**3.4 Application of HEPOP® and problems experienced during the COVID-19 pandemic**

Study participants with various diseases, as described in the previous section (2.1), were given exercise instructions using HEPOP® and encouraged to exercise independently at home. Several weeks later, those who were non-frail, frail, or in need of care at the time of the intervention were surveyed to determine whether they had implemented the exercises [22]. Approximately 50% of those in the non-frail group and those in need of care were able to implement exercises at least once a week, whereas the frail group had a lower frequency, in the 30% range. The non-frail group was more likely to exercise because they already had a higher rate of exercise, whereas those in need of nursing care used some kind of nursing care service and required more involvement from a third party. On the other hand, the individuals with frailty were

less likely to participate in social activities because of limitations in their communities, such as a lack of social gatherings and senior citizen clubs, which are the main hubs for social participation activities, as well as having fewer friends and neighbors, which may have resulted in less social participation and consequently fewer exercise opportunities [32, 33]. As the spread of COVID-19 is expected to be prolonged, and the associated limitations on social participation are presumed to further increase the risk of functional decline [34], we would like to build on these results and expand the use of tools such as HEPOP® for frail older adults and their family and medical caregivers to complement the opportunities for and quality of exercise.
