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Happier Elderly Residents. The Positive Impact of Physical Activity on Objective and Subjective Health Condition of Elderly People in Nursing Homes. Evidence from a Multi-Site Randomized Controlled Trial

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We explore the effects of adapted physical exercise programs in nursing homes, in which some residents suffer from dementia and/or physical limitations and others do not. We use data from 452 participants followed over 12 months in 32 retirement homes in four European countries. Using a difference-in-difference with individual random effects model, we show that the program had a significant impact on the number of falls and the self-declared health and health-related quality of life of residents (EQ-5D). The wide scope of this study, in terms of sites, countries, and measured outcomes, brings generality to previously existing evidence. A simple computation, in the case of France, suggests that such programs are highly cost-efficient.

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  3. Convention VS/2011/0059

  4. The ethics approval was obtained in CCPg Ile de France center (n ID RCB: 2012-A00646–37). The protocol was registered under the acronym HAPPIER (Healthy Activity and Physical Program Innovations in Elderly Residences). There was no data monitoring committee other than the Institute for Public Policy that oversaw the study. The study protocol can be fund online at



Aggressive Behavior Scale


Activity of Daily Living


European Quality of Life Survey (


Geriatric Depression Scale


Ordinary Least Square


Randomized Controlled Trial


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Jean-Daniel Mueller, Guillaume Lefebvre and Jean-Michel Ricard (Siel Bleu) designed and implemented the protocol, with the contribution of Chloe Gerves, who also collected the data. We thank two anonymous referees for their insightful comments.


The experiment was funded by the European Commission, Convention VS/2011/0059. It also benefited from the financial support of the French Agence nationale de la recherche (ANR-16-MYBL-0001-02), and the program Investissements d’Avenir (ANR-10-LABX-93-01).

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Authors and Affiliations



The protocol was designed by Siel Bleu with the contribution of Chloe Gerves, who also collected the data. Patricia Dargent contributed to the design of the protocol, in particular the outcome measures. Carine Milcent was initially the statistician for this study, and was later replaced by Guglielmo Zappalà as statistical analyst. Claudia Senik conducted the analysis of the data and wrote the report, which was reviewed, revised and subsequently approved by all authors.

Corresponding author

Correspondence to Guglielmo Zappalà.

Ethics declarations

The protocol was registered under the acronym HAPPIER (Healthy Activity and Physical Program Innovations in Elderly Residences). There was no data monitoring committee other than the Institute for Public Policy that oversaw the study. The study protocol can be fund online at http://ec.europa. eu/employment/defis/publigrant/public/publications/266/frame?publicationLanguage = fr.

Ethics Approval

The ethics approval was obtained in CCPg Ile de France center (n ID RCB: 2012-A00646–37).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Disclosure of Potential Conflicts of Interest

The authors have no relevant financial or non-financial interests to disclose.

Conflicts of Interest/Competing Interests

The authors have no conflicts of interest to declare that are relevant to the content of this article.

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Senik, C., Zappalà, G., Milcent, C. et al. Happier Elderly Residents. The Positive Impact of Physical Activity on Objective and Subjective Health Condition of Elderly People in Nursing Homes. Evidence from a Multi-Site Randomized Controlled Trial. Applied Research Quality Life 17, 1091–1111 (2022).

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