Review of Central-Eastern European Propagation and Larvae Nursing Method for Common Carp (Cyprinus carpio L.).

Common carp (Cyprinus carpio L.) as a cultivated fish species has huge importance all over the world. According to FAO statistics, carp is the third most widely bred freshwater pond fish species; only two other Cyprinids (silver carp and grass carp) are bred in higher amounts. Carp is native all over Asia and in a large part of Europe. As a result of human intervention, at present, carp are widespread all over the world, except for the Arctic region. Carp breeding was launched in the antique period, in the ancient Chinese Empire and the Roman Empire. The presently applied method of breeding of common carp has a long evolution. From the effectiveness point of view, the propagation and early-life nursing are crucial parts of carp production, as they provide seed stocks for the further growing section. Without effective propagation, there is no intensive carp production. Nowadays, more advanced propagation methods are available all over the world; however, in the current review, only the main milestones and production efficiency of the propagation and nursing method used in the ponds of Eastern Central Europe are discussed. In the historical overview of carp reproduction, first the natural reproduction, then the semi-extensive and intensive hatchery propagation are presented and investigated in detail. The analysis focuses on the advantages and disadvantages of the method. In particular, the different important milestones of the advanced hatchery method are shown and explained. The effectiveness is proven even with practical calculations. Not only the reproduction, but the pond nursing method is also presented and discussed, concentrating on the management of evolutionarily adapted natural feeds (Zooplankton) and their effect on the survival of fish larvae.

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection.

After SARS-CoV-2 infection, strict recommendations for return-to-sport were published. However, data are insufficient about the long-term effects on athletic performance. After suffering SARS-CoV-2 infection, and returning to maximal-intensity trainings, control examinations were performed with vita-maxima cardiopulmonary exercise testing (CPET). From various sports, 165 asymptomatic elite athletes (male: 122, age: 20y (IQR: 17-24y), training:16 h/w (IQR: 12-20 h/w), follow-up:93.5 days (IQR: 66.8-130.0 days) were examined. During CPET examinations, athletes achieved 94.7 ± 4.3% of maximal heart rate, 50.9 ± 6.0 mL/kg/min maximal oxygen uptake (V̇O2max), and 143.7 ± 30.4L/min maximal ventilation. Exercise induced arrhythmias (n = 7), significant horizontal/descending ST-depression (n = 3), ischemic heart disease (n = 1), hypertension (n = 7), slightly elevated pulmonary pressure (n = 2), and training-related hs-Troponin-T increase (n = 1) were revealed. Self-controlled CPET comparisons were performed in 62 athletes: due to intensive re-building training, exercise time, V̇O2max and ventilation increased compared to pre-COVID-19 results. However, exercise capacity decreased in 6 athletes. Further 18 athletes with ongoing minor long post-COVID symptoms, pathological ECG (ischemic ST-T changes, and arrhythmias) or laboratory findings (hsTroponin-T elevation) were controlled. Previous SARS-CoV-2-related myocarditis (n = 1), ischaemic heart disease (n = 1), anomalous coronary artery origin (n = 1), significant ventricular (n = 2) or atrial (n = 1) arrhythmias were diagnosed. Three months after SARS-CoV-2 infection, most of the athletes had satisfactory fitness levels. Some cases with SARS-CoV-2 related or not related pathologies requiring further examinations, treatment, or follow-up were revealed.

Improving the Nutrient Quality of Foods and Beverages Using Product Specific Standards for Nutrients to Limit Will Substantially Reduce Mean Population Intakes of Energy, Sodium, Saturated Fat and Sugars towards WHO Guidelines.

BACKGROUND: International strategies to reduce chronic diseases have called for a reduction in the amounts of saturated fat (SAFA), trans fat (TFA), salt and sugars in the global food supply. This paper describes the development approach and potential impact of a set of standards for these nutrients to drive food (re)formulation. METHODS: To set the standards, WHO nutrient guidelines for daily intake were translated into product group specific standards. The impact of reformulation towards these standards on population nutrient intakes was modelled using the food consumption data of five countries: UK, France, US, Brazil and China. The impact of the TFA standards could not be modelled due to lack of data. RESULTS: (Re)formulation of foods and beverages towards these standards would substantially decrease mean population intakes of energy, sodium, SAFA and sugars, with reductions up to 30%. CONCLUSIONS: These science-based standards for nutrients to limit could drive impactful reductions in energy, sodium, SAFA and sugars in food and beverage products, enabling mean population intakes to move closer to WHO nutrient guidelines.

Carp Breeding in the Carpathian Basin with a Sustainable Utilization of Renewable Natural Resources.

In the Central European region, there is a long tradition of breeding fish in artificially constructed ponds. As the area belongs to the temperate zone, farmed fish need to survive cold winter periods. Common carp (Cyprinus carpio L.), which is an omnivorous, bioturbating species, is well adapted to warm and cold periods and the alluvial water environment. Since the Middle Ages, a large scale, efficient carp farming methodology has been developed in the region, where production is based on natural resources (protein and fatty acid sources) of renewable water ecosystems. This summary aims to present this well-developed breedi:ng method through discussing aspects of hydrobiology and energy transfer through the food chain as well. Capabilities and effects of agro-technical treatments such as liming and organic manuring, zooplankton management and possible supplementary feedings are also reviewed. Analysing chemical processes of waters uncovers that biological production has no carbon footprint; no carbon dioxide is released into the atmosphere. In contrast, gaseous carbon dioxide diffuses into pond water containing calcium and/or magnesium, then it accumulates in algae production and, through energy migration to upper trophic levels, increases carp production. Thus, it can be declared that pond-farmed carp provides an environmentally friendly, delicious meat among products of animal origin.

Differential Diagnostic Challenges in the COVID-19 Pandemic: Renal Abscess After SARS-CoV-2 Infection in a Young Adolescent.

BACKGROUND Prolonged fever in pediatric patients is often a diagnostic challenge. Clinicians tend to associate prolonged fever with COVID-19-related diseases in patients with a history of SARS-CoV-2 infection. Here we present a patient who was admitted with a clinical suspicion of multi-inflammatory syndrome in children (MIS-C) and was finally diagnosed with a renal abscess. CASE REPORT A 16-year-old girl with prolonged fever, bilateral non-purulent conjunctivitis, weight loss, muscle pain, general malaise, cough, and yellow sputum was admitted to Heim Pál National Pediatric Institute, Budapest, Hungary. She had proven SARS-CoV-2 infection 3 weeks prior to admission. Although inflammatory markers were elevated, repeated urine analyses, aerobic and anaerobic urine cultures, hemoculture, chest X-ray, and otorhinolaryngology examinations were negative. Based on clinical and laboratory criteria, the diagnosis of MIS-C was eventually ruled out. Abdominal ultrasound revealed a 17×20×15 mm simplex cyst at the edge of the parenchyma in the upper third of the left kidney. Magnetic resonance imaging was performed, showing a multi-compartment, septated, thick-walled parenchymal lesion of 50×40×52 mm in the upper pole of the right kidney, which showed signal characteristics of an abscess, and 20×16 mm and 8 mm lesions in the upper pole of the left kidney, which appeared to be cysts. After being unresponsive to intravenous wide-spectrum antibiotic therapy (meropenem 2 g tid for 5 days), surgical intervention was needed to remove the abscess. CONCLUSIONS This case demonstrates that during the COVID-19 pandemic, besides the obvious post-COVID etiology, other life-threatening conditions should be investigated in the first line.

Reef Cover, a coral reef classification for global habitat mapping from remote sensing.

Coral reef management and conservation stand to benefit from improved high-resolution global mapping. Yet classifications underpinning large-scale reef mapping to date are typically poorly defined, not shared or region-specific, limiting end-users' ability to interpret outputs. Here we present Reef Cover, a coral reef geomorphic zone classification, developed to support both producers and end-users of global-scale coral reef habitat maps, in a transparent and version-based framework. Scalable classes were created by focusing on attributes that can be observed remotely, but whose membership rules also reflect deep knowledge of reef form and functioning. Bridging the divide between earth observation data and geo-ecological knowledge of reefs, Reef Cover maximises the trade-off between applicability at global scales, and relevance and accuracy at local scales. Two case studies demonstrate application of the Reef Cover classification scheme and its scientific and conservation benefits: 1) detailed mapping of the Cairns Management Region of the Great Barrier Reef to support management and 2) mapping of the Caroline and Mariana Island chains in the Pacific for conservation purposes.

Benthic and coral reef community field data for Heron Reef, Southern Great Barrier Reef, Australia, 2002-2018.

This paper describes benthic coral reef community composition point-based field data sets derived from georeferenced photoquadrats using machine learning. Annually over a 17 year period (2002-2018), data were collected using downward-looking photoquadrats that capture an approximately 1 m2 footprint along 100 m-1500 m transect surveys distributed along the reef slope and across the reef flat of Heron Reef (28 km2), Southern Great Barrier Reef, Australia. Benthic community composition for the photoquadrats was automatically interpreted through deep learning, following initial manual calibration of the algorithm. The resulting data sets support understanding of coral reef biology, ecology, mapping and dynamics. Similar methods to derive the benthic data have been published for seagrass habitats, however here we have adapted the methods for application to coral reef habitats, with the integration of automatic photoquadrat analysis. The approach presented is globally applicable for various submerged and benthic community ecological applications, and provides the basis for further studies at this site, regional to global comparative studies, and for the design of similar monitoring programs elsewhere.

The Myrmecofauna (Hymenoptera: Formicidae) of Hungary: Survey of Ant Species with an Annotated Synonymic Inventory.

Ants (Hymenoptera: Forimicidae) are exceedingly common in nature. They constitute a conspicuous part of the terrestrial animal biomass and are also considered common ecosystem engineers. Due to their key role in natural habitats, they are at the basis of any nature conservation policy. Thus, the first step in developing adequate conservation and management policies is to build a precise faunistic inventory. More than 16,000 valid ant species are registered worldwide, of which 126 are known to occur in Hungary. Thanks to the last decade's efforts in the Hungarian myrmecological research, and because of the constantly changing taxonomy of several problematic ant genera, a new checklist of the Hungarian ants is presented here. The state of the Hungarian myrmecofauna is also discussed in the context of other European countries' ant fauna. Six species (Formica lemani, Lasius nitidigaster, Tetramorium immigrans, T. staerckei, T. indocile and Temnothorax turcicus) have been reported for the first time in the Hungarian literature, nine taxon names were changed after systematic replacements, nomenclatorial act, or as a result of splitting formerly considered continuous populations into more taxa. Two species formerly believed to occur in Hungary are now excluded from the updated list. All names are nomenclaturally assessed, and complete synonymies applied in the Hungarian literature for a certain taxon are provided. Wherever it is not self-evident, comments are added, especially to explain replacements of taxon names. Finally, we present a brief descriptive comparison of the Hungarian myrmecofauna with the ant fauna of the surrounding countries. The current dataset is a result of ongoing work on inventorying the Hungarian ant fauna, therefore it is expected to change over time and will be updated once the ongoing taxonomic projects are completed.

Factors associated with sedentary lifestyle among older people with the ability to walk, living in nursing homes / Az ülo életmóddal kapcsolatos tényezok idosotthonban élo, járásképes idos személyek körében

INTRODUCTION: Due to sedentary lifestyle, not only the risk of many chronic diseases and multimorbidity increase, but older people also lose their functional independency earlier. The first step to design effective interventions aiming to decrease sedentary lifestyle is to explore the factors associated with sedentary lifestyle. AIM: Our aims were to describe the type and duration of sitting activities and to examine the factors associated with sedentary lifestyle, namely 1) sociodemographic factors (i.e., age, gender, education level, marital status); 2) medical factors (chronic diseases, use of walking aids); 3) lifestyle factors (i.e., duration of institutionalization, smoking status) among older people living in nursing homes providing long-term care. METHOD: Data collected with questionnaire from 248 participants were analysed using logistic regression. RESULTS: There were 159 participants (64.1%) in total who were characterized by sedentary lifestyle. In our sample, the sedentary lifestyle was associated with the smoking status, the number of age-related chronic diseases, the duration of institutionalization, and the use of walking aids. CONCLUSION: The older people who have more chronic diseases, who are smokers and were institutionalized earlier are more likely to be characterised by sedentary lifestyle. Therefore, decision-making graduate health-care professionals should preferably focus their efforts on these older people in order to change the sedentary lifestyle by providing information about risk of this lifestyle, and offering programs relevant to older people's interests and functional status. Orv Hetil. 2020; 161(26): 1175-1180.

Economic evaluation of guideline implementation in primary care: a systematic review.

PURPOSE: To review the economic evaluation of the guideline implementation in primary care. DATA SOURCES: Medline and Embase. STUDY SELECTION: Electronic search was conducted on April 1, 2019, focusing on studies published in the previous ten years in developed countries about guidelines of non-communicable diseases of adult (≥18 years) population, the interventions targeting the primary care provider. Data extraction was performed by two independent researchers using a Microsoft Access based form. RESULTS OF DATA SYNTHESIS: Among the 1338 studies assessed by title or abstract, 212 qualified for full text reading. From the final 39 clinically eligible studies, 14 reported economic evaluation. Cost consequences analysis, presented in four studies, provided limited information. Cost-benefit analysis was reported in five studies. Patient mediated intervention, and outreach visit applied in two studies showed no saving. Audit resulted significant savings in lipid lowering medication. Audit plus financial intervention was estimated to reduce referrals into secondary care. Analysis of incremental cost-effectiveness ratios was applied in four studies. Educational meeting evaluated in a simulated practice was cost-effective. Educational meeting extended with motivational interview showed no improvement; likewise two studies of multifaceted intervention. Cost-utility analysis of educational meeting supported with other educational materials showed unfavourable outcome. CONCLUSION: Only a minor proportion of studies reporting clinical effectiveness of guideline implementation interventions included any type of economic evaluation. Rigorous and standardized cost-effectiveness analysis would be required, supporting decision-making between simple and multifaceted interventions through comparability.

Economic burden of vertigo: a systematic review.

BACKGROUND: Vertigo, a highly prevalent disease, imposes a rising burden on the health care system, exacerbated by the ageing of the population; and further, contributes to a wide span of indirect burden due to reduced capacity to work or need of assistance in activities of daily living. The aim of this review was to summarise the evidence on the economic burden of vertigo. METHODS: All original studies published between 2008 and 2018 about the economic evaluation of peripheral or central vestibular vertigo in developed countries were considered eligible, unrestricted to setting, health care provider, or study type. RESULTS: The electronic search in three databases identified 154 studies from which 16 qualified for inclusion. All studies presented partial economic evaluation referring to a variety of vestibular vertigo including unspecified vertigo. Nine studies presented monetised cost results and seven studies reported health care utilization. Direct costs derived mainly from repeated and not well-targeted consultations at all levels of health care, excessive use of diagnostic imaging, and/or of emergency care. Considerable societal burden was caused by decreased productivity, mainly due to work absenteeism. CONCLUSION: To the best of our knowledge, this is the first systematic review of the existing evidence of the economic burden of vertigo. The lack of conclusive evidence revealed apparent targets of future research. First, studies of diagnostics and therapies for vestibular disease should include cost-effectiveness considerations. Population-based studies of health services utilization should include simple vestibular assessments to get more reliable estimates of the burden of disease and associated costs on the level of the general population. Further, clinical and population-based registries that include patients with vestibular disease, should consider collecting long-term data of societal burden. Primary data collection should increasingly include assessment of health care utilization e.g. by linking their diagnoses and outcomes to routine data from health insurances.

[Fear of falling among community-living older adults]. / Az eleséstol való félelem otthon élo idosek körében.

INTRODUCTION: Due to fear of falling, older people may restrict their activities, causing muscle weakness and impaired balance and, consequently, admission to an institute. Accordingly, fear of falling is a common and serious health problem among older individuals. The prevalence of the fear of falling and its associated factors as well as possible preventive and therapeutic methods have been widely investigated in geriatrics. AIM: The aim of our study was to describe the prevalence of the fear of falling and its associations with demographic (age, gender) and health factors (age-related chronic diseases, functional mobility, falling in the previous year, medications) among community-living older adults. METHOD: Two-hundred individuals participated in the study. The fear of falling was diagnosed based on the cut-off value of the short Falls Efficacy Scale - International (FES-I). Logistic regression analysis was used to assess associations. In total, 61 participants were diagnosed with fear of falling. RESULTS: In our sample, the fear of falling was associated with age, the number of diseases and functional mobility. CONCLUSION: The short FES-I is simple, easy to fill-out and has a validated Hungarian version as well. By its use, people of higher age affected by multiple chronic illnesses are primarily worth of screening in order to identify those who are in need for further more detailed examinations and, if needed, more targeted interventions. Orv Hetil. 2019; 160(5): 191-197.

Gait parameters in physically active and inactive elderly as well as young community-living people.

BACKGROUND: This study aimed to reveal the effects of a complex exercise program on gait among older people through analyzing the gait parameters in three groups: 1) older individuals participating in complex exercise program called 60+; 2) older individuals who were physically inactive; and 3) young individuals. METHODS: Fifty-seven community-living individuals were enrolled in this study. Variability of step length, step time, step width, and double support ratio as well as automaticity were measured. RESULTS: We found that the variability of step length, step time, and double support ratio, as well as the cognitive automaticity index of physically inactive elderly individuals were significantly worse compared to both physically active elderly (step length P=0.007; step time P=0.002; double support ratio P=0.036; cognitive automaticity index P=0.006) and young individuals (step length P<0.001; step time P<0.001; double support ratio P=0.001; cognitive automaticity index P=0.003). However, the variability of gait step width did not differ among the three groups. CONCLUSIONS: This study demonstrated that 60+ program has beneficial effects on gait parameters. Thus, the 60+ program can enrich the range of geriatric exercise programs aiming to improve gait safety.

Correction to: barriers and facilitators for the management of vertigo: a qualitative study with primary care providers.

After publication of the original article [1] it was brought to the authors' attention that a sentence was missing in the acknowledgement section. The full acknowledgement is included in this Correction article.

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care.

BACKGROUND: As clinical practice guidelines represent the most important evidence-based decision support tool, several strategies have been applied to improve their implementation into the primary health care system. This study aimed to evaluate the effect of intervention methods on the guideline adherence of primary care providers (PCPs). METHODS: The studies selected through a systematic search in Medline and Embase were categorised according to intervention schemes and outcome indicator categories. Harvest plots and forest plots were applied to integrate results. RESULTS: The 36 studies covered six intervention schemes, with single interventions being the most effective and distribution of materials the least. The harvest plot displayed 27 groups having no effect, 14 a moderate and 21 a strong effect on the outcome indicators in the categories of knowledge transfer, diagnostic behaviour, prescription, counselling and patient-level results. The forest plot revealed a moderate overall effect size of 0.22 [0.15, 0.29] where single interventions were more effective (0.27 [0.17, 0.38]) than multifaceted interventions (0.13 [0.06, 0.19]). DISCUSSION: Guideline implementation strategies are heterogeneous. Reducing the complexity of strategies and tailoring to the local conditions and PCPs' needs may improve implementation and clinical practice.

Pilot cluster randomized controlled trial of a complex intervention to improve management of vertigo in primary care (PRIMA-Vertigo): study protocol.

OBJECTIVES: Vertigo and dizziness are highly prevalent symptoms in primary care, frequently misdiagnosed. Based on a thorough need assessment, INDICORE (INform, DIagnose, COmmunicate, REfer), an evidence-based complex intervention has been developed to transfer knowledge of specialized tertiary clinics to primary care providers (PCPs), improve the referral process and, ultimately, improve the functioning and quality of life of patients with vertigo/dizziness. The main objective of the PRIMA-Vertigo pilot study is to examine whether the INDICORE intervention is feasible and sufficiently promising to warrant a larger trial. METHODS: We plan to perform a single-blind, pragmatic cluster-randomized controlled pilot study with an accompanying process evaluation. PCPs will be the cluster units of randomization. Patients who consult these PCPs because of vertigo/dizziness symptoms will be included consecutively and considered the units of analysis. The intervention will be multi-faceted training on diagnostics targeted at the PCPs, supported by patient education material and a newly developed tool to structure the referral process. To balance the influence of non-specific effects, all clusters will receive generic communication training. EXPECTED RESULTS: The process evaluation aims to provide results on the acceptability and feasibility of the INDICORE intervention components to PCPs and patients. Additionally, this study will provide a first estimate of the likely effectiveness of the intervention on patients' quality of life, functioning and participation. CONCLUSIONS: The PRIMA-Vertigo pilot study will allow further tailoring of the INDICORE intervention to stakeholder needs before its effectiveness is evaluated in a large-scale main study.

Barriers and facilitators for the management of vertigo: a qualitative study with primary care providers.

BACKGROUND: Although the management of patients presenting with vertigo and dizziness in primary care has been reported to be inefficient, little is known about the primary care providers' (PCPs) perspectives, needs, and attitudes regarding vertigo management. The objective of this study was to understand which challenges and barriers PCPs see when diagnosing and treating patients presenting with vertigo or dizziness. Specifically, we wanted to identify facilitators and barriers of successful guideline implementation in order to inform the development of targeted interventions. METHODS: A theory-based interview structure was developed based on the implementation theory of capability, opportunity, and motivation for behaviour change (COM-B) using questions based on constructs from the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Transcripts of the semi-structured interviews were analysed using directed content analysis. The pathways through which guideline characteristics and supportive interventions affect the relationship between the PCPs' perceived capability, opportunity, and motivation as well as their practice of managing vertigo patients were graphically presented using the COM-B model structure. RESULTS: Twelve PCPs from Bavaria in Southern Germany participated in semi-structured interviews. Diagnostics posed the biggest challenge in vertigo management to the PCPs. Requirements for an acceptable guideline were stakeholder involvement in the development process, clarity of presentation, and high applicability. Guideline implementation might be effectively supported through educational meetings and sustained by organisational interventions. CONCLUSIONS: From the PCPs' perspective, both guideline characteristics and interventions supporting guideline implementation may help resolve challenges in vertigo management in primary care. These results should be used to guide future interventions in the primary care setting to ensure successful and targeted patient management.

Cross-cultural validation of the Falls Efficacy Scale-International to assess concerns about falls among Hungarian community-living older people.

PURPOSE: The Falls Efficacy Scale-International (FES-I) is a reliable and valid tool for assessing concerns about falling. Our aims were to translate, culturally adapt, and evaluate the main psychometric characteristics (internal consistency, reproducibility, and convergent construct validity) of the Hungarian version of the FES-I on a sample of community-living older adults. METHODS: After translating and culturally adapting the original scale, 165 community-living older adults (aged 60 years or over) participated in the measurements and filled in the questionnaire. After two weeks, a subsample of 64 persons filled in the FES-I again to determine the test-retest reliability. RESULTS: The test-retest analysis showed excellent reliability: Intraclass Correlation Coefficient was 0.831. The FES-I Hungarian consisted of two factors that showed good internal consistency: Cronbach's alpha 0.95 (Factor 1), 0.89 (Factor 2), and 0.93 (whole scale). The FES-I was able to discriminate the participants based on gender and fall history. It showed a significant correlation with the Timed Up and Go test (r = 0.740) and the general health perception (r = -0.713). CONCLUSIONS: Translation and cultural adaptation of the original scale were successful. The Hungarian version proved to be a reliable, valid tool confirming that it can be used in future clinical and scientific work with Hungarian older people. Implications for rehabilitation Excessive concerns about falls may lead to avoidance of activities, decreasing functional abilities, increasing of risk of a future fall, ultimately premature nursing home admission. The Falls Efficacy Scale-International is a widespread tool for assessing concerns about falls. The Hungarian version of Falls Efficacy Scale-International has an excellent test-retest reliability, good internal consistency, and acceptable construct validity. The Hungarian version of Falls Efficacy Scale-International is a valid and reliable tool for measuring the concerns about falls among Hungarian-speaking community-living older people in everyday clinical practice and scientific studies.

Study of the effects of multimodal exercise program on physical fitness and health perception in community-living Hungarian older adults.

BACKGROUND: The aim of this study was to investigate the effects on fitness indicators and subjective health-perception of a multimodal exercise program provided by a district in Budapest among community-living seniors. METHODS: Sixty community-living older adults aged over 60 years formed beginner group (who were at the beginning of the exercise program), advanced group (who had been in the programme for 3-6 months), active group (who had been participating in the exercise program for at least 6 months, in addition to Nordic walking program) and a physically inactive control group. Balance, functional mobility, lower and upper limb strength, lower and upper body flexibility, aerobic endurance and self-reported health perception were measured at baseline, and after a 12-week follow-up period. RESULTS: The beginner group and the advanced group improved in upper body flexibility (beginner Δ=1.2; d=0.83; advanced: Δ=1.7; d=1.39), lower body flexibility (beginner: Δ=1.7, d=0.484; advanced: Δ=1.9; d=1.55), lower limb strength (beginner: Δ=1.47; d=0.84; advanced: Δ=1.57; d=0.72), and functional mobility (beginner: Δ=-0.6; d=0.54; advanced: Δ=-0.4; d=0.90). There were also improvements in aerobic endurance (Δ=11.06; d=0.96) and balance (Δ=1.6; d=0.62) of beginner group. These indicators declined in the control group. Indicators of the active group did not change. The self-perceived health status declined (Δ=-13.9; d=0.73) in the control group but did not change in any exercising groups. CONCLUSIONS: This multimodal exercise program can be effective among community-living older adults, even in Hungary, a country where geriatric physical activity is not widespread. Therefore, it would be useful to extend this model program to other settlements as well.