Individualized home-based exercise and nutrition interventions improve frailty in older adults: a randomized controlled trial

Tsung-Jen Hsieh, Shin-Chang Su, Chun-Wei Chen, Yaw-Wen Kang, Ming-Hsia Hu, Li-Lin Hsu, Szu-Yun Wu, Likwang Chen, Hsing-Yi Chang, Shao-Yuan Chuang, Wen-Harn Pan, Chih-Cheng Hsu, Tsung-Jen Hsieh, Shin-Chang Su, Chun-Wei Chen, Yaw-Wen Kang, Ming-Hsia Hu, Li-Lin Hsu, Szu-Yun Wu, Likwang Chen, Hsing-Yi Chang, Shao-Yuan Chuang, Wen-Harn Pan, Chih-Cheng Hsu

Abstract

Background: Frail older adults are predisposed to multiple comorbidities and adverse events. Recent interventional studies have shown that frailty can be improved and managed. In this study, effective individualized home-based exercise and nutrition interventions were developed for reducing frailty in older adults.

Methods: This study was a four-arm, single-blind, randomized controlled trial conducted between October 2015 and June 2017 at Miaoli General Hospital in Taiwan. Overall, 319 pre-frail or frail older adults were randomly assigned into one of the four study groups (control, exercise, nutrition, and exercise plus nutrition [combination]) and followed up during a 3-month intervention period and 3-month self-maintenance period. Improvement in frailty scores was the primary outcome. Secondary outcomes included improvements in physical performance and mental health. The measurements were performed at baseline, 1 month, 3 months, and 6 months.

Results: At the 6-month measurement, the exercise (difference in frailty score change from baseline: - 0.23; 95% confidence interval [CI]: - 0.41, - 0.05; p = 0.012), nutrition (- 0.28; 95% CI: - 0.46, - 0.11; p = 0.002), and combination (- 0.34; 95% CI: - 0.52, - 0.16; p < 0.001) groups exhibited significantly greater improvements in the frailty scores than the control group. Significant improvements were also observed in several physical performance parameters in the exercise, nutrition, and combination groups, as well as in the 12-Item Short Form Health Survey mental component summary score for the nutrition group.

Conclusions: The designated home-based exercise and nutrition interventions can help pre-frail or frail older adults to improve their frailty score and physical performance.

Trial registration: Retrospectively registered at ClinicalTrials.gov (identifier: NCT03477097); registration date: March 26, 2018.

Keywords: Exercise; Frailty; Individualized home-based interventions; Nutrition; Older adults.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study participants in the frailty intervention randomized controlled trial. Legend: ITT, intention-to-treat
Fig. 2
Fig. 2
Mean changes from baseline in frailty score, physical performance, and mental health outcomes during the 6-month study period. Legend: a: Frailty score; b: Handgrip strength; c: 10-m gait speed; d: Upper body flexibility; e: Lower body flexibility; f: Lower extremity strength; g: Geriatric Depression Scale; h: 12-Item Short Form Health Survey mental component summary. : Control group; : Exercise group; : Nutrition group; : Combination group

References

    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752–762. doi: 10.1016/S0140-6736(12)62167-9.
    1. Rockwood K, Song XW, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173:489–495. doi: 10.1503/cmaj.050051.
    1. Collard RM, Boter H, Schoevers RA, Voshaar RCO. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487–1492. doi: 10.1111/j.1532-5415.2012.04054.x.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Cardiovascular health study collaborative research group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M156.
    1. Lo YL, Hsieh YT, Hsu LL, Chuang SY, Chang HY, Hsu CC, et al. Dietary pattern associated with frailty: results from nutrition and health survey in Taiwan. J Am Geriatr Soc. 2017;65:2009–2015. doi: 10.1111/jgs.14972.
    1. Cesari M, Vellas B, Hsu FC, Newman AB, Doss H, King AC, et al. LIFE study group. A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. J Gerontol A Biol Sci Med Sci. 2015;70:216–222. doi: 10.1093/gerona/glu099.
    1. Ng TP, Feng L, Nyunt MSZ, Feng L, Niti M, Tan BY, et al. Nutritional, physical, cognitive, and combination interventions and frailty reversal among older adults: a randomized controlled trial. Am J Med. 2015;128:1225–1236. doi: 10.1016/j.amjmed.2015.06.017.
    1. Tieland M, Dirks ML, van der Zwaluw N, Verdijk LB, van de Rest O, de Groot LCPGM, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13:713–719. doi: 10.1016/j.jamda.2012.05.020.
    1. Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, et al. LIFE study investigators. Effect of structured physical activity on prevention of major mobility disability in older adults the LIFE study randomized clinical trial. Jama-J Am Med Assoc. 2014;311:2387–2396. doi: 10.1001/jama.2014.5616.
    1. Tarazona-Santabalbina FJ, Gomez-Cabrera MC, Perez-Ros P, Martinez-Arnau FM, Cabo H, Tsaparas K, et al. A multicomponent exercise intervention that reverses frailty and improves cognition, emotion, and social networking in the community-dwelling frail elderly: a randomized clinical trial. J Am Med Dir Assoc. 2016;17:426–433. doi: 10.1016/j.jamda.2016.01.019.
    1. Dedeyne L, Deschodt M, Verschueren S, Tournoy J, Gielen E. Effects of multi-domain interventions in (pre) frail elderly on frailty, functional, and cognitive status: a systematic review. Clin Interv Aging. 2017;12:873–896. doi: 10.2147/CIA.S130794.
    1. Moher D, Schulz KF, Altman DG. The CONSORT group. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 2001;357:1191–1194. doi: 10.1016/S0140-6736(00)04337-3.
    1. Sheikh JI, Yesavage JA. 9/geriatric depression scale (GDS) recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–173. doi: 10.1300/J018v05n01_09.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1435–1445. doi: 10.1249/mss.0b013e3180616aa2.
    1. DOH . Food guides (Balance diet recommendations for adults) Taipei: Department of Health; 1995.
    1. Wu SY, Hsu LL, Hsu CC, Hsieh TJ, Su SC, Peng YW, et al. Dietary education with customised dishware and food supplements can reduce frailty and improve mental well-being in elderly people: a single-blind randomized controlled study. Asia Pac J Clin Nutr. 2018;27:1018–1030.
    1. Fougere B, van Kan GA, Vellas B, Cesari M. Redox systems, antioxidants and sarcopenia. Curr Protein Pept Sci. 2018;19:643–648. doi: 10.2174/1389203718666170317120040.
    1. Gray SR, Da Boit M. Fish oils and their potential in the treatment of sarcopenia. J Frailty Aging. 2013;2:211–216.
    1. Wu IC, Lin CC, Hsiung CA, Wang CY, Wu CH, Chan DCD, et al. Sarcopenia and translational aging research in Taiwan (START) team. Epidemiology of sarcopenia among community-dwelling older adults in Taiwan: a pooled analysis for a broader adoption of sarcopenia assessments. Geriatr Gerontol Int. 2014;14:52–60. doi: 10.1111/ggi.12193.
    1. Liou YM, Jwo CJC, Yao KG, Chiang LC, Huang LH. Selection of appropriate Chinese terms to represent intensity and types of physical activity terms for use in the Taiwan version of IPAQ. J Nurs Res. 2008;16:252–263. doi: 10.1097/01.JNR.0000387313.20386.0a.
    1. Chen LJ, Chen CY, Lue BH, Tseng MY, Wu SC. Prevalence and associated factors of frailty among elderly people in Taiwan. Int J Gerontol. 2014;8:114–119. doi: 10.1016/j.ijge.2013.12.002.
    1. Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Act. 1999;7:129–161. doi: 10.1123/japa.7.2.129.
    1. Lunsford BR, Perry J. The standing heel-rise test for ankle plantar flexion: criterion for normal. Phys Ther. 1995;75:694–698. doi: 10.1093/ptj/75.8.694.
    1. Ware JE, Kosinski M, Turner-Bowker DM, Gandek B. User’s manual for the SF-12v2® health survey (with a supplement documenting version 1) QualityMetric Incorporated: Lincoln; 2002.
    1. Faul F, Erdfelder E, Lang AG, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–191. doi: 10.3758/BF03193146.
    1. Miller RG., Jr . Simultaneous statistical inference. 2. New York: Springer-Verlag; 1981.
    1. Cress M. E., Buchner D. M., Questad K. A., Esselman P. C., deLateur B. J., Schwartz R. S. Exercise: Effects on Physical Functional Performance in Independent Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 1999;54(5):M242–M248. doi: 10.1093/gerona/54.5.M242.
    1. Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev. 2010;9:226–237. doi: 10.1016/j.arr.2010.03.004.
    1. Colcombe SJ, Erickson KI, Scalf PE, Kim JS, Prakash R, McAuley E, et al. Aerobic exercise training increases brain volume in aging humans. J Gerontol A Biol Sci Med Sci. 2006;61:1166–1170. doi: 10.1093/gerona/61.11.1166.
    1. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JCT. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008;56:2234–2243. doi: 10.1111/j.1532-5415.2008.02014.x.
    1. de Vries NM, van Ravensberg CD, Hobbelen JSM, Rikkert MGMO, Staal JB, Nijhuis-van der Sanden MWG. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: a meta-analysis. Ageing Res Rev. 2012;11:136–49.
    1. Yamada M, Arai H, Sonoda T, Aoyama T. Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. J Am Med Dir Assoc. 2012;13:507–511. doi: 10.1016/j.jamda.2012.04.001.
    1. Millen BE, Ohls JC, Ponza M, McCool AC. The elderly nutrition program: an effective national framework for preventive nutrition interventions. J Am Diet Assoc. 2002;102:234–240. doi: 10.1016/S0002-8223(02)90055-6.
    1. Fernandez-Barres S, Garcia-Barco M, Basora J, Martinez T, Pedret R, Arija V. Project ATDOM-NUT group. The efficacy of a nutrition education intervention to prevent risk of malnutrition for dependent elderly patients receiving home care: a randomized controlled trial. Int J Nurs Stud. 2017;70:131–141. doi: 10.1016/j.ijnurstu.2017.02.020.
    1. Salas-Salvado J, Bullo M, Babio N, Martinez-Gonzalez MA, Ibarrola-Jurado N, Basora J, et al. PREDIMED study investigators. Reduction in the incidence of type 2 diabetes with the Mediterranean diet results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34:14–19. doi: 10.2337/dc10-1288.
    1. Payette H, Boutier V, Coulombe C, Gray-Donald K. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. J Am Diet Assoc. 2002;102:1088–1095. doi: 10.1016/S0002-8223(02)90245-2.
    1. Smoliner C, Norman K, Scheufele R, Hartig W, Pirlich M, Lochs H. Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition. Nutrition. 2008;24:1139–1144. doi: 10.1016/j.nut.2008.06.024.
    1. Kim CO, Lee KR. Preventive effect of protein-energy supplementation on the functional decline of frail older adults with low socioeconomic status: a community-based randomized controlled study. J Gerontol A Biol Sci Med Sci. 2013;68:309–316. doi: 10.1093/gerona/gls167.
    1. Ngandu T, Lehtisalo J, Solomon A, Levalahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385:2255–2263. doi: 10.1016/S0140-6736(15)60461-5.
    1. Kwon J, Yoshida Y, Yoshida H, Kim H, Suzuki T, Lee Y. Effects of a combined physical training and nutrition intervention on physical performance and health-related quality of life in prefrail older women living in the community: a randomized controlled trial. J Am Med Dir Assoc. 2015;16:263.e1–263.e8. doi: 10.1016/j.jamda.2014.12.005.
    1. Luger E, Dorner TE, Haider S, Kapan A, Lackinger C, Schindler K. Effects of a home-based and volunteer-administered physical training, nutritional, and social support program on malnutrition and frailty in older persons: a randomized controlled trial. J Am Med Dir Assoc. 2016;17:671.e9–671.16. doi: 10.1016/j.jamda.2016.04.018.
    1. Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of progressive resistance training in depressed elders. J Gerontol A Biol Sci Med Sci. 1997;52:M27–M35. doi: 10.1093/gerona/52A.1.M27.
    1. Blumenthal JA, Babyak MA, Moore KA, Craighead E, Herman S, Khatri P, et al. Effects of exercise training on older patients with major depression. Arch Intern Med. 1999;159:2349–2356. doi: 10.1001/archinte.159.19.2349.

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