Article

The Effects of an 8-Month Multicomponent Training Program in

Body Composition, Functional Fitness, and Sleep Quality in
Aged People: A Randomized Controlled Trial
Pedro Forte 1,2,3,4, * , Samuel G. Encarnação 2,3,5 , Luís Branquinho 6,7,8 , Tiago M. Barbosa 3,4 ,
António M. Monteiro 3,4 and Daniel Pecos-Martín 1

1 Physiotherapy and Pain Group, Department of Physical Therapy, University of Alcala, 28801 Madrid, Spain;
daniel.pecos@uah.es
2 Department of Sports, Higher Institute of Educational Sciences of the Douro, 4560-708 Penafiel, Portugal
3 Research Centre for Active Living and Wellbeing (LiveWell), Instituto Politécnico de Bragança,
5300-253 Bragança, Portugal
4 Department of Sports Sciences, Instituto Politécnico de Bragança, 5300-253 Bragança, Portugal
5 Department of Physical Activity and Sport Sciences, Universidad Autónoma de Madrid (UAM),
28049 Madrid, Spain
6 Biosciences Higher School of Elvas, Polytechnic Institute of Portalegre, 7350-092 Portalegre, Portugal
7 Life Quality Research Centre (LORQ-CIEQV), 2001-964 Santarém, Portugal
8 Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD),
6201-001 Covilhã, Portugal
* Correspondence: pedromiguel.forte@iscedouro.pt or p.gomes@edu.uah.es

Abstract: Background/Objectives: This study examined the effects of an intervention on anthro-

pometrics, body composition, physical fitness, and sleep quality in aged individuals, comparing
a control group (N = 11) and an experimental group (N = 13) across two measurement points.
Methods: A multicomponent training program of 8 months was adopted as the intervention group.
Citation: Forte, P.; Encarnação, S.G.;
A bioimpedance balance, functional fitness test, and Pittsburgh Sleep Quality Index measured body
Branquinho, L.; Barbosa, T.M.; composition, functional fitness, and sleep quality. Results: Both groups showed minimal changes
Monteiro, A.M.; Pecos-Martín, D. The in body mass and hand grip strength. However, the experimental group experienced significant
Effects of an 8-Month improvements in physical fitness, including a 26% increase in arm curl repetitions, an 18% reduction
Multicomponent Training Program in in 5 times sit-to-stand (5TSTS) completion time, and a 29% rise in 2-min step test (2MST) steps,
Body Composition, Functional Fitness, indicating enhanced muscle endurance and cardiovascular fitness. Flexibility decreased significantly
and Sleep Quality in Aged People: A in the experimental group, while body fat percentage was reduced by 10%. Sleep quality improved
Randomized Controlled Trial. J. Clin.
by 47% in the experimental group but declined by 14% in the control group. Correlational analysis
Med. 2024, 13, 6603. https://doi.org/
revealed that better sleep quality was linked to improved fitness performance and reduced body fat
10.3390/jcm13216603
in the experimental group, with post-intervention results further confirming the connection between
Academic Editor: Anastassios sleep and fat reduction. In the control group, improved sleep quality was associated with higher
Philippou metabolic rates after 8 months. Conclusions: These findings suggest that the intervention positively
Received: 20 September 2024
impacted physical fitness and sleep quality, with potential benefits for overall health.
Revised: 21 October 2024
Accepted: 1 November 2024 Keywords: ageing; fitness; sleep; quality
Published: 3 November 2024

1. Introduction
Copyright: © 2024 by the authors.
The elderly commonly experience deterioration in the visual and proprioceptive sys-
Licensee MDPI, Basel, Switzerland.
tems, which can impact balance and postural control [1,2]. In older adults, proprioceptive
This article is an open access article
distributed under the terms and
information plays an important role in maintaining balance. Other studies [3,4] have un-
conditions of the Creative Commons
derscored the role of balance training in improving proprioception and dynamic balance.
Attribution (CC BY) license (https://
The balance training type can enhance ankle stability (i.e., lower limbs function), neuro-
creativecommons.org/licenses/by/ muscular function (i.e., related to strength), and postural control system efficiency [5,6].
4.0/). This highlights the significance of incorporating balance exercises targeting proprioception

J. Clin. Med. 2024, 13, 6603. https://doi.org/10.3390/jcm13216603 https://www.mdpi.com/journal/jcm

J. Clin. Med. 2024, 13, 6603 2 of 15

in older adults to enhance dynamic balance and reduce the risk of falls [7]. Finally, [8]
identified a link between sleep quality and dynamic balance, indicating that poor sleep
quality may be associated with dynamic imbalance in older adults. However, the authors
were unable to evaluate the effects of training exercise programs on physical fitness, sleep
quality, and balance.
The relationship between sleep quality and physical exercise in older people has been
widely documented in the literature. Studies have shown that aerobic exercise can improve
self-reported sleep and quality of life in older adults with insomnia [9]. Additionally,
systematic reviews have indicated that physical activity programs positively impact var-
ious aspects of sleep in generally healthy older adults [10]. A study [11] showed that in
community-dwelling older adults, exercise can impact sleep through mechanisms such
as light exposure, temperature regulation, and mood. A recent systematic review and
meta-analysis have further supported the positive effects of physical exercise programs
on improving sleep quality in older adults [12]. However, a longitudinal study demon-
strated that sleep quality plays a crucial role in older adults’ level of physical activity,
with better sleep quality promoting more physical activity [13]. Older individuals often
struggle with changing positions during sleep due to musculoskeletal pain, decreased
mobility, and motor impairments [14,15], leading to discomfort and sleep disturbances [16].
Also, chronic pain conditions and limited ability to change positions worsen sleep difficul-
ties [17], compounded by physical disabilities and cognitive impairments [15]. Poor sleep
quality is independently linked to physical disability and functional limitations in older
adults [18,19], stressing the need to address sleep disturbances to enhance overall health
and well-being [18,20]. Upon that, physical exercise training programs may improve body
functionality and possibly sleep quality. Between the different exercise training programs,
the American College of Sports Medicine (ACSM) previously highlighted the importance
of multicomponent training (MCT) for older adults, citing its benefits for strength, aerobic
fitness, and balance [21]. This type of program (MCT) including exercises for aerobics,
resistance, balance, and flexibility composes the multicomponent training [22,23]. It could
improve metabolic outcomes, functional and cognitive performance, cardiorespiratory
fitness and autonomy. The fundamental part of each training session aims to train aerobic,
resistance, and balance skills [22,23]. Subsequent research has supported these claims. A
review of 27 studies showed that MCT improves physical fitness and overall health in
older populations [24]. Additionally, a meta-analysis comparing aerobic training, resistance
training, and MCT found MCT to be the most effective for cognitive improvement [25].
Recent research also supports MCT’s positive effects on attention and executive function
in older adults [26]. MCT programs include exercises targeting physical and cognitive
health [5,27,28], aiming to enhance muscle mass, power output, functional outcomes, cog-
nitive function, and brain health [6,29]. Overall, MCT appears effective in improving
physical function, muscle mass, cognitive function, and mental health in older adults, even
those with conditions like mild cognitive impairment, dementia, Alzheimer’s disease, and
sarcopenia [28,30].
The relationship between exercise, physical fitness, body composition, and sleep qual-
ity in older adults may be complex and interconnected [31,32]. In light of the above, it seems
important to continue investigating to understand the complexity of the phenomenon to
broadly understand the effects of exercise on sleep quality and its associations with physical
fitness and body composition, which can play a fundamental role in the development of
interventions that promote healthy aging and improve the well-being of older individuals.
Given this, this research aimed to evaluate the effects of 8 months of multicomponent
training programs on critical variables such as physical fitness, body composition, and
sleep quality. Additionally, we aim to seek the associations between physical fitness, body
composition, and sleep quality. It was hypothesized that an 8-month multicomponent
training program would significantly positively affect physical fitness, body composition,
and sleep quality.
J. Clin. Med. 2024, 13, 6603 3 of 15

2. Materials and Methods

2.1. Design and Sample
This was a randomized controlled trial with pre- and post-intervention measure-
ments (The trial was registered with the ID NCT06646380 on the ClinicalTrials.gov: https:
//clinicaltrials.gov/study/NCT06646380). Forty participants were contacted to participate
in this study and randomly divided into two groups of 20 participants (Control and Experi-
mental Groups). The convenience sample’s mean age was 69 years old. The sample was
recruited in the Bragança Municipality in Portugal. All participants were aged community
people. All procedures were carried out in accordance with the recommendations of the
Declaration of Helsinki for human studies. The research project received approval by the
Ethical Committee of the Instituto Politécnico de Bragança (number: 2576). The partici-
pants were instructed to maintain normal daily activities to prevent physical inactivity.
The participants were asked to complete a sample characterization questionnaire during
the first visit. The criteria for inclusion in the study were: (i) being aged 65 years or older,
(ii) maintaining functional independence in daily tasks, (iii) having no severe chronic
diseases or medications to sleep that could affect the results, (iv) do not have significant
cardiovascular, muscular, metabolic, or joint complications. Among the 40 contacted par-
ticipants, only 32 subjects completed the first evaluation (15 were from the experimental
group (EG) and 17 were from the control group (CG)). Eight participants (25% of the total
sample) dropped out due to undeclared health issues and losing interest in the study.
Between them, 2 participants from the experimental group did not attend the minimum
of 75% of the exercise sessions. Thus, the data from the remaining participants (13 in EG:
11 women and 2 men) were not involved in any physical exercise or similar intervention
during all follow-ups. The CG (11: 9 women and 2 men) were instructed to maintain
daily routines. However, the typical profile of this group was that the participants were
regularly physically active people. Most participate in municipal activities like nature
walking, physical activity sessions including dance (casually), board and card games, and
traditional games (Bocce, Adapted Bowling, and darts). After 32 weeks and in the second
J. Clin. Med. 2024, 13, x FOR PEER REVIEW
moment, only 24 participants finalized the study (13 from EG and 11 from CG). Figure 4 of 16
1
depicts the sampling flowchart of the sampling process.

Figure1.1.Participants
Figure Participantsflowchart
flowchartof
ofsampling.
sampling.

2.2. Intervention Program

The exercise program integrated aerobic, resistance, flexibility, and balance activities
[22,23]. Each session lasted between 50 and 60 min and consisted of five key components
(Figure 2): (i) a 5–8 min warm-up with slow walking and stretching; (ii) 15–20 min of
aerobic activities, including walking, jogging, aerobics, and dancing, with at least 8–10
min; and (iii) 1–3 sets of resistance exercises using elastic bands and free weights in a
circuit format, targeting major muscle groups, such as knee flexors/extensors, shoulder
J. Clin. Med. 2024, 13, 6603 4 of 15

2.2. Intervention Program

The exercise program integrated aerobic, resistance, flexibility, and balance activi-
ties [22,23]. Each session lasted between 50 and 60 min and consisted of five key compo-
nents (Figure 2): (i) a 5–8 min warm-up with slow walking and stretching; (ii) 15–20 min of
aerobic activities, including walking, jogging, aerobics, and dancing, with at least 8–10 min;
and (iii) 1–3 sets of resistance exercises using elastic bands and free weights in a circuit
format, targeting major muscle groups, such as knee flexors/extensors, shoulder abduc-
tors/adductors, elbow flexors/extensors, pectorals, and abdominals, with 40–60 s of rest
between sets. To ensure proper familiarization and technique, the training intensity started
lower at the beginning of each month, beginning with 8 repetitions in 1 set and gradually
increasing to 12–15 repetitions and 3 sets; (iv) 5–8 min of static and dynamic balance train-
J. Clin. Med. 2024, 13, x FOR PEER REVIEW 5 of 16
ing using sticks, balls, and balloons; and (v) a 5-min cool-down period at the end of each
session, including breathing exercises and stretching.

Figure 2.
Figure Multicomponent training
2. Multicomponent training component
component volume.
volume.

The repetitions
The repetitions and
and time
time increased
increased by
by 30%
30% after
after each
each 2-month
2-month intervention. The
intervention. The
training intensity was controlled using Borg’s 10-point categoric ratio scale (CR-10) [33].
training intensity was controlled using Borg’s 10-point categoric ratio scale (CR-10) [33].
The coaches aimed to work in an intensity range from 3 (moderate) to 5 (intense). Table 1
The coaches aimed to work in an intensity range from 3 (moderate) to 5 (intense). Table 1
presents the training session plan.
presents the training session plan.
2.3. Anthropometrics and Body Composition
Table 1. Components and exercises were used day-by-day over the week for the training sessions
Anthropometric
during measurements included height and weight. Body composition was
the training protocol.
assessed using a digital bioimpedance scale (Tanita BC-50, IL, USA), which recorded
ComponentsDay #1 of the Weekvariables such as lean Day #2 of the
mass, Week
body fat percentage, boneDay #3 of the
mineral Week visceral fat, total
density,
Jogging and cardio-based warm-up Jogging and cardio-based warm-up Jogging and
body mass, muscle mass, fat mass, and bone density. Evaluations were conductedcardio-based warm-up in
Warm-up
Dynamic stretchingthe targeting Dynamic stretching targeting Dynamic stretching targeting
morning before breakfast, with participants wearing only light clothing and no shoes
(5 min)
shoulders, hips, andor ankles.
socks. Height shoulders,
was measuredhips, and ankles.
while shoulders,
the participants stoodhips,
withand ankles.
their head aligned
1–3 sets, 40–60 s restinbetween sets 1–3 sets, 40–60 s rest between sets 1–3 sets,
the Frankfurt plane. Waist and hip circumferences were also measured.40–60 s rest between sets
Metabolic
6 repetitions (reps) kettlebell clean and 12 reps alternating single-arm 12 reps single-arm KB swings per side
variables, including systolic and diastolic blood pressure and resting heart rate, were
press + 6 reps single-arm kettlebell
recorded using an kettlebell
OMRONrows (M2(touching the ground) 12 reps KB goblet squats: focus on a
HEM-7143-E) and brachial cuff (Easy 22–32) (Amsterdam,
Resistance thrusters 12 reps Romanian deadlifts slow descent, explosive ascent
The Netherlands). The metabolic rate was assessed via bioimpedance using the Tanita
training 12 reps single-arm kettlebell rows 12 reps Dumbbell chest flys 12 reps bodyweight lunges: with a 2-s
scale.
(1–3 sets; 15–12 reps kettlebell sumo deadlift high 12 reps single-arm kettlebell curls pause at the bottom
20 min) pulls 12 reps kettlebell biceps curls 12 reps KB Romanian deadlifts
12 reps dumbbell lateral raises 6 reps KB overhead extensions
12 reps single-arm kettlebell triceps 6 reps triceps kickbacks per side
extensions
(2 sets, IR: 30 s between sets) (2 sets, IR: 30 s between sets) (2 sets, IR: 30 s between sets)
J. Clin. Med. 2024, 13, 6603 5 of 15

Table 1. Components and exercises were used day-by-day over the week for the training sessions
during the training protocol.

Components Day #1 of the Week Day #2 of the Week Day #3 of the Week
Jogging and cardio-based Jogging and cardio-based Jogging and cardio-based
Warm-up warm-up warm-up warm-up
(5 min) Dynamic stretching targeting Dynamic stretching targeting Dynamic stretching targeting
shoulders, hips, and ankles. shoulders, hips, and ankles. shoulders, hips, and ankles.
1–3 sets, 40–60 s rest between
1–3 sets, 40–60 s rest between
sets
sets 1–3 sets, 40–60 s rest between
12 reps single-arm KB swings
6 repetitions (reps) kettlebell sets
per side
clean and press + 6 reps 12 reps alternating single-arm
12 reps KB goblet squats:
single-arm kettlebell thrusters kettlebell rows (touching the
focus on a slow descent,
Resistance training 12 reps single-arm kettlebell ground)
explosive ascent
(1–3 sets; 15–20 min) rows 12 reps Romanian deadlifts
12 reps bodyweight lunges:
12 reps kettlebell sumo deadlift 12 reps Dumbbell chest flys
with a 2-s pause at the bottom
high pulls 12 reps single-arm kettlebell
12 reps KB Romanian deadlifts
12 reps dumbbell lateral raises curls
6 reps KB overhead extensions
12 reps single-arm kettlebell 12 reps kettlebell biceps curls
6 reps triceps kickbacks per
triceps extensions
side
(2 sets, IR: 30 s between sets)
(2 sets, IR: 30 s between sets)
Single-leg deadlifts: 3 per leg
Complex [4 high knees with
Dynamic lateral lunges: 3 per
hold + 4 controlled leg
side (hold each lunge position (2 sets, IR: 30 s between sets)
swings]
for 3 s) 5 m side shuffle + 2
4 toe taps with ankle mobility
Balance training Alternating high knees: 3 per alternating side lunges + 5 m
+ 4 static high knees
(5–8 min) side (hold each knee up for 3 s) Jog
Single-leg complex [2
Reverse lunges with glute 10 m heel-to-toe walk
controlled leg swings + 2
squeeze: 6 per leg 6 high knees with 2 quick taps
quick high knees + 2 single-leg
Toe touches with step forward:
balance holds (without
6 per side (step forward to
touching the ground)]
touch toes)
3 Sets, 60 s ON, 30 s OFF, IR: 60 3 Sets, 60 s ON, 30 s OFF, IR: 3 Sets, 60 s ON, 30 s OFF, IR:
s between sets 60 s between sets 60 s between sets
Marching in place Arm circles High knees
Aerobic fitness
Light jogging Punches (shadow boxing) Arm circles
15–20 min)
Light jogging Shoulder taps Step touches
Step touches Front and lateral raises Lateral lunges
Low-impact jumping jacks High knees with arm swing Front and lateral raises
5 min 5 min 5 min
Upper and lower body static Upper and lower body static Upper and lower body static
Stretching: stretches like stretching: stretches like stretching: stretches like
hamstring stretches, quadriceps hamstring stretches, hamstring stretches,
Cool down stretches, shoulder stretches, quadriceps stretches, shoulder quadriceps stretches, shoulder
(5 min) and tricep stretches. stretches, and tricep stretches. stretches, and tricep stretches.
Dynamic trunk stretching and Dynamic trunk stretching and Dynamic trunk stretching and
breathing exercises: torso twists, breathing exercises: torso breathing exercises: torso
side bends, and deep twists, side bends, and deep twists, side bends, and deep
diaphragmatic breathing. diaphragmatic breathing. diaphragmatic breathing.

2.4. Physical Fitness

Handgrip strength was assessed using a digital palmar dynamometer (CAMRY® ,
Lisbon, Portugal), with the maximum kilograms-force (kgf) achieved using a palm grip as
the measurement. The participants stood with their arms away from their body and, upon
the researcher’s signal, exerted maximum palm grip force on the dynamometer for 4 s [34].
Each participant was given three attempts, and the highest recorded result was noted by
the evaluator.
J. Clin. Med. 2024, 13, 6603 6 of 15

The Functional Fitness Test was used to assess the main physical parameters associated
with functional mobility. The Functional Fitness Test evaluated key aspects of physical
mobility [35]. It included the 2-Minute Step Test, where the evaluator set a knee height
marker using a measuring tape to measure from the kneecap to the iliac crest, and partici-
pants aimed to take as many steps as possible in 2 minutes, with performance checks at 60
and 90 s. The Seat-to-Stand Test required participants to repeatedly sit and stand from a
43-cm highchair for 30 s, with the number of repetitions recorded. In the Arm Curl Test,
participants seated on a 43-cm chair used a 2-kg dumbbell to perform elbow curls for 30
s. The Time-Up-and-Go Test involved starting from a seated position on a 43-cm chair,
walking quickly around a cone placed 2.44 m away, and returning to the chair, with the
time recorded after 2 attempts. The Sit and Reach Test, conducted while seated on a 43-cm
chair with one leg extended and toes reached, and the Back Scratch Test, where participants
attempted to touch one hand with the other behind their back, were timed in seconds.
The lower limb muscle power was assessed using the five-time sit-to-stand test with
a chair 0.49 m high. The evaluator started the stopwatch when the participant stood up
and stopped it after completing five repetitions, marking the time as soon as they sat back
down for the fifth time. The evaluator encouraged the participant to maintain maximum
speed and proper technique throughout the test. Each participant performed 2 attempts,
with a 60-s rest between them, and the shortest time was recorded [36].

2.5. Sleep Quality

Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), a 19-item
questionnaire developed by Buysse et al. [37] and validated for the Portuguese popula-
tion [38]. The PSQI items are divided into the following components: (1) subjective sleep
quality, (2) sleep latency, (3) sleep duration, (4) habitual sleep efficiency, (5) sleep distur-
bances, (6) use of sleeping medication, and (7) daytime dysfunction. Each item is scored
from 0 to 3, with the total score ranging from 0 to 21; higher scores indicate more severe
sleep disturbances. A global score of 5 or higher in 2 components signifies significant sleep
difficulties, while a score in 3 or more components indicates moderate sleep issues. A total
score below 5 indicates good sleep quality, whereas a score above 5 indicates poor sleep
quality.

2.6. Statistical Analysis

The analysis of the sample statistical power was classified as reduced of the prior
recruited sample in this study (<0.80). The standard statistical methods were used to
calculate the means and standard deviation. The Kolmogorov–Smirnov test allowed us
to assess the normality of the distribution, and Levene’s test assessed the homogeneity
(N < 30).
The t-test permitted the comparison of variables by sex and sleep quality, and Pear-
son’s correlation permitted the test of the association between the variables for the control
and the experimental group, respectively. The test was made at a significance level of 5%.
Effect sizes were calculated based on Cohen’s d and classified as 0.2—trivial; 0.6—small;
1.2—large; and>2.0—very large [39]. Statistical analyses were performed with 95% CI;
p < 0.05. All procedures were performed with SPSS version 24.0 (SPSS, Inc., Chicago, IL,
USA). Additionally, we applied statistical procedures based on Bayesian assumptions. For
this purpose, a two-way mixed effect Bayesian ANOVA was applied to capture effects
within, between, and interactions between within subjects [40]. This version of the classifi-
cation analysis of variance is robust when statistical assumptions, such as minimal sample
size and statistical power, are not satisfied [41]. For this purpose, we considered the main
metric of significance, which is the Bayes factor, considering Jeffreys’s [42] cut-offs (≤3 =
Anecdotal evidence, between 3 and 10 = Moderate evidence, >10 = Strong evidence). Thus,
we considered only differences classified with a strong level of evidence to reject the null
hypothesis in a 95% confidence interval [41,42]. The Bayesian ANOVA was performed in R,
the statistical computing programming language (version 4.4.2.) [43].
J. Clin. Med. 2024, 13, 6603 7 of 15

3. Results
Table 2 shows the means, standard deviations (mean ± Sd), and percentage of varia-
tions for the control (N = 11) and experimental group (N = 13) across two measurement
times (M1 and M2) anthropometrics and body composition, physical fitness, and sleep
quality. Additionally, it presents the comparisons between moments for the control and
experimental groups. In the control group, significant differences were only noted for
total sleep (t = 2.869; p = 0.017; d = −0.865), indicating a statistically significant decrease
in quality. In the experimental group, several variables showed significant differences.
The Arm Curl exhibited a significant improvement (t = −4.696; p = 0.001; d = −0.373)
in the number of arm curls performed. The 5TSTS showed a significant decrease in the
time to perform five sit-to-stand movements (t = 5.392; p < 0.001; d = −0.058). CS30 had
a significant (t = −8.469; p < 0.001; d = −0.161) decrease in the number of chair stands
performed in 30 s. TUG showed a significant increase in the time to complete the test
(t = 4.212; p = 0.001; d = 0.243). The Seat and Reach test revealed a decrease in flexibility
(t = −4.127; p = 0.001; d = −0.265), and the Back Stretch test showed the same tendency
(t = −3.722; p = 0.003; d = −0.519). The 2MST variable significantly increased the number
of steps performed in two minutes (t = −9.617; p < 0.001; d = −0.040). The Total Fat (%)
significantly decreased (t = 2.225; p = 0.046; d = 0.228), and lastly, the Sleep quality score
significantly improved (t = 2.856; p = 0.014; d = −0.865).
Table 3 below presents the group comparison results after 32 weeks of multicomponent
training intervention. The mixed effects Bayesian ANOVA revealed that there were only
significant post-prior probabilities (p < 0.05) regarding increases in upper limb strength for
the experimental group, with a significant isolated effect of time (Bayes Factor = 85.02357
± 1.12%) and a significant group × time interaction (Bayes Factor = 80.38867 ± 1.76%).
There was also a significant increase (p < 0.05) in the lower limb flexibility in favour of
the experimental group, with only a group × time interaction (Bayes Factor = 7.937376
± 2.16%). Finally, there was a significant increase in the absolute sleep scores regarding
the control group, with a significant group × time interaction (Bayes Factor = 10.34395 ±
2.07%) highlighting the increased risk of sleep disorders in this group.
Intending to understand the link between physical fitness, body composition, and
sleep quality, the Pearson correlation test presents significant associations with total sleep
(Table 4). The control group revealed significant associations between total sleep quality
and body water (Moment 2: r = 0.665; p = 0.026). The experimental group revealed
significant associations between sleep quality TUG (Moment 1: r = 0.575; p = 0.040), total fat
(Moment 1: r = 0.526; p = 0.046), Fat percentage (Moment 1: r = 0.619; p = 0.024 | Moment 2:
r = 0.620; p = 0.024), and body water (Moment 1: r = 0.646; p = 0.017). Figure 3 presents the
correlation heatmap.
J. Clin. Med. 2024, 13, 6603 8 of 15

Table 2. Mean, standard deviations, percentage of variations, and comparisons for anthropometrics, body composition, physical fitness, and sleep quality measures
for the control and experimental groups by moments of evaluations.

Control Group (N = 11) Experimental Group (N = 13)

M1 Mean ± Sd M2 Mean ± Sd ∆% t p d M1 Mean ± Sd M2 Mean ± Sd ∆% t p d
Body Mass (Kg) 65.64 ± 6.77 66.00 ± 5.44 0% −0.251 0.807 −0.068 63.62 ± 12.99 64.75 ± 11.88 3% −0.794 0.443 −0.068
Hang Grip (Kgf) 26.91 ± 7.83 26.72 ± 5.83 0% 0.110 0.915 −0.007 20.08 ± 8.11 22.50 ± 5.64 12% −1.351 0.202 −0.007
Arm Curl (Reps) 22.27 ± 5.42 24.09 ± 3.24 8% −1.237 0.244 −0.373 18.92 ± 3.01 24.31 ± 2.59 26% −4.696 0.001 * −0.373
Waist circumference (cm) 89.73 ± 7.18 85.73 ± 8.71 −4% 1.298 0.223 0.391 85.35 ± 11.82 84.79 ± 11.40 0% 0.638 0.535 0.391
Hip circinferemce (cm) 101.82 ± 6.74 101.36 ± 3.34 0% 0.255 0.804 0.084 98.46 ± 9.98 98.38 ± 10.44 0% 0.166 0.871 0.084
5TSTS (sg) 6.85 ± 1.16 6.93 ± 1.43 1% −0.155 0.880 −0.058 7.54 ± 1.11 6.10 ± 1.24 −18% 5.392 <0.001 * −0.058
CS30 (reps) 22.73 ± 2.94 23.27 ± 4.47 2% −0.534 0.605 −0.161 23.85 ± 4.51 20.31 ± 3.99 19% −8.469 <0.001 * −0.161
TUG (sg) 5.91 ± 0.701 5.41 ± 1.33 −7% 1.025 0.330 0.243 4.79 ± 0.68 5.56 ± 1.02 −14% 4.212 0.001 * 0.243
Seat and Reach (cm) 3.27 ± 5.35 6.73 ± 9.63 106% −0.879 0.400 −0.265 −6.52 ± 11.18 2.15 ± 6.73 −118% −4.127 0.001 * −0.265
Back Stretch (cm) −7.46 ± 10.69 −4.45 ± 9.32 −40% −1.722 0.116 −0.519 −6.89 ± 8.52 −3.46 ± 7.63 −52% −3.722 0.003 * −0.519
2MST (reps) 189.18 ± 38.19 192.64 ± 62.22 2% −0.134 0.896 −0.040 174.69 ± 26.85 222.08 ± 37.17 29% −9.617 <0.001 * −0.040
Total Fat (kg) 20.55 ± 5.20 19.73 ± 4.43 −4% 0.726 0.484 0.213 20.24 ± 7.15 19.59 ± 7.71 −3% 1.888 0.083 0.213
Total Fat (%) 30.91 ± 5.69 29.81 ± 4.77 −3% 0.815 0.434 0.228 29.42 ± 8.82 26.61 ± 9.73 −10% 2.225 0.046 * 0.228
Lean Mass (kg) 43.09 ± 4.59 43.00 ± 3.77 −1% 0.115 0.911 0.094 41.97 ± 6.13 42.40 ± 5.65 1% −0.758 0.463 0.094
Body Water (%) 48.73 ± 4.03 48.55 ± 3.98 0% 0.176 0.864 −0.003 49.38 ± 5.55 49.95 ± 5.69 1% −1.171 0.264 −0.003
Visceral Fat (a.u.) 7.91 ± 2.59 8.18 ± 2.52 3% −1.399 0.192 −0.422 7.08 ± 2.63 6.92 ± 2.33 −1% 0.519 0.613 −0.422
MET (Kcal) 1341.64 ± 125.61 1356.91 ± 93.91 −19% 1.384 0.196 0.417 1304.08 ± 183.17 1310.54 ± 181.06 1% −0.567 0.581 0.417
Sleep Quality (a.u.) 4.64 ± 2.34 6.82 ± 1.17 47% −2.869 0.017 * −0.865 5.46 ± 1.45 4.62 ± 1.45 −14% 2.856 0.014 * −0.865
Legend: Kg—kilograms; Kgf—Kilograms of force; reps—repetitions; 5TSTS—Five Times Sit-to-Stand Test; CS30—30-Second Chair Stand Test; TUG—Timed Up and Go Test;
2MST—Two-Minute Step Test; MET—Metabolic Rate; * p < 0.05.

Table 3. Results of 32 weeks of multicomponent training in the functional fitness and body composition regarding the interaction with group and time.

Variable Moment Exercise (N = 13) Control (N = 11) ANOVA Bayes Factor Sig. Prob.
Pre 63.6 ± 12.9 65.6 ± 6.77 Time 0.31 ± 4.84% Anecdotal
Body mass (kg) Post 64.6 ± 11.8 66 ± 5.44 Group 0.38 ± 1.1% Anecdotal
Interaction 0.04 ± 1.65% Anecdotal
Pre 20.2 ± 8.18 26.9 ± 7.83 Time 0.37 ± 0.98% Anecdotal
HG (kgf) Post 22.6 ± 5.68 26.7 ± 5.83 Group 2.41 ± 0.95% Anecdotal
Interaction 0.44 ± 2.48% Anecdotal
J. Clin. Med. 2024, 13, 6603 9 of 15

Table 3. Cont.

Variable Moment Exercise (N = 13) Control (N = 11) ANOVA Bayes Factor Sig. Prob.
Pre 18.9 ± 3.01 22.3 ± 5.42 Time 85.02 ± 1.12% Strong
ULS (rep) Post 24.3 ± 2.59 24.1± 3.24 Group 0.56 ± 0.64% Anecdotal
Interaction 80.39 ± 1.76% Strong
Pre 85.5 11.8 89.9 ± 7.20 Time 0.44 ± 0.86% Anecdotal
Waist (cm) Post 84.8 11.4 85.7 ± 8.72 Group 0.39 ± 3.49% Anecdotal
Interaction 0.08 ± 2.13% Anecdotal
Pre 98.5 ± 9.94 102.0 ± 6.74 Time 0.29 ± 1.32% Anecdotal
Hip (cm) Post 98.4 ± 10.5 101.0 ± 3.36 Group 0.57 ± 1.7% Anecdotal
Interaction 0.06 ± 2.09% Anecdotal
Pre 7.46 ± 1.33 6.73 ± 1.35 Time 0.85 ± 0.88% Anecdotal
LLP (sec) Post 6.08 ± 1.26 7.09 ± 1.3 Group 0.37 ± 0.81% Anecdotal
Interaction 2.00 ± 3.31% Anecdotal
Pre 20.3 ± 3.99 22.7 ± 2.94 Time 1.92 ± 1.74% Anecdotal
LLS (rep) Post 23.8 ± 4.51 23.3 ± 4.47 Group 0.43 ± 0.8% Anecdotal
Interaction 0.78 ± 2.95% Anecdotal
Pre 5.56 ± 1.02 5.80 ± 0.824 Time 2.68 ± 0.95% Anecdotal
DB (sec) Post 4.78 0.681 5.38 ± 1.34 Group 0.61 ± 2.98% Anecdotal
Interaction 0.79 ± 3.6% Anecdotal
Pre −6.54 ± 11.2 3.27 ± 5.35 Time 3.79 ± 0.64% Moderate
LLF (cm) Post 2.15 ± 6.73 6.73 ± 9.63 Group 2.62 ± 0.63% Anecdotal
Interaction 7.94 ± 2.16% Strong
Pre −6.85 ± 8.57 −7.46 ± 10.7 Time 0.82 ± 0.72% Anecdotal
ULF (cm) Post −3.46 ± 7.63 −4.46 ± 9.32 Group 0.41 ± 0.56% Anecdotal
Interaction 0.80 ± 83.77% Anecdotal
Pre 175.0 ± 26.9 189.0 ± 38.2 Time 2.33 ± 0.99% Anecdotal
AF (rep) Post 222.0 ± 37.2 193.0 ± 62.2 Group 0.36 ± 0.75% Anecdotal
Interaction 1.24 ± 1.78% Anecdotal
J. Clin. Med. 2024, 13, 6603 10 of 15

Table 3. Cont.

Variable Moment Exercise (N = 13) Control (N = 11) ANOVA Bayes Factor Sig. Prob.
Pre 20.3 ± 7.05 20.5 ± 5.20 Time 0.31 ± 2.31% Anecdotal
Tot. BF (kg) Post 19.7 ± 7.74 19.7 ± 4.43 Group 0.36 ± 0.94% Anecdotal
Interaction 0.04 ± 3.85% Anecdotal
Pre 29.4 ± 8.80 30.9 ± 5.63 Time 0.46 ± 1.09% Anecdotal
BF percentage (%) Post 26.5 ± 9.81 29.9 ± 4.66 Group 0.52 ± 1.41% Anecdotal
Interaction 0.10 ± 5.03% Anecdotal
Pre 42 ± 6.03 43.3 ± 4.65 Time 0.30 ± 1.29% Anecdotal
Tot. LM (kg) Post 42.4 ± 5.74 43 ± 3.77 Group 0.45 ± 7.9% Anecdotal
Interaction 0.05 ± 2.41% Anecdotal
Pre 50 ± 5.13 48.7 ± 4.03 Time 0.29 ± 1.49% Anecdotal
Wat. Percentage (%) Post 50.1 ± 5.75 48.7 ± 4.12 Group 0.50 ± 2.21% Anecdotal
Interaction 0.05 ± 2.3% Anecdotal
Pre 7.08 ± 2.63 7.91 ± 2.59 Time 0.30 ± 1.65% Anecdotal
Visc. Fat (Index) Post 6.92 ± 2.33 8.18 ± 2.52 Group 0.64 ± 0.98% Anecdotal
Interaction 0.07 ± 2.43% Anecdotal
Pre 1304 ± 183 1669 ± 762 Time 0.58 ± 1.55% Anecdotal
Basal Met. Post 1311 ± 181 1357 ± 937 Group 0.83 ± 0.78% Anecdotal
Interaction 0.47 ± 1.64% Anecdotal
Pre 5.46 ± 1.45 4.64 ± 2.34 Time 0.51 ± 3.41% Anecdotal
Sleep score Post 4.62 ± 1.26 6.82 ± 1.17 Group 0.56 ± 1.11% Anecdotal
Interaction 10.35 ± 2.07% Strong

Table 4. Associations of sleep quality with anthropometrics, body composition, physical fitness variables, and sleep quality for both control and experimental
groups, and by moments.
Wist Hip
Hand Seat and Bach Fat Visceral
Group Variable Age Body Mass Arm Curl Circumfer- Circumfer- STS5T CS30 TUG 2MST Total Fat Lean Mass Body Water MET
Grip Reach Strech Percentage Fatt
ence ence

r −0.55 0.196 0.3 0.282 0.427 0.392 0.237 0.426 0.378 0.175 −0.255 0.441 −0.153 −0.03 −0.183 0.372 0.036 −0.155
Sleep Quality M1
p 0.079 0.564 0.37 0.402 0.19 0.233 0.483 0.191 0.252 0.606 0.448 0.174 0.654 0.929 0.59 0.26 0.917 0.649
Control r 0.150 0.042 0.214 −0.418 0.145 −0.124 0.082 −0.124 −0.101 −0.014 −0.128 0.038 −0.485 −0.064 0.193 0.665 * 0.386 0.442
Sleep Quality M2
p 0.659 0.901 0.528 0.201 0.670 0.716 0.810 0.717 0.768 0.968 0.708 0.913 0.130 0.833 0.623 0.026 0.241 0.174

r −0.023 0.364 −0.154 −0.201 0.454 0.485 0.360 −0.272 0.575 * 0.256 −0.001 0.098 0.562 * 0.619 * −0.044 −0.646 * 0.515 0.064
Sleep Quality M1
p 0.941 0.221 0.616 0.510 0.119 0.093 0.227 0.369 0.040 0.399 0.997 0.750 0.046 0.024 0.886 0.017 0.072 0.837
Experimental
r −0.113 0.367 −0.243 −0.063 0.253 0.368 0.492 −0.378 0.359 −0.297 −0.115 0.363 0.541 0.620 * −0.052 −0.523 0.472 0.004
Sleep Quality M2
p 0.714 0.218 0.423 0.839 0.404 0.217 0.088 0.203 0.229 0.325 0.708 0.222 0.056 0.024 0.867 0.067 0.103 0.991

Legend: 5TSTS—Five Times Sit-to-Stand Test; CS30—30-Second Chair Stand Test; TUG—Timed Up and Go Test; 2MST—Two-Minute Step Test; MET—Metabolic Rate; * p < 0.05.
 J. Clin. Med. 2024, 13, x FOR PEER REVIEW 12 of 16
J. Clin. Med. 2024, 13, 6603 11 of 15

Figure3.3.Correlation
Figure Correlationheat
heatmap.
map.Warm
Warmcolors
colorssignify
signifystatistically
statisticallysignificant
significantassociations,
associations,and
andcold
cold
and neutral colors represent statistical insignificance.
and neutral colors represent statistical insignificance.

4.4.Discussion
Discussion
Thisstudy
This studyaimedaimedtoto assess
assess thethe effects
effects of 8ofmonths
8 months of multicomponent
of multicomponent trainingtraining
pro-
programs
grams on critical
on critical variables
variables such as such as physical
physical fitness,fitness, body composition,
body composition, and sleep and sleep
quality.
Itquality. It was hypothesized
was hypothesized that a multicomponent
that a multicomponent training program trainingof 8program of 8 months
months significantly
significantly
improves improves
physical fitness,physical fitness, body and
body composition, composition,
quality ofand life. quality
The resultsof life. The results
revealed that
after the multicomponent training program, the experimental
revealed that after the multicomponent training program, the experimental group group improved the arm curl,
5TSTS,
improved CS30, the2MST, total5TSTS,
arm curl, fat (%),CS30,
and sleep
2MST, quality; conversely,
total fat (%), and the sleepTUG, Seat and
quality; Reach,
conversely,
and
the the
TUG, BackSeatStretch tests revealed
and Reach, and theworse
Back results.
Stretch Thetestscontrol
revealed group
worse revealed a worse
results. sleep
The control
quality after the follow-up.
group revealed a worse sleep quality after the follow-up.
Regarding
Regarding the physical fitness
the physical fitnessvariables,
variables,the theimprovements
improvements align
align with
with thethe litera-
literature,
ture, where multicomponent training programs
where multicomponent training programs improve physical fitness improve physical fitness and functionality
functionality
[22,24,30,44,45].
[22,24,30,44,45]. In In the
thecurrent
currentresearch,
research,the theexperimental
experimentalgroup groupimproved
improvedthe thevariables
variables
related
related to aerobic and resistance exercise (arm curl, 5TSTS, CS30, 2MST). Theoflack
to aerobic and resistance exercise (arm curl, 5TSTS, CS30, 2MST). The lack speci-of
ficity of multicomponent
specificity of multicomponent trainingtraining
may explain these results.
may explain these Aresults.
previous study [33]study
A previous revealed
[33]
that, independent
revealed of the training
that, independent type (multicomponent,
of the training type (multicomponent, resistance, or power),
resistance, it wasit
or power),
possible to note improvements in upper and lower limb strength,
was possible to note improvements in upper and lower limb strength, upper and lower upper and lower limb
flexibility and aerobic resistance but not in the TUG test after eight
limb flexibility and aerobic resistance but not in the TUG test after eight months of months of intervention.
Also, after 8 months,
intervention. a multicomponent
Also, after 8 months, a training program improved
multicomponent the maximal
training program voluntary
improved the
contraction
maximal voluntary contraction of upper and lower limbs in older women [46].revealed
of upper and lower limbs in older women [46]. Another study [47] Another
that
studyafter
[47]6 revealed
months of intervention,
that after 6 months the Chair stand test, the
of intervention, ArmChair
curl, stand
Chair test,
sit and
Arm reach,
curl,
Back scratch, TUG, 2MST, Hand grip strength, and BMI significantly
Chair sit and reach, Back scratch, TUG, 2MST, Hand grip strength, and BMI significantly improved. Regarding
the body composition,
improved. Regarding the thebody
EG ofcomposition,
the present study
the EGreduced the total
of the present fat percentage.
study reduced theThis total
aligns with previous studies that applied a multicomponent
fat percentage. This aligns with previous studies that applied a multicomponent training program in the older
training
population,
program inwhere fat mass
the older was reduced
population, whereafter 8 [22]was
fat mass and reduced
6 monthsafter[47].8However,
[22] and 6there are
months
quite controversial results at 6 months, where in some studies, total fat mass did not reduce
J. Clin. Med. 2024, 13, 6603 12 of 15

after the intervention [46,48]. Furthermore, the multicomponent training programs seem to
be adequate to improve aged people’s (>60 years old) physical fitness and frailty [49].
As for the sleep quality, the EG significantly improved the sleep quality. A systematic
review with meta-analysis [12] revealed that exercise programs improved sleep quality.
The same was noted when applying for multicomponent training programs. In the study
by Vaz Fragoso et al. [46], in-home- and center-based participants from 24–30 months
with moderate intensity and 5 times per week found sleep quality improvements in the
participants. The study from Laredo-Aguilera et al. [50], with 10 weeks of duration and a
self-determined intensity to perform 8–12 repetitions, 3 times per week, revealed significant
improvements in sleep quality. Finally, Bademli et al. [51], in nursing home residents,
applied a 20-week program with moderate intensity and 3–4 times per week and showed
improved sleep quality scores. The studies are in line with the current study, where the
multicomponent training program with 8-months duration and moderate intensity also
improved sleep quality.
The present study evaluated associations between sleep quality, physical fitness, and
body composition variables to understand the variables that may explain the total sleep
quality for the CG and EG after and before the multicomponent training program. The
CG revealed significant associations between total sleep quality and body water (Moment
2: r = 0.665; p = 0.026). The association between total sleep quality and body water was
noted in the second evaluation moment and revealed that the higher the percentage of body
water, the lower the sleep quality. During the night, many elderlies experience the need
for frequent urination due to the difficulty of controlling it with aging [52–54]. With this
need to frequently urinate, the circadian rhythm will negatively impact sleep continuity
and quality [54,55]. The EG presented significant associations between sleep quality and
TUG (baseline), total fat (baseline), and body water (baseline). The fat percentage presented
significant associations with sleep quality at baseline and post-intervention). The results
showed that before the multicomponent exercise program, the higher the TUG, the poorer
the sleep quality. As for body composition, higher total fat and body water scores also
indicate poor sleep quality. Factors such as waist circumference, visceral fat, and total
fat can affect sleep quality through hormonal regulation, inflammation, and metabolic
health [56,57], possibly affecting the circadian rhythm [54,55] and sleep quality.
Altogether, this study presents promising results regarding the effectiveness of exercise-
based interventions to improve physical fitness and sleep quality. However, there are
some important limitations to be addressed: (i) the sample of this study is too small
and makes it impossible to perform sex comparisons or generalize the results; (ii) the
intervention program lasted for 8 months, and daily life activities were not controlled;
(iii) co-variates such as mental health or wellbeing behaviors were not assessed; (iv) only
two time measures (before and after) were made in this study. Upon that, future re-
search should be conducted: (i) higher sample sizes will allow generalizing of the results;
(ii) monitoring daily life physical activity; (iii) mental health and well-being lifestyle
should be assessed; (iv) different durations and types of exercise-based programs should
be assessed.

5. Conclusions
The findings of this study demonstrate that a targeted physical fitness intervention
can significantly improve physical performance and sleep quality in aging adults. The
experimental group showed marked improvements in muscle endurance, as evidenced by
increased arm curl repetitions and improved performance in the 5TSTS and 2MST tests.
Additionally, the intervention led to a significant reduction in total fat percentage and
enhanced sleep quality. In contrast, the control group exhibited a decline in sleep quality
over the study period, highlighting the potential protective effects of physical exercise on
sleep in older adults. These results underscore the importance of incorporating regular,
targeted exercise programs into the routines of aging individuals to enhance overall health,
physical fitness, and sleep quality.
J. Clin. Med. 2024, 13, 6603 13 of 15

Author Contributions: Conceptualization, P.F. and A.M.M.; methodology, A.M.M.; software, S.G.E.;
validation, D.P.-M., L.B., and T.M.B.; formal analysis, P.F.; investigation, P.F. and S.G.E.; resources,
A.M.M.; data curation, L.B.; writing—original draft preparation, P.F.; writing—review and editing,
S.G.E., L.B., A.M.M., T.M.B., and D.P.-M.; visualization, S.G.E.; supervision, A.M.M., T.M.B., and
D.P.-M.; project administration, A.M.M.; funding acquisition, T.M.B. All authors have read and agreed
to the published version of the manuscript.
Funding: This research was funded by the Research Center for Active Living and Wellbeing.
Institutional Review Board Statement: All procedures were carried out in accordance with the
recommendations of the Declaration of Helsinki for human studies. The research project received
approval by the Ethical Committee of the Instituto Politécnico de Bragança (number: 2576).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Written informed consent has been obtained from the patient(s) to publish this paper.
Data Availability Statement: Contact corresponding author.
Conflicts of Interest: The authors declare no conflicts of interest.

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