Feasibility of Pilates for Late-Stage Frail Older Adults to Minimize Falls and Enhance Cognitive Functions  
[PERSON]  
1 Graduate School of Comprehensive Human Sciences, Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-8577, Japan 11 Graduate School of Comprehensive Human Sciences, Faculty of Health and Sport Sciences, University of 65-74 years and late-stage seniors > 75 years) can clarify at which age seniors generally start losing their healthy, independent lifestyles [2; 3; 4; 5]. Once the health statuses of seniors decline below a certain level, engagement in regular activities becomes increasingly challenging [6]. Preventive or rehabilitation approaches are, therefore, somewhat underutilized for late-stage older adults due to various special considerations required for safety precautions [7; 8]. It is, however, still necessary to devise feasible strategies for vulnerable populations with limited mobility to combat deterioration [9] because indefinite reliance on nursing care without the intention for recovery can only result in the gradual progression of fundamental health declines [10]. For the older population, the two major factors causing constant nursing care are falls-related injuries during locomotion and declined cognitive functions. In other words, health enhancement for seniors should focus on these two aspects, but, first of all, reliable assessment methods are essential to evaluate individuals' locomotion and cognitive functions. Gait biomechanics utilizing 3D motion capture systems can accurately record human movements and quantify fall risks by looking at foot motion and dynamic balance [11]. While simple locomotion tests (e.g., 6 min walking and timed up and go test) are practical, no detailed examinations are possible to understand how their walking patterns can increase fall risks [12]. Despite rather complicated settings, gait testing based on 3D motion capture systems can biomechanically explain falling risks by characterizing swing foot motion and dynamic balance [11]. For assessments of cognitive functions, overall impairments can be checked by Mini-Mental State Examination (MMSE), while Trail Making Test-A (TMT-A) is a specific examination for executive functions that are highly linked with motor behaviors [13]. By undertaking these tests before and after an intervention, changes in the health functions of the frail senior population can be monitored, reflecting the 'effectiveness' of intervention strategies to prevent falls and cognitive impairments. Among various intervention strategies available for this purpose, 'exercise' should be prioritized due to the benefits for falls prevention, mental health and cognitive functions; suitability for rehabilitation; and cost advantages and relatively less adverse side effects, if executed appropriately [14; 15; 16; 17]. Nevertheless, the frail late-stage senior population tends to avoid continuous engagement into exercise due to critical physical limitations and motivation issues. It is obvious that the safe prescription of adequate exercise is often challenging for late-stage older adults, but lack of motivation can also discourage physically and cognitively impaired populations from continuously engaging in exercise programs [18]. Pilates exercise was originally developed by [PERSON] to pursue 'natural human health', and its structural operation played an important role during World War I for wounded soldiers' rehabilitation. Many training sequences included the use of special equipment such as Cadillac, Reformer, and Wundachair. Mat-based Pilates is often conducted in the lying and sitting postures to avoid overloading of the foot and cardiovascular systems [19]. Unlike general exercise programs involving dynamic movements in strength and cardio training, Pilates focuses on fine-movement control to enhance 'core' stability and skeletal alignment [20], requiring less gross physical motions and is therefore more suitable for the frail population.