# Use of Wearables in Frail Institutionalized Older Adults While Ambulating in Different Environments
## 2 Materials and Methods
### Participants and Assessment Instruments  
The sample consisted of older adults from residential centers affiliated with the Grupo Asistencial NJ company, located in the province of Zamora, Spain. The participant sample was obtained through a non-probabilistic convenience sampling strategy.  
To determine the appropriate sample size, G*Power software (version 3.1.7) was used, obtaining a sample size of 25 subjects, calculated with an effect size of 0.6, a statistical power of 0.8, and a type I error rate of 0.05 for the comparison of matched pairs of means. Allowing for 10% of possible sample losses, the final sample size was 28 subjects.  
Inclusion criteria were as follows: being a resident of the assistance centers affiliated with Grupo Asistencial NJ; being 60 years of age or older; and being independent for walking with or without assistive devices. Exclusion criteria included: having experienced 3 or more falls in the last year; wheelchair users; and non-acceptance and failure to sign the informed consent form.  
Height and weight data for each participant were collected from the weekly reports of the nursing service at the residence. This information was used to calculate the BMI using the formula weight in kilograms divided by the square of height in meters. To categorize the sample, individuals with a BMI less than 24.9 were considered to have normal weight, while those with a BMI greater than or equal to 25 were classified as overweight [22].  
To record the time taken to complete the routes and energy expenditure, measured in METs, ActiGraph wGT3X-BT accelerometers were used, programmed at a frequency of 30 Hz. The ActiGraph wGT3X-BT captures and records high-resolution information about human activity through a 3-axis accelerometer [23]. In recent years, the ActiGraph accelerometer has been the most widely used in research and has consistently demonstrated good validity and reliability in many studies [24]. The ActiLife 6 software was used for processing accelerometer data.  
The Modified Borg Scale, used since the 1980s, is a visual analog scale that allows for the graphical assessment of the subjective perception of physical exertion. It consists of a range from 0 to 10, where 0 corresponds to \"nothing at all\" and 10 to \"very, very strong\" or \"very, very heavy\", referring to the exercise or physical work that the subject perceives as the most strenuous [25].  
The Timed Up and Go (TUG) test has been widely used to assess older adults and is also utilized as a predictor of falls [26; 27]. The test measures the time it takes for subjects to rise from a chair, walk a distance of three meters, turn, return to the chair, and sit back down [28]. A score of less than 10 s predicts a low risk of falls, between 10 and 20 s indicates frailty, and when it exceeds 20 s, the elderly individual is considered to have a high risk of falls [28; 29]. In a recent study, the TUG test showed a sensitivity of 76.2% and a specificity of 89.8% [27].  
The Mini-Examen Cognostitivo de Lobo (MEC) is the adapted and validated Spanish version of the Mini-Mental Status Examination by Folstein, a standard instrument for assessing cognitive function. The items that compose it explore five cognitive areas: orientation, fixation, concentration and calculation, memory, and language and construction. In this study, the 35-point version was used as it is the most well-known. This scale has a cutoff point for geriatric patients at 23/24, with a sensitivity of 89.8% and a specificity of 83.9% for this point, indicating that below this score, there is some type of cognitive impairment [30]. Individuals without cognitive impairment were those with a score equal to or greater than 24, while all those with a score lower than 24 were included as individuals with cognitive impairment [30].