ArticlesPhysical exercise and/or enriched foods for functional improvement in frail, independently living elderly: A randomized controlled trial☆,☆☆,★,★★
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
References (32)
- et al.
Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders?
Arch Phys Med Rehabil
(1998) - et al.
Groningen Active Living Model (GALM): stimulating physical activity in sedentary older adults
Prev Med
(1999) - et al.
Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly
J Nutr
(1995) - et al.
Validity of the Physical Activity Scale for the Elderly (PASE): according to energy expenditure assessed by the doubly labeled water method
J Clin Epidemiol
(1997) - et al.
The Physical Activity Scale for the Elderly (PASE): development and evaluation
J Clin Epidemiol
(1993) - et al.
Improvements in quadriceps strength with regular seated exercise in the institutionalized elderly
Arch Phys Med Rehabil
(1994) - et al.
Measuring functional status: cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990-1993)
J Clin Epidemiol
(1996) - et al.
Ageing and the relationship between functional status and self-rated health in elderly men
Soc Sci Med
(1997) - et al.
Functional biochemical and nutrient indices in frail elderly people are partly affected by dietary supplements but not by exercise
J Nutr
(1999) - et al.
Preventing frail health
Clin Geriatr Med
(1992)
Frailty in elderly people: an evolving concept
Can Med Assoc J
The etiology and reversibility of muscle dysfunction in the aged
J Gerontol
The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults
J Gerontol
High-intensity strength training in nonagenarians. Effects on skeletal muscle
JAMA
Exercise training and nutritional supplementation for physical frailty in very elderly people
N Engl J Med
Muscle rehabilitation in impaired elderly nursing home residents
Arch Phys Med Rehabil
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2019, Free Radical Biology and MedicineCitation Excerpt :An increase in lower body strength and a reduction in body-fat mass was found in the old participants [125]. Other studies with different nutritional supplements such as alpha-linolenic acid [126], fruits and dairy products enriched with vitamins and minerals [127] have failed to show a synergistic effect in the combination of exercise with the nutritional supplements. In these studies, the beneficial effects of the exercise intervention were not overextended when the nutritional supplements were included.
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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.
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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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