The effects of exercise and protein–energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study

Abstract

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 randomised trial with a factorial design. Fiftyseven 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 legextensor 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 (2 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. Protein -energy supplements and exercise: Fat-free mass: Sarcopenia: Frail elderly

Age-related decline in muscle mass and muscle function in Flemish Caucasians: a 10-year follow-up

“…A negative relationship was found between protein intake and percent change per year in S 20 % and change in PT dynamic60°, and a negative trend could also be observed for change in S 20 % and percent change per year in PT dynamic60°i n women (Table 6). This is not in line with previous findings of intervention studies, showing a positive relationship between muscle function, protein intake, and physical activity, even in older adults (Bonnefoy et al 2003;Goodpaster et al 2008). It should be noted that the current study did not account for the type of sport although previous studies have shown that resistance exercise is most effective in improving muscle function and that sports practice is also age-related.…”

“…In 2012, Stenholm et al reported that lifestyle (e.g., education, leisure time and work-related physical activity, smoking behavior, alcohol consumption), and physical health (e.g., chronic conditions such as hypertension, coronary heart disease, cardiovascular disease, or diabetes mellitus) earlier in life determine the rate of muscle strength decline (measured as handgrip strength) in old age (Stenholm et al 2012). Furthermore, various studies have evidenced that nutritional supplementation-such as vitamin D or protein intake-and exercise interventions can have a beneficial effect on muscle strength and physical performance, even in older populations (Bonnefoy et al 2003;Binder et al 2005;Chale-Rush et al 2010;Pahor et al 2014;Cesari et al 2015). In 2015, Sahni et al found a significantly higher leg lean mass in both males (n = 1166, age 60.2 ± 9.3 years) and females (n = 1509, age 59.0 ± 9.3 years) in the highest quartile of total protein and animal protein intake compared with those in the lowest quartiles (Sahni et al 2015).…”

Nutritional interventions in sarcopenia: a critical review

“…A recent systematic review (10) identified five protein supplement studies (11)(12)(13)(14)(15) , which are summarised in Table 1; Cruz-Jentoft et al concluded that there was no consistent effect on muscle mass, strength or function. A closer examination of the studies reveal why this may be so.…”

Influences of carbohydrate plus amino acid supplementation on differing exercise intensity adaptations in older persons: skeletal muscle and endocrine responses

“…In fact, prior to the current study, any validation of the use of EAAs (supplements in combination with resistance training) in improving functional abilities in older adults was scarce and tended to be limited to frail older persons (Fiatarone et al 1994), rather than the comparatively healthy group in the current study. In fact, where it existed in healthy populations, earlier evidence was as contradictory as in frail persons, with some studies showing no additional benefit (Rosendahl et al 2006) and others highlighting clear benefits (Bonnefoy et al 2003) of supplementation on improvements in functional abilities. Further than this, our data would suggest that increased background physical activity even of a relatively low level, works well in combination with supplementation to improve markers of increased independence in old age, such as get-up-and-go, standing-from-lying and 6-min walk tasks.…”

“…Nevertheless, in support of the potential of combining these two interventions, a study by Levenhagen et al (2002) showed that amino acid availability is more important than the availability of energy per se for post-exercise repair and synthesis of muscle proteins. Furthermore, studies also exist, which show that protein/amino acid supplements alone have little or no effect on muscle strength and mass without concomitant exercise interventions in frail elderly (Bonnefoy et al 2003;Fiatarone et al 1994;Rosendahl et al 2006) and otherwise undernourished sedentary individuals (Bonnefoy et al 2003;Fiatarone et al 1994;Rosendahl et al 2006).…”