According to the report of the World Health Organization , there are currently 1 billion people aged 60 years and above, which will increase to 1.4 billion and 2.1 billion by 2030 and 2050, respectively. This historically significant change in the global population requires adaptations to the way societies are structured across all sectors (e.g., health and social care) . In Taiwan, the recent average life expectancy at birth was 81 years (male: 77.7; female: 84.2); however, the healthy life expectancy at birth was 71 years [2, 3]. This means nearly 10 years of life were spent disabled and of less quality before death. There is a huge gap between life expectancy and healthy life expectancy. Healthy life expectancy is a useful indicator of a population’s overall health, reflecting the length of life as well as the quality of life. It also refers to an individual’s length of life lived without limitations in conducting daily activities [4, 5]. Furthermore, in an aging society, as greater age puts increased pressure on social systems, extending a healthy life expectancy and shortening life expectancy with disability are becoming global priorities .
The ideal concepts of healthy aging with dignity and aging in their living place are gradually becoming a common ideology for most Taiwanese people and are included in all health policies . Since 2010, the government in response to the WHO’s initiative began the promotion of “age-friendly cities” suitable for the eldes to live and work in peace. Through the 8 domains highlighted by the WHO, including social participation, community support, and health services, assisting county and city governments to inspect favorable and unfavorable living conditions for aging, and propose effective improvement programs are currently implemented . Taiwan is a free marketing country wherein any adult who receives a certificate for long-term care training hours can be a community care worker (CCW), and the budget provided by the local government would assist them to establish access for elders in villages to bring them together in community activity centers for social participation via physical activity or providing free lunch meals.
Taiwan has implemented national health insurance, covering 99% of the population for more than 20 years now, and most of its citizens are highly satisfied with the program. However, non-communicable diseases, cancers, and cardiometabolic and lung diseases are collectively responsible for almost all deaths in the country. The increasing cost burden of the national health insurance program is becoming a challenge to the government. Some evidence supports that low pulmonary function is associated with low muscle mass or sarcopenia . Several studies have indicated that adopting regular exercise has health benefits to the lungs and reducing the above-mentioned noncommunicable diseases, especially in the aging population [2, 8]. Therefore, some sports experts have coined the term “health fitness” to emphasize the importance of preserving the body’s health-related aspects and components of fitness targeted at sustaining the body’s well-being, which is especially important for the elders. There are four factors of health-related fitness: cardiopulmonary endurance, muscle strength, body flexibility, and body fat percentage [2, 3, 9].
Due to the effects of aging on the central nervous system, there exists an imbalance in the body's coordination capacity. Hence, the prevention of falls is an important issue among the elders. Moreover, aging is accompanied by changes in lung function due to factors such as loss of lung elasticity, weakened respiratory muscles, and decreased surface area for alveolar gas exchange. Thus, lung function parameters such as FVC (forced vital capacity) and FEV1 (forced expiratory volume in 1 second) decline with age [10, 11]. Some previous studies and systematic reviews have indicated that the traditional Chinese exercise, Baduanjin (also called the eight-section brocade), significantly improved the physical and mental health of the elderly (e.g., reducing lower back pain, symptoms of knee osteoarthritis, obesity, depression, blood pressure, waistline, frailty, static and homeostasis, cardiopulmonary endurance) [12–15]. Baduanjin is a very popular Chinese exercise, characterized by low-intensity aerobic exercise that consists of eight simple, safe, slow, coordinative, and sequential movements [16, 17].
Furthermore, the literature has indicated that singing can affect health and well-being [18, 19, 20]. For instance, in Japan, Miyazaki and Mori have found that frequent karaoke training improves respiratory function in elderly people , and singing has also shown widespread beneficial effects on health and well-being [19, 20]. This was confirmed by a longitudinal study conducted by Batt-Rawden and Stedje  in older people in Norway. They observed that singing interventions could be a vital component for the enhancement of health, well-being, and quality of life for elderly adults; its effects include reduced uneasiness; increased comfort, well-being, and joy; and improved sleep. Moreover, they believe that singing potentially reduced the need for medications and prevented accidents among their nursing home residents. According to them, singing in groups as a way of social connection enhanced the elders’ sense of identity and belonging and thereby increased their self-esteem and promoted social inclusion .
Social participation through engaging in community physical activities is an important routine for the older adults, and the proportion of individuals aged 65 years old in Yunlin county is 19.1%, which is the second-highest in Taiwan . Additionally, this figure is over 25% in many townships in the western coastal area. Many elders have been encouraged to stay at home due to the COVID-19 pandemic since January 2020. Consequently, most elders had to cut down on their previously regular physical exercise in the community center. As part of measures to prevent COVID-19 infection since January 2020, all citizens were mandated to wear facemasks in public and practice frequent hand washing . Taiwan is one of the few countries where the societies are functioning normally due to the low infection rate on June 2020 [20, 21]. Therefore, this study aimed to establish an innovative summer camp (ISC) program and evaluate its effects on physiological biomarkers and health fitness in the community older adults.