Introduction
Frailty syndrome is one of the syndromes that is receiving more attention with the increase in the elderly population [2]. This syndrome is characterized by physical complications such as weakness, fatigue, decreased energy, physical activity, and unintentional weight loss, leading to an increased chance of falling. Movement restriction reduces the ability to perform daily life activities and even social interactions among the elderly [3, 4]. 
Choosing and using appropriate therapeutic interventions can effectively improve the conditions of elderly people with dementia and the consequences of this syndrome [8, 9, 10]. One of the exciting interventions in this field is various types of physical activity [11, 12]. Despite the rapid increase in the Iranian elderly population in the future, there is still no accurate information on the prevalence of obesity and appropriate interventions to address it [19]. 
The current study was conducted to investigate the effectiveness of short-term postural-balance exercises on balance and functional limitations in elderly women with frailty syndrome.
Methods
The current randomized controlled trial (RCT) study was conducted with the participation of 54 elderly women. The sample size was determined based on the difference between two groups of the same size in a similar study, and the samples were selected by a one-stage cluster random sampling method. Examples of entry criteria include being over 55 years old, having at least 3 positive indicators from the Frito-Fried tool, scoring at least 21 on the Berg test, scoring at least 22 on the mobility limitation questionnaire, having no ban on performing sports exercises, and having no severe visual and auditory impairment. The leaving criteria include the withdrawal in case of unwillingness to continue cooperation and the experiencing severe skeletal-muscular injury during the intervention. From the questionnaires of demographic information, Fried Frailty Index, Short Form Berg Balance Scale (9 items), Fear of Falling and Mobility Limitation Questionnaire respectively to collect general and health information, the severity of frailty, balance level, and movement restriction was used to perform activities in the elderly.
The exercise program followed the standard exercise protocol for frailty in the elderly, which includes fall compensation techniques, posture correction, and Otago balance exercises. The exercises were performed under the supervision of an occupational therapist, considering the appropriate intensity and number of repetitions. The intervention was carried out for 6 weeks of 2 sessions of 1-hour training per week and as a group. Before the implementation of the intervention, safe environmental conditions were provided, and the necessary equipment was prepared. Each session’s first and last 15 minutes were devoted to warm-up and cool-down exercises, and the middle 30 minutes were committed to the leading practices. A virtual group in WhatsApp software sends teaching aids materials. People in the control group did not receive any special training. Data were collected immediately after the completion of the intervention.
This research has been approved by the Ethics Committee of Shiraz University of Medical Sciences (No: IR.SUMS.REHAB.REC.1398.03) and registered in the clinical trial system of Iran (IRCT20180514039648N1). An informed consent form was obtained from the participants.
Results
According to the normal distribution of the data, parametric methods were used to analyze the data. According to the findings, 51.8% (28 persons) of the participants in the age group of 60-65 years, 0.50% (27 persons) of the participants were divorced, and 35% (19 persons) were widows. 94.4% of the participants (51 persons) had at least one chronic disease, and 40.7% (22 persons) had a history of chronic disease between 6-10 years. 38.8% (21 persons) of the participants had a secondary education level. 48.1% (26 persons) evaluated their health status as healthy (I have some health problems that I control well). 
Examining the situation of the fatigue index in the participants showed that 18.5% of the participants (10 persons) according to the unwanted weight loss index, 74.0% (40 persons) according to the first question of the fatigue index (total effort), “my life is fruitless”, 25.9% (14 persons) according to the second question of fatigue index “I can’t continue anymore”, 25.9% (14 persons) according to the walking speed index, 90.7% (49 persons) according to the index of physical activity, 92.5% (50 persons) were classified according to the index of hand grip strength. Based on Fisher’s exact test results, there was no significant difference between the participants of the intervention group and the control group regarding demographic variables and Fartuity indices.
Table 1 compares the sample’s obesity, balance, and mobility indicators.


According to the results, at the beginning of the study, there was no significant difference between the intervention group and the control group regarding fatigue, balance status, or movement limitation. After the intervention implementation, the walking speed in the intervention group was significantly lower, and the physical activity was significantly higher than in the control group. Also, although no significant difference was observed in the status of any of the parameters of obesity after the intervention in the control group, in the intervention group, the average scores of walking speed decreased significantly, and physical activity increased significantly (P<0.001). In addition, after the implementation of the intervention in the control group, there was no significant difference in the balance and movement limitations of the elderly; however, in the intervention group, the average score of the elderly’s balance status increased significantly, and the average score of movement restriction significantly decreased (P<0.001).
In addition, the distribution of Bayes factor scores for the response variables showed that the intervention was able to significantly improve physical activity level (t=4.342, Bayes Factor=0.004), walking time (t=3.301, Bayes Factor=0.056), movement limitation (t=77.047, Bayes Factor=0.000) and improve balance (t=10.851, Bayes Factor=0.000) (P<0.0001), but there was no significant effect on mental fatigue (P=0.349) and grip strength (P=0.329).
Discussion
This study aimed to investigate the effect of short-term postural-balance exercises on balance and functional limitations in elderly women with Fertotti syndrome. 
According to the results, although the intervention did not significantly affect unintentional weight loss, mental fatigue, and hand grip strength, it improved other indicators of fatigue such as physical activity level, walking speed, increased balance, and reduction of movement limitations among the elderly.
According to the results, although the intervention did not have a significant effect on the components of unintentional weight loss, feeling of mental fatigue, and hand grip strength, it was able to improve other fatigue indicators such as the level of physical activity and walk speed, increasing balance and reducing movement limitations. It was elderly.
The findings of this study were in line with previous studies about the effect of sports programs on improving walking speed and preventing the lack of hand grip strength in the elderly. The reason for the reduction of movement limitation following the implementation of balance exercises was introduced in the study of Aartolahti et al. (2020) to improve balance and in the study of Brahms et al. (2021) to improve the walking speed of the elderly. The elderly in the current study can be attributed to the improvement of the two mentioned components due to the intervention.

Ethical Considerations
Compliance with ethical guidelines
The ethics committee of Shiraz University of Medical Sciences has approved this research with the number IR.SUMS.REHAB.REC.1398.03 and it has been registered in the clinical trial system of Iran with the number IRCT20180514039648N1. An informed consent form was completed for all participants.

Funding
This research was supported by the research assistant of Shiraz University of Medical Sciences Faculty of Health.

Authors' contributions
Designing, conducting interviews, collecting data, writing the introduction section Contribution: Forozan Tuan and Mahsa Yarollahi; Methods, statistical analysis, results: Abdolrahim Asadollahi, Ms. Farozan Tuan and Ms. Mehsa Yarollahi; Supervising the process of study, discussion and conclusion: Abdolrahim Asadollahi, Nagin Shiretnagar and Mrs. Forozan Tuan; All authors have also approved the final version.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The Farzanegan Foundation of Shiraz and its esteemed management, Tahereh Sokoot, and the elderly who helped us in this research are thanked and appreciated.


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