The ALIVE-Project: Activity, Life Satisfaction, Inclusion, Vitality, Elderly Women

• Supervised Group Exercise in Fitness Clubs (Behavioral): Participants assigned to this intervention will receive a 16-week supervised group exercise program delivered in fitness clubs. Exercise sessions will be conducted twice weekly in stable groups of approximately 8 to 15 participants and led by trained health and exercise professionals. Each 60-minute session includes warm-up, aerobic and resistance exercises, functional circuit training, balance exercises, and cool-down. Participants will also have opportunities for informal social interaction with fellow participants following each session. The intervention is designed to combine regular physical activity with structured social participation in order to promote social connectedness, well-being, and physical health in older women.
• Individual exercise (Behavioral): Participants will receive a 16-week membership to a different SATS fitness club in the same district, which includes access to advanced cardio and resistance equipment, but without the group-based exercises. They will be given one supervised session to learn how to use the equipment. This group represents access to a community exercise arena without structured social facilitation through group-based exercise classes, thereby allowing examination of whether access alone is sufficient, or whether structured social participation is necessary for improved mental and physical health. Importantly, this comparison enables evaluation of the added value of structured social participation beyond access to exercise facilities alone. It also allows us to explore whether simply leaving the home environment and being exposed to a social setting may in itself contribute to improved quality of life.

Primary outcomes

• Loneliness and socal isolation [Baseline and immediately after the 16-week intervention]: The Revised UCLA Loneliness Scale-6 (RULS-6) will be used to assess subjective feelings of loneliness and social isolation. The instrument consists of 6 items evaluated on a 4-point Likert scale. Individual item scores are summed to produce a single total score.The scale has a minimum value of 6 and a maximum value of 24. A higher total score on the RULS-6 indicates a worse outcome, representing a higher degree of perceived loneliness and social alienation. Conversely, lower scores represent a better outcome (greater social connectedness).

Secondary outcomes

• Health-related quality of life [Baseline and immediately after the 16-week intervention]: The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) assesses health-related quality of life. The items are scored and transformed into standardized domain scores. Each scale has a minimum value of 0 and a maximum value of 100. A higher score indicates a better outcome (better health and higher quality of life)
• Depression and anxiety [Baseline and immediately after the 16-week intervention]: The Hospital Anxiety and Depression Scale (HADS) assesses symptoms of anxiety and depression using two separate 7-item subscales (HADS-A and HADS-D). Each subscale has a minimum value of 0 and a maximum value of 21. A higher score indicates a worse outcome (greater severity of anxiety or depressive symptoms).
• Functional independence [Baseline and immediately after the 16-week intervention]: The Lawton Instrumental Activities of Daily Living Scale (IADL) assesses an individual's ability to perform complex daily tasks necessary for independent community living. The instrument evaluates eight distinct functional domains. The scale has a minimum value of 0 and a maximum value of 8. A higher score indicates a better outcome, representing a higher level of functional independence and autonomy.
• Musculoskeletal complaints [Baseline and immediately after the 16-week intervention]: Selected items from the Trøndelag Health Study (HUNT4) will be used for descriptive purposes to map chronic pain. The screening item registers the presence or absence of chronic pain. The subsequent 13 anatomical pain sites are formatted as checkboxes to register whether a complaint is present.
• Urinary incontinence [Baseline and immediately after the 16-week intervention]: The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) assesses the frequency, severity, and impact of urinary incontinence on daily life. The instrument utilizes three scored items to calculate a total additive score, alongside one unscored self-diagnostic item. The scale has a minimum value of 0 and a maximum value of 21. A higher score indicates a worse outcome, representing greater symptom severity and a higher negative impact on quality of life.
• Endurance [Baseline and immediately after the 16-week intervention]: The 6-Minute Walk Test evaluates functional exercise capacity and aerobic endurance. The test measures the total distance a participant can walk in a period of 6 minutes, with the outcome recorded in meters. A higher score indicates a better outcome (higher physical endurance and better functional mobility).
• Lower-body muscle strength and functional mobility [Baseline and immediately after the 16-week intervention]: The 30-Second Chair Stand Test evaluates lower-body muscle strength and functional mobility. The test measures the total number of times a participant can stand up completely from a seated position in a period of 30 seconds without using their arms. A higher score indicates a better outcome.
• Hand grip strength [Baseline and immediately after the 16-week intervention]: The Hand Grip Strength Test evaluates isometric muscular strength of the hand and forearm using a hand-held dynamometer. The test measures the maximum squeezing force exerted by the participant, with the outcome recorded in kilograms (kg). A higher score indicates a better outcome.
• Balance and postural stabilit [Baseline and immediately after the 16-week intervention]: The One-Leg Standing Test evaluates static balance and postural stability. The test measures the total duration a participant can maintain balance standing on a single leg, with the outcome recorded in seconds. A higher score indicates a better outcome (superior static balance and lower fall risk).
• Body composition [Baseline and immediately after the 16-week intervention]: Body Composition analysis using the InBody 770 evaluates body composition metrics (including skeletal muscle mass and body fat mass) via multi-frequency bioelectrical impedance analysis. Raw metrics are recorded in kilograms (kg) or percentages (%). For skeletal muscle mass, a higher score indicates a better outcome (greater muscle reserve), while for body fat mass, extreme scores in either direction indicate a worse outcome (clinical underweight or obesity).
• Metabolic biomarkers [Baseline and immediately after the 16-week intervention]: Finger prick tests for glucose, cholesterol, and triglycerides evaluate metabolic biomarkers using a capillary blood sample. Metrics are recorded in millimoles per liter (mmol/L). For glucose, total cholesterol, LDL-cholesterol, and triglycerides, elevated levels indicate a worse outcome (metabolic risk). Conversely, for high-density lipoprotein (HDL) cholesterol, a higher score indicates a better outcome (cardiovascular protection).
• Device-measured physical activity [Baseline and immediately after the 16-week intervention]: Device-measured physical activity using accelerometers evaluates movement patterns through continuous objective monitoring for seven days. Outcomes are recorded as raw acceleration counts, which are used to calculate time spent in moderate-to-vigorous physical activity in minutes. A higher score indicates a better outcome (higher physical fitness and physical activity level).

Sex: Female, ages: 75 Years to 100 Years, accepts healthy volunteers

Inclusion Criteria:

* Women aged ≥75 years
* Currently living alone for at least four months (including widowed or single women)
* Residing at home in Oslo with convenient access to participating SATS fitness clubs in the Nordre Aker or Vestre Aker districts
* Participating in <60 minutes per week of planned, structured exercise at moderate-to-vigorous intensity, whether individually or in an organized setting (excluding recreational walking and other habitual physical activity)

Exclusion Criteria:

* Dementia or other cognitive impairment
* Diseases that are contraindicated for exercise or testing (such as unstable angina, recent heart attack, uncontrolled arrhythmia, or recent coronary bypass surgery)

• Study Protocol (PDF, 2026-08-18)