# Use of Wearables in Frail Institutionalized Older Adults While Ambulating in Different Environments
## 3 Results  
The total sample consisted of 30 institutionalized older adults, and their sociodemographic data are reflected in Table 1. Considering the cutoff points of the TUG assessment test, nearly all participants exhibited frailty, and consequently, a risk of falls. The total sample was grouped based on BMI and cognitive level. \begin{table}
\begin{tabular}{l c c} \hline \hline  & & **Participants** \\  & & **(n = 30)** \\ \hline Age & & 78.90 \(\pm\) 9.08 \\ Sex & & \\  & Men (\%) & 15 (50) \\  & Women (\%) & 15 (50) \\ Height (cm) & & 160.43 \(\pm\) 7.76 \\ Weight (kg) & & 70.16 \(\pm\) 12.82 \\ Timed Up and Go & & 15.01 \(\pm\) 3.19 \\  & Low fall risk (\%) & 1 (3.3) \\  & Frailty/Risk of falling (\%) & 28 (93.3) \\  & High risk of falling (\%) & 1 (3.3) \\ Body Mass Index & & 27.19 \(\pm\) 4.22 \\  & Normal weight (\%) & 8 (26.7) \\  & Overweight (\%) & 22 (73.3) \\ Mini-examen Cognoscitivo de Lobo & & 24.27 \(\pm\) 5.17 \\  & No cognitive impairment (\%) & 11 (36.7) \\  & With cognitive impairment (\%) & 19 (63.3) \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Sociodemographic data of the total sample (n = 30). Table 2 and Figure 1 display the differences between the results of time, energy expenditure, and perceived exertion in a controlled environment and an uncontrolled environment, along with the magnitude of these differences, calculated using the effect size. These results reveal that participants take less time and exhibit higher energy expenditure, as well as a greater perception of effort, when walking in the uncontrolled outdoor environment compared to walking in the controlled residential environment. There are significant differences in all three variables (\(p<0.05\)) and a large effect size for energy expenditure and perceived exertion (d \(\geq\) 0.8). When grouping the sample based on BMI, older adults with normal weight (n = 8) had a mean BMI of \(21.81\pm 1.64\), while those overweight (n = 22) had a mean BMI of \(29.15\pm 2.95\). The mean differences between groups in time, energy expenditure, and perceived exertion in each environment, along with the magnitude of these differences calculated through effect size, are shown in Table 3 and Figure 2.  
Among participants with normal weight and those overweight, statistically significant differences are observed in energy expenditure (\(p<0.05\)) when walking in a controlled residential environment and an uncontrolled outdoor environment. In both environments, overweight older adults show higher energy expenditure compared to those with normal weight, with their energy expenditure being higher in the uncontrolled external environment. The effect size is moderate for energy expenditure in the controlled residential environment (d = 0.5-0.7) and large for energy expenditure in the uncontrolled outdoor environment (d \(\geq\) 0.8). \begin{table}
\begin{tabular}{l l l l l l} \hline \hline  & **Controlled** & **Uncontrolled** & & & & \\  & **Residential** & **External** & **Test Statistic** & \(p\)**-Value** & **d-** \\  & **Environment** & **Environment** & & & & \\ \hline Time (min) & \(5.75\pm 1.38\) & \(5.01\pm 1.12\) & \(-2.707\) & \(0.007\) * & \(0.589\) \\ MET & \(1.42\pm 0.68\) & \(2.24\pm 1.28\) & \(-4.268\) & \(<\)0.001 * & \(0.800\) \\ Borg Scale & \(6.13\pm 1.01\) & \(6.97\pm 1.10\) & \(-4.291\) & \(<\)0.001 * & \(0.795\) \\ \hline \hline \end{tabular} Data expressed in M \(\pm\) SD; * \(p<0.05\); MET = energy expenditure.  
\end{table} 
Table 2: Comparison of time, energy expenditure, and perceived exertion during ambulation in a controlled and uncontrolled environment (n = 30). Figure 1: Graph comparing time, energy expenditure, and perceived exertion during ambulation in a controlled and uncontrolled environment (n = 30). Data expressed as mean; MET = energy expenditure; time data expressed in minutes. When grouping older adults by their scores on the MEC, those without cognitive impairment (n = 11) had a mean score of 30.18 \(\pm\) 2.68, while those with cognitive impairment (n = 19) had a mean score of 20.84 \(\pm\) 2.29.