# Effects of an Adapted Sports Intervention on Elderly Women in Need of Long-Term Care: A Pilot Study
## 1 Introduction  
The average life expectancy in Japan for women was 87.45 years old in 2019, and their healthy life expectancy was 75.5 years old, both of which are some of the highest in the world [1]. However, the number of women who select \"good/very good\" for a subjective assessment of individual health status and self-rated health is low in Japan compared with its internationally reported values [2]. A gap between objective and subjective health is seen and needs resolution.  
The effects of sports and physical activity on activities of daily living (ADL) and health-related quality of life (HRQoL) in the elderly have been shown in various previous studies [3; 4; 5]. However, studies on elderly people in need of long-term care (NLTC) have reported limited effects of exercise on ADL [6; 7; 8], and little concern for the risk of injury and health status deterioration [9]. Consequently, safety and security are prioritized in exercises for the elderly in NLTC, and simple movements such as walking, balance training, and flexibility exercises have been selected [10; 11]. A study on exercise habits among the aged population in Japan showed that the number of people who exercised or played sports in the age group between 65 and 74 years has increased, whereas that in the age group of 75 years and above has decreased rapidly [12]. When examining the group of people whose exercise habits are in decline and the reasons behind this deterioration, one cause may be the inability to continue the exercise due to a decline in ADL; this is all the more significant because this age group are enthusiasts of ADL-demanding exercises, such as walking, aerobic dancing, and competitive sports (e.g., table tennis, golf, bowling) [12]. Additionally, a study comparing elderly men and women without exercise habits using self-rated health showed that the HRQoL scores of elderly women were significantly low, especially forphysical health [13]. Considering these facts, there is an urgent need to develop sports programs for elderly women in the NLTC. Therefore, in this study, we focused on adapted sports (AdS).  
AdS is derived from the research field of Adapted Physical Activity, that means \"a sport in which everyone can participate by devising rules and equipment that take into account the physical abilities of the participants\" [14,15]. Previous studies on AdS have demonstrated positive effects on subjective health, such as mood [16] and HRQoL[17,18] in participants with limited physical function. In particular, mood state is an important measure that leads to improvement in homeboundness and participation in activities, such as exercise [19].  
Boccia is a sport that is competitive, safe to perform, and even easier to improve in [20]. In addition, it has been shown to have a positive effect on mood states, even in severely impaired individuals [21]. However, to the best of our knowledge, the effect of participation in boccia on the subjective health status of older women in NLTC is unclear.  
Therefore, the present study aimed to clarify the effects of AdS on elderly women in NLTC and examine the changes in mood state and HRQoL after intervention with boccia.