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Although exercise is a recognized non-pharmacological intervention, existing evidence has largely been generated in selected community-dwelling populations, limiting its applicability to vulnerable older adults in real-world long-term care settings. The SCOPE study (Sarcopenia Care in Oldest-old: a Pragmatic Exercise cluster-randomized controlled trial) evaluates the effectiveness and feasibility of caregiver-led modified Baduanjin, resistance training, and combined exercise interventions for sarcopenia management in nursing home residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This pragmatic, cluster-randomized controlled trial aims to recruit 104 residents aged\u2009\u2265\u200975\u00a0years with sarcopenia from a large nursing home in Hangzhou, China. Participants will be randomized by residential building into four groups: Modified Baduanjin Group, Resistance Training Group, Combined Exercise Group, and Control Group. The 48-week intervention will be delivered by trained caregivers using video-guided sessions, with phased reduction in specialist supervision. The primary outcome is a composite sarcopenia Z-score integrating handgrip strength, Short Physical Performance Battery, and appendicular skeletal muscle mass index. Secondary outcomes include functional mobility, balance, physical activity and sedentary behaviour, neuromuscular activation, questionnaire-based assessments, and saliva biological markers. Clinical events and care-dependency records will also be collected throughout the intervention and follow-up periods. Assessments will be conducted at baseline, week 12, week 24, week 48, and at 1 and 2\u00a0years post-intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The SCOPE study addresses the need for feasible and sustainable exercise interventions for sarcopenia in real-world nursing home settings. By integrating pragmatic caregiver-led delivery, multimodal outcome assessment, and long-term follow-up, this trial aims to inform exercise prescription, implementation feasibility, and potential mechanisms of adaptation in oldest-old nursing home residents. The findings are expected to support the development of scalable exercise intervention frameworks for sarcopenia management in long-term care facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Chinese Clinical Trial Registry (ChiCTR2500107315).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-08002-8","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:34:00Z","timestamp":1788168840000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementing an exercise intervention for sarcopenia in oldest-old nursing home residents: protocol for a pragmatic cluster-randomized controlled trial (SCOPE Study)"],"prefix":"10.1186","volume":"26","author":[{"given":"Cheng","family":"Xiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianzhi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuwen","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenye","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixi","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziru","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changxu","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Run","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xucheng","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yincun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shen","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuyun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"issue":"10191","key":"8002_CR1","doi-asserted-by":"publisher","first-page":"2636","DOI":"10.1016\/S0140-6736(19)31138-9","volume":"393","author":"AJ Cruz-Jentoft","year":"2019","unstructured":"Cruz-Jentoft AJ, Sayer AA. 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