Abstract
BackgroundExercise and nutrition are important for older adults to maintain or to regain their muscle mass, function, strength, and ultimately quality of life. The effectiveness of combined resistance exercise and diet interventions is commonly evaluated in controlled clinical studies, but evidence from real-life settings is lacking. This article describes the effectiveness, process, and economic evaluation design of a combined nutrition and exercise intervention for community-dwelling older adults in a Dutch real-life setting.MethodsThe ProMuscle in Practice study is a randomised controlled multicentre intervention study, conducted in five municipalities in the Netherlands. Two hundred community-dwelling older adults (≥65 years) who are frail or pre-frail based on Fried frailty criteria or who experience strength loss are randomised over an intervention and control group by municipality. In the first 12-week intensive support intervention, participants in the intervention group perform resistance exercise training guided by a physiotherapist twice a week and increase protein intake by consuming protein-rich products under the supervision of a dietitian. Afterwards, they continue with a 12-week moderate support intervention. The control group receives only regular care during the two 12-week periods. Effect outcomes are measured at all locations at baseline, 12 weeks, 24 weeks, 36 weeks and only at three locations at 52 weeks. The primary outcome is physical functioning (Short Physical Performance Battery). Secondary outcomes include leg muscle strength, lean body mass, activities of daily living, social participation, food intake, and quality of life. Qualitative and quantitative implementation process data are collected during the intervention. Healthcare use and intervention costs are registered for the economic evaluation.DiscussionEvaluating the effects, implementation, and costs of this combined intervention provides valuable insight into the feasibility of this intervention for community-dwelling older adults and into the intervention’s ability to improve or to maintain physical functioning and quality of life.Trial registrationNetherlands Trial Register (NTR6038) since 30 August 2016.
Highlights
Exercise and nutrition are important for older adults to maintain or to regain their muscle mass, function, strength, and quality of life
The intervention focuses on resistance exercise for the major muscle groups and the consumption of at least 25 g of protein at the three main meals
The intensive support intervention is aimed at initiating behaviour change under the supervision of healthcare professionals, whereas the moderate support intervention provides support to sustain the behaviour change, making use of local facilities
Summary
Exercise and nutrition are important for older adults to maintain or to regain their muscle mass, function, strength, and quality of life. This article describes the effectiveness, process, and economic evaluation design of a combined nutrition and exercise intervention for community-dwelling older adults in a Dutch real-life setting. Reviews and meta-analyses have shown that interventions including resistance exercise (RE) and dietary strategies towards improving protein intake effectively increase muscle outcomes in older adults [6,7,8,9]. As these interventions are mostly implemented in highly controlled settings, no conclusions can be drawn about their effectiveness when implemented in a real-life setting. There is a need to translate these efficacious clinical interventions to real-life healthcare and community settings and investigate their effectiveness in practice
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