Nordic walking training and nutritional supplementation in pre-frail older Indians: an open-labelled experimental pre-test and post-test pilot study to develop intervention model

Abstract

BackgroundIdentifying and treating people in a pre-frail state may be an effective way to prevent or delay frailty and preserve their functional capacity. This study aimed to assess the efficacy of, and compliance with, a 12 week individualized nutritional supplementation (INS) and Nordic walking (NW) program in pre-frail older Indians. The primary measure is physical performance, as indicated by Fried’s Frailty scale. Other measures include: cognition, as indicated by the Hindi Mental Status Examination; mood, by the Geriatric Depression Scale; and nutritional status, by the Mini Nutritional Assessment.MethodsThis is an open-labeled experimental pre-test and post-test study, which took place from October 2012 to December 2014. The study was approved by Institute Ethics committee (IEC/NP-350/2012/RP-26/2012) at the All India Institute of Medical Sciences (AIIMS), New Delhi. Participants were sixty-six pre-frail elderly, who were randomly allocated into three subgroups, namely: A (NW only), B (INS only), and C (NW and INS). One-way ANOVA was used to statistically assess differences in baseline characteristics for quantitative variables, with the Chi-Square/Fischer exact test utilized for qualitative variables. Paired t-tests were used to assess pre and post intervention difference within the group for quantitative variables, with McNemar’s Chi-Square test used for qualitative variables. Kruskal Wallis test was used to assess significant intervention effects among the groups. A p-value < 0.05 was considered as statistically significant.ResultsThere was significant effect of intervention in gait speed in group A (p = 0.001) and C (p = 0.002), but not in group B (p = 0.926). While there was no significant change in grip strength in Group A (p = 0.488) and B (p = 0.852), a statistically significant increase was observed in group C (p = 0.013). Mood significantly improved in group B (p = 0.025) and C (p = 0.021). No significant difference was noted in cognitive status across groups. Following the interventions, a total of 18.18% of pre-frail participants were classified as non-frail.ConclusionsCombining NW and INS provides a simple, pragmatic intervention with efficacy in the management of functionally vulnerable older adults, and allows their maintained independence. Future studies should replicate this readily applicable intervention in a larger cohort with a longer follow-up period.Trial registrationClinical Trial Registry-India CTRI/2016/05/006937 [Registered on: 16/05/2016]; Trial was Registered Retrospectively.

Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials

“…With the exception of one study 57 that was a cluster randomized clinical trial, all remaining studies were individually randomized controlled trials. The main characteristics of the 19 included publications are summarized in Table 2 57,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] and details concerning their results can be found in Supplementary Table S2.…”

“…Most studies 57,[59][60][61][62][63][64][65][66][67][68] included only frail individuals, two studies 69,70 included only pre-frail individuals and six studies 14,71-75 included participants with both frailty and pre-frailty. The criteria used by each study to diagnose frailty and pre-frailty are described in detail in Suplementary Table S3.…”

“…None of the included studies were focused on populations with specific comorbidities and several of them excluded patients with cancer (nine studies), 14,59-61,63,64,66,71-74 chronic renal failure (seven studies), [65][66][67][71][72][73][74] diabetes (six studies) 62,67,71-74 and neurologic impairment (seven studies). 62,67,69,[71][72][73][74] Only one study 66 explicitly allowed the inclusion of patients with cancer or kidney failure, although it is not clear from its report how many participants had those conditions. We present details regarding the comorbidities included/allowed and excluded in each original study in Supplementary Table S4.…”

“…We present details regarding the comorbidities included/allowed and excluded in each original study in Supplementary Table S4. Eight studies 14,68,69,[71][72][73][74][75] used the CHS frailty criteria to define physical frailty based on the following five criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, low physical activity. 28 One study 59,60,63 defined frailty based on the Chin A Paw criteria.…”

Assessment of frailty and outcome of an ethnogeriatric population in periurban slums of Delhi, India – An interventional strategy in a primary health care setting

“…An extensive review of the literature was done which showed a wide-ranged prevalence of 10–60 percentage of frailty among the elderly. [ 23 24 25 26 27 ] Considering a prevalence of 30 percent among the frail olds in a multicultural setting and at a confidence limit of 5% with 95% interval, with an absolute error of 7% with 10% nonresponse, we rounded it off to 200. The study was carried from March 2018 till July 2019 with a pretested validated Edmonton Frailty assessment questionnaire and the WHO-QOL-BREF (Quality of life) questionnaire from the willing study participants who consented.…”