Change in inflammatory parameters in prefrail and frail persons obtaining physical training and nutritional support provided by lay volunteers: A randomized controlled trial

Sandra Haider,Eva Winzer,Sylvia Titze,Igor Grabovac,Karin Emmi Schindler,Thomas Ernst Dorner,Ali Kapan,Christian Lackinger,Jacobus P. van Wouwe

doi:10.1371/journal.pone.0185879

Sandra Haider, Eva Winzer + Show 7 more

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https://doi.org/10.1371/journal.pone.0185879

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Abstract

The aim of the study was to compare the effects of home visits with physical training and nutritional support on inflammatory parameters to home visits with social support alone within a randomized controlled trial. Prefrail and frail persons received home visits from lay volunteers twice a week for 12 weeks. Participants in the physical training and nutritional intervention group (PTN, n = 35) conducted two sets of six strength exercises and received nutritional support. The social support group (SoSu, n = 23) received visits only. TNF-α, IL-6, CRP, and total leukocyte count were assessed at baseline and after 12 weeks. Changes over time within groups were analyzed with paired t-tests; differences between groups were analyzed with ANCOVA for repeated measurements. In the PTN group, IL-6 and CRP remained stable, whereas in the SoSu group, IL-6 increased significantly from a median value of 2.6 pg/l (min–max = 2.0–10.2) to 3.0 pg/l (min–max = 2.0–20.8), and CRP rose from 0.2 mg/dl (min–max = 0.1–0.9) to 0.3 mg/dl (min–max = 0.1–3.0) after 12 weeks. In CRP, a significant difference between groups was found. TNF-α and total leukocyte count did not change in either the PTN group or the SoSu group. Persons showing an increase in physical performance (OR 4.54; 95% CI = 1.33–15.45) were more likely to have constant or decreased IL-6 values than persons who showed no improvement. In conclusion, in non-robust older adults, a physical training and nutritional support program provided by lay volunteers can delay a further increase in some inflammatory parameters.

Highlights

Cross-sectional studies have shown that the geriatric syndrome of frailty is linked to increased inflammatory parameters [1, 2]
We demonstrated that home visits with physical training and nutritional support provided by lay volunteers can increase handgrip strength significantly, with no significant difference to home visits with social support alone [35]
Two (1.6%) individuals performed physical training and talked about nutrition, they were assigned to the Social support (SoSu) group; they were analyzed in the PTN group

Summary

Introduction

Cross-sectional studies have shown that the geriatric syndrome of frailty is linked to increased inflammatory parameters [1, 2]. As lower muscle mass and muscle strength, poor physical performance, and decreased functional abilities are associated with higher immediate inflammatory parameters in older adults, these factors might influence chronic inflammation [11, 12]. In very old and frail individuals, muscle mass is not related to TNF-α, IL-6, and CRP [13, 14], and physical performance has only a limited association with IL-6 and CRP [15]. It has been shown that chronic inflammation in older persons can result in a future decrease in muscle mass [16, 17], higher incidence of physical disabilities [18], diabetes mellitus [19], hypertension and myocardial infarction [15], ischemic stroke and transient attacks [20], as well as all-cause mortality [21]

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