Patients: 127 adults ≥ 65 years of age (mean age 79 y, 51% men) who used wheelchairs for mobility, had lived in a partici- pating nursing home for ≥ 3 months, were cognitively intact, and were moderately or heavily dependent for their activities of dailyliving(Barthelindexscore21to90).Exclusioncriteriain- cludedsevereoracutecardiovascular,musculoskeletal,orpulmo- naryillness;orspinalcordinjurywithnopotentialforrehabilitation.