Implementing an exercise intervention for sarcopenia in oldest-old nursing home residents: protocol for a pragmatic cluster-randomized controlled trial (SCOPE Study).

BACKGROUND: Sarcopenia is a progressive age-related condition characterized by loss of muscle mass, strength, and function, with particularly high prevalence among nursing home residents and the oldest-old population. Although exercise is a recognized non-pharmacological intervention, existing evidence has largely been generated in selected community-dwelling populations, limiting its applicability to vulnerable older adults in real-world long-term care settings. The SCOPE study (Sarcopenia Care in Oldest-old: a Pragmatic Exercise cluster-randomized controlled trial) evaluates the effectiveness and feasibility of caregiver-led modified Baduanjin, resistance training, and combined exercise interventions for sarcopenia management in nursing home residents. METHODS: This pragmatic, cluster-randomized controlled trial aims to recruit 104 residents aged ≥ 75 years with sarcopenia from a large nursing home in Hangzhou, China. Participants will be randomized by residential building into four groups: Modified Baduanjin Group, Resistance Training Group, Combined Exercise Group, and Control Group. The 48-week intervention will be delivered by trained caregivers using video-guided sessions, with phased reduction in specialist supervision. The primary outcome is a composite sarcopenia Z-score integrating handgrip strength, Short Physical Performance Battery, and appendicular skeletal muscle mass index. Secondary outcomes include functional mobility, balance, physical activity and sedentary behaviour, neuromuscular activation, questionnaire-based assessments, and saliva biological markers. Clinical events and care-dependency records will also be collected throughout the intervention and follow-up periods. Assessments will be conducted at baseline, week 12, week 24, week 48, and at 1 and 2 years post-intervention. DISCUSSION: The SCOPE study addresses the need for feasible and sustainable exercise interventions for sarcopenia in real-world nursing home settings. By integrating pragmatic caregiver-led delivery, multimodal outcome assessment, and long-term follow-up, this trial aims to inform exercise prescription, implementation feasibility, and potential mechanisms of adaptation in oldest-old nursing home residents. The findings are expected to support the development of scalable exercise intervention frameworks for sarcopenia management in long-term care facilities. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500107315).