Skip to main content

Advertisement

SpringerLink
Log in

Effects of essential amino acid supplementation and rehabilitation on functioning in hip fracture patients: a pilot randomized controlled trial

  • Original Research
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Physical exercise and nutrition seem to have a key role in the management of hip fracture patients.

Aim

To evaluate the impact of a 2-month rehabilitative protocol combined with dietetic counseling, with or without essential amino acid supplementation, on functioning in hip fracture patients.

Methods

In this pilot randomized controlled study, we recruited patients aged more than 65 years, at 3 months after hip fracture. We randomly assigned the participants into two groups (A and B). Both groups performed a physical exercise rehabilitative programme (five sessions of 40 min/week for 2 weeks, followed by a home-based exercise protocol) and received a dietetic counseling; only group A was supplemented with two sachets of 4 g/day of essential amino acids (Aminotrofic®). We evaluated at baseline and after 2 months of intervention (T1): hand grip strength, Timed Up and Go, and Iowa Level of Assistance scale (ILOA).

Results

The 32 hip fracture patients (mean aged 79.03 ± 7.80 years) were allocated into two groups: group A (n = 16) and group B (n = 16). All the participants showed significant differences in all outcomes at T1 (p < 0.017). Sarcopenic patients in group A (n = 10) showed statistically significant differences in all the primary outcomes at T1 (p < 0.017), whereas sarcopenic patients in group B (n = 13) showed a significant reduction of ILOA only. In non-sarcopenic patients, we found no differences at T1 in all outcome measures.

Discussion

Hip fractures are a complex multifactorial condition of the elderly that determines devastating effects on functioning and independence.

Conclusion

A multidisciplinary rehabilitative and nutritional intervention seems to be effective on functioning in hip fracture patients, in particular sarcopenic ones.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Tarantino U, Capone A, Planta M et al (2010) The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study. Arthritis Res Ther 12:R226

    Article  Google Scholar 

  2. Roche J, Wenn RT, Sahota O et al (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374

    Article  CAS  Google Scholar 

  3. Magaziner J, Fredman L, Hawkes W et al (2003) Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol 157:1023–1031

    Article  Google Scholar 

  4. Piscitelli P, Brandi M, Cawston H et al (2014) Epidemiological burden of postmenopausal osteoporosis in Italy from 2010 to 2020: estimations from a disease model. Calcif Tissue Int 95:419–427

    Article  CAS  Google Scholar 

  5. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  Google Scholar 

  6. Castelli A, Daidone S, Jacobs R et al (2015) The determinants of costs and length of stay for hip fracture patients. PLoS One 10:e0133545

    Article  Google Scholar 

  7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423

    Article  Google Scholar 

  8. Morley JE (2012) Sarcopenia in the elderly. Fam Pract 29(Suppl 1):i44–i48. https://doi.org/10.1093/fampra/cmr063

    Article  PubMed  Google Scholar 

  9. Reginster JY, Cooper C, Rizzoli R et al (2016) Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia. Aging Clin Exp Res 28:47–58

    Article  Google Scholar 

  10. Visser M, Harris TB, Fox KM et al (2000) Change in muscle mass and muscle strength after a hip fracture: relationship to mobility recovery. J Gerontol A Biol Sci Med Sci 55:M434–M440

    Article  CAS  Google Scholar 

  11. Wehren LE, Hawkes WG, Hebel JR et al (2005) Bone mineral density, soft tissue body composition, strength, and functioning after hip fracture. J Gerontol A Biol Sci Med Sci 60:80–84

    Article  Google Scholar 

  12. Di Monaco M, Castiglioni C, Vallero F et al (2011) Appendicular lean mass does not mediate the significant association between vitamin D status and functional outcome in hip-fracture women. Arch Phys Med Rehabil 92:271–276

    Article  Google Scholar 

  13. Hida T, Ishiguro N, Shimokata H et al (2013) High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture. Geriatr Gerontol Int 13:413–420

    Article  Google Scholar 

  14. Fiatarone Singh MA (2014) Exercise, nutrition and managing hip fracture in older persons. Curr Opin Clin Nutr Metab Care 17:12–24

    CAS  PubMed  Google Scholar 

  15. Pioli G, Barone A, Giusti A et al (2006) Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res 18:381–387

    Article  CAS  Google Scholar 

  16. Iolascon G, Gimigliano R, Bianco M et al (2017) Are dietary supplements and nutraceuticals effective for musculoskeletal health and cognitive function? A scoping review. J Nutr Health Aging 21:527–538

    Article  CAS  Google Scholar 

  17. Roberts KC, Brox WT (2015) AAOS clinical practice guideline: management of hip fractures in the elderly. J Am Acad Orthop Surg 23:138–140

    Article  Google Scholar 

  18. Artaza-Artabe I, Sáez-López P, Sánchez-Hernández N et al (2016) The relationship between nutrition and frailty: effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly. A systematic review. Maturitas 93:89–99

    Article  CAS  Google Scholar 

  19. Collins J, Longhurst G, Roschel H et al (2016) Resistance training and co-supplementation with creatine and protein in older subjects with frailty. J Frailty Aging 5:126–134

    CAS  PubMed  Google Scholar 

  20. Rondanelli M, Klersy C, Terracol G et al (2016) Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly. Am J Clin Nutr 103:830–840

    Article  CAS  Google Scholar 

  21. Finger D, Goltz FR, Umpierre D et al (2015) Effects of protein supplementation in older adults undergoing resistance training: a systematic review and meta-analysis. Sports Med 45:245–255

    Article  Google Scholar 

  22. Pescatello LS (2014) American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription, 9th edn. Wolters Kluwer-Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  23. Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441

    Article  CAS  Google Scholar 

  24. Linn BS, Linn MW, Gurel L (1968) Cumulative illness rating scale. J Am Geriatr Soc 16:622–626

    Article  CAS  Google Scholar 

  25. Janssen I, Heymsfield SB, Baumgartner RN et al (2000) Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol (1985) 89:465–471

    Article  CAS  Google Scholar 

  26. Lukaski HC, Johnson PE, Bolanchuk WW et al (1985) Assessment of fat-free mass using bioelectrical impedance measurement of the human body. Am J Clin Nutr 41:810–817

    Article  CAS  Google Scholar 

  27. Piccoli A, Rossi B, Pillon L et al (1994) A new method for monitoring body fluid variation by bioimpedance analysis: the RXc graph. Kidney Int 46:534–539

    Article  CAS  Google Scholar 

  28. Studenski SA, Peters KW, Alley DE et al (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 69:547–558

    Article  Google Scholar 

  29. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    Article  CAS  Google Scholar 

  30. Soh SE, Stuart L, Raymond M et al (2017) The validity, reliability, and responsiveness of the modified Iowa Level of Assistance scale in hospitalized older adults in subacute care. Disabil Rehabil 31:1–7

    Google Scholar 

  31. Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233

    Article  Google Scholar 

  32. Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50:889–896

    Article  Google Scholar 

  33. Ikeda T, Aizawa J, Nagasawa H et al (2016) Effects and feasibility of exercise therapy combined with branched-chain amino acid supplementation on muscle strengthening in frail and pre-frail elderly people requiring long-term care: a crossover trial. Appl Physiol Nutr Metab 41:438–445

    Article  CAS  Google Scholar 

  34. WHO (2018) Ageing. http://www.who.int/topics/ageing. Accessed 15 Apr 2018

  35. Kaeberlein M, Rabinovitch PS, Martin GM (2015) Healthy aging: the ultimate preventative medicine. Science 350:1191–1193

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Marco Invernizzi, Alessandro de Sire, Giovanni Iolascon and Carlo Cisari contributed equally to this work.

Authors and Affiliations

  1. Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Viale Piazza D’Armi, 1, 28100, Novara, Italy

    Marco Invernizzi, Alessandro de Sire & Carlo Cisari

  2. Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Alessandro de Sire & Giovanni Iolascon

  3. Clinical Nutrition Unit, University Hospital “Maggiore della Carità”, Novara, Italy

    Federico D’Andrea & Deborah Carrera

  4. Innovative Research Laboratory for Wound Healing, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy

    Filippo Renò

  5. Section of Health Sciences, Department of Movement, Human and Health Sciences, University “Foro Italico”, Rome, Italy

    Silvia Migliaccio

  6. Physical Medicine and Rehabilitation Unit, University Hospital “Maggiore della Carità”, Novara, Italy

    Carlo Cisari

Authors
  1. Marco Invernizzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro de Sire
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federico D’Andrea
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deborah Carrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Filippo Renò
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Silvia Migliaccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giovanni Iolascon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlo Cisari
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Each author is expected to have made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; or have drafted the work or substantively revised it; and has approved the submitted version (and version substantially edited by journal staff that involves the author’s contribution to the study); and agrees to be personally accountable for the author’s own contributions and for ensuring that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and documented in the literature.

Corresponding author

Correspondence to Marco Invernizzi.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest. Funding sponsors had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, and in the decision to publish the results.

Ethical standards

The experiments comply with the current laws of the country in which they were performed.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Invernizzi, M., de Sire, A., D’Andrea, F. et al. Effects of essential amino acid supplementation and rehabilitation on functioning in hip fracture patients: a pilot randomized controlled trial. Aging Clin Exp Res 31, 1517–1524 (2019). https://doi.org/10.1007/s40520-018-1090-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-018-1090-y

Keywords

Search

Navigation