Ursolic Acid-Standardized Apple Pomace Supplementation for Muscle Strength and Physical Performance in Older Adults With Mild Sarcopenia: A Randomized, Double-Blind, Placebo-Controlled Trial

Effects of Ursolic Acid-Standardized Apple Pomace Extract Formulated With Phospholipids on Muscle Strength and Physical Performance in Older Adults With Mild Sarcopenia: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Trial

Sarcopenia is an age-related condition characterized by loss of muscle strength and physical performance, leading to increased risk of falls and disability. This randomized, double-blind, placebo-controlled clinical trial aims to evaluate the effects of ursolic acid-standardized apple pomace supplementation on muscle strength and physical performance in older adults with mild sarcopenia. Participants will be randomly assigned to receive either 200 mg/day, 400 mg/day of the supplement, or placebo for 12 weeks. The primary outcome is change in handgrip strength, with additional assessments of physical performance, body composition, fatigue, and quality of life. The study will also evaluate the safety and tolerability of the intervention.

Study Overview

• Status: Not yet recruiting
• Conditions: Sarcopenia
• Intervention / Treatment: Dietary supplement: Ursolic Acid-Standardized Apple Pomace Extract; Other: Placebo

Detailed Description

Sarcopenia is an age-related skeletal muscle disorder characterized by progressive decline in muscle strength and physical performance, resulting in increased risk of falls, disability, and loss of independence. Despite its clinical relevance, no pharmacological therapies are currently approved, and management relies primarily on exercise and nutritional strategies, which may be insufficient or impractical for many individuals.

Ursolic acid is a naturally occurring triterpenoid found in apple peel and other plant sources, with preclinical evidence demonstrating beneficial effects on skeletal muscle mass, strength, and metabolic function. These effects have been linked to modulation of anabolic signaling pathways, including insulin and insulin-like growth factor-1 pathways, as well as suppression of muscle atrophy-related genes. Human studies remain limited, particularly in older adults with sarcopenia.

This study is a randomized, double-blind, placebo-controlled, parallel-group clinical trial designed to evaluate the effects of ursolic acid-standardized apple pomace extract formulated with phospholipids on muscle strength and physical performance in older adults with mild sarcopenia. A total of 105 participants will be randomized in a 1:1:1 ratio to receive either 200 mg/day, 400 mg/day of the active supplement, or placebo for 12 weeks.

The primary endpoint is change in handgrip strength from baseline to Week 6 and Week 12. Key secondary endpoints include measures of lower-limb functional strength and physical performance, including five-times chair stand test, Short Physical Performance Battery score, gait speed, and Timed Up and Go test. Additional outcomes include body composition assessed by bioelectrical impedance analysis, patient-reported outcomes such as fatigue and health-related quality of life, and safety assessments including adverse events and laboratory parameters.

The study is conducted in accordance with Good Clinical Practice and the Declaration of Helsinki, and aims to provide clinical evidence on the efficacy and safety of ursolic acid supplementation in a population with clinically relevant muscle function impairment.

• Study Type: Interventional
• Enrollment (Estimated): 105
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Amjad Khan, DPhil; Phone Number: 03330506955; Email: amjadkhan@lumhs.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 65 to 80 years (inclusive)
• Male or female
• Community-dwelling outpatients
• Able and willing to provide written informed consent
• Able to comply with study procedures and attend scheduled visits
• Able to walk independently (assistive devices permitted) and safely perform physical performance assessments
• Stable medical condition and stable medication regimen for at least 4 weeks prior to screening
• Mild sarcopenia defined as:
• SARC-F score ≥4 or clinical suspicion of sarcopenia, and

Low muscle strength defined as:

Handgrip strength <27 kg for men or <16 kg for women, or Five-times chair stand test >15 seconds or inability to complete without use of arms

- Eligible for body composition assessment using bioelectrical impedance analysis (BIA)

Exclusion Criteria:

• Severe sarcopenia or severe functional impairment precluding safe participation
• Unstable or uncontrolled medical conditions that may interfere with participation or safety
• Severe renal or hepatic disease, including:
• eGFR <30 mL/min/1.73 m²
• Significant liver disease or markedly abnormal liver function tests
• Uncontrolled endocrine or metabolic disorders
• Active malignancy or ongoing cancer treatment
• Use of medications affecting muscle mass or function, including:
• Chronic systemic corticosteroids
• Anabolic steroids or testosterone therapy
• Other investigational muscle-modifying agents
• Recent structured resistance training within the past 3 months
• Use of muscle-targeted supplements (e.g., creatine, HMB) within the previous 4-8 weeks
• Contraindications to BIA (e.g., pacemaker or implanted electronic device)
• Acute illness within 4 weeks prior to screening
• Cognitive impairment preventing informed consent or protocol compliance
• Known allergy or intolerance to ursolic acid or study product components
• Any condition that, in the opinion of the investigator, may compromise safety, compliance, or data integrity

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Ursolic Acid 200 mg/day; Participants will receive ursolic acid-standardized apple pomace extract tablets at a total daily dose of 200 mg for 12 weeks. The dosing regimen consists of one 200 mg active tablet taken at breakfast and one placebo tablet taken at dinner.	Dietary supplement: Ursolic Acid-Standardized Apple Pomace Extract; Oral supplementation with ursolic acid-standardized apple pomace extract formulated with phospholipids. The product is standardized to contain triterpenes including ursolic acid and is administered as tablets.; Other Names: Apple pomace extract, Ursolic acid supplement; Other: Placebo; Matching placebo tablets identical in appearance, taste, and packaging to the active supplement, administered orally.
Experimental: Ursolic Acid 400 mg/day; Participants will receive ursolic acid-standardized apple pomace extract tablets at a total daily dose of 400 mg for 12 weeks. The dosing regimen consists of one 200 mg active tablet taken at breakfast and one 200 mg active tablet taken at dinner.	Dietary supplement: Ursolic Acid-Standardized Apple Pomace Extract; Oral supplementation with ursolic acid-standardized apple pomace extract formulated with phospholipids. The product is standardized to contain triterpenes including ursolic acid and is administered as tablets.; Other Names: Apple pomace extract, Ursolic acid supplement
Active Comparator: Placebo; Participants will receive matching placebo tablets identical in appearance to the active supplement, administered as one tablet at breakfast and one tablet at dinner for 12 weeks.	Other: Placebo; Matching placebo tablets identical in appearance, taste, and packaging to the active supplement, administered orally.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in handgrip strength from baseline	Handgrip strength will be measured in kilograms using a calibrated hand dynamometer. The best value from three attempts on the dominant hand in a standardized seated position will be recorded. The outcome represents the change from baseline.	Baseline to Week 12

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in five-times chair stand test time	Time in seconds required to complete five consecutive chair stands without use of the arms, assessed as change from baseline.	Baseline to Week 12
Change in Short Physical Performance Battery (SPPB) score	Total SPPB score (range 0-12) assessing lower extremity function, including balance, gait speed, and chair stand performance, evaluated as change from baseline.	Baseline to Week 12
Change in gait speed	Usual gait speed measured over a 4-meter walk test, expressed in meters per second and evaluated as change from baseline.	Baseline to Week 12
Change in Timed Up and Go test time	Time in seconds required to stand from a chair, walk 3 meters, turn, return, and sit down, assessed as change from baseline.	Baseline to Week 12
Change in body composition	Body composition parameters assessed by bioelectrical impedance analysis, including skeletal muscle mass, skeletal muscle index, and fat mass, evaluated as change from baseline.	Baseline to Week 12
Change in fatigue severity	Fatigue severity assessed using a validated fatigue severity scale, evaluated as change from baseline.	Baseline to Week 12
Change in health-related quality of life	Health-related quality of life assessed using the SF-12 physical and mental component summary scores, evaluated as change from baseline.	Baseline to Week 12

Collaborators and Investigators

• Sponsor: Liaquat University of Medical & Health Sciences

Study record dates

Study Major Dates

• Study Start (Estimated): May 10, 2026
• Primary Completion (Estimated): August 31, 2026
• Study Completion (Estimated): September 15, 2026

Study Registration Dates

• First Submitted: April 24, 2026
• First Submitted That Met QC Criteria: April 24, 2026
• First Posted (Actual): May 1, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: May 1, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Muscular Atrophy; Atrophy; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Sarcopenia
• Other Study ID Numbers: LUMHS/REC/-1612/30.04.2026

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No