SummaryThis systematic review summarizes the effect of combined exercise and nutrition intervention on muscle mass and muscle function. A total of 37 RCTs were identified. Results indicate that physical exercise has a positive impact on muscle mass and muscle function in subjects aged 65 years and older. However, any interactive effect of dietary supplementation appears to be limited.IntroductionIn 2013, Denison et al. conducted a systematic review including 17 randomized 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 update the prior systematic review and include studies published up to October 2015.MethodsUsing the electronic databases MEDLINE and EMBASE, we identified RCTs which assessed the combined effect of exercise training and nutritional supplementation on muscle strength, muscle mass, or physical performance in subjects aged 60 years and over. Study selection and data extraction were performed by two independent reviewers.ResultsThe search strategy identified 21 additional RCTs giving a total of 37 RCTs. Studies were heterogeneous in terms of protocols for physical exercise and dietary supplementation (proteins, essential amino acids, creatine, β-hydroxy-β-methylbuthyrate, vitamin D, multi-nutrients, or other). In 79% of the studies (27/34 RCTs), muscle mass increased with exercise but an additional effect of nutrition was only found in 8 RCTs (23.5%). Muscle strength increased in 82.8% of the studies (29/35 RCTs) following exercise intervention, and dietary supplementation showed additional benefits in only a small number of studies (8/35 RCTS, 22.8%). Finally, the majority of studies showed an increase of physical performance following exercise intervention (26/28 RCTs, 92.8%) but interaction with nutrition supplementation was only found in 14.3% of these studies (4/28 RCTs).ConclusionPhysical 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.). We observed huge variations in regard to the dietary supplementation protocols. Based on the included studies, mainly performed on well-nourished subjects, the interactive effect of dietary supplementation on muscle function appears limited.

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The world is aging. The population aged over sixty years worldwide is predicted to rise from 841 million in 2013 to more than 2 billion by 2050. Musculoskeletal (MSK) disease is a significant burden on the aging population, contributing 7.5% of the disease burden in those over 60 years. MSK diseases have a pronounced effect on disability level and independence in old age, with consequent significant public health burden and impact on quality of later life. As numbers of older individuals and their disease burden increases, it is important to examine MSK disease in older life in detail. The musculoskeletal aging phenotype comprises four often interwoven key elements; osteoporosis, osteoarthritis, sarcopenia and frailty and this review will focus on these four themes. It is crucial that we are able to accurately measure each phenotype in order that we might identify those individuals at greatest risk of developing these conditions, and design trials of therapeutic agents that might impact their development. Accurate measurement of the musculoskeletal aging phenotype is necessary firstly to document the burden of each condition, and then to enable factors to be identified which may accelerate or retard their development or progression. In some areas of MSK disease, this work is more advanced (osteoporosis); in other areas (sarcopenia) the field is currently very rapidly evolving. We will explore the tools currently used to measure the musculoskeletal aging phenotype and how they compare, as well as highlight areas where more work is needed.