In the 20th century, advances in public health and medicine nearly doubled the global average life expectancy at birth (LEB), increasing it from around 30 years in 1800 to approximately 67 years by 2000.¹ In South Korea, the proportion of individuals aged ≥65 years is projected to reach 19.2% and continue to increase, surpassing 20% by 2025, thereby marking the country’s transition to a “super-aged society” with over 20% of the population aged ≥65 years.² Additionally, the Organization for Economic Co-operation and Development average LEB decreased by 0.2 years compared to 2016, whereas South Korea’s LEB increased from 82.4 years in 2016 to 83.6 years in 2021.3 However, health life expectancy (HLY), defined as the period one can expect to live in good health excluding years lived with disease or injury, declined from 66.3 years in 2020 to 65.8 years in 2022. This decline can be attributed to the rising prevalence of chronic diseases, with cancer, cardiovascular diseases, pneumonia, and cerebrovascular diseases identified as the leading causes of death.⁴ Despite ongoing increases in LEB owing to advancements in medical technology and an aging population, a contrasting trend of declining HLY has been observed. Multimorbidity and frailty are key factors contributing to health deterioration in older adults.⁵

Aging is an inevitable physiological process characterized by a gradual decline in function across various body systems. Musculoskeletal degeneration is particularly pronounced, characterized by a reduction in bone density, loss of muscle mass, and joint degeneration, leading to decreased mobility and strength. Additionally, aging is often accompanied by neurological changes, especially in sensory systems, such as reduced sensitivity in proprioception, vestibular function, and tactile.⁶ These changes further impair balance and coordination, exacerbating difficulties in maintaining physical activity.⁷ This decline is directly associated with reduced physical functioning, rendering it increasingly challenging for older adults to engage in routine physical activities. Consequently, this leads to further reductions in physical activity levels, creating a vicious cycle.⁸ Physical inactivity accelerates muscle weakness and neuromuscular deficits, thereby increasing the risks of falls and frailty.^5,9 Thus, the health issues faced by older adults have shifted from an individual concern to a significant national priority.

To objectively evaluate the effectiveness of various group physical activity programs, statistically analyzing the research data and presenting evidence-based findings are essential. However, systematic reviews and meta-analyses on the outcomes of group physical activity programs in public health centers and branches are scarce. These facilities provide unique advantages, such as accessibility for underserved groups, cost-effectiveness, and integration into existing community health initiatives. Such characteristics make them ideal for implementing group physical activity programs, particularly for older adults who may face barriers to participating in private or specialized facilities. To the best of our knowledge, no analysis has been conducted based on a recognized International Classification of Functioning, Disability and Health (ICF) model, a standardized framework for comprehensively evaluating physical function, body structure, activities, participation, and environmental factors. The application of the ICF model allows for a multidimensional analysis of program effectiveness, distinguishing it from traditional evaluation methods by addressing not only physical improvements but also activity, participation, and environmental influences. Therefore, this study aimed to provide foundational data for the development of structured programs that can be implemented by public health centers and branches. Hence, a systematic review was conducted to analyze the frequency, intensity, time, type, and effectiveness of group programs for older adults in the community grounded in the ICF model.

1. Study design

This study was organized according to the PICOTS-SD format, commonly used in systematic reviews (Participation, Intervention, Comparisons, Outcomes, Timing of outcome measurement, Settings, Study Design). The participants (P) were adults engaged in programs at public health centers and branches. Intervention (I) involved a multicomponent group exercise program. Comparison (C) included pre- and post-intervention evaluations within the groups or between the intervention and control groups. Outcomes (O) focused on physical function changes, and timing (T) corresponded to the intervention duration. Settings (S) are defined as public health centers and branches serving as central hubs for community health programs, with facilities such as exercise rooms or community halls and access to medical and rehabilitation staff. The study design (SD) included randomized controlled trials, nonrandomized studies, and observational studies.

2. Database source and search

The scope of the literature included studies conducted within the last 10 years, focusing on physical activity programs applied in public health centers and branches in South Korea since 2015. This systematic review included only studies published in the Korean language. These studies were searched using the DBpia, e-Article, KISS, KMbase, RISS, and Scholar databases. Inclusion and exclusion criteria were applied to ensure objectivity, and the authors reviewed the materials together. The main search keywords included “public health center” AND “physical activity,” “public health center” AND “exercise,” “public health center” AND “program,” “public health center branch” AND “physical activity,” “public health center branch” AND “exercise,” and “public health center branch” AND “program.” Titles and abstracts were screened to select relevant studies.

3. Inclusion and exclusion criteria

The inclusion criteria were as follows: studies implementing multicomponent group exercise intervention programs focused on public health centers or branches; studies with an experimental intervention period of at least 4 weeks; and studies in which each sample size of the experimental group, control group, or comparison group included at least 10 participants. The exclusion criteria were as follows: studies conducted in facilities outside public health centers or branches; studies that did not use evaluation tools related to physical function; and dissertations, books, posters, reviews, and meta-analyses.

4. Literature selection process

A total of 1,804 studies were identified through an initial literature search of six databases (DBpia, e-Article, KISS, KMbase, RISS, and Scholar). After excluding 1,144 duplicate articles, 660 were included in the final selection. The titles and abstracts of 660 articles were reviewed, and 617 studies that did not meet the inclusion or exclusion criteria were eliminated, leaving 43 articles for further review. After reviewing the full text of the selected articles, 34 were excluded, and nine studies were ultimately selected for the final review (Figure 1).

Fig. 1. PRISMA flowchart diagram.

5. Quality assessment

This study analyzed evidence levels in five stages using the evidence-based medicine quality level analysis model developed by Arbesman et al.¹⁰ ROB 2.0 is designed to assess the risk of bias in randomized studies and evaluates five domains. Each domain is assessed using an algorithm that classifies the risk of bias as “low,” “some concerns,” or “high.” RoBANS 2, a tool for evaluating the risk of bias in nonrandomized studies, consists of eight domains. The risk of bias in these domains is classified as “low,” “high,” or “unclear.” The researchers independently performed quality assessments, reviewed the consistency of their evaluations, and discussed any discrepancies in determining the risk of bias. The criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions and Handbook for Clinical Practice Guideline Developer, version 2.0 were followed.^11,12

1. Quality assessment

The quality levels of the nine studies analyzed in this research were as follows.^13-21 Levels I, II, and III included two (22.2%)13,18, two (22.2%)19,21, and five studies (55.6%), respectively (Table 1).^14-17,20 No studies at Levels IV or V were identified (0%). The risk of bias for the two randomized controlled trials was assessed using the ROB 2.0 tool^13,18, whereas the risk of bias for the seven non-randomized studies was evaluated using the RoBANS 2 tool (Figure 2).^14-17,19-21

Table 1

The structure and delivery of community-based programs

Study	Participants	Intervention	Comparison	Outcomes	Level of evidence
Jung (2015)	Elderly (48) CG: only female, mean age 67.37± 1.97 IG: only female, mean age 68.33± 2.31	Duration: 12 wk Frequency: 60 min, 3/wk Intensity: AE (30-60%HRmax), RT (60%1RM) Component (min): WU (5), AE, RT (50), CD (5)	NR	Body structure: ↓BW*‡, ↓PBF*‡, ↑SMM*‡, ↓BMI*†‡ Body function: ↑HGST*‡, ↑BST* Activity: ↑30CST*‡, ↑6MWT*†‡, →OLST	Ⅰ
Son et al. (2016)	Disabled elderly (40): Physical disability (19), Disability of brain lesion (21) 45% female, mean age NR	Duration: 12 wk Frequency: 40 min, 2/wk Component (min): WU (5), RT, BT (30), CD (5)	-	Body function: ↑GDSSF-K* Activity: ↑4SBT*, ↑30CST*, ↑FRT*, ↓TUG*, ↑WHOQOL-BREF*	Ⅲ
Han and Kim (2016)	Elderly (65) Only female, mean age 75.6± 6.79	Duration: 36 wk Frequency: 60 min, 3/wk Component (min): Recreation exercise (NR)	-	Body structure: ↑BDM* Body function: ↑HGST*, ↑SRT*	Ⅲ
Ko et al. (2017)	Individuals with chronic disease (33): HTN (21), DM (8), HTN+DM (4) 69.7% female, mean age 66.03± 5.68	Duration: 8 wk Frequency: 60 min, 2/wk Intensity: RPE 13-17 Component (min): WU (5), AE (10), RT (45), CD (10)	-	Body structure: ↓BW*, ↓BMI*, ↓WC*, ↓HC*, ↓FFM*, →SMM, ↓PBF*, ↓SBP*, ↓DBP*, →BG, ↓TC*, ↓TG*, ↑HDL-C*, ↓LDL-C*, ↓HbA1c* Body function: ↑HGST*, ↑SRT* Activity: ↑30CST*, ↓TUG*, ↓F8WT*, ↑6MWT*	Ⅲ
Kim and Heo (2018)	Elderly (20) 60% female, mean age 73.55± 1.90	Duration: 5 wk Frequency: 60 min, 2/wk Component (min): WU (10), BT (45), CD (5)	-	Activity: Romberg test (↓EO-L*, ↓EO-AS*, ↓EC-L*, ↓EC-AS*), ↑FRT, ↑BPT*, ↓TUG*	Ⅲ
Ju and Bang (2018)	Elderly stroke patients (30) CG (15): 40.0% female, mean age 71.7 IG (15): 46.7% female, mean age 71.9	Duration: 12 wk Frequency: 90 min, 1/wk Component (min): WU (5), BT (30), CD (5), CT (40)	Duration: 12 wk Frequency: 90 min, 1/wk Component (min): PM (40), break (10), PA (40)	Body function: ↑LOTCA-G*‡, ↓BDI*‡ Activity: ↑WMFT-K (FAS)*‡, ↓WMFT-K (PT)*‡, ↑BBS*‡	Ⅰ
Kim and Kim (2020)	Elderly (22) Only female, mean age NR	Duration: 12 wk Frequency: 60 min, 3/wk Intensity: RPE 13-14 (1-6 wk), RPE 15-16 (7-12 wk) Component (min): WU (10), RT (40) or AE (40), CD (10)	Standard care	Body structure: →BW, ↓BFM†, ↑FFM† Body function: ↑AC*†‡, ↑SRT†‡, ↑MMSE-DS†‡, ↓GDSSF-K‡Activity: ↑30CST*‡, ↑2MST*‡, ↓8UG‡, ↑OLST‡	Ⅱ
Park et al. (2021)	Adult (17) 52.94% female, mean age NR	Duration: 4 wk Frequency: 60 min, 1/wk Component(min): FL (NR), BE (NR), RT (NR), FL(NR)	-	Body function: →FVC, →FEV1, →FEV1/FVC, →MIP, →MEP, →PCF Activity: ↓TUG*, ↓FTSST*	Ⅲ
Park et al. (2021)	Individuals with metabolic syndrome (150) Only female LE (30): mean age 55.9±6.5 ME (60): mean age 56± 5.8 HE (60): mean age 55.9± 5.5	Duration (GE): 12 wk Frequency: 80 min, 1/wk Intensity: NR Component: WU, FL, RT, AE (50 min), Education (30 min) Duration (PE): 12 wk Frequency: 50 min, 5/wk Intensity: 40-55%HRR or RPE 12-13 Component: AE (50 min), RT (NR)	Same	Body structure: ↓BFM (ME, HE)* (LE vs. HE)‡, →WC (LE, ME, HE)*, ↓SBP (ME, HE)*(LE vs. HE)‡, ↓DBP (ME, HE)*, →FBS, ↓TG (LE, ME, HE)*(LE vs. ME, LE vs. HE)‡, ↑HDL-C (HE)*(LE vs. HE)‡Body functions: ↑HGST (ME, HE)*, ↑SRT (LE, ME, HE)*(LE vs. HE)‡, ↑CU (LE, ME, HE)*(LE vs. ME, LE vs. HE)‡	Ⅱ

2MST: 2 Minute step test, 30CST: 30-Second chair test, 4SBT: 4-Stage balance test, 6MWT: 6-Minute walk test, 8UG: 8-Foot up and go, AC: Arm curl, AE: Aerobic exercise, AS: Average speed, BBS: Berg balance scale, BDI: Beck depression inventory, BDM: Bone density mass, BE: Breathing exercise, BFM: Body fat mass, BG: Blood glucose, BMD: Bone mineral density, BMI: Body mass index, BPT: Balance pad test, BST: Back scratch test, BT: Balance training, BW: Body weight, CD: Cool down, CG: Control group, CT: Cognitive training, CU: Curl up, DBP: Diastolic blood pressure, DM: Diabetes mellitus, EC: Eyes closed, EO: Eyes open, F8WT: Figure of 8 walk test, FBS: Fasting blood sugar, FFM: Fat free mass, FL: Flexibility, FEV1: Forced expiratory volume in 1 second, FRT: Functional reach test, FTSST: Five times sit to stand test, FVC: Forced vital capacity, GDSSF-K: Geriatric depression scale short form-Korean version, HbA1c: Hemoglobin A1c, HC: Hip circumference, HDL-C: High density lipoprotein cholesterol, HE: High frequency exercise group, HGST: Hand grip strength test, HTN: Hypertension, IG: Intervention group, L: Length, LDL-C: Low density lipoprotein cholesterol, LE: Low frequency exercise group, LOTCA-G: Lowenstein occupational therapy cognitive assessment-geriatric population, ME: Middle frequency exercise group, MEP: Maximal expiratory pressure, MIP: Maximal inspiratory pressure, MMSE-DS: Mini mental state examination-dementia screening, NR: Not reported, OLST: One leg standing test, PA: Physical activity, PBF: Percentage body fat, PCF: Peak cough flow, PM: Physical modality, RT: Resistance training, SBP: Systolic blood pressure, SMM: Skeletal muscle mass, SRT: Sit-and-reach test, TC: Total cholesterol, TG: Triglyceride, TUG: Timed up and go, WC: Waist circumference, WHOQOL-BREF: Who quality of life-BREF, WMFT-K: Wolf motor function test-Korean, WU: Warm-up.

↑: significantly increased, →: no change, ↓: significantly decreased, level of significance (p<0.05). *significant within-group change from pre to post in intervention group, ^†change in intervention group significantly lager than change in CG group, ^‡significant interaction effect between groups and time points.

Fig. 2. Risk of bias.

2. General characteristics

Nine studies were included based on the selection criteria. Of these, six studies were published between 2015 and 2019, and three studies were published from 2020 to 2024. Regarding the academic fields of the researchers, four studies were in sports science, two in physical therapy, two in occupational therapy, and one in nursing. Regarding participant demographics, five studies included both male and female participants, whereas four studies focused solely on female participants. However, no study has focused exclusively on male participants. The age criteria of the participants varied, with two studies including participants aged ≥60 years, one study including those aged ≥65 years, one study including participants aged ≥70 years, one study including participants aged 40–64 years, one study including participants aged 60–70 years, and three studies not specifying an exact age criterion. The sample sizes varied, with three studies having fewer than 30 participants and six studies having ≥30 participants. Only one study was approved by the institutional review board. The general characteristics of the participants are summarized in Table 2.

Table 2

General characteristics and methodology

Variable	Category	n	Study
Publication year	2015-2019	6	Jung YS (2015), Son BY et al. (2016), Han H and Kim J (2016), Ko SH et al. (2017), Kim C and Heo J (2018), Ju A and Bang S (2018)
	2020-2024	3	Kim C and Kim H (2020), Park TS et al. (2021), Park BM et al. (2021)
Major field of researchers	Sports science	4	Jung YS (2015), Han H and Kim J (2016), Ko SH et al. (2017), Kim C and Kim H (2020)
	Physical therapy	2	Kim C and Heo J (2018), Park TS (2021)
	Occupational therapy	2	Son BY et al. (2016), Ju A and Bang S (2018)
	Nursing	1	Park BM et al. (2021)
Gender of participants	Women and men	5	Son BY (2016), Ju A and Bang S (2018), Ko SH et al. (2017), Park TS (2021), Kim C and Heo J (2018)
	Only women	4	Jung YS (2015), Han H and Kim J (2016), Kim C and Kim H (2020), Park BM et al. (2021)
Age criteria of sample	Over 60 years	2	Son BY et al. (2016), Han H and Kim J (2016)
	Over 65 years	1	Jung YS (2015)
	Over 70 years	1	Kim C and Heo J (2018)
	40-64	1	Park BM et al. (2021)
	60-70	1	Kim C and Kim H (2020)
	Not described	3	Ko SH et al. (2017), Ju A and Bang S (2018), Park TS et al. (2021)
Sample size	Under 30	3	Kim C and Heo J (2018), Kim C and Kim H (2020), Park TS et al. (2021)
	Over 30	6	Jung YS (2015), Son BY et al. (2016), Han H and Kim J (2016), Ko SH et al. (2017), Ju A and Bang S (2018), Park BM et al. (2021)
Institutional review board	Approved	1	Park BM et al. (2021)
	Not approved	8	Jung YS (2015), Son BY et al. (2016), Han H and Kim J (2016), Ko SH et al. (2017), Kim C and Heo J (2018), Ju A and Bang S (2018), Kim C and Kim H (2020), Park TS et al. (2021)
Frequency of exercise	Once a week	3	Ju A and Bang S (2018), Park TS et al. (2021), Park BM et al. (2021)
	Twice a week	3	Son BY et al. (2016), Ko SH et al. (2017), Kim C and Heo J (2018)
	Three times per week	3	Jung YS (2015), Han and Kim (2016), Kim C and Kim H (2020)
Intensity of exercise	Described	3	Jung YS (2015), Ko SH et al. (2017), Kim C and Kim H (2020)
	Not described	6	Son BY et al. (2016), Han and Kim (2016), Kim C and Heo J (2018), Ju A and Bang S (2018), Park TS et al. (2021), Park BM et al. (2021)
Time of one session	≥ 60 Minutes	8	Jung YS (2015), Han and Kim (2016), Ko SH et al. (2017), Kim C and Heo J (2018), Ju A and Bang S (2018), Kim C and Kim H (2020), Park TS et al. (2021), Park BM et al. (2021)
	< 60 Minutes	1	Son BY et al.(2016)
Duration of exercise program	4 Weeks	1	Park TS et al. (2021)
	5 Weeks	1	Kim C and Heo J (2018)
	8 Weeks	1	Ko SH et al. (2017)
	12 Weeks	5	Jung YS (2015), Son BY et al. (2016), Ko SH et al. (2017), Kim C and Kim H (2020), Park TS et al. (2021)
	36 Weeks	1	Han H and Kim J (2016)
Composition of exercise program	Warmup	7	Jung YS (2015), Son BY et al. (2016), Ko SH et al. (2017), Kim C and Heo J (2018), Ju A and Bang S (2018), Kim C and Kim H (2020), Park BM et al. (2021)
	Flexibility exercise	2	Park TS et al. (2021), Park BM et al. (2021)
	Resistance exercise	5	Jung YS (2015), Son BY et al. (2016), Ko SH et al. (2017), Kim C and Kim H (2020), Park BM et al. (2021)
	Aerobic exercise	4	Jung YS (2015), Ko SH et al. (2017), Kim C and Kim H (2020), Park BM et al. (2021)
	Neuromotor exercise	3	Son BY et al. (2016), Kim C and Heo J (2018), Ju A and Bang S (2018)
	Cooldown	6	Jung YS (2015), Son BY et al. (2016), Ko SH et al. (2017), Kim G and Heo M (2018), Ju E and Bang Y (2018), Kim C and Kim H (2020)
	Other	4	Han H and Kim J (2016), Ju E and Bang Y (2018), Park TS et al. (2021), Park BM et al. (2021)
Program facilitator	Trained instructor	4	Jung YS (2015), Han H and Kim J (2016), Ko SH et al. (2017), Park BM et al. (2021)
	Occupational therapist	2	Son BY et al. (2016), Ju E and Bang Y (2018)
	Physical therapist	1	Park TS et al. (2021)
	Not described	2	Kim G and Heo M (2018), Kim C and Kim H (2020)

3. Program characteristics

The exercise interventions in the selected studies were analyzed based on the key components essential for exercise programs, including frequency, intensity, duration, type, and program facilitators. In terms of exercise frequency, three studies implemented exercise sessions once per week, three studies implemented sessions twice per week, and three studies implemented sessions three times per week. Exercise intensity was reported in three studies, with two studies using the rate of perceived exertion^16,19 and one study using the maximal heart rate (HRmax).¹³ The exercise duration was ≥60 minutes per session in eight studies. The most common exercise period was 12 weeks (five studies), followed by 36, 8, 5, and 4 weeks, each represented by one study. The types of exercise included warm-up (seven studies), stretching (two studies), resistance training (six studies), aerobic exercise (four studies), balance training (three studies), breathing exercises (one study)20, and cool-down (six studies). Eight studies focused solely on physical activity, whereas one study integrated both physical activity programs and educational components. Program facilitators included trained instructors in four studies, occupational therapists in two studies, and physical therapists in one study, with no facilitator specified in two studies. The characteristics of the program are summarized in Table 2.

4. Analysis of outcome measurement variables

The outcome measurement variables in the selected studies were analyzed according to ICF components, specifically body function, structure, activity, and participation (Table 3). “Body function” pertains to the classification of physiological functions of the body, whereas “body structure” refers to the classification of anatomical structures. “Activity and participation” refers to aspects such as performance of daily activities, task execution, and fulfillment of social roles.²²

Table 3

Characteristics of research outcome

Domain	Variable	n	Study
Body structure	Blood glucose	1	Ko SH et al. (2017)
	Body fat mass	3	Ko SH et al. (2017), Kim C and Kim H (2020), Park BM et al. (2021)
	Body mass index	2	Jung YS (2015), Ko SH et al. (2017)
	Body weight	3	Jung YS (2015), Ko SH et al. (2017), Kim C and Kim H (2020)
	Bone density mass	1	Han H and Kim J (2016)
	Diastolic blood pressure	2	Ko SH et al. (2017), Park BM et al. (2021)
	Fasting blood sugar	1	Park BM et al. (2021)
	Fat-free mass	2	Ko SH et al. (2017), Kim C and Kim H (2020)
	Hemoglobin A1c	1	Ko SH et al. (2017)
	High-density lipoprotein cholesterol	2	Ko SH et al. (2017), Park BM et al. (2021)
	Hip circumference	1	Ko SH et al. (2017)
	Low-density lipoprotein cholesterol	1	Ko SH et al. (2017)
	Percentage body fat	2	Jung YS (2015), Ko SH et al. (2017)
	Skeletal muscle mass	2	Jung YS (2015), Ko SH et al. (2017)
	Systolic blood pressure	2	Ko SH et al. (2017), Park BM et al. (2021)
	Total cholesterol	1	Ko SH et al. (2017)
	Triglyceride	2	Ko SH et al. (2017), Park BM et al. (2021)
	Waist circumference	2	Ko SH et al. (2017), Park BM et al. (2021)
Body function	Arm curl	1	Kim C and Kim H (2020)
	Back scratch test	1	Jung YS (2015)
	Beck depression inventory	1	Ju A and Bang S (2018)
	Curl up	1	Park BM et al. (2021)
	Forced expiratory volume in 1 second	1	Park TS et al. (2021)
	Forced expiratory volume in 1 second/forced vital capacity	1	Park TS et al. (2021)
	Forced vital capacity	1	Park TS et al. (2021)
	Geriatric depression scale short form - Korean	2	Son BY et al. (2016), Kim C and Kim H (2020)
	Hand grip strength test	4	Jung YS (2015), Han H and Kim J (2016), Ko SH et al. (2017), Park BM et al. (2021)
	Lowenstein occupational therapy cognitive assessment - geriatric population	1	Ju A and Bang S (2018)
	Maximal expiratory pressure	1	Park TS et al. (2021)
	Maximal inspiratory pressure	1	Park TS et al. (2021)
	Mini mental state examination - dementia screening	1	Kim C and Kim H (2020)
	Peak cough flow	1	Park TS et al (2021)
	Sit-and-reach test	4	Han H and Kim J (2016), Ko SH et al. (2017), Kim C and Kim H (2020), Park BM et al. (2021)
Activity	2 Minute step test	1	Kim C and Kim H (2020)
	30-Second chair test	4	Jung YS (2015), Son BY et al. (2016), Ko SH et al. (2017), Kim C and Kim H (2020)
	4-Stage balance test	1	Son BY et al. (2016)
	6-Minute walk test	2	Jung YS (2015), Ko SH et al. (2017)
	8-Foot up and go	1	Kim C and Kim H (2020)
	Balance pad test	1	Kim C and Heo J (2018)
	Berg balance scale	1	Ju A and Bang S (2018)
	Figure of 8 walk test	1	Ko SH et al. (2017)
	Five times sit to stand test	1	Park TS et al. (2021)
	Functional reach test	2	Son BY et al. (2016), Kim C and Heo J (2018)
	One leg standing test	2	Jung YS (2015), Kim C and Kim H (2020)
	Romberg test	1	Kim C and Heo J (2018)

1) Body function and structure

Body composition was primarily assessed through body weight (BW) and body fat mass (BFM), as reported in three studies. Systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C) levels were reported in two studies. Strength and flexibility were the most commonly measured body function variables (five studies each), followed by depression (three studies), cognitive function (two studies), and respiratory function (one study). The most frequently used assessment tools were the hand grip strength test (HGST) and sit-and-reach test (SRT), each evaluated in four studies.

2) Activity and participation

In the activity domain, the 30-second chair stand test (30CST) and timed up-and-go test (TUG) were each assessed in four studies, whereas the 6-minute walk test (6MWT), one-leg standing test (OLST), and functional reach test (FRT) were each measured in two studies.

5. Outcome analysis

When analyzing the effects of the physical activity program on aspects of body structure, improvements were reported in studies on BFM (three studies), BW (two studies), BMI (two studies), and HDL-C (two studies). Additionally, among the physiological indicators, strength and flexibility showed improvements in four studies each, with the HGST and SRT being the most frequently measured. Improvements in depression and cognitive function were confirmed in one study each using the Beck Depression Inventory, Loewenstein Occupational Therapy Cognitive Assessment for Geriatrics, and Mini-Mental State Examination for Dementia Screening in terms of depression and cognitive function. However, the positive effects of the Geriatric Depression Scale-Short Form-Korean version were demonstrated in two studies. In the activity domain, improvements were observed in four studies each for the 30CST and TUG, whereas the 6MWT and FRT demonstrated effectiveness in two studies each.

This study was conducted to analyze the effectiveness of group exercise programs implemented in public health centers and branches through a systematic review based on the ICF model. By examining these programs, the study aimed to identify key components of group exercise programs targeting older adults in the community and propose effective elements for their implementation.

Regarding body composition, in a meta-analysis by Gonzalez-Rocha et al.²³, a reduction of 3.7kg in body fat and a 2.1% decrease in the percentage of body fat (PBF) were reported in studies involving resistance exercise interventions. These results align with the findings of Jung¹³ and Ko et al.¹⁶ in this review, both of which included resistance exercises and demonstrated reductions in PBF. These findings further support the effectiveness of resistance training in reducing body fat. Furthermore, although Jung¹³ observed increases in skeletal muscle mass (SMM), Ko et al.¹⁶ have reported no significant changes in muscle mass. According to a meta-analysis by Schoenfeld et al.²⁴, greater increases in SMM are associated with more weekly resistance exercise sets. Consistent with this, Jung¹³, whose study involved a relatively high weekly exercise frequency, has reported increased SMM.

In blood-related body functions, in studies by Ko et al.¹⁶ and Park et al.²¹, significant increases in HDL-C levels and reductions in TG levels were observed after group exercise interventions. This aligns with the findings of Marques et al.²⁵, who have reported increased HDL-C levels (9.3%, p<0.001) and reduced TG levels (−5.1%, p=0.006) after an 8-month combined exercise intervention in elderly women. Although numerical differences were observed, the effects were consistent across studies. Considering that three studies primarily involved elderly female participants, combined exercise interventions may be effective in reducing the risk factors of metabolic diseases in elderly women. Furthermore, three studies showed reductions in SBP and DBP following participants’ involvement in exercise programs. According to a meta-analysis by Herrod et al.²⁶, combined exercise interventions reduced SBP by 5.86mmHg (95% confidence interval [CI], −8.27 to −3.45, I2=73.2%, p=0.000) and DBP by 3.51mmHg (95% CI, −4.43 to −2.59, I2=43.3%, p=0.048), without significant additional benefit observed in extending exercise durations beyond 3 months.²⁶ These findings could help determine intervention duration in exercise programs aimed at blood pressure control.

The HGST scores showed significant improvements in four studies. Grip strength (GS) is associated with health behavior, mental health, functional disabilities, morbidity, mortality, and hospitalization.²⁷ A 1-lb annual reduction in GS increases the risk of Alzheimer’s disease by 9%28, whereas a decrease of 1 SD in GS raises the risk of depression by approximately 15%.²⁹ According to McGrath et al.³⁰, every 5 kg reduction in GS results in limitations in daily activities, including 20% in eating, 14% in walking, 9% in bathing, and 6% in toilet use. In this review, GS was assessed in four of the nine studies, underscoring its importance in exercise programs for the elderly, particularly as a key component of group exercise interventions.

As for the results regarding activity level, the 30CST showed improvements in four studies included in this review, all of which incorporated strength training into their group intervention programs. According to Schot et al.³¹, after an 8-week strength training program involving 38 older adults, peak forward, downward, and upward velocities increased during the sit-to-stand motion, and the relative transition time demonstrated a delay, indicating a more efficient standing strategy. Lord et al.³² have suggested that the 30CST indicates not only strength but also endurance, balance, and mobility, recommending that exercise programs for older adults include interventions to improve sit-to-stand performance.

TUG test was used in four studies, and one study used the 8-foot up-and-go test, all of which showed significant improvements. In a meta-analysis by Lu et al.³³, resistance and mixed exercise interventions also improved TUG performance in the experimental groups (standardized mean difference=−0.66, 95% CI, −0.94 to −0.38, p< 0.00001, I2=60%). For older adults, the TUG is a crucial activity level assessment tool, serving as a strong predictor of limitations in ADL, instrumental activities of daily living³⁴, and fall risk, and decline in global health.³⁵ Poorer TUG outcomes are associated with an increased mortality risk.³⁶ The TUG test are highly valuable for assessing activity and participation levels, as they require minimal equipment or space and provide extensive information quickly. Structured group exercise programs may be beneficial for improving TUG test performance in older adults.

The FRT showed significant improvements in two studies, whereas OLST yielded mixed results. Kim and Kim¹⁹ observed a significant interaction effect in the intervention group compared with the control group, whereas Jung¹³ identified no difference. Although both the FRT and OLST are commonly used to assess balance in older adults, they differ in focus. FRT measures functional stability limits and anticipatory postural control, whereas OLST is more related to static stability.³⁷ According to a systematic review by Omaña et al.³⁸, FRT has higher sensitivity and specificity (0.73, 0.88) for fall prediction in community-dwelling adults aged ≥60 years than OLST (0.51, 0.61). As fall risk is a critical concern in older adults, using the FRT as an outcome measure may be more effective for predicting fall risk than the OLST, except when evaluating specific aspects of balance.

The 6MWT showed significant improvements in two studies that applied a combined exercise intervention. Similarly, Levy et al.³⁹ have reported a significant group×time interaction effect and main effects of time and group after applying a community-based combined exercise program twice weekly for 3 months, favoring the intervention group over the control group. The 6MWT has shown moderate correlations with gait speed (r=−0.73), standing balance (r=0.52), and chair stand performance (r=0.67).⁴⁰ Furthermore, the 6MWT is associated with not only physical function but also quality of life in older adults.⁴¹ Therefore, for community-dwelling older adults, the 6MWT is recommended as a test that covers a broad spectrum within the ICF, effectively assessing intervention effects on activity and participation levels.

In all the studies included in this review, 51 assessments were conducted at the body structure and function level, whereas 23 assessments were conducted at the activity and participation levels, indicating a higher emphasis on body structure and function. Future research should prioritize interventions and evaluations focused on activity and participation levels over individual elements of the body structure. Additionally, only three of the nine studies met the World Health Organization guidelines for older adults^13,15,19, which recommend at least 150 minutes of moderate-intensity or 75 minutes of high-intensity aerobic exercise per week, along with strength training 2–3 days per week. Greater adherence to these guidelines is recommended when planning structured programs. Finally, Rimmer²² has highlighted the importance of considering personal factors from the ICF model, such as motivation and self-efficacy, when designing physical activity programs. The authors of this study agree with this perspective, emphasizing that considering both personal and environmental factors in exercise programs for older adults may enhance participation and outcomes.

This systematic review demonstrates that group exercise programs implemented at public health centers and branches offer substantial physical and psychological benefits to older adults. Key improvements in body composition, strength, flexibility, and overall physical function were noted, all of which are essential for maintaining mobility and independence. Additionally, these programs positively impact mental health by reducing symptoms of depression and enhancing cognitive function, thus addressing critical areas of well-being in the aging population.

Future research should explore the optimal program duration and intensity based on age, gender and health condition to maximize these benefits and promote healthier and more active aging communities. Additionally, policy support will likely be necessary to implement these programs in a sustainable manner, rather than as one-time interventions. In closing, this review is expected to provide foundational data for developing effective group programs for older adults and individuals with chronic diseases, which physical therapists can utilize in public health centers and community settings.

This study was funded by the Seoul Physical Therapy Association as part of its 2023 Policy Research Project, titled “Community-Based Rehabilitation Research and Lectures on Musculoskeletal Problem-Solving.”