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Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: A randomized controlled trial,☆☆,,★★

https://doi.org/10.1053/apmr.2001.23278Get rights and content

Abstract

Chin A Paw MJM, de Jong N, Schouten EG, Hiddink GJ, Kok FJ. Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: a randomized controlled trial. Arch Phys Med Rehabil 2001;82:811-7. Objective: To examine the effects of an exercise program and an enriched food regimen on physical functioning of frail elderly persons. Design: A 17-week randomized, placebo-controlled trial. Setting: Community. Participants: One hundred fifty-seven independently living frail elderly (mean age, 78.7 ± 5.6yr). Intervention: Thirty-nine subjects participated in a twice weekly group exercise designed to improve daily functioning; 39 subjects daily ate foods enriched with vitamins and minerals (at 25%-100% of the recommended daily allowances); 42 subjects exercised and ate enriched foods; and 37 subjects served as controls. Nonexercising groups followed a social program; nonsupplement groups received the same food products without the micronutrients. Main Outcome Measures: Functional performance based on 6 performance tests, physical fitness based on 7 fitness tests, and disabilities based on the self-reported ability to perform 16 daily activities. Results: Performance sum scores were significantly enhanced in trained (+8%) compared with nontrained subjects (−8%) (difference in change: 1.9 points, p <.001, adjusted for baseline scores). Fitness sum scores were significantly enhanced as well (+3% in trained vs −2% in nontrained) (difference in change: 0.9 points, p =.05, adjusted for baseline scores). No exercise effects on the disability score were observed. Consumption of enriched products did not affect performance, fitness, or disability scores. Conclusion: Our comprehensive exercise program, designed for widespread applicability, enhanced physical performance and fitness in a population of frail elderly. Daily consumption of micronutrient enriched foods showed no functional benefits within 17 weeks.

Section snippets

Design

The study was a randomized, placebo-controlled intervention trial based on a 2 × 2 factorial design that permitted assessment of the effects of the exercise and nutritional interventions as well as possible interactions.

Study population

Subjects were recruited by mail from senior housing complexes, Meals-on-Wheels programs, home care organizations, and general practitioners. Subsequent screening by telephone determined which subjects met the inclusion criteria. The main screening criteria for frailty were

Compliance

Of the 217 randomized subjects, 56 dropped out of the study (25 of the 56 drop-outs quit during or immediately after the baseline measurements). Reasons given for dropping out included: too much trouble, the duration of the program, and inconvenience. The main reasons for dropping out during the intervention period were health problems (20%) including hospitalization (eg, hip operation, kidney stones, n = 14) and disease (eg, cancer, rheumatoid arthritis, n = 8). Two subjects, both with

Discussion

Our exercise program significantly improved functional performance in a group of frail Dutch elderly people. We also found a small effect on fitness but no effects on self-rated disabilities. We observed no effects from the enriched foods. The stronger effect on performance emphasizes the specificity of training; strength training is expected to improve muscle strength, whereas a comprehensive program is necessary for an improvement in functional tasks.

Most studies of frail elderly have focused

Conclusion

Our exercise program enhanced functional performance and physical fitness in a population of frail older persons. Daily micronutrient supplementation at 25% to 100% of the RDA showed no additional functional benefits in 17 weeks.

Acknowledgements

The authors acknowledge the cooperation of the volunteers in this study; the dedicated work of the fieldwork team, the creative therapist, all exercise instructors, and Martin Stevens and Petrus Bult (Department of Human Movement Sciences, University of Groningen) for their contributions to the development of the exercise program; and Wiebe Visser of the Dutch Dairy Foundation on Nutrition and Health for establishing and coordinating the contacts with the following companies: Roche Nederland

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    Supported by the Dutch Dairy Foundation on Nutrition and Health, Maarssen, and the Dutch Prevention Fund, the Hague, the Netherlands.

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprint requests to Marijke J.M. Chin A Paw, PhD, Institute for Research in Extramural Medicine, Div of Social Medicine, Vrye Universiteit Amsterdam Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands, e-mail: [email protected].

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