Aging Clinical and Experimental Research

, Volume 20, Issue 2, pp 159–170 | Cite as

Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial

  • Elisabeth Rydwik
  • Eva Lammes
  • Kerstin Frändin
  • Gunnar Akner
Original Article

Abstract

Background and aims: There are few studies published that combine the interventions of physical training and nutrition. The aim of the present study was to describe the impact of a physical and nutritional intervention program for frail community-dwelling elderly people over the age of 75. Methods: Ninety-six community-dwelling elderly people (58 women) were randomized to four different groups: i) a physical training program (aerobic, muscle strength, balance), ii) a nutritional intervention program (individually targeted advice and group sessions), iii) a combination of these interventions, and iv) a control group. At baseline subjects were screened for physical performance such as muscle strength, balance, mobility and activities of daily living, as well as nutritional aspects such as energy intake, body weight and fat-free mass. These measurements were repeated immediately after the intervention, which lasted for 12 weeks, and after another 6 months. Results: The intention-to-treat analysis indicated significant improvements in lower-extremity muscle strength in both training groups compared with the nutrition group at 1st follow-up. There were small significant changes for some of the balance measurements in the training group without nutrition treatment. The nutrition intervention did not show any significant results. Conclusions: This study shows the positive effect on lower-extremity muscle strength directly after the intervention. Balance training most probably needs to be more individualized in order to be effective for frail elderly people. Further studies are needed, with larger sample sizes, to investigate the effects of these types of interventions before any further conclusions can be drawn.

Keywords

Elderly frailty nutrition physical training RCT 

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References

  1. 1.
    Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56.PubMedCrossRefGoogle Scholar
  2. 2.
    Chin A Paw MJ, Dekker JM, Feskens EJ, Schouten EG, Kromhout D. How to select a frail elderly population? A comparison of three working definitions. J Clin Epidemiol 1999; 52: 1015–21.PubMedCrossRefGoogle Scholar
  3. 3.
    Studenski S, Hayes RP, Leibowitz RO, et al. Clinical global impression of change in physical frailty: development of a measure based on clinical judgment. J Am Geriatr Soc 2004; 52: 1560–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 1769–75.PubMedCrossRefGoogle Scholar
  5. 5.
    Bonnefoy M, Cornu C, Normand S, et al. The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomized study. Br J Nutr 2003; 89: 731–9.PubMedCrossRefGoogle Scholar
  6. 6.
    de Jong N, Chin A Paw MJM, de Groot LC, Hiddink GJ, van Staveren WA. Dietary supplements and physical exercise affecting bone and body composition in frail elderly persons. Am J Public Health 2000; 90: 947–54.PubMedCrossRefGoogle Scholar
  7. 7.
    Chin A Paw MJM, de Jong N, Schouten EG, Hiddink GJ, Kok FJ. Physical exercise and/or enriched foods for functional improvement in frail, independently living elderly: a randomized controlled trial. Arch Phys Med Rehabil 2001; 82: 811–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Shumaker SA, Dugan E, Bowen DJ. Enhancing adherence in randomized controlled clinical trials. Control Clin Trials 2000; 21 (Suppl. 5): 226S–32.PubMedCrossRefGoogle Scholar
  9. 9.
    McAuley E, Jerome GJ, Elavsky S, Marquez DX, Ramsey SN. Predicting long-term maintenance of physical activity in older adults. Prev Med 2003; 37: 110–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Schutzer KA, Graves BS. Barriers and motivations to exercise in older adults. Prev Med 2004; 39: 1056–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Taylor SE. Health Psychology. 4th ed. Singapore: McGraw-Hill Book Co, 1999.Google Scholar
  12. 12.
    Mattiasson-Nilo I, Sonn K, Johannesson K, Gosman-Hedström G, Person GB, Grimby G. Domestic activities and walking in elderly: evaluation from a 30-hour heart rate recording. Aging Clin Exp Res 1990; 2: 191–8.CrossRefGoogle Scholar
  13. 13.
    Frändin K, Grimby G. Assessment of physical activity, fitness and performance in 76-year-olds. Scand J Med Sci Sports 1994; 4: 41–6.CrossRefGoogle Scholar
  14. 14.
    Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care 2002; 40: 771–81.PubMedCrossRefGoogle Scholar
  15. 15.
    Phillips WT, Batterham AM, Julie E, Valenzuela JE, Burkett LN. Reliability of maximal strength testing in older adults. Arch Phys Med Rehabil 2004; 85: 329–34.PubMedCrossRefGoogle Scholar
  16. 16.
    Rydwik E, Karlsson C, Frändin K, Akner G. Muscle strength testing with one repetition maximum in the arm/shoulder for people aged 75+ — test-retest reliability. Clin Rehabil 2007; 21: 258–65.PubMedCrossRefGoogle Scholar
  17. 17.
    American College of Sports Medicine (ACSM). ACSM’s guidelines for exercise testing and prescription. Baltimore: Williams & Wilkins 1993.Google Scholar
  18. 18.
    Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Quar Exerc Sport 1999; 70: 113–9.CrossRefGoogle Scholar
  19. 19.
    Franchignoni F, Tesio L, Martino MT, Ricupero C. Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females. Aging Clin Exp Res 1998; 10: 26–31.Google Scholar
  20. 20.
    Lin M-R, Hwang H-F, Hu M-H, Wu H-DI, Wang Y-W, Huang F-C. Psychometric comparisons of the Timed Up and Go, One-leg stand, Functional reach, and Tinetti balance measures in community-dwelling older people. J Am Geriatr Soc 2004; 52: 1343–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Jarnlo G-B, Nordell E. Reliability of the modified figure of eight — a balance performance test for elderly women. Phys Ther Pract 2003; 19: 35–43.CrossRefGoogle Scholar
  22. 22.
    Frändin K, Sonn U, Svantesson U, Grimby G. Functional balance tests in 76-year-olds in relation to performance, activities of daily living and platform tests. Scand J Rehabil Med 1995; 27: 231–41.PubMedGoogle Scholar
  23. 23.
    Sherrington C, Lord SR. Reliability of simple portable tests of physical performance in older people after hip fracture. Clin Rehabil 2005; 19: 496–504.PubMedCrossRefGoogle Scholar
  24. 24.
    Podsiadlo D, Richardson S. The Timed Up and Go: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142–8.PubMedGoogle Scholar
  25. 25.
    Lundin-Olsson L, Nyberg L, Gustafsson Y. Attention, frailty and falls: The effect of a manual task on basic mobility. J Am Geriatr Soc 1998; 46: 758–61.PubMedGoogle Scholar
  26. 26.
    Steffen TM, Hacker TA, Mollinger L. Age-and-gender related test performance in community-dwelling elderly people: six-minute walk test, Berg’s Balance scale, Timed Up and Go, and Gait speeds. Phys Ther 2002; 82: 128–37.PubMedGoogle Scholar
  27. 27.
    Kidd D, Stewart G, Baldry J, et al. The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil 1995; 1: 10–14.CrossRefGoogle Scholar
  28. 28.
    Daving Y, Andrén E, Nordholm L, Grimby G. Reliability of an interview approach to the Functional Independence Measure. Clin Rehabil 2001; 15: 301–10.PubMedCrossRefGoogle Scholar
  29. 29.
    Grimby G, Andrén E, Daving Y, Wright B. Dependence and perceived difficulty in daily activities in community-living stroke survivors 2 years after stroke. Stroke 1998; 29: 1843–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Daving Y, Andrén E, Grimby G. Inter-rater agreement using the Instrumental Activity Measure. Scand J Occup Ther 2000; 7: 33–8.CrossRefGoogle Scholar
  31. 31.
    Edwards DA, Hammond WH, Healy MJ, et al. Design and accuracy of callipers for measuring subcutaneous tissue thickness. Br J Nutr 1955; 9: 133–43.PubMedCrossRefGoogle Scholar
  32. 32.
    Siri W. Techniques for measuring body composition. In Edition Washington D.C.: National Academy of Sciences, National Research Council, 1961.Google Scholar
  33. 33.
    Durnin JV, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974; 32: 77–97.PubMedCrossRefGoogle Scholar
  34. 34.
    Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 77–81.Google Scholar
  35. 35.
    Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail older persons: a consensus report. J Am Geriatr Soc 2004; 52: 625–34.PubMedCrossRefGoogle Scholar
  36. 36.
    Chin A Paw MJM, van Poppel MNM, Twisk JWR, van Mechelen W. Once a week not enough, twice a week not feasible? A randomised controlled exercise trial in long-term care facilities. Patient Educ Couns 2006; 63: 205–14.PubMedCrossRefGoogle Scholar
  37. 37.
    Rydwik E, Frändin K, Akner G. Effects of physical training on physical performance in institutionalised elderly patients (70+) with multiple diagnoses. Age Ageing 2004; 33: 13–23.PubMedCrossRefGoogle Scholar
  38. 38.
    Wolf S, Barnhardt HX, Kutner NG, Mc Neely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. J Am Geriatr Soc 1996; 44: 489–97.Google Scholar
  39. 39.
    Wolfson L, Whipple R, Derby C, et al. Balance and strength training in older adults: intervention gains and Tai Chi maintenance. J Am Geriatr Soc 1996; 44: 498–506.PubMedGoogle Scholar
  40. 40.
    Dewalt DA, Pignone MP. The role of literacy in health and health care. Am J Pub Med 2005; 72: 387–8.Google Scholar
  41. 41.
    Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: an evidence based approach to treatment. CAB International, Wallingford, UK, 2003: 12–14.Google Scholar
  42. 42.
    Nordhamn K, Södergren E, Olsson E, Karlström B, Vessby B, Berglund L. Reliability of anthropometric measurements in overweight and lean subjects: consequences for correlations between anthropometric and other variables. Int J Obes 2000; 24: 652–7.CrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2008

Authors and Affiliations

  • Elisabeth Rydwik
    • 1
  • Eva Lammes
    • 2
  • Kerstin Frändin
    • 3
  • Gunnar Akner
    • 4
  1. 1.Research and Development Unit for the Elderly North, Jakobsbergs HospitalKarolinska InstitutetJärfällaSweden
  2. 2.Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska InstitutetKarolinska University HospitalHuddinge
  3. 3.Department of Neurobiology, Caring Sciences and Society, Division of PhysiotherapyKarolinska InstitutetHuddinge
  4. 4.Department of Geriatric MedicineÖrebro University HospitalÖrebroSweden

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