Effectiveness of exercise and nutrition interventions on older adults with frailty status

Abstract

Objective To synthesise evidences from randomised controlled trials(RCTs)to evaluate the effectiveness of exercise and nutrition interventions on functioning, muscle strength and body composition in older people with frailty. Methods A systematic review and meta-analysis was performed.The electronic databases of Pubmed, Ovid, Web of Science EMBASE and Cochrane were consulted.We included RCT trials of exercise and nutrition interventions for older people with frailty identified through a validated frailty scale of Fried phenotype.The related articles were extracted and cross-checked independently by two reviewers.Methodological quality of trials was evaluated according to Cochrane Handbook criteria.Meta analysis was conducted using RevMan software.The outcomes of performance-based physical function such as gait speed, timed up and go(TUG), muscle strength(knee extension strength or leg extension strength)and body lean mass, fat mass, appendicular lean mass(ALM)were assessed. Results We included 13 articles reporting on 9 trials of exercise interventions(total n=1 034 participants)and included 5 trials of nutrition interventions(n=423 participants). Overall, exercise interventions had a significant beneficial effect on knee extension strength post-intervention compared to usual care control[standardised mean differences(SMD)=1.20, 95%CI: 0.32-2.08, Z=2.67, P=0.008, I2=62.0%]. We found no effects upon gait speed or TUG time (both P>0.05). Exercise and nutrition interventions had some effects on ALM, but no significant different(SMD=0.45, 95%CI: -0.18-1.09, Z=1.40, P=0.163, I2=82.2%)compared to control.There were no differences in gait speed or leg extension strength after nutrition interventions(both P>0.05). The effects of exercise and nutrition interventions on body composition index were inconsistent. Conclusions Exercise interventions had some positive effects on functioning for older people with frailty, but these were based on small, low quality studies.Further large-scale and high quality studies of rigorously RCT interventions are needed. Key words: Frailty; Exercise; Nutrition therapy; Systems analysis