# Use of Wearables in Frail Institutionalized Older Adults While Ambulating in Different Environments
## 4 Discussion

Table 4: Comparison of time, energy expenditure, and perceived exertion during ambulation in a controlled and uncontrolled environment among institutionalized older adults based on their cognitive status (n = 30). During moderate-intensity walking, [PERSON] et al. [33] found significant differences in perceived exertion, measured with the Borg Scale, between young adults and older adults. They also concluded that assessing perceived exertion is recommended to estimate exercise intensity in older adults. The results of the present study contribute to the understanding that frail institutionalized older adults exhibit differences in perceived exertion when walking in a controlled residential environment compared to an uncontrolled outdoor environment, experiencing greater effort when walking in the uncontrolled outdoor environment. When analyzing the study variables considering the sample's grouping by BMI, the results show statistically significant differences in energy expenditure. As expected, individuals with overweight have higher energy expenditure than those with normal weight, both in the controlled residential environment and the uncontrolled outdoor environment. A recent review [41] supports that energy expenditure is generally higher in overweight and obese individuals compared to individuals within the normal range for age, height, and sex. Similarly to our results, [PERSON] et al. [42] found that overweight adults showed higher total energy expenditure when walking compared to normal-weight adults, regardless of the pace. However, our results do not show differences between overweight and normal-weight older adults in the time it took to complete both walks or in perceived exertion. This aligns with the work by [PERSON] et al. [42], where they did not find significant differences in speed between normal-weight and overweight adults during a self-selected walking pace. This result is similar to what is presented in the current study, as speed and time during walking are related, and our study adds novelty by observing these results in frail institutionalized older adults. However, our study is the only one that focuses on perceived exertion, comparing it by BMI groups and in two different environments. The lack of significant differences in perceived exertion between overweight and normal-weight older adults when walking in a controlled residential environment and an uncontrolled outdoor environment may be due to the small overall sample size and the difference in size in each of the groups. When grouping the sample based on cognitive level, our data show that there are no statistically significant differences in time, energy expenditure, or perceived exertion among institutionalized older adults with and without cognitive impairment when walking in a controlled residential environment and an uncontrolled outdoor environment. These findings complement those presented in the study by [PERSON] et al. [43], who also did not find statistically significant differences in walking speed, mobility capacity, and functional balance when comparing institutionalized older adults with and without cognitive impairment. The limitations of this study include the small sample size, the fact that the sample is from the same region, and the convenience sampling method, which could hinder the generalization of the results. For future studies, larger and more diverse samples from various locations across the country should be considered. Additionally, expanding the sample to include both frail and non-frail elderly individuals would provide a more comprehensive understanding of the relationships studied.