The journal of nutrition, health & aging

, Volume 16, Issue 2, pp 162–167

Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. A randomised, controlled pilot study

Nutritional Intervention and Physical Training of the Frail Elderly

Abstract

Objectives

To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RMR) and body composition in the frail elderly.

Design

Open, randomised, controlled pilot treatment study.

Setting

Community-based research centre.

Participants

Ninety-six community-dwelling frail elderly people aged 75 and older, 40% men.

Intervention

Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 × 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group.

Measurements

The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months’ intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals).

Results

The training group showed a significantly increased RMR at 3 months. Otherwise, there were no observed differences within or between the four groups. There was no correlation over time between energy intake, RMR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study (‘responders’) had a statistically significantly lower BMI (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the ‘non-responders.’ The ‘non-responders’ showed a small but statistically significant decrease in body fat percentage at F1, and in body weight, BMI and FFM at 9 months (F3).

Conclusion

Individual nutrition counselling and physical exercise had no effect on energy intake, RMR or fat free mass in community-dwelling frail elderly people aged 75 and older. Interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.

Key words

Energy intake frail elderly resting metabolic rate body composition physical training 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    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: 1015–1021CrossRefGoogle Scholar
  2. 2.
    Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 1769–1775PubMedCrossRefGoogle Scholar
  3. 3.
    Singh MA. Combined exercise and dietary intervention to optimize body composition in aging. Ann N Y Acad Sci 1998; 854: 378–393PubMedCrossRefGoogle Scholar
  4. 4.
    Bonnefoy M, Cornu C, Normand S, Boutitie F, Bugnard F, Rahmani A, Lacour JR, Laville M. The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. Br J Nutr 2003; 89: 731–739PubMedCrossRefGoogle Scholar
  5. 5.
    Chin A Paw MJ, 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: 811–817CrossRefGoogle Scholar
  6. 6.
    Rosendahl E, Lindelof N, Littbrand H, Yifter-Lindgren E, Lundin-Olsson L, Haglin L, Gustafson Y, Nyberg L. High-intensity functional exercise program and proteinenriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial. Aust J Physiother 2006; 52: 105–113PubMedCrossRefGoogle Scholar
  7. 7.
    Mattiasson-Nilo I, Sonn U, Johannesson K, Gosman-Hedstrom G, Persson GB, Grimby G. Domestic activities and walking in the elderly: evaluation from a 30-hour heart rate recording. Aging (Milano) 1990; 2: 191–198.Google Scholar
  8. 8.
    Frändin K, Grimby G. Assessment of physical activity, fitness and performance in 76-yearolds. Scand J Med Sci Sports 1994; 4: 41–46CrossRefGoogle Scholar
  9. 9.
    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: 771–781PubMedCrossRefGoogle Scholar
  10. 10.
    Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede J. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15: 116–122PubMedCrossRefGoogle Scholar
  11. 11.
    Edwards DA, Hammond WH, Healy MJ, Tanner JM, Whitehouse RH. Design and accuracy of calipers for measuring subcutaneous tissue thickness. Br J Nutr 1955; 9: 133–143PubMedCrossRefGoogle Scholar
  12. 12.
    Siri W. Techniques for measuring body composition. 1961. Washington D.C.: National Academy of Sciences, National Research Council.Google Scholar
  13. 13.
    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. 16 to 72 years. Br J Nutr 1974; 32: 77–97PubMedCrossRefGoogle Scholar
  14. 14.
    Kidd D, Stewart G, Baldry J, Johnson J, Rossiter D, Petruckevitch A, Thompson AJ. The Functional Independence Measure: a comparative validity and reliability study. Disabil Rehabil 1995; 17: 10–14PubMedCrossRefGoogle Scholar
  15. 15.
    Daving Y, Andren E, Nordholm L, Grimby G. Reliability of an interview approach to the Functional Independence Measure. Clin Rehabil 2001; 15: 301–310PubMedCrossRefGoogle Scholar
  16. 16.
    Grimby G, Andren E, Daving Y, Wright B. Dependence and perceived difficulty in daily activities in community-living stroke survivors 2 years after stroke: a study of instrumental structures. Stroke 1998; 29: 1843–1849PubMedCrossRefGoogle Scholar
  17. 17.
    Rydwik E, Lammes E, Frändin K, Akner G. Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial. Aging Clin Exp Res 2008; 20: 159–170PubMedGoogle Scholar
  18. 18.
    de Jong N, Chin APMJ, 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: 947–954PubMedCrossRefGoogle Scholar
  19. 19.
    FAO-WHO-UNU. Energy and protein requirements. 1985. WHO technical report series. Geneva: World Health OrganizationGoogle Scholar
  20. 20.
    Starling RD, Poehlman ET. Assessment of energy requirements in elderly populations. Eur J Clin Nutr 2000; 54:Suppl 3, S104–S111PubMedCrossRefGoogle Scholar
  21. 21.
    Roberts SB, Dallal GE. Energy requirements and aging. Public Health Nutr 2005; 8: 1028–1036PubMedCrossRefGoogle Scholar
  22. 22.
    Lammes E, Akner G. Repeated assessment of energy and nutrient intake in 52 nursing home residents. J Nutr Health Aging 2006; 10: 222–230PubMedGoogle Scholar
  23. 23.
    Payette H, Boutier V, Coulombe C, Gray-Donald K. Benefits of nutritional supplementation in free-living, frail, undernourished elderly people: a prospective randomized community trial. J Am Diet Assoc 2002; 102: 1088–1095PubMedGoogle Scholar
  24. 24.
    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–M156.PubMedCrossRefGoogle Scholar
  25. 25.
    Studenski S, Hayes RP, Leibowitz RO et al. Clinical global impression of change in physical frailty: Development of a measure based on clinical judgement. J Am Geriatr Soc 2004; 52: 1560–1566.PubMedCrossRefGoogle Scholar
  26. 26.
    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: 625–634.PubMedCrossRefGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2012

Authors and Affiliations

  1. 1.Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska InstitutetKarolinska University HospitalStockholmSweden
  2. 2.Research Unit for the Elderly, North, Jakobsbergs HospitalKarolinska InstitutetJärfällaSweden
  3. 3.Dept. of Geriatric MedicineÖrebro University HospitalÖrebroSweden

Personalised recommendations