Effects of a 12-week unsupervised and adapted physical activity prescription on physical per-formance in geriatric outpatients with overweight or obesity: the PACE tool

Background: Sarcopenia and obesity often coexist in older adults and are associated with high-er functional decline, disability, and reduced quality of life. Although physical activity (PA) is protective, prescription and adherence to exercise programs remains low in this population. Pragmatic and scalable interventions are therefore needed. Thus, we evaluated the effects of a 12-week unsupervised PA prescription program on physical performance in overweight/obese frail geriatric outpatients. Methods: A single-arm interventional study was conducted among geriatric outpatients aged over 60 years. Thirty-seven overweight/obese participants (20 women) completed the 12-week home-based PACE prescription which included individualized functional and resistance exercises with walking. Physical performance [i.e. functional capacity (SPPB), walking speed, Timed Up and Go (TUG), lower-limb muscle endurance (30-STS) and function (5-STS)], clinical status (probable sarcopenia, fall risk, walking speed) and clinically meaningful changes were assessed. Results: Participants achieved 238 min/week of PA on average, with 65% meeting recommended PA guidelines. Significant improvements were observed in lower-limb muscle function (p=0.033) and endurance (p=0.006) and in absolute (p=0.038) or relative (p=0.045) estimated muscle power. The prevalence of probable sarcopenia decreased significantly following the intervention (p=0.011). Clinically meaningful improvements were observed in muscle endurance (p<0.001) and functional status (p=0.040). Conclusion: In overweight/obese frail geriatric outpatients, the prescription of PACE achieved high PA adherence and improved lower-limb muscle function. Integrating this pragmatic and personalized PA strategy into routine geriatric care may support healthy aging and help prevent sarcopenia-obesity related functional decline.