Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-16T15:33:24.407Z Has data issue: false hasContentIssue false
  • English
  • Français

The effects of exercise and protein–energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study

Published online by Cambridge University Press:  09 March 2007

M. Bonnefoy ,
C. Cornu ,
S. Normand ,
F. Boutitie ,
F. Bugnard ,
A. Rahmani ,
J. R. Lacour  and
M. Laville
M. Bonnefoy
Affiliation:
Service de Médecine Gériatrique, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite Cedex, France Centre de Recherche en Nutrition Humaine de Lyon, Faculté de Médecine Laënnec, Rue Guillaume Paradin, 69372 Lyon Cedex 08, France Unité INSERM 449, Faculté de Médecine Laënnec, Rue Guillaume Paradin, 69372 Lyon Cedex 08, France Laboratoire de Physiologie de I'Exercice, Faculté de Médecine, Lyon Sud BP12, 69921 Oullins, France
C. Cornu
Affiliation:
Service de Pharmacologie Clinique EA643, 69500 Brow, Hôpital LouisPradel, Lyon, France
S. Normand
Affiliation:
Centre de Recherche en Nutrition Humaine de Lyon, Faculté de Médecine Laënnec, Rue Guillaume Paradin, 69372 Lyon Cedex 08, France
F. Boutitie
Affiliation:
Service de Biostatistiques, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424 Lyon Cedex 03, France
F. Bugnard
Affiliation:
Service de Pharmacologie Clinique EA643, 69500 Brow, Hôpital LouisPradel, Lyon, France
A. Rahmani
Affiliation:
Laboratoire de Physiologie de I'Exercice, Faculté de Médecine, Lyon Sud BP12, 69921 Oullins, France
J. R. Lacour
Affiliation:
Laboratoire de Physiologie de I'Exercice, Faculté de Médecine, Lyon Sud BP12, 69921 Oullins, France
M. Laville*
Affiliation:
Centre de Recherche en Nutrition Humaine de Lyon, Faculté de Médecine Laënnec, Rue Guillaume Paradin, 69372 Lyon Cedex 08, France Unité INSERM 449, Faculté de Médecine Laënnec, Rue Guillaume Paradin, 69372 Lyon Cedex 08, France
*
*Corresponding Author: Professor M. Laville, fax +33 4 72 11 78 65, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly. To our knowledge, the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn. We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly, and would bring about concomitant benefits in body composition and muscle power. Accordingly, this exercise and nutritional combination was assessed in the frail elderly in a 9-month randomised trial with a factorial design. Fifty-seven elderly volunteers over 72 years, from sixteen retirement homes in Lyon, France participated in the study. Dietary supplements were compared with placebo, and physical exercise was compared with memory training. Main outcome measures were fat-free mass (FFM) and muscle power. FFM was determined by labelled water, and muscle power was measured by a leg-extensor machine. At 9 months, the compliance was 63 % for exercise sessions, and 54 % for nutritional supplements. In patients with dietary supplements, muscle power increased by 57 % at 3 months (P=0·03), and showed only a tendency at 9 months; although FFM increased by 2·7 % at 9 months, the difference was not significant (P=0·10). Exercise did not improve muscle power at 9 months, but improved functional tests (five-time-chair rise, P=0·01). BMI increased with supplements (+3·65 %), but decreased with placebo (−0·5 %) at 9 months (P=0·007). A long-term combined intervention is feasible in frail elderly individuals with a good rate of compliance. Nutritional supplements and exercise may improve muscle function. Despite no significant results on FFM, due to the limited number of volunteers, combined intervention should be suggested to counteract muscle weakness in the frail elderly.

Keywords

Protein–energy supplements and exerciseFat-free massSarcopeniaFrail elderly
Type
Research Article
Information
British Journal of Nutrition , Volume 89 , Issue 5 , May 2003 , pp. 731 - 738
Copyright
Copyright © The Nutrition Society 2003

References

Arock, M, Desnault, H, Viars, P & Guillosson, J (1985) Dosage de l'azote total dans les milieux biologiques par chimioluminescence, comparaison avec la méthode de référence (Dosage of total N2 In biological environments by chemiluminescence, comparison with the reference method). Annales de Biologie Clinique 43 872–874.Google Scholar
Bassey, EJ, Fiatarone, MA, O'Neill, EF, Kelly, M, Evans, WJ & Lipsitz, LA (1992) Leg extensor power and functional performance in very old men and women. Clinical Science 82 321–327.CrossRefGoogle ScholarPubMed
Blanc, S, Normand, S, Ritz, P, Pachiaudi, C, Vico, L, Gharib, C & Gauquelin-Koch, G (1998) Energy and water metabolism, body composition and hormonal changes induced by 42 days of head down bed rest. Journal of Clinical Endocrinology and Metabolism 83 4289–4297.Google Scholar
Bosco, C, Belli, A & Astrua, M (1995) A dynamometer for evaluation of dynamic muscle work. European Journal of Applied Physiology 70 379–386.CrossRefGoogle ScholarPubMed
Campbell, WW, Crim, MC, Young, VR & Evans, WJ (1994) Increased energy requirements and changes in body composition with resistance training in older adults. American Journal of Clinical Nutrition 60 167–175.CrossRefGoogle ScholarPubMed
Chumlea, W, Guo, S, Glaser, R & Vellas, B (1997) Sarcopenia, function and health. Nutrition and Health 1 7–12.Google Scholar
Coward, WA (1990) Calculation of pool size and flux rates. In The Doubly Labelled Water Method for Measuring Energy Expenditure, [Prentice, AM, editor]. Vienna, Austria: International Atomic Agency.Google Scholar
De Jong, N, Chin, A, Paw, MJM, De Groot, L, de Graaf, C, Kok, FJ & Van Staveren, WA (2000) Dietary supplements and physical exercise affecting bone and body composition in frail elderly persons. American Journal of Public Health 90 947–954.Google ScholarPubMed
Evans, W (1997) Functional and metabolic consequences of sarcopenia. Journal of Nutrition 127 998S–1003S.Google ScholarPubMed
Fiatarone, MA, Marks, EC, Ryan, ND, Meredith, CN, Lipsitz, LA & Evans, WJ (1990) High-intensity strength training in nonagenarians. Effects of skeletal muscle. Journal of American Medical Association 263 3029–3034.CrossRefGoogle ScholarPubMed
Fiatarone, MA, O'Neill, EF, Doyle Ryan, N, Clements, KM, Solares, GR, Lipsitz, LA & Evans, WJ (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine 330 1769–1775.CrossRefGoogle ScholarPubMed
Fiatarone Singh, MA, Ding, W, Manfredi, TJ, Solares, GS, O'Neill, EF, Clements, KM, Ryan, ND, Kehayias, JJ, Fielding, RA & Evans, WJ (1999) Insulin-like growth factor I in skeletal muscle after weight-lifting exercise in frail elders. American Journal of Physiology 277 E135–E143.Google Scholar
Fischer, NM, Pendergast, DR & Calkins, E (1991) Muscle rehabilitation in impaired elderly nursing home residents. Archives of Physical Medicine and Rehabilitation 72 181–185.Google Scholar
Foldvari, M, Clark, M, Laviolette, LC, Bernstein, MA, Kaliton, D, Castaneda, C, Pu, CT & Fiatarone Singh, MA (2000) Association of muscle power with functional status in community-dwelling elderly women. Journal of Gerontology: Biological Medical Sciences 55 M192–M199.Google ScholarPubMed
Frayn, K (1983) Calculation of substrate oxidation rates in vivo from gaseous exchange. Journal of Applied Physiology 55 R628–R634.CrossRefGoogle ScholarPubMed
Frontera, WR, Meredith, CR, O'Reilly, KP, Knuttgen, HG & Evans, WJ (1988) Strength conditioning in older men; skeletal muscle hypertrophy and improved function. Journal of Applied Physiology 64 1038–1044.CrossRefGoogle ScholarPubMed
Gallagher, D, Ruts, E, Visser, M, Heshka, S, Baumgartner, RN, Wang, J, Pierson, RN, Pi-Sunyer, FX & Heymsfield, SB (2000) Weight stability masks sarcopenia in elderly men and women. American Journal of Physiology and Endocrinology Metabolism 279 E366–E375.CrossRefGoogle ScholarPubMed
Guralnik, JM, Ferrucci, L, Simonsick, EM, Salive, ME & Wallace, RB (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. New England Journal of Medicine 332 556–561.CrossRefGoogle ScholarPubMed
Jozsi, AC, Campbell, WW, Joseph, L, Davey, SL & Evans, WJ (1999) Changes in power with resistance training in older and younger men and women. Journal of Gerontology: Biological Medical Sciences, 54A M591–M596.Google Scholar
Katz, S, Ford, AB, Moskowitz, RW, Jackson, BA & Jaffe, MW (1963) Studies of illness in the aged: the index of ADL. A standardized measure of biological and psychosocial function. Journal of the American Medical Association 185 914–919.CrossRefGoogle Scholar
Kostka, T, Rahmani, A, Berthouze, SE, Lacour, JR & Bonnefoy, M (2000) Quadriceps muscle function in relation to habitual physical activity and VO2max in men and women aged more than 65 years. Journal of Gerontology: Biological Medical Sciences 55A, B481–B4881.Google Scholar
Lawton, MP & Brody, EM (1969) Assessment of older people: selfmaintaining and instrumental activities of daily living. Gerontologist 9 179–186.CrossRefGoogle ScholarPubMed
Lazowski, DA, Ecclestone, NA, Myers, AM, Paterson, DH, Tudor-Locke, C, Fitzgerald, C, Jones, G, Shima, N & Cunningham, DA (1999) A randomized outcome evaluation of group exercise programs in long-term care institutions. Journal of Gerontology: Biological Medical Sciences 54A, M621–M628.Google Scholar
McCartney, N, Hicks, AL, Martin, J & Webber, CE (1996) A longitudinal trial of weight training in the elderly: continued improvements in year 2. Journal of Gerontology: Biological Medical Sciences 51A, B425–B433.Google Scholar
McMurdo, ME & Rennie, LM (1994) Improvements in quadriceps strength with regular seated exercise in the institutionalized elderly. Archives of Physical Medicine and Rehabilitation 75 600–603.CrossRefGoogle ScholarPubMed
Meredith, CN, Frontera, WR, O'Reilly, KP & Evans, WJ (1992) Body composition in elderly men: effect of dietary modification during strength training. Journal of the American Geriatrics Society 40 155–162.CrossRefGoogle ScholarPubMed
Millward, DJ, Fereday, A, Gibson, N & Pacy, PJ (1997) Aging, protein requirements, and protein turnover. American Journal of Clinical Nutrition 66 774–786.CrossRefGoogle ScholarPubMed
Nourhashemi, F, Gillette-Guyonnet, S, Andrieu, S, Ghisolfi, A, Ousset, PJ, Grandjean, H, Grand, A, Pous, J, Vellas, B & Albarede, JL (2000) Alzheimer disease: protective factors. American Journal of Clinical Nutrition 73 127–128.Google Scholar
Pacala, J, Judge, J & Boult, C (1996) Factors affecting sample selection in a randomized trial of balance enhancement: the FICSIT study. Journal of the American Geriatrics Society 44 377–382.CrossRefGoogle Scholar
Pace, N & Rathburn, EN (1945) Studies on body composition. III. The body water and chemically combined nitrogen content in relation to fat content. Journal of Biological Chemistry 158 685–691.CrossRefGoogle Scholar
Payette, H, Hanusaik, N, Bourier, V, Morais, JA & Gray-Donald, K (1998) Muscle strength and functional mobility in relation to lean body mass in free living frail elderly women. European Journal of Clinical Nutrition 52 45–53.CrossRefGoogle ScholarPubMed
Rahmani, A, Belli, A, Kostka, T, Dalleau, G, Bonnefoy, M & Lacour, JR (1998) Evaluation of knee extensor muscles under non-isokinetic conditions in elderly subjects. Journal of Applied Biomechanics 15 337–344.CrossRefGoogle Scholar
Sipila, S & Suominen, H (1995) Effects of strength and endurance training on thigh and leg muscle mass and composition in elderly women. Journal of Applied Physiology 78 334–340.CrossRefGoogle ScholarPubMed
Skelton, DA, Young, A, Greig, CA & Malbut, KE (1995) Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older. Journal of the American Geriatrics Society 43 1081–1087.CrossRefGoogle ScholarPubMed
Tinetti, ME, Speechley, M & Ginter, SF (1988) Risk factors for falls among elderly persons living in the community. New England Journal of Medicine 319 1701–1707.CrossRefGoogle ScholarPubMed
Vellas, B, Guigoz, Y, Baumgartner, M, Garry, PJ, Lauque, S & Albarede, JL (2000) Relationships between nutritional markers and the mini-nutritional assessment in 155 older persons. Journal of the American Geriatrics Society 48 1300–1309.CrossRefGoogle ScholarPubMed