Effects of a combined physical training and nutrition intervention on physical performance and health-related quality of life in prefrail older women living in the community: a randomized controlled trial. Combined effects of functionally-oriented exercise regimens and nutritional supplementation on both the institutionalised and free-living frail elderly (double-blind, randomised clinical trial) Effects of nutritional supplements on muscle mass and activities of daily living in elderly rehabilitation patients with decreased muscle mass: A randomized controlled trial Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial Should oral nutritional supplementation be given to undernourished older people upon hospital discharge? A controlled trial. Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease--a randomized controlled trial. The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. Effects of elastic band resistance training and nutritional supplementation on physical performance of institutionalised elderly — A randomized controlled trial The Boston FICSIT study: the effects of resistance training and nutritional supplementation on physical frailty in the oldest old. Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status, and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study. A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD Effects of muscle strength training and megestrol acetate on strength, muscle mass, and function in frail older people. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews The effect of protein intake and resistance training on muscle mass in acutely ill old medical patients - A randomized controlled trial. Nutritional Supplementation of Very Old People at Hospital Discharge Increases Muscle Strength: A Randomised Controlled Trial The effect of resistance exercise to augment long-term benefits of intradialytic oral nutritional supplementation in chronic hemodialysis patients.
OBJECTIVES The purpose of this study was to examine whether a 12-week combined physical exercise training and nutritional intervention improves physical performance and enhances health-related quality of life ( HRQOL ) among prefrail elderly women living in the community . DESIGN This was a r and omized controlled trial in which participants were recruited and r and omly assigned to the exercise and nutrition group ( EN , n = 30 ) , exercise only group ( E , n = 28 ) , and control group ( C , n = 31 ) . SETTING Group training classes were held at a research center in Itabashi Ward , Tokyo , Japan . PARTICIPANTS Eighty-nine prefrail women aged 70 years or older . INTERVENTION The EN group participated in an exercise training and nutritional program ( cooking class ) once a week , and the E group participated in the exercise training program only . MEASUREMENTS Outcome measures that included physical performance ( h and grip strength , balance , walking speed ) and HRQOL ( Medical Outcomes Study 36-Item Short Form Health Survey ) were obtained at entry , the end of the 12-week intervention , and 6 months after completion of the intervention program . RESULTS At the end of the 12-week intervention , significant improvements in the physical component summary score and 3 ( role physical , bodily pain , role emotional ) of the 8 domains of the Medical Outcomes Study 36-Item Short Form Health Survey were observed in the EN group . The E group exhibited a significantly increased h and grip strength at postintervention . The positive effects , however , were not maintained at 6-month follow-up , but were reduced . CONCLUSIONS The combined physical exercise training and nutritional intervention program has beneficial effects on several domains of HRQOL and h and grip strength in prefrail elderly women living in the community . However , further studies are needed to examine approaches that facilitate maintenance of the improved outcomes by combined exercise training and nutritional intervention Background Consistently swelling proportion of the frail elderly within a modern society challenges the overstrained public health sector to provide both adequate medical care and comprehensive assistance in their multiple functional deficits of daily living . Easy-to-apply and task-specific ways of addressing this issue are being sought out , with a view to proposing systemic solutions for nationwide application . Methods The present r and omised , double-blind , placebo-controlled , 7-week clinical trial aim ed to determine whether specifically structured , intensive exercise regimens , combined with nutritional supplementation , might improve and help sustain individual muscle strength and mobility , and possibly enhance individual functional capabilities in an on-going quest for active prevention of care-dependency . Ninety-one frail elderly ( F 71 M 20 ; mean age 79 years ) were recruited from both nursing home residents and community dwellers and r and omly split into four groups : Group I – progressive resistance exercises ( PRE ) + functionally-oriented exercises ( FOE ) + nutritional supplementation ( NS ) , Group II – PRE + FOE + placebo , Group III – st and ard exercises ( SE ) + FOE + NS , Group IV – SE + FOE + placebo . Each group pursued a 45 min . exercise session 5 times weekly . The subjects ' strength with regard to four muscle groups , i.e. hip and knee extensors and flexons , was assessed at 80 % ( 1 RM ) weekly , whereas their balance and mobility at baseline and at the end of the study . Results The study was completed by 80 subjects . Despite its relatively short duration significant differences in muscle strength were noted both in Group I and Group II ( p = 0.01 ; p = 0.04 ; respectively ) , although this did not translate directly into perceptible improvement in individual mobility . Notable improvements in individual mobility were reported in Group III and Group IV ( p = 0.002 ) , although without positive impact on individual muscle strength . Conclusion Comprehensively structured , high-intensity regimen made up of diverse exercise types , i.e. functionally-oriented , progressive resistance and st and ard ones , preferably if combined with nutritional supplementation in adequate volume , demonstrates clear potential for appreciably improving overall functional status in the frail elderly in terms of individual walking capacity and muscle strength . Trial registration Central Register of Clinical Trials , Pol and – CEBK180/2000 Objective To investigate the effects of nutritional intervention with resistance training on skeletal muscle mass in elderly patients with disabilities in a convalescent rehabilitation setting . Design A r and omized controlled trial . ( UMIN Clinical Trials Registry ID : UMIN000006238 ) . Setting A rehabilitation hospital . Participants 39 elderly patients with decreased skeletal muscle mass in an inpatient convalescence rehabilitation unit . Interventions A combination of resistance training plus nutritional supplementation ( R/N group ) or resistance training alone ( R group ) . The training and supplementation were conducted essentially from the patient ’s admission to discharge ( 2–6 months ) . Outcome Measures The patients were evaluated at the time of admission and at the end of the intervention for skeletal muscle mass ( calf circumference [ CC ] as a primary outcome , and arm circumference [ AC ] ) , h and grip strength ( HG ) , Mini-Nutritional Assessment -Short Form ( MNA ® -SF ) score , serum albumin level ( Alb ) , body mass index ( BMI ) , and activities of daily living ( ADL ) as represented by the Barthel Index ( BI ) score . Results Significant treatment effects were seen for CC , AC , BI , Alb in the R/N group compared to the R group . A mean treatment effect of 3.2 ( 95%CI : 2.0–4.4 ) was seen in CC , 1.4 ( 95%CI : 0.8–2.1 ) was seen in AC , 11.2 ( 95%CI : 0.5–21.8 ) was seen in BI , 0.3 ( 95%CI : 0.1–0.5 ) was seen in Alb . Conclusion The results of this study suggest that nutritional intervention added to resistance training during convalescent rehabilitation may improve skeletal muscle mass and activities of daily living Background and aims : There are few studies published that combine the interventions of physical training and nutrition . The aim of the present study was to describe the impact of a physical and nutritional intervention program for frail community-dwelling elderly people over the age of 75 . Methods : Ninety-six community-dwelling elderly people ( 58 women ) were r and omized to four different groups : i ) a physical training program ( aerobic , muscle strength , balance ) , ii ) a nutritional intervention program ( individually targeted advice and group sessions ) , iii ) a combination of these interventions , and iv ) a control group . At baseline subjects were screened for physical performance such as muscle strength , balance , mobility and activities of daily living , as well as nutritional aspects such as energy intake , body weight and fat-free mass . These measurements were repeated immediately after the intervention , which lasted for 12 weeks , and after another 6 months . Results : The intention-to-treat analysis indicated significant improvements in lower-extremity muscle strength in both training groups compared with the nutrition group at 1st follow-up . There were small significant changes for some of the balance measurements in the training group without nutrition treatment . The nutrition intervention did not show any significant results . Conclusions : This study shows the positive effect on lower-extremity muscle strength directly after the intervention . Balance training most probably needs to be more individualized in order to be effective for frail elderly people . Further studies are needed , with larger sample sizes , to investigate the effects of these types of interventions before any further conclusions can be drawn OBJECTIVES To determine whether the oral nutritional supplementation of undernourished older people upon discharge from hospital improves muscle function and reduces disability . DESIGN R and omized controlled trial . SETTING Community-based study in two centers in Scotl and . PARTICIPANTS Two hundred fifty-three people . INTERVENTION R and omization to oral nutritional supplementation ( 600 kcal/d ) or control supplement of 200 kcal/d . MEASUREMENTS Primary outcome ( 20-point activity of daily living Barthel Index ) and secondary outcomes ( h and grip strength , Sit-to-St and test , and Euroquol ) were measured at baseline ( after discharge from the hospital and before supplement was commenced ) and 8 and 16 weeks and accelerometry-measured physical activity levels at baseline and 16 weeks . Falls were recorded prospect ively . RESULTS Mean age was 82 . There was no significant difference in change in Barthel score between supplement and control groups ( adjusted mean difference=0.28 , 95 % confidence interval (CI)=-0.28 - 0.84 ) . H and grip strength improved more in the supplemented group ( adjusted mean difference=1.52 kg , 95 % CI=0.50 - 2.55 ; P=.004 ) . The supplemented group exhibited modestly greater vector movement ( overall activity ) than controls ( P=.02 ) . There were no significant between-group differences in Sit-to-St and test , health-related quality of life , or falls . Adherence was 38.2 % in the nutritional supplement group and 50.0 % in the control supplement group . Weight did not increase in the nutritional supplement group as a whole , but on-treatment analysis adjusting for adherence showed a mean weight gain of 1.17 kg ( 95 % CI=0.07 - 2.27 ; P=.04 ) more than in controls . CONCLUSION Oral nutritional supplementation  of undernourished older people upon hospital discharge did not reduce disability , despite improving h and grip strength and modestly increasing objective ly measured physical activity levels . Lack of an effect of the nutritional supplement used in this study may have been due to low adherence , suggesting that different approaches to nutritional supplementation need to be tested in this population Objective : To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance . Design : R and omized clinical trial . Setting : University hospital physiotherapy department . Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score ( SD ) of —1.8 ( 0.8 ) . Interventions : A three-month programme consisting of exercise/protein including training of muscular strength , co-ordination , balance and endurance . Calcium/ vitamin D was supplemented in all participants for a 12-month period . Outcome measures : Assessment took place prior to and following the months 3 , 6 , 9 and at the end of the study ; primary dependent variables assessed were risk of falling ( Berg Balance Test ) and postural balance ( forceplate ) . Secondary measures included body composition , strength , activity level , number of falls , bone mineral content , biochemical indices , nutritional status and general health . Results : Significant reductions of risk of falling ( repeated measures ANOVA F = 8.90 , P = 0.008 ) , an increase in muscular strength ( ANOVA F = 3.0 , P = 0.03 ) , and an increase in activity level ( ANOVA F = 3.38 , P = 0.02 ) were found in the experimental group as compared to the control group . Further on , there was 89 % reduction of falls reported in the experimental group ( experimental pre/post 8/1 falls ; control group pre/post 5/6 falls ) . Conclusion : This study provides support for our intervention programme aim ed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis . The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger r and omized trial BACKGROUND Malnutrition is a common problem in patients with digestive disease and is associated with impaired outcome . OBJECTIVE We investigated the effect of a three-month post-hospital nutritional intervention with high protein and energy supplements on body composition , muscle function and quality of life ( QoL ) in malnourished GI patients . PATIENTS AND INTERVENTION Eighty malnourished patients with benign digestive disease were r and omized to receive either oral nutritional supplements ( ONS ) for three months in addition to dietary counselling ( DC ) ( ONS patients ) or only dietary counselling ( DC patients ) . METHODS Nutritional status was determined with the subjective global assessment , body composition by bioelectrical impedance and anthropometry , muscle function with h and -grip strength and peak flow . QoL was assessed by the 36-item short-form question naire . RESULTS Age , body cell mass ( BCM ) , muscle function , gender distribution and QoL did not differ between ONS patients ( n=38 ) and DC patients ( n=42 ) at baseline . Body weight and BCM improved significantly in both groups after three months . However , h and -grip strength ( 26.1+/-11.3 - 31.5+/-10.1 kg , p<0.0001 ) and peak flow ( 329.2+/-124.0 - 388.9+/-108.4 l /min , p=0.004 ) improved only in the ONS patients and remained unchanged in the DC patients . Similarly , all eight scales of the QoL improved in the ONS patients compared with merely three in the DC patients . DC patients experienced significantly more readmissions ( n=20 ) than ONS patients ( n=10 ) during the study period ( p=0.041 ) . CONCLUSION A three month intervention with high protein oral supplements improves outcome in malnourished patients with digestive disease in terms of functional status , QoL and rehospitalization Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly . To our knowledge , the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn . We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly , and would bring about concomitant benefits in body composition and muscle power . Accordingly , this exercise and nutritional combination was assessed in the frail elderly in a 9-month r and omised trial with a factorial design . Fifty-seven elderly volunteers over 72 years , from sixteen retirement homes in Lyon , France participated in the study .  Dietary supplements were compared with placebo , and physical exercise was compared with memory training . Main outcome measures were fat-free mass ( FFM ) and muscle power . FFM was determined by labelled water , and muscle power was measured by a leg-extensor machine . At 9 months , the compliance was 63 % for exercise sessions , and 54 % for nutritional supplements . In patients with dietary supplements , muscle power increased by 57 % at 3 months ( P=0.03 ) , and showed only a tendency at 9 months ; although FFM increased by 2.7 % at 9 months , the difference was not significant ( P=0.10 ) . Exercise did not improve muscle power at 9 months , but improved functional tests ( five-time-chair rise , P=0.01 ) . BMI increased with supplements ( + 3.65 % ) , but decreased with placebo ( -0.5 % ) at 9 months ( P=0.007 ) . A long-term combined intervention is feasible in frail elderly individuals with a good rate of compliance . Nutritional supplements and exercise may improve muscle function . Despite no significant results on FFM , due to the limited number of volunteers , combined intervention should be suggested to counteract muscle weakness in the frail elderly OBJECTIVES To evaluate the effects of elastic b and resistance training in combination with nutrient supplementation on muscular strength and the ability to perform mobility-related activities of daily living in older adults living in retirement care facilities . DESIGN R and omized controlled trial , with a 6-month intervention period . SETTING A retirement care facility , Vienna , Austria . PARTICIPANTS One hundred and seventeen older adults ( 14 males ( 12 % ) and 103 females ( 88 % ) ) , aged 65 to 97 years ( mean age : 82.8 ± 6.0 ) , having a mini-mental state examination score ≥ 23 and no chronic diseases posing a medical contraindication to training therapy . INTERVENTION Participants were r and omly assigned , but stratified by sex , to one of three intervention groups : supervised resistance exercise training ( RT ) , RT in combination with nutrient supplementation ( RTS ) , or cognitive training group ( CT ) . All interventions were performed two times a week for 6 months . RT was design ed to train all major muscle groups using elastic b and s. The nutrient supplement ( rich in proteins , vitamin D , B2 , B12 ) was distributed every morning as well as after each RT session . MEASUREMENTS A battery of motor ability tests and functional test were performed prior to as well as following 3 months and finally after 6 months of intervention . These tests included isokinetic torque measurements of the knee extensors and flexors in concentric mode at 60 and 120 ° /s , isometric h and grip strength , senior arm-lifting test , chair st and test , maximum walking speed and a 6-minute walking test ( 6 MWT ) . RESULTS A repeated- measures ANOVA analysis revealed significant improvements in physical function of lower ( p=0.002 ) and upper extremities ( p=0.006 ) for RT and /or RTS in comparison to CT . For isokinetic measurements , 6 MWT , and gait speed time effects ( p<0.05 ) were detected without any group × time interaction effects . Dropouts showed lower performance in chair st and test ( p=0.012 ) , 6 MWT ( p=0.003 ) , and gait speed ( p=0.013 ) at baseline than that of the finishers of the study . CONCLUSION Six months of a low intensity resistance exercise using elastic b and s and own body weight is safe and beneficial in improving functional performance of institutionalised older people . Multinutrient supplementation did not offer additional benefits to the effects of RT in improving muscular performance Research indicates that lower extremity muscle weakness in the elderly is consistently related to impaired mobility and fall risk . Reversible components of the muscle weakness of aging include underuse syndromes and undernutrition , both of which are prevalent in nursing home population s. The Boston FICSIT study is a nursing home-based intervention to improve muscle strength through progressive resistance training of the lower extremities and /or multi-nutrient supplementation in chronically institutionalized subjects aged 70 - 100 . Baseline measurements of falls , medical status , psychological variables , functional status , nutritional intake and status , body composition , muscle mass and morphology , muscle function , and gait and balance are taken . The nursing home residents are then r and omly assigned to one of four treatment groups for 10 weeks : ( 1 ) high intensity progressive resistance training of the hip and knee extensors 3 days per week ; ( 2 ) multi-nutrient supplementation with a 360-kcal high carbohydrate , low fat liquid supplement every day ; ( 3 ) a combination of groups ( 1 ) and ( 2 ) ; and ( 4 ) a control group . Both non-supplemented groups receive a liquid placebo every day , and both non-exercising groups attend three sessions of " leisure activities " every week in order to control for the attentional aspects of the exercise and nutritional interventions . At the end of the 10-week period , all baseline measurements are re-assessed OBJECTIVES The objective of this study was to assess the effects of a hyperproteic , hypercaloric oral nutritional supplement with prebiotic fiber , vitamin D , and calcium , plus a st and ardized physical intervention , in the functional status , strength , nutritional status , and quality of life of frail institutionalized older adults . DESIGN Multicentric prospect i ve observational study under usual clinical practice conditions . SETTING Four nursing homes from Burgos ( 2 ) , Albacete , and Madrid , Spain . PARTICIPANTS Participants included 91 institutionalized older adults ( age ≥70 ) , able to walk 50 m , and meeting at least 3 of the Fried frailty phenotype criteria . INTERVENTION Daily intake of two 200-mL bottles of an oral nutritional supplement , each bottle containing 300 kcal , 20 g protein , 3 g fiber , 500 IU vitamin D , and 480 mg calcium , plus a st and ardized physical exercise training consisting of flexibility , balance , and strengthening exercises for arms and legs , 5 days per week . MEASUREMENTS Short Physical Performance Battery ( SPPB ) , Short-Form-Late-Life Function and Disability Instrument ( SF-LLFDI ) function subscale , h and grip strength , EuroQoL-5 Dimensions visual analogic scale ( EQ5DVAS ) , weight , body mass index ( BMI ) , and Short-Form Mini Nutritional Assessment ( MNA-SF ) at baseline and 6 and 12 weeks . RESULTS Forty-eight participants ( 52.7 % ) improved at least 1 point in the SPPB at week 6 , and 44 ( 48.4 % ) did so at week 12 ; 39 participants ( 42.9 % ) improved at least 2 points in the SF-LLFDI at week 6 , and 46 ( 50.5 % ) at week 12 . Participants improved their quality of life measured with the EQ5DVAS by 6 % ( 95 % confidence interval [ CI ] 3%-10 % ) at week 6 , and by 5 % ( 95 % CI 0%-10 % ) at week 12 . They also improved their nutritional status ( weight gain , BMI increase , and higher MNA-SF scores at 6- and 12-week follow-up ) . This improvement was higher in participants with more frailty criteria , lower functional level , lower vitamin D levels , and poorer nutritional status . CONCLUSION A 12-week intervention with oral nutritional supplementation plus physical exercise improves function , nutritional status , and quality of life in frail institutionalized older adults Abstract Background Evidence regarding the efficacy of nutritional supplementation to enhance exercise training responses in COPD patients with low muscle mass is limited . The objective was to study if nutritional supplementation targeting muscle derangements enhances outcome of exercise training in COPD patients with low muscle mass . Methods Eighty‐one COPD patients with low muscle mass , admitted to out‐patient pulmonary rehabilitation , r and omly received oral nutritional supplementation , enriched with leucine , vitamin D , and omega‐3 fatty acids ( NUTRITION ) or PLACEBO as adjunct to 4 months supervised high intensity exercise training . Results The study population ( 51 % males , aged 43–80 ) showed moderate airflow limitation , low diffusion capacity , normal protein intake , low plasma vitamin D , and docosahexaenoic acid . Intention‐to‐treat analysis revealed significant differences after 4 months favouring NUTRITION for body mass ( mean difference ± SEM ) ( + 1.5 ± 0.6 kg , P = 0.01 ) , plasma vitamin D ( + 24 % , P = 0.004 ) , eicosapentaenoic acid ( + 91%,P < 0.001 ) , docosahexaenoic acid ( + 31 % , P < 0.001 ) , and steps/day ( + 24 % , P = 0.048 ) . After 4 months , both groups improved skeletal muscle mass ( + 0.4 ± 0.1 kg , P < 0.001 ) , quadriceps muscle strength ( + 12.3 ± 2.3 Nm , P < 0.001 ) , and cycle endurance time ( + 191.4 ± 34.3 s , P < 0.001 ) . Inspiratory muscle strength only improved in NUTRITION ( + 0.5 ± 0.1 kPa , P = 0.001 ) and steps/day declined in PLACEBO ( −18%,P = 0.005 ) . Conclusions High intensity exercise training is effective in improving lower limb muscle strength and exercise performance in COPD patients with low muscle mass and moderate airflow obstruction .  Specific nutritional supplementation had additional effects on nutritional status , inspiratory muscle strength , and physical activity compared with placebo OBJECTIVES To determine the independent and combined effects of progressive resistance muscle strength training ( PRMST ) and megestrol acetate ( MA ) on strength , muscle mass , and function in older recuperative care patients . DESIGN Double-blind , r and omized , controlled intervention using a two-by-two factorial design and conducted between 1999 and 2001 . SETTING University-affiliated Department of Veterans Affairs hospital . PARTICIPANTS Twenty-nine patients ( mean age 79.4 + /- 7.4 , 90 % white ) aged 65 and older and had recent functional decline . INTERVENTIONS After r and omization to one of four treatment groups ( low-resistance exercises plus 800 mg per day of MA or a placebo or high-intensity PRMST plus 800 mg/d of MA or placebo ) , subjects received training and the drug or placebo for 12 weeks . MEASUREMENTS Change in muscle strength , mid-thigh muscle area , and aggregate functional performance score as assessed using analysis of covariance . RESULTS Five subjects withdrew from the study before its completion . Based on intent-to-treat analyses , subjects who received high-intensity PRMST and placebo experienced the greatest strength gains . The addition of MA was associated with worse outcomes than with high-intensity exercise training alone , especially with regard to the leg exercises . Post hoc analysis demonstrated that subjects who received high-intensity PRMST and placebo experienced significantly greater percentage increases in leg strength than subjects in either of the MA treatment groups ( P<.05 for each comparison ) . There was also a significant negative effect of MA on physical function . In general , subjects who received MA experienced a deterioration in aggregate physical function scores , whereas the remaining subjects improved ( -0.80+/-0.40 vs 0.48+/-0.41 , P=.04 ) . There was not a significant interaction between exercise and MA for any outcome . CONCLUSION High-intensity PRMST is a safe and well-tolerated exercise regimen for frail elderly patients . The addition of MA appears to blunt the beneficial effects of PRMST , result ing in less muscle strength and functional performance gains Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made BACKGROUND & AIM Stress metabolism is associated with accelerated loss of muscle that has large consequences for the old medical patient . The aim of this study was to investigate if an intervention combining protein and resistance training was more effective in counteracting loss of muscle than st and ard care . Secondary outcomes were changes in muscle strength , functional ability and body weight . METHODS 29 acutely admitted old ( > 65 years ) patients were r and omly assigned to the intervention ( n = 14 ) or to st and ard care ( n = 15 ) . The Intervention Group received 1.7 g protein/kg/day during admission and a daily protein supplement ( 18.8 g protein ) and resistance training 3 times per week the 12 weeks following discharge .  Muscle mass was assessed by Dual-energy X-ray Absorptiometry . Muscle strength was assessed by H and Grip Strength and Chair St and Test . Functional ability was assessed by the de Morton Mobility Index , the Functional Recovery Score and the New Mobility Score . Changes in outcomes from time of admission to three-months after discharge were analysed by linear regression analysis . RESULTS The intention-to-treat analysis showed no significant effect of the intervention on lean mass ( unadjusted : β-coefficient = -1.28 P = 0.32 , adjusted for gender : β-coefficient = -0.02 P = 0.99 , adjusted for baseline lean mass : β-coefficient = -0.31 P = 0.80 ) . The de Morton Mobility Index significantly increased in the Control Group ( β-coefficient = -11.43 CI : 0.72 - 22.13 , P = 0.04 ) . No other differences were found . CONCLUSION No significant effect on muscle mass was observed in this group of acutely ill old medical patients . High compliance was achieved with the dietary intervention , but resistance training was challenging . Clinical trials identifier NCT02077491 Background : Undernutrition is common in older people admitted to hospital , but little is known about how nutritional state changes after discharge . Objective : This r and omised controlled trial was design ed to examine the effect of oral nutritional supplementation of undernourished very old people prepared to take supplements after hospital discharge following acute illness . Methods : Participants aged ≧75 years with a BMI ≤24 kg/m2 and triceps skin fold thickness or mid-arm muscle circumference below the 10th centile and /or weight loss ≧5 % during an acute hospital stay were allocated at r and om to either oral nutritional supplementation for 8 weeks from hospital discharge or to usual care . Primary outcome was change in weight , secondary outcomes were h and grip strength and anthropometry . Results : Of 198 patients eligible to participate , 136 patients ( mean age 85 years ) were r and omised and 76/136 ( 56 % ) completed the study . Twenty percent ( 13/66 ) of the intervention group withdrew after only 2 weeks , citing intolerance of the supplements . Using intention-to-treat analysis , body weight increased by a mean of 1.6 and 2.2 % in the control and intervention groups , respectively , but this between-group difference was not significant ( p = 0.188 ) . However , h and grip strength increased more ( p = 0.055 ) in the intervention group ( 13.9 % ) than in the control group ( 7.2 % ) . Conclusions : Oral nutritional supplementation was associated with a greater increase in h and grip strength than in non-supplemented controls and this observation merits further study BACKGROUND Resistance exercise combined with intradialytic oral nutrition ( IDON ) supplementation improves net protein balance in the acute setting in chronic hemodialysis patients . We hypothesized that combination of long-term resistance exercise and IDON would improve markers of muscle mass and strength further compared with IDON alone . METHODS Thirty-two participants ( 21 male ; mean age , 43 ± 13 years ) on chronic hemodialysis were r and omly assigned to IDON plus resistance exercise ( NS + EX ) , or IDON ( NS ) alone for 6 months . IDON consisted of a lactose-free formula consisting of protein , carbohydrate , and fat . Three sets of 12 repetitions of leg-press were completed before each dialysis session in the NS + EX arm . Primary outcome measurement was lean body mass . Muscle strength and other nutritional parameters were measured as secondary outcomes . RESULTS Of 32 participants , 22 completed the 6-month intervention . There were no statistically significant differences between the study interventions with respect to changes in lean body mass and body weight , when comparing NS + EX to NS . There were also no statistically significant differences in any of the secondary outcomes measured in the study . Body weight ( 80.3 ± 16.6 kg , 81.1 ± 17.5 kg , and 80.9 ± 18.2 kg at baseline , month 3 , and month 6 , respectively ; P = .02 ) and 1-repetition maximum ( 468 ± 148 lb , 535 ± 144 lb , and 552 ± 142 lb , respectively ; P = .001 ) increased statistically significantly during the study for all patients combined . CONCLUSION This study did not show further benefits of additional resistance exercise on long-term somatic protein accretion above and beyond nutritional supplementation alone . When both treatments groups were combined , body weight and muscle strength improved during the study
Results indicate that physical exercise has a positive impact on muscle mass and muscle function in subjects aged 65 years and older .
Conclusion Physical exercise has a positive impact on muscle mass and muscle function in healthy subjects aged 60 years and older .
The biggest effect of exercise intervention , of any type , has been seen on physical performance ( gait speed , chair rising test , balance , SPPB test , etc . )
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We observed huge variations in regard to the dietary supplementation protocol s. Based on the included studies , mainly performed on well-nourished subjects , the interactive effect of dietary supplementation on muscle function appears limited
Summary This systematic review summarizes the effect of combined exercise and nutrition intervention on muscle mass and muscle function .
However , any interactive effect of dietary supplementation appears to be limited .
Introduction In 2013 , Denison et al. conducted a systematic review including 17 r and omized controlled trials ( RCTs ) to explore the effect of combined exercise and nutrition intervention to improve muscle mass , muscle strength , or physical performance in older people .
They concluded that further studies were needed to provide evidence upon which public health and clinical recommendations could be based .
The purpose of the present work was to up date the prior systematic review and include studies published up to October 2015 .