during the TUGT, the gluteus maximus and quadriceps femoris contract concentrically to extend the hip and knee joints, raising the center of gravity. During walking, the primary force driving forward motion is generated by the contraction of the calf triceps and quadriceps femoris. Resistance band training specifically targets these muscle groups. Several studies showed that resistance exercise enhances knee extension strength in individuals with sarcopenia and frailty [38]. A meta-analysis indicated that lower-limb resistance exercises significantly improved performance on the functional reach test, which assesses dynamic balance. Furthermore, muscle strength plays a vital role in postural stability. Resistance training increases both muscle volume and the content of contractile proteins in the elderly, with the most substantial gains occurring in type II muscle fibers. This enhances reaction speed, balance, and neuromuscular function in older adults [39]. Research has shown that training with elastic devices, such as bands or tubes, can increase the conduction velocity of motor units [40], likely due to the increased recruitment of fast motor units in elastic band exercises [13]. These factors likely contribute to the improved TUGT performance observed in the resistance band and mixed exercise groups in the present study.

Our study demonstrated significant changes in pre- and post-intervention SPPB scores across all 3 intervention groups. These results contrast with a prior study that reported no significant changes in short-term SPPB scores after 10 weeks of resistance training among elderly individuals in the early stages of sarcopenia [41]. The participants in the latter study included both elderly and young individuals with early-stage sarcopenia, with an average baseline SPPB score of 11.2 out of 12. Given that many participants had near-maximal scores, a ceiling effect was assumed. However, this effect did not apply to the elderly sarcopenic participants in the present study, who had lower baseline SPPB scores. Notably, in the standing balance subcomponent of the SPPB, the Baduanjin group showed significantly greater improvement compared to the control group. This can be attributed to emphasis of Baduanjin exercise on static balance training, incorporating movements such as lower-limb half squats and dynamic exercises, including the “drawing the bow” and “sway the head and shake the tail to dispel Xin Huo” to promote internal balance. These exercises focus on closed-chain lower-limb movements, which exert higher resistance, while even upper-limb resistance training requires lower-limb muscles to maintain static contraction. Studies have demonstrated that 12 weeks of TCE training can enhance the neuromuscular response in the lower limbs of elderly sarcopenic patients, reducing their neuromuscular response time during balance loss, and improving postural control [41]. Regarding the sit-to-stand test (SST) sub-item, no significant changes were observed in the Baduanjin group after the exercise intervention, consistent with previous research. Chia-Yu Huang et al [31] suggested that traditional exercises, such as tai chi, did not notably improve SST performance compared to controls. In contrast, significant differences were observed in both the resistance band and mixed exercise groups after the intervention, although no significant change was noted when compared to the control group. Silva et al [42] found that 12 weeks of resistance exercise significantly improved SST performance in elderly individuals with sarcopenia. The discrepancy with our findings may be attributed to the use of different evaluation systems: our study used a 4-point scale for the SST, whereas Silva et al measured performance in seconds. Had the SST been evaluated in seconds, the results might have aligned with those of Silva et al.

LIMITATIONS:

This study has several limitations. First, due to the sample characteristics, only community-dwelling participants without mobility impairments were included, limiting the generalizability of the results to elderly individuals with sarcopenia who are partially dependent on others for activities of daily living or are very frail. Second, the study did not control or record participants’ dietary intake (including protein, carbohydrates, lipids, and micronutrients), which could influence body composition and physical fitness. Third, due to the impact of the Covid-19 pandemic, no post-intervention follow-up assessments were conducted, preventing an evaluation of the long-term effects. Future research should extend the intervention duration, incorporate follow-up assessments, monitor nutrient intake, and include additional measures such as electromyography and immunomics to comprehensively explore the therapeutic effects and mechanisms of various exercise interventions on primary sarcopenia in the elderly, thereby providing further guidance for exercise prescriptions for sarcopenia.

Conclusions

This study demonstrates that distinct exercise modalities produce different benefits in sarcopenic patients. While resistance band training and mixed exercise were effective for augmenting skeletal muscle mass and overall physical function, Baduanjin exercise provided improvements in balance. Consequently, an optimal therapeutic approach should be multifaceted and goal-oriented: resistance band training could serve as an effective modality for combating muscle loss and general physical function, whereas Baduanjin exercise could be an essential adjunct for fall prevention.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.