Feasibility and preliminary effects of music-enhanced calisthenic exercise in healthy sedentary older adults: a randomized controlled pilot study| JOURNAL OF GERONTOLOGY AND GERIATRICS

Abstract

Objective. Physical inactivity in older adults is associated with decreased mobility, functional decline, and reduced quality of life. Music may enhance exercise engagement and adherence. This pilot randomized controlled trial evaluated the feasibility of a music-enhanced calisthenic exercise program in residential care homes and explored its preliminary effects on functional and psychosocial outcomes.
Methods. Thirty-one healthy, sedentary older adults (mean age = 74.4 ± 5.9 years) were randomly assigned to a Calisthenic Exercise Group (CEG), a Music-Enhanced Calisthenic Exercise Group (MCEG), or a Control Group (CG). Intervention groups completed 16 supervised sessions over 8 weeks. The MCEG performed exercises with rhythmic music. Feasibility outcomes included recruitment, retention, adherence, and adverse events. Functional outcomes were assessed using the Timed Up and Go (TUG), 30-Second Sit-to-Stand test, and Joint Position Sense test; health-related quality of life was measured using the Nottingham Health Profile (NHP).
Results. Recruitment was 96.9%, retention 100%, and adherence 87.5%. No adverse events occurred. Both intervention groups improved significantly compared with the CG (p = 0.001), with larger effects in the MCEG, particularly in proprioception (p = 0.002, d = 1.46). TUG scores improved by 17% (p = 0.004, d = 0.26).
Conclusions. Music-enhanced calisthenic exercise was feasible, safe, and well tolerated. Preliminary findings indicate benefits for physical function and health-related quality of life, supporting the need for larger trials. Trial Registration. ClinicalTrials.gov Identifier: NCT06973538 (retrospectively registered)

INTRODUCTION

Aging is accompanied by changes in physical and health domains that can affect quality of life ¹. Regular physical activity supports functional independence, reduces morbidity, and improves overall performance in older adults ^2,3. Calisthenic exercises, which use body weight for resistance, are cost-effective and well suited for older populations ⁴. Music may further enhance exercise outcomes by improving mood, reducing perceived exertion, and increasing engagement.⁵

Before applying these approaches widely in residential care, their feasibility, safety, and acceptability should be evaluated. Therefore, this randomized controlled pilot study aimed to assess the feasibility and preliminary effects of calisthenic exercises-with and without music –on physical performance and health-related quality of life in older adults.

METHODS

PARTICIPANTS

Of the 32 individuals assessed for eligibility, one participant passed away due to causes unrelated to the study after completing baseline assessments but before randomization. Consequently, 31 healthy, sedentary older adults (mean age = 74.41 ± 5.86 years) were randomized into three groups (Fig. 1). Participants were recruited from local senior centers in Niğde and Isparta, Turkey. Inclusion criteria were (1) age ≥ 65 years, (2) medical clearance for exercise from the facility physician, and (3) provision of written informed consent. The intervention was delivered by a licensed physiotherapist experienced in exercise instruction. No additional eligibility requirements – such as specialization in geriatrics or a minimum number of years of experience – were applied to the interventionist. No participants were lost to follow-up, and outcome data were available for all 31 participants: 10 in the CEG, 9 in the MCEG, and 12 in the CG. Recruitment began on May 8, 2023, and follow-up concluded on September 18, 2023.

TRIAL DESIGN

This three-arm, parallel-group, randomized controlled pilot trial used a 1:1:1 allocation ratio and a superiority framework. The primary aim was to evaluate the feasibility and acceptability of music-enhanced calisthenic exercise in residential care. The secondary aim was to explore the preliminary effects on physical performance and health-related quality of life. The study was not powered for formal hypothesis testing; instead, results were intended to guide a future definitive trial.

Feasibility outcomes included recruitment rate, retention, adherence, and adverse events over the 8-week intervention. Attendance was calculated as the proportion of sessions attended out of 16 for each participant. Adherence was the average attendance across both intervention groups. Group-specific attendance rates were not analyzed, and no standardized enjoyment or motivation questionnaires were used; instead, informal verbal feedback was noted by the physiotherapist. Preliminary effectiveness outcomes included the TUG test, 30-Second Sit-to-Stand test, Joint Position Sense test, and the NHP, assessed at baseline and post-intervention. No predefined thresholds were set for progression to a full trial, and progression criteria were not prespecified.

SAMPLE SIZE ESTIMATION

This study was designed as a pilot controlled trial; therefore, no formal sample size calculation for effectiveness was performed. Instead, the sample size (approximately 9-12 participants per group) was chosen to enable feasibility assessment and to provide preliminary estimates of outcome variability to inform future trials. Ultimately, 31 participants were recruited across three groups. All hypothesis tests were considered exploratory.

RANDOMIZATION AND BLINDING

Following baseline assessments and the provision of informed consent, participants were randomly assigned to one of three groups: 10 to the CEG, 9 to the MCEG, and 12 to the CG. Simple randomization without restrictions (e.g., blocking or stratification) was conducted using a Microsoft Excel-generated sequence by the principal investigator, who also enrolled participants and had full access to the allocation sequence. Consequently, no allocation concealment methods (e.g., sealed opaque envelopes) were applied. Due to the nature of the intervention, blinding of participants and intervention providers was not feasible. The outcome assessor, who was also the principal investigator, was aware of group assignments, introducing a high risk of selection, performance, and measurement bias.

INTERVENTION

The intervention comprised 16 supervised sessions over eight weeks, with two sessions per week. Each session consisted of a 10-minute warm-up, a 30-minute main exercise phase, and a 10-minute cool-down. The warm-up included a 10-minute walk to prepare participants for exercise.

The main exercise component included:

1. Upper extremity: seated shoulder press, biceps curls at 90° shoulder flexion, triceps extensions, and shoulder rotations;
2. Core: seated trunk rotations, double knee-to-chest, alternating lower-limb raises with extended knees, and bilateral hip flexion;
3. Lower extremity: sit-to-stand, knee extensions with heel slides, modified squats, and hip flexion, abduction, and extension.

The cool-down phase focused on breathing exercises and static stretching of the pectoral, hamstring, and trapezius muscles. Sessions were delivered face-to-face in a group format by the same licensed physiotherapist in the activity rooms of two residential care homes.

Participants in the MCEG performed the same exercises accompanied by Turkish folk music played through a sound system. Commercially available Turkish folk music tracks were delivered through the residential home’s loudspeaker system. The tempo and sound intensity were not systematically measured; however, the music corresponded to a moderate tempo commonly used in group exercise classes (approximately 90-120 beats per minute, 4/4 meter) and was played at a comfortable conversational volume (approximately 60-70 dB A-weighted), which was not perceived as disturbing by participants. All participants listened via the same loudspeaker system in the exercise room; no headphones were used. Participants with hearing aids attended with their usual settings, and no special adjustments were required. The CEG followed the same protocol under identical conditions but without music.

During the first four weeks, exercises were bodyweight-based; from week five onward, elastic resistance bands were introduced to progressively increase intensity. Participants performed resistance exercises using TheraBand^® elastic bands. All participants initially received a medium-resistance (green) band. If a participant was able to complete 15 repetitions without difficulty in two consecutive sessions, progression was made to the next resistance level (blue band). Each exercise was performed in two sets of 10 repetitions, with 60 seconds of rest between sets. Exercise intensity was adjusted to a light-to-moderate level of perceived exertion (approximately Borg RPE 11-13). Prior to each session, participants’ blood pressure and heart rate were measured; those with values above 140/90 mmHg were not allowed to participate in that day’s session. The standardized protocol was applied uniformly across all participants, with no individualized modifications.

The CG did not receive any intervention and continued with their regular daily routines. It was hypothesized that the MCEG would demonstrate greater improvements in balance, proprioception, and lower-extremity strength compared to the CEG and CG, along with benefits in mobility, reduced discomfort, and enhanced emotional well-being.

Participants attended an average of 14 out of 16 sessions, corresponding to an adherence rate of 87.5%. Attendance was recorded for each session, and fidelity was maintained through consistent delivery by the same physiotherapist using the standardized protocol. While formal enjoyment metrics were not collected, participants in the MCEG frequently provided positive verbal feedback, describing the sessions as more enjoyable and motivating when accompanied by music.

No concomitant care or co-interventions were provided during the study. Participants were encouraged to report any discomfort, injuries, or negative experiences; none were reported.

ASSESSMENT TIMELINE AND TRIAL INTEGRITY

All participants were assessed before and after the intervention period using a pre-test/post-test design. No significant modifications to the trial design, outcome measures, or analytical approach were made after commencement.

No interim analyses were conducted, and no early stopping criteria were established. The scheduled progression in exercise intensity—specifically, the introduction of resistance bands in week five—was a predetermined element of the protocol. This adjustment was not based on interim findings. The intervention was implemented exactly as planned, with no deviations or modifications.

OUTCOME MEASURES

Outcome measures included assessments of balance, lower-extremity strength, joint proprioception, and health-related quality of life.

Balance was assessed using the TUG test. Participants rose from a chair, walked three meters, turned, returned, and sat down. Completion times longer than 15 seconds indicated an increased risk of falling. After one familiarization trial, two additional trials were performed, and the mean time was recorded ⁶. The TUG test demonstrates excellent reliability in older adults (ICC > 0.90). A minimal detectable change (MDC95) of 3.5 seconds has been reported in community-dwelling older adults ⁷. To reduce expectancy effects, standardized instructions were read verbatim to all participants, and the functional tests were administered in a fixed order. The investigator avoided providing motivational feedback beyond the scripted directions.

Strength was evaluated using the 30-Second Sit-to-Stand Test. Participants sat in an armless chair with arms crossed over the chest and performed as many full stands as possible in 30 seconds. The total number of stands was recorded ⁶. This test is a valid and reliable measure of lower-limb strength in older adults, with an MDC90 of two repetitions ⁸.

Knee and ankle joint proprioception was assessed with a universal goniometer (Baseline Evaluation Instruments, Fabrication Enterprises Inc., White Plains, NY, USA). For the ankle, participants were tested in a seated position with the target angle set at 10° dorsiflexion. For the knee, participants sat on a chair with the hip and knee flexed at approximately 90°, and the lower leg was passively moved to 45° of knee flexion from full extension, which served as the target angle. At each joint, the target position was first demonstrated with eyes open and then reproduced by the participant with eyes closed. Randomization was performed between participants, not by body side; therefore, only the dominant limb was assessed. Each angle was tested three times, and the mean absolute deviation (in degrees) across the three trials was calculated ⁹.

Health-related quality of life (HRQoL) was measured using the NHP, which includes six subdomains: energy level (three items), emotional reactions (nine items), physical activity (eight items), pain (eight items), sleep (five items), and social isolation (five items). Higher scores indicate poorer perceived quality of life ¹⁰. The NHP has been validated for use in older adults. While no universal MDC exists, a 10-point change is often considered clinically meaningful in similar populations.¹¹

STATISTICAL ANALYSIS

Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Change scores (Δ = post-pre) were calculated for each outcome. The normality of Δ distributions was assessed with the Shapiro–Wilk test. Within-group changes were expressed as means (SD) of Δ and tested with paired-samples t tests or Wilcoxon signed-rank tests, as appropriate; standardized within-group effect sizes were reported as Hedges’ g with 95% confidence intervals (CIs).

For between-group comparisons, two approaches were applied depending on the assumptions. When normality was satisfied, analysis of covariance (ANCOVA) was performed with the post-test value as the dependent variable, group as the fixed factor, and the baseline value as a covariate. When non-normality persisted, Δ scores were compared across groups using the Kruskal-Wallis test followed by Dunn’s Bonferroni-adjusted post hoc procedure. Between-group effect sizes were reported as partial η² (ANCOVA) or rank-based indices (e.g., η² or rank-biserial correlation) with 95% CIs.

Categorical baseline variables were analyzed using the chi-square test. The significance level was set at p < 0.05. Analyses included only participants who completed both pre- and post-intervention assessments (per-protocol analysis). The final analytical sample consisted of 31 participants, analyzed according to the original group assignments. No imputation for missing data was required, as complete data were available for all participants.

No statistical comparisons were conducted for harms because no adverse events occurred. No unintended consequences or unanticipated problems were observed during the intervention or follow-up period. Additional analyses, such as subgroup or sensitivity tests, were not performed. Given the exploratory design of this pilot study, findings should be interpreted with caution and considered preliminary.

RESULTS

PARTICIPANT CHARACTERISTICS

A total of 31 participants (mean age = 74.41 ± 5.86 years) were included. Baseline demographic and clinical characteristics are presented in Tables I and II. Groups were generally comparable at baseline; only assistive device use differed significantly (p = 0.047).

INTRAGROUP COMPARISONS

Both the CEG and the MCEG showed statistically significant improvements in balance, lower-extremity strength, proprioception, and HRQoL after the intervention (p < 0.05). No significant changes were observed in the CG (Tab. III).

Across both intervention groups combined, participants attended an average of 14 out of 16 sessions, corresponding to an adherence rate of 87.5%. Group-specific attendance data were not collected. Although no standardized enjoyment scale was applied, participants in the MCEG frequently provided positive verbal feedback, describing the sessions as “more energetic” and “motivating” due to the music.

INTERGROUP COMPARISONS

Post-intervention, statistically significant differences were found among the three groups for all measured outcomes. The MCEG demonstrated greater improvements in balance, strength, proprioception, and selected HRQoL domains compared with both the CEG and CG (p < 0.05) (Tab. IV).

All 31 randomized participants were included in both feasibility and preliminary effectiveness analyses (10 in the CEG, 9 in the MCEG, and 12 in the CG). All participants completed pre- and post-intervention assessments for physical and psychosocial outcomes (TUG, 30-Second Sit-to-Stand Test, Joint Position Sense test, and NHP).

Key intergroup findings included:

1. Balance (TUG test): significant improvements were observed in the intervention groups, particularly the MCEG (p = 0.001), with no meaningful change in the CG;
2. Lower-extremity strength (30-Second Sit-to-Stand Test): both intervention groups improved, with the MCEG outperforming the CEG (p = 0.001);
3. Proprioception: significant gains in knee and ankle joint sense were observed in the intervention groups (p < 0.01), with no change in the CG;
4. HRQoL (NHP subdomains): Statistically significant improvements were observed for emotional reactions (p = 0.014) and physical activity (p = 0.011) in the MCEG. No improvements were seen in the CG.

Although p values were reported, confidence intervals were not calculated due to the exploratory nature of this pilot study. Nonetheless, the magnitude of between-group differences may guide effect size estimations for future randomized controlled trials.

DISCUSSION

This pilot randomized controlled trial demonstrated that calisthenic exercises, with or without music, significantly improved balance, lower-extremity strength, proprioception, and HRQoL in healthy sedentary older adults. The MCEG showed superior gains – particularly in emotional well-being – suggesting that music may enhance outcomes by promoting movement synchronization, reducing perceived exertion, and stimulating emotional and cognitive engagement ^12-14. These findings contribute to the literature on implementing music-enhanced calisthenic exercise in residential care homes and add valuable evidence to intervention research in this setting.

This study was conducted as a pilot trial to assess feasibility and inform future large-scale trials, as recommended by Thabane et al. ¹⁵.

The observed improvements in balance and strength align with previous studies showing that regular physical activity enhances muscle strength, joint stability, and neuromuscular coordination in older adults ^16-18. The MCEG’s superior performance may be explained by the sensory and emotional stimulation provided by music, which engages multiple neural pathways and supports motor efficiency ^19,20. Maintaining proprioception and muscle strength is critical for fall prevention and functional independence in aging populations ²⁰.

Psychologically, music can reduce anxiety and depressive symptoms while improving mood, potentially contributing to the MCEG’s HRQoL improvements ²¹. Music likely acted as both a motivational aid and a psychological enhancer, encouraging greater effort and engagement. Even without formal enjoyment metrics, participants in the MCEG frequently described sessions as “more energetic” and “motivating”, suggesting that music enhanced not only physical outcomes but also exercise engagement.

Physiologically, rhythmic auditory cues may improve motor timing and coordination – key areas affected by aging – by promoting more efficient muscle activation and supporting strength and balance gains ^20,22,23.

Feasibility outcomes were strong: recruitment was 96.9% (31/32), adherence was 87.5%, retention was 100%, and no adverse events occurred. The intervention was delivered successfully in two residential care homes by a licensed physiotherapist, without specialized equipment or advanced training, supporting its replicability and scalability.

Although this pilot study was not powered for confirmatory hypothesis testing, the preliminary improvements – especially in the MCEG – suggest promising clinical effects consistent with previous research on music-enhanced exercise for older adults. However, it should be noted that the mean TUG improvements (≈2.07 s in the CEG, 1.35 s in the MCEG) did not exceed the reported MDC95 of 3.5 seconds, and therefore should not be interpreted as clinically meaningful at the individual level. Instead, they may represent encouraging group-level trends that warrant confirmation in larger trials. By contrast, the 30-Second Sit-to-Stand Test showed increases of +4 to +4.9 repetitions, which exceeded the MDC90 of 2 repetitions, can therefore be cautiously interpreted as clinically meaningful in lower-extremity strength.

Key strengths include the randomized design, validated outcome measures, and focus on an institutionalized older adult population within residential care settings.

Limitations include the small sample size, which limits generalizability, and the inability to blind participants and providers, introducing potential performance bias. The same investigator conducted recruitment, randomization, intervention delivery, and outcome assessment, which may have increased selection and measurement biases despite standardized protocols. To minimize bias, data were analyzed by an independent statistician who was blinded to group allocation. In addition, the control group lacked attention matching, and participant enjoyment or motivation was not assessed with validated tools, which restricts inference about the specific contribution of music. Furthermore, only the dominant limb was assessed for proprioception, and the order of limb testing was not randomized, which may limit the generalizability of proprioceptive outcomes. Given the pilot nature of this study, the analyses were exploratory and not powered to detect definitive between-group differences.

Attendance data were analyzed only in aggregate for both intervention groups, limiting interpretation of group-specific adherence. Enjoyment was assessed informally through verbal feedback rather than validated scales, restricting conclusions on music’s direct effects on adherence and motivation.

No correction for multiple testing was applied, consistent with the exploratory aim, but consistent implementation across two facilities supports internal validity. Long-term adherence, sustainability, and applicability in more diverse care environments remain uncertain.

The feasibility outcomes of this pilot study yielded promising results to guide the design of a future definitive trial. The recruitment rate was 96.9% (31 of 32 eligible individuals), with one participant passing away prior to randomization. All 31 randomized participants completed the 8-week intervention, resulting in a 100% retention rate. Mean adherence was 87.5% (14 of 16 sessions on average), reflecting strong participant commitment and demonstrating the feasibility of the intervention in this setting. Although formal enjoyment metrics (e.g., validated enjoyment scales) were not collected, participants – particularly in the music-enhanced group – frequently expressed positive verbal feedback and appeared highly engaged. These observations, together with the high adherence and retention rates, suggest favorable acceptability and potential enjoyment of the intervention. Preliminary outcome data indicated clinically meaningful improvements in balance, lower-extremity strength, proprioception, and HRQoL, particularly in the music-enhanced group. While the study was not powered for definitive hypothesis testing, the observed effect sizes can inform sample size calculations for a future fully powered randomized controlled trial.

Future trials should therefore include group-specific adherence metrics, standardized enjoyment and motivation scales, blinded outcome assessment, extended follow-up, and larger, more diverse samples to better establish effectiveness and clinical utility.

CONCLUSIONS

This pilot randomized controlled trial demonstrated the feasibility and potential benefits of music-enhanced calisthenic exercise for improving physical function, proprioception, and quality of life in sedentary older adults. As a low-cost, accessible, and easily implemented approach for physiotherapists in institutional settings, this intervention shows promise for supporting healthy aging on a broader scale. Music appears to enhance both the physical and psychological effects of exercise, making it a valuable adjunct in geriatric care. Future research should explore long-term outcomes, cognitive effects, and cost-effectiveness in larger and more diverse older adult populations.

Acknowledgments

The authors sincerely thank the older adults who voluntarily participated in this study. We also express our gratitude to the facility staff for their valuable assistance and support throughout the intervention process. Additionally, we acknowledge the use of AI-based writing assistance (ChatGPT, OpenAI) for improving the clarity and grammar of the manuscript.

Conflict of interest statement

The authors declare no conflict of interest.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author contributions

FAK: study design, data collection, manuscript writing; NB: supervision, data analysis, manuscript review.

Ethical considerations

Ethical approval was obtained from the Non-Interventional Ethics Committee of Niğde Ömer Halisdemir University (Approval No. 2022/11-12, 26 September 2022). Written informed consent was obtained from all participants before enrollment. The study complied with the ethical standards of the Declaration of Helsinki.

This trial was retrospectively registered at (Identifier: NCT06973538) on May 7, 2025. The full trial protocol is available at: .

The dataset generated and analyzed during the current study is not publicly available due to participant confidentiality but may be obtained from the corresponding author upon reasonable request. No patients or members of the public were involved in the design, conduct, or reporting of this research.

History

Received: August 17, 2025

Accepted: October 12, 2025

Published online: Dec 18, 2025

Figures and tables

Figure 1.Participant flow diagram. Flow diagram prepared according to the CONSORT 2010 extension for pilot and feasibility trials. Recruitment: 96.9%, Retention: 100%, Adherence: 87.5%. No adverse events.

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