Blended home‐based exercise and dietary protein in community‐dwelling older adults: a cluster randomized controlled trial

Abstract

Background Effective and sustainable interventions are needed to counteract the decline in physical function and sarcopenia in the growing aging population. The aim of this study was to determine the 6 and 12 month effectiveness of blended (e-health + coaching) home-based exercise and a dietary protein intervention on physical performance in community-dwelling older adults. Methods This cluster randomized controlled trial allocated 45 clusters of older adults already engaged in a weekly community-based exercise programme. The clusters were randomized to three groups with ratio of 16:15:14; (i) no intervention, control (CON); (ii) blended home-based exercise intervention (HBex); and (iii) HBex with dietary protein counselling (HBex-Pro). Both interventions used a tablet PC with app and personalized coaching and were targeting on behaviour change. The study comprised coached 6 month interventions with a 6 month follow-up. The primary outcome physical performance was assessed by modified Physical Performance Test (m-PPT). Secondary outcomes were gait speed, physical activity level (PAL), handgrip muscle strength, protein intake, skeletal muscle mass, health status, and executive functioning. Linear mixed models of repeated measured were used to assess intervention effects at 6 and 12 months. Results The population included 245 older adults (mean age 72 ± 6.5 (SD) years), 71% female, and 54% co-morbidities observed. Dropout of the intervention was 18% at 6 months and 26% at 12 months. Participants were well functioning, based on an m-PPT score of 33.9 (2.8) out of 36. For the primary outcome m-PPT, no significant intervention effects (HBex, +0.03, P = 0.933; HBex-Pro, À0.13, P = 0.730) were found. Gait speed (+0.20 m/s, P = 0.001), PAL (+0.06, P = 0.008), muscle strength (+2.32 kg, P = 0.001), protein intake (+0.32 g/kg/day, P < 0.001), and muscle mass (+0.33 kg, P = 0.017) improved significantly in the HBex-Pro group compared with control group after 6 month intervention. The protein intake, muscle mass, and strength remained significantly improved after 12 months as compared with those of control. Health change and executive functioning improved significantly in both intervention groups after 6 months. Conclusions This HBex and dietary protein interventions did not change the physical performance (m-PPT) in community-dwelling older adults. Changes were observed in gait speed, PAL, muscle mass, strength, and dietary protein intake, in response to this combined intervention.

Nutrition in the spotlight in cachexia, sarcopenia and muscle: avoiding the wildfire

“…We selected articles investigating nutrition interventions, macronutrient intake below recommended, and micronutrient deficiency. We found 26 articles: 10 clinical trials, 3,25–33 five cross‐sectional studies, 34–38 three experimental animal studies 39–41 (one of which also included a human cross‐sectional analysis 38 ), three narrative reviews, 6,42,43 two retrospective studies, 44,45 two systematic reviews or meta‐analyses, 46,47 and one questionnaire survey 48 . Within the 320 original and review articles published in 2018, 2019, and 2020 in JCSM , the 26 articles on nutrition that we found comprise approximately 8%.…”

“…Of the nutrition studies that we found, one explored the role of protein, 31 three explored the role of vitamin D, 26,38,39 two explored the role of several nutrients, 3,41 and one explored the role of natural product (astaxanthin) supplements 40 . Seven studies 25,27–30,32,33 investigated the effects of multimodal interventions (defined as two or more approaches) on muscle mass. Articles also explored the associations of protein intake, 46,47 iron deficiency, 37,42 micronutrients, 35 calorie restriction, 43 nitrate dietary intake, 36 retrospective evaluation of early dietary supplementation, 44 and overall dietary intake and patterns 34 with several clinical outcomes and/or biomarkers of sarcopenia or cachexia.…”

The Relevance of Diet, Physical Activity, Exercise, and Persuasive Technology in the Prevention and Treatment of Sarcopenic Obesity in Older Adults

“…The use of blended care, the combination of face-to-face counseling with health technology, is more and more used ( 108 , 109 ). These blended interventions are more effective than “stand-alone” interventions without professional guidance ( 110 ). The integration of online and offline leads to improved adherence rates which is crucial for the effectiveness of digital health technologies ( 82 ).…”

“…One good example of a blended care intervention for older adults, that was built on well-described theoretical principles of behavior change is the VITAMIN trial ( 111 ). This trial was developed to counteract the decline in physical functioning and sarcopenia using a blended-care home-based exercise and dietary protein intervention and showed positive effects on among others muscle mass, muscle strength and protein intake, but not on physical performance in healthy older adults (55 years and over) ( 110 , 112 ). However, whether this approach also works for frail older people and people with or at risk for sarcopenic obesity should be further explored.…”

Digital Intervention (Keep-On-Keep-Up Nutrition) to Improve Nutrition in Older Adults: Protocol for a Feasibility Randomized Controlled Trial

“…It is well established that progressive resistance training combined with strength and balance exercises are safe and effective for improving muscle mass, hip and lumbar spine bone mineral density, and muscle strength and function [ 1 ] and for reducing the risk of falls [ 2 ], hospitalizations, fractures [ 3 ], and mortality. Furthermore, diet has a fundamental role in the health of older adults [ 4 ], and meta-analyses have found that nutritional interventions in addition to physical activity lead to greater improvements in physical function, body composition, and strength in frail and pre-frail older adults [ 5 - 7 ].…”