set the recommended dietary allowance (RDA) for protein at 0.8 g/kg/d for the entire adult population. It remains controversial whether protein intake greater than the RDA is needed to maintain protein anabolism in older adults. OBJECTIVE To investigate whether increasing protein intake to 1.3 g/kg/d in older adults with physical function limitations and usual protein intake within the RDA improves lean body mass (LBM), muscle performance, physical function, fatigue, and well-being and augments LBM response to a muscle anabolic drug. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial with a 2 × 2 factorial design was conducted in a research center. A modified intent-to-treat analytic strategy was used. Participants were 92 functionally limited men 65 years or older with usual protein intake less thanor equal to 0.83 g/kg/d within the RDA. The first participant was randomized on September 21, 2011, and the last participant completed the study on January 19, 2017. INTERVENTIONS Participants were randomized for 6 months to controlled diets with 0.8 g/kg/d of protein plus placebo, 1.3 g/kg/d of protein plus placebo, 0.8 g/kg/d of protein plus testosterone enanthate (100 mg weekly), or 1.3 g/kg/d of protein plus testosterone. Prespecified energy and protein contents were provided through custom-prepared meals and supplements. MAIN OUTCOMES AND MEASURES The primary outcome was change in LBM. Secondary outcomes were muscle strength, power, physical function, health-related quality of life, fatigue, affect balance, and well-being. RESULTS Among 92 men (mean [SD] age, 73.0 [5.8] years), the 4 study groups did not differ in baseline characteristics. Changes from baseline in LBM (0.31 kg; 95% CI, −0.46 to 1.08 kg; P = .43) and appendicular (0.04 kg; 95% CI, −0.48 to 0.55 kg; P = .89) and trunk (0.24 kg; 95% CI, −0.17 to 0.66 kg; P = .24) lean mass, as well as muscle strength and power, walking speed and stair-climbing power, health-related quality of life, fatigue, and well-being, did not differ between men assigned to 0.8 vs 1.3 g/kg/d of protein regardless of whether they received testosterone or placebo. Fat mass decreased in participants given higher protein but did not change in those given the RDA: between-group differences were significant (difference, −1.12 kg; 95% CI, −2.04 to −0.21; P = .02). CONCLUSIONS AND RELEVANCE Protein intake exceeding the RDA did not increase LBM, muscle performance, physical function, or well-being measures or augment anabolic response to testosterone in older men with physical function limitations whose usual protein intakes were within the RDA. The RDA for protein is sufficient to maintain LBM, and protein intake exceeding the RDA does not promote LBM accretion or augment anabolic response to testosterone. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01275365

NCT03011957.

Background Despite the known benefits of ambulation, most hospitalized patients remain physically inactive. One possible approach to this problem is to employ Ambulation Orderlies (AOs) – employees whose main responsibility is to ambulate patients throughout the day. For this study, we examined an AO program implemented among post-cardiac surgery patients and its effect on patient outcomes. Methods We evaluated post-operative length of stay, hospital complications, discharge disposition, and 30-day readmission for all patients who underwent coronary artery bypass and/or cardiac valve surgery in the nine months before and after the introduction of the AO program. In addition to pre-post comparisons, we performed an interrupted time series analysis to adjust for temporal trends and differences in baseline characteristics. Results We included 447 and 478 patients in the pre- and post-AO intervention groups, respectively. Post-operative length of stay was lower in the post-AO group, with median (IQR) of 10 (7,14) days versus 9 (7,13) days (p<0.001), and also had significantly less variability in mean monthly length of stay (Levene’s test p=0.03). Using adjusted interrupted time series analysis, the program was associated with a decreased mean monthly post-operative length of stay (-1.57 days, p=0.04), as well as a significant decrease in the trend of mean monthly post-operative length of stay (p=0.01). Other outcomes were unaffected. Conclusion The implementation of an AO program was associated with a significant reduction in post-operative length and variability of hospital stay. These results suggest that an AO program is a reasonable and practical approach towards improving hospital outcomes.