Combat sports are considered risky physical activity due to their high injury rates in elite athletes (1, 2). For example, in Olympic combat sports athletes, the most frequent injuries and illnesses were 45.8% head/face injuries and bruises in boxing, 10.9% low back injuries in judo, 22.8% finger sprains in taekwondo, and 24.8% knee sprains in wrestling (1). Despite the aforementioned risks, combat sports are a prevalent physical activity practice (3). In addition, it has been suggested that, with appropriate dosage (e.g., selection of technical foundations, number of sessions and time, volume, intensity, and density), they can be used to train adults (4) and older people (5, 6), achieving benefits similar to other physical activity strategies at the physical, physiological, and psychoemotional levels. Recent systematic reviews (7, 8) have not been able to establish conclusive results regarding the favorable effects of Olympic combat sports on the health status of older people. However, the individual results of the studies analyzed indicate a significant reduction in fall risk (8) and an improvement in health-related quality of life (HRQoL) (7), with a mean adherence that is more significant than 80%.

In particular, adapted taekwondo interventions for older women have reported a significant increase in the number of repetitions of the chair stand (9, 10) and arm curl tests (10), as well as higher performance in the handgrip strength (HGS) (9, 11), and chair sit-and-reach tests (10). In addition, a significant reduction in systolic and diastolic blood pressure (9), a decrease in the seconds in the timed up-and-go (TUG) test (9, 10), significant improvements in brain-derived neurotrophic factor (10), and a substantial decrease in resting epinephrine (11) have also been reported to improve the HRQoL in healthy older women (10), hypertensive older women (11), and those with depression (9).

However, multicomponent training, which involves at least three essential physical qualities or abilities, typically resistance, aerobic capacity, balance, and flexibility (12, 13), has broad support and diffusion as a safe and effective physical activity intervention strategy for older people (12). Among the main benefits reported in an umbrella review of systematic reviews (12) were significant improvements in muscle strength, mobility, gait, balance, and general physical performance in community-dwelling frail older people. However, the review mentioned above indicated that there is still uncertainty about the most appropriate physical activity characteristics (type, frequency, intensity, duration, and combinations) for achieving the most beneficial and sustainable results over the long term (12).

Considering all of the above, it seems that both adapted taekwondo and multicomponent training achieve similar results concerning the general health status of older people (4, 6, 8, 12). Additionally, in Chile, older women are more sedentary, and the prevalence of being overweight/obese is higher among them than among men (14). According to the data available, this negatively affects the health status of Chilean older women (15), thereby justifying the promotion of novel physical activity strategies to encourage regular practice in this population group. In this sense, the present study aimed to analyze and compare the effects of an adapted taekwondo program concerning multicomponent training on blood pressure, morphological variables, food consumption frequency, HRQoL, physical fitness, HGS, and postural balance in independent older women. Based on previous systematic reviews (6–8, 12, 16), we hypothesized that adapted taekwondo would produce significantly greater effects on HRQoL and postural balance than a multicomponent training.

The mixed ANOVA revealed significant time × group interactions for the mental health (F_1,23 = 6.47; p = 0.038; and ηp² = 0.22) and general health (F_1,23 = 15.81; p = 0.002; and ηp² = 0.20) dimensions of HRQoL (Table 2). For blood pressure, morphological variables, food consumption frequency, and other dimensions of HRQoL, no significant time × group interactions were found (Table 2). Table 3 shows the results of the time × group interactions of physical fitness, HGS, and postural balance. Regarding physical fitness, significant interactions were revealed in the chair stand (F_1,23 = 6.43; p = 0.038; and ηp² = 0.19), arm curl (F_1,23 = 13.55; p = 0.007; and ηp² = 0.36), 2-min step (F_1,23 = 6.34; p = 0.039; and ηp² = 0.36), and chair sit-and-reach (F_1,23 = 9.07; p = 0.019; and ηp² = 0.28) tests. Similarly, significant interactions were only exhibited in postural balance for the eyes-closed condition in the center of the pressure area (F_1,23 = 5.29; p = 0.033; and ηp² = 0.07), mean velocity (F_1,23 = 6.19; p = 0.041; and ηp² = 0.21), and mediolateral velocity (F_1,23 = 5.66; p = 0.040; and ηp² = 0.17). There were no time × group interactions in HGS and other variables of postural balance.

The post-hoc analyses showed that, in the TKD, there were significant improvements in the assessments of the mental health (p = 0.024; ES = 0.91) and general health (p < 0.001; ES = 0.75) dimensions of HRQoL, while in the MCT, there were significant improvements in the general health dimension (p = 0.013; ES = 0.95) of HRQoL (Figure 3). Intergroup comparisons showed no significant differences.

However, in the TKD, physical fitness tests showed significant improvements in the performance of the chair stand (p = 0.001; ES = 1.18), arm curl (p < 0.001; ES = 2.10), 2-min step (p < 0.001; ES = 1.73), and chair sit-and-reach (p = 0.001; ES = 0.91) tests (Figure 4). Multiple comparisons revealed no significant pre- and post-intervention differences in the MCT. For the chair stand (p = 0.017; ES = 1.79), arm curl (p = 0.003; ES = 1.77), and 2-min step (p = 0.018; ES = 0.91) tests, significant differences were observed between the groups in the post-intervention assessment, favoring the TKD group.

Finally, in the TKD, multiple comparisons revealed a significant reduction in postural balance for the eyes-closed condition in the center of the pressure area (p = 0.021; ES = 0.89), mean velocity (p = 0.004; ES = 0.79), and mediolateral velocity (p < 0.001; ES = 1.26). In the MCT, the mediolateral velocity of postural balance for the eyes-closed condition significantly reduced (p = 0.039; ES = 0.28) (Figure 5). Intergroup comparisons showed no significant differences.

The baseline secondary outcomes revealed that, in general, the independent older women analyzed in this study had a mean age of 63.00 ± 2.16 years. Furthermore, 56% of them had a primary academic level, 36% had a secondary academic level, and 8% had a bachelor's or postgraduate degree. Additionally, it can be noted that 76% were married, 16% were separated, and 8% were widowed. Finally, 92% did not smoke (Table 4).

This study aimed to analyze and compare the effects of an adapted taekwondo program comprising multicomponent training on blood pressure, morphological variables, food consumption frequency, HRQoL, physical fitness, HGS, and postural balance in independent older women. The primary outcomes indicated the following: (i) The TKD obtained significantly higher post-intervention results in the chair stand, arm curl and 2-min step tests than the MCT; (ii) the TKD significantly increased the mental health and general health dimensions of HRQoL and significantly improved performance in the chair stand, arm curl, 2-min step, and chair sit-and-reach tests of physical fitness, in addition to achieving significant improvements in postural balance for the eyes-closed condition in the center of the pressure area, mean velocity, and mediolateral velocity; (iii) the MCT significantly increased the general health dimension of HRQoL and improved postural balance for the eyes-closed condition in mediolateral velocity; and (iv) there are no significant changes in the TKD and MCT for blood pressure, morphological variables, food consumption frequency, HGS, back scratch test, and TUG, in six dimensions of HRQoL (physical function, role physical, body pain, vitality, social function, and role emotional) and postural balance for the eyes-open condition after 8 weeks of intervention. Based on our outcomes, the hypothesis was partially confirmed.

Blood pressure, morphological variables, and food consumption frequency did not present post-intervention changes in either the TKD or the MCT. Contrary to this finding, another previously adapted taekwondo intervention reported a significant reduction in body fat percentage, systolic blood pressure, and diastolic blood pressure in older women with depression when compared to an inactive control group (9). It has been reported that older people who participate in physical activity interventions enriched with nutrition education tend to select healthier food options than those who do not have such advice (32). Not finding beneficial changes in the mentioned variables with the TKD and MCT probably indicates the lack of nutritional advice. Nutritional education has been shown to have beneficial effects on food consumption frequency and body composition (33), while reducing the consumption of high-energy-density foods (foods rich in salt, sugar, and fat), such as ultra-processed foods. The reduction in high-energy-density foods' consumption can help reduce systolic and diastolic blood pressure in older people (34). Therefore, an adapted combat sports strategy targeting older people seeking changes in morphological variables and food consumption frequency should incorporate nutritional education. This can generate changes in participants' lifestyles (32, 33), leading to a positive impact on systolic and diastolic blood pressure.

HRQoL did not reveal significant differences between the TKD and MCT. Nonetheless, although the participants presented favorable baseline values for most HRQoL dimensions, they showed improved mental health in the TKD and improved general health in both the TKD and MCT post-intervention. This observation is significant as it has been linked to poor morphological variables and physical fitness; for example, among the HRQoL dimensions, body mass, waist circumference, back scratch test, and TUG were significantly associated with low mental and general health in physically active older women (35). Furthermore, our findings are consistent with interventions based on Olympic combat sports (7) and multicomponent training (16), which have reported beneficial small-to-moderate ES on HRQoL in middle-aged and older people. Older women are a vulnerable group facing the perception of HRQoL because they face more adverse and traumatic life events than older men, along with more frequent negative thoughts and intrusive memories than older men (36). Hence, participating in regular physical activity programs can help promote their general wellbeing (35).

Regarding physical fitness, significant differences were observed in favor of the TKD compared to the MCT in the post-intervention chair stand, arm curl, and 2-min step tests. Furthermore, the TKD demonstrated significant improvements in the results of the chair sit-and-reach test, but no significant changes were observed in the results of the back scratch test, TUG, and HGS. As for the MCT, it did not demonstrate significant changes in the physical fitness tests and HGS. Similar results were presented in previous studies that adapted taekwondo for older women; these studies reported substantial improvements in chair stand (9, 10), arm curl (10), and sit-and-reach (10) tests in favor of the taekwondo group. In addition, they found significant improvements in HGS (9, 11), which we did not detect in our study. However, previous studies (9–11) included control groups that continued their usual activities of daily living, unlike the present study that compared two training programs (TKD vs. MCT). Even though both groups (TKD and MCT) trained at the same intensity (50–70% of the HRmax), the TKD improved the results of the 2-min step test (related to cardiorespiratory fitness). This improvement was probably because of improvements in the chair stand test (related to the muscle strength of lower limbs). The improvements in the chair stand tests may have been due to the specificity of taekwondo's technical foundations, especially the knee raise achieved through hip flexion during kicks (which involve unipodal supports), which could also influence postural balance. In this sense, improving performance in tests related to muscle strength of the upper and lower limbs, cardiorespiratory fitness, and the flexibility of the lower limbs is associated with preventing or reducing sarcopenia (37) and achieving greater autonomy and independence in basic activities of daily living (16), which collectively favor active and healthy aging.

Although there were significant interactions in postural balance for the eyes-closed condition in the center of the pressure area, mean velocity, and mediolateral velocity, no significant differences between the TKD and MCT could be found. Nevertheless, both the TKD and MCT showed a substantial reduction in postural oscillations in the eyes-closed condition in mediolateral velocity. Furthermore, the TKD reduced postural instabilities, which was reflected in the decrease in the center of the pressure area and mean velocity. Similar to this finding, one study reported a significant improvement in postural balance in the eyes-open condition for both the adapted taekwondo and walking exercise groups compared to the passive control group, which was reflected in the decrease in the center of the pressure area, mean velocity, and mediolateral velocity (38). For its part, multicomponent training has been described as the best physical activity strategy to improve, among other variables, the rate of falls and balance performance in physically frail older adults (39). Carrying out interventions that lead to enhanced postural balance in older adults is crucial to decreasing fall risk in healthy older people because, during aging, there is a deterioration in static, dynamic, reactive, or multitasking balance (40), and falls are the second leading cause of death from unintentional injuries worldwide (41).

Some of the possible limitations of the study are as follows: (i) The lack of control and follow-up on food consumption, which could influence blood pressure, morphological variables, food consumption frequency, physical fitness, HGS, and postural balance in older women and (ii) the lack of an inactive control group to make a complete comparison between the training programs. Some of the main strengths of the study are as follows: (i) The comparison of two physically active groups (TKD vs. MCT) and the initial randomization of participants, which increased the study's internal consistency; (ii) the use of validated assessments that are widely used in scientific literature, which increased external validity, and (iii) the use of training programs tailored to the characteristics of older women, which reduced injury risk and increased adherence to interventions. Future studies could include men and women in the interventions to analyze the possible similarities or differences between the genders, in addition to including an inactive control group, which would help analyze the physical activity programs.

Finally, despite the statistical differences observed between the two groups (TKD and MCT) concerning the variables analyzed, the more effective intervention method for promoting health among older women may be related to intrinsic choices and participants' adherence to maintaining their participation in the intervention (42). Thus, in health promotion actions undertaken as part of municipal, state, or national interventions, it may be more advantageous to offer participants the freedom to choose the type of physical activity programs that best align with their preferences, thereby promoting increased adherence, satisfaction, and pleasure. Consequently, positive outcomes in terms of physical, nutritional, and psychological status can be expected, highlighting the importance of the principle of continuity of training for older people.

The multiple comparisons showed that the adapted taekwondo program achieved significantly higher results in the chair stand, arm curl, and 2-min step tests than multicomponent training in independent older women. In addition, the TKD offered beneficial and significant changes in mental health, the general health dimension of HRQoL, the chair sit-and-reach test, and postural balance for the eyes-closed condition, specifically in the area, mean velocity, and mediolateral velocity. In contrast, the MCT showed significant improvements in the general health dimension of HRQoL and postural balance for the eyes-closed condition, specifically, in mediolateral velocity. Compared to multicomponent training, taekwondo improves postural balance and achieves better benefits at physical fitness and HRQoL levels among older women. Therefore, it is possible to recommend taekwondo as a safe physical activity strategy, given its high adherence to intervention among older women when following the dosage and activities proposed in this study's program.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving humans were approved by the Scientific Ethics Committee of the Universidad Católica del Maule, Chile (Number: N°29-2022). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

PV-B was responsible for conceptualizing the study. The methodology was developed by PV-B, EG-M, and TH-V. PV-B and EG-M were involved in the implementation of software. Formal analysis was conducted by PV-B, EG-M, and TH-V. The investigation involved the efforts of PV-B, EG-M, TH-V, BB, JH-M, and HN. PV-B prepared the initial draft and review and editing were performed by PV-B, EG-M, TH-V, BB, JH-M, and HN. PV-B, EG-M, and TH-V supervised the project. All authors have reviewed and approved the final version of the manuscript for publication.