The journal of nutrition, health & aging

, Volume 20, Issue 2, pp 185–191 | Cite as

Effects of nutritional supplements on muscle mass and activities of daily living in elderly rehabilitation patients with decreased muscle mass: A randomized controlled trial

  • Yoshihiro YoshimuraEmail author
  • K. Uchida
  • S. Jeong
  • M. Yamaga



To investigate the effects of nutritional intervention with resistance training on skeletal muscle mass in elderly patients with disabilities in a convalescent rehabilitation setting.


A randomized controlled trial. (UMIN Clinical Trials Registry ID: UMIN000006238).


A rehabilitation hospital.


39 elderly patients with decreased skeletal muscle mass in an inpatient convalescence rehabilitation unit.


A combination of resistance training plus nutritional supplementation (R/N group) or resistance training alone (R group). The training and supplementation were conducted essentially from the patient’s admission to discharge (2–6 months).

Outcome Measures

The patients were evaluated at the time of admission and at the end of the intervention for skeletal muscle mass (calf circumference [CC] as a primary outcome, and arm circumference [AC]), hand grip strength (HG), Mini-Nutritional Assessment-Short Form (MNA®-SF) score, serum albumin level (Alb), body mass index (BMI), and activities of daily living (ADL) as represented by the Barthel Index (BI) score.


Significant treatment effects were seen for CC, AC, BI, Alb in the R/N group compared to the R group. A mean treatment effect of 3.2 (95%CI: 2.0–4.4) was seen in CC, 1.4 (95%CI: 0.8–2.1) was seen in AC, 11.2 (95%CI: 0.5–21.8) was seen in BI, 0.3 (95%CI: 0.1–0.5) was seen in Alb.


The results of this study suggest that nutritional intervention added to resistance training during convalescent rehabilitation may improve skeletal muscle mass and activities of daily living.

Key words

Sarcopenia rehabilitation malnutrition elderly 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC. Mini Nutritional Assessment International Group: Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010;58:1734–1738CrossRefPubMedGoogle Scholar
  2. 2.
    Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, De Meynard C, Donini L, Harris T, Kannt A, Keime-Guibert F, Onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 2011;12:249–256PubMedGoogle Scholar
  3. 3.
    Yaxley A, Miller MD, Fraser RJ, Cobiac L, Crotty M. The complexity of treating wasting in ambulatory rehabilitation: Is it starvation, sarcopenia, cachexia or a combination of these conditions? Asia Pac J Clin Nutr 2012;21:386–393PubMedGoogle Scholar
  4. 4.
    Sánchez-Rodríguez D, Marco E, Miralles R, Fayos M, Mojal S, Alvarado M, Vázquez-Ibar O, Escalada F, Muniesa JM. Sarcopenia, physical rehabilitation and functional outcomes of patients in a subacute geriatric care unit. Arch Gerontol Geriatr 2014;59:39–43CrossRefPubMedGoogle Scholar
  5. 5.
    Wakabayashi H, Sashika H. Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study. J Rehabil Med 2014;46:277–282CrossRefPubMedGoogle Scholar
  6. 6.
    Wakabayashi H, Sakuma K. Rehabilitation nutrition for sarcopenia with disability: a combination of both rehabilitation and nutrition care management. J Cachexia Sarcopenia Muscle 2014;5:269–277PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M. European working group on sarcopenia in older people: Sarcopenia: European consensus on definition and diagnosis. Age Ageing 2010;39:412–423PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Morley JE, Argiles JM, Evans WJ, Bhasin S, Cella D, Deutz NE, Doehner W, Fearon KC, Ferrucci L, Hellerstein MK, Kalantar-Zadeh K, Lochs H, MacDonald N, Mulligan K, Muscaritoli M, Ponikowski P, Posthauer ME, Rossi-Fanelli F, Schambelan M, Schols AM, Schuster MW, Anker SD. Society for Sarcopenia, Cachexia, and Wasting Disease. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 2010;11:391–396PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, Chen LK, Fielding RA, Martin FC, Michel JP, Sieber C, Stout JR, Studenski SA, Vellas B, Woo J, Zamboni M, Cederholm T. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative(EWGSOP and IWGS). Age Ageing 2014;43:748–759PubMedCentralPubMedGoogle Scholar
  10. 10.
    Martone AM, Lattanzio F, Abbatecola AM, La-Carpia D, Tosato M, Marzetti E, Calvani R, Onder G, Landi F. Treating sarcopenia in older and oldest old. Curr Pharm Des. 2015;30. [Epub ahead of print]Google Scholar
  11. 11.
    Beavers KM, Gordon MM, Easter L, Beavers DP, Hairston KG, Nicklas BJ, Vitolins MZ. Effect of protein source during weight loss on body composition, cardiometabolic risk and physical performance in abdominally obese, older sdults: a pilot feeding study. J Nutr Health Aging 2015;19:87–95. doi:  10.1007/s12603-015-0438-7 CrossRefPubMedGoogle Scholar
  12. 12.
    Komar B, Schwingshackl L, Hoffmann G. Effects of leucine-rich protein supplements on anthropometric parameter and muscle strength in the elderly: a systematic review and meta-analysis. J Nutr Health Aging, 2014. doi:  10.1007/s12603-014-0559-4 Google Scholar
  13. 13.
    Yamada M, Arai H, Yoshimura K, Kajiwara Y, Sonoda T, Nishiguchi S, Aoyama T. Nutritional supplementation during resistance training improved skeletal muscle mass in community-dwelling frail older adults. J Frailty Aging 20141: 64–70Google Scholar
  14. 14.
    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;89:731–739CrossRefPubMedGoogle Scholar
  15. 15.
    Price R, Daly F, Pennington CR, McMurdo ME. Nutritional supplementation of very old people at hospital discharge increases muscle strength: a randomised controlled trial. Gerontology 2005;51:179–185CrossRefPubMedGoogle Scholar
  16. 16.
    Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2009;15:003288Google Scholar
  17. 17.
    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;330:1769–1775CrossRefPubMedGoogle Scholar
  18. 18.
    Cesari M. Perspective: Protein supplementation against sarcopenia and frailty: future perspectives from novel data. J Am Med Dir Assoc 2013;14:62–63CrossRefPubMedGoogle Scholar
  19. 19.
    Malafarina V, Uriz-Otano F, Iniesta R, Gil-Guerrero L. Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: a systematic review. J Am Med Dir Assoc 2013;14:10–17CrossRefPubMedGoogle Scholar
  20. 20.
    Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 2006;144:37–48CrossRefPubMedGoogle Scholar
  21. 21.
    Rabadi MH, Coar PL, Lukin M, Lesser M, Blass JP. Intensive nutritional supplements can improve outcomes in stroke rehabilitation. Neurology 2008;71:1856–1861CrossRefPubMedGoogle Scholar
  22. 22.
    Miller MD, Crotty M, Whitehead C, Bannerman E, Daniels LA. Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial. Clin Rehabil 2006;20:311–323CrossRefPubMedGoogle Scholar
  23. 23.
    Ishii S, Tanaka T, Shibasaki K, Ouchi Y, Kikutani T, Higashiguchi T, Obuchi SP, Ishikawa-Takata K, Hirano H, Kawai H, Tsuji T, Iijima K. Development of a simple screening test for sarcopenia in older adults. Geriatr Gerontol Int 2014;1:93–101CrossRefGoogle Scholar
  24. 24.
    Kawakami R, Murakami H, Sanada K, Tanaka N, Sawada SS, Tabata I, Higuchi M, Miyachi M. Calf circumference as a surrogate marker of muscle mass for diagnosing sarcopenia in Japanese men and women. Geriatr Gerontol Int, 2014;. doi:  10.1111/ggi.12377 Google Scholar
  25. 25.
    Rolland Y, Lauwers-Cances V, Cournot M, Nourhashémi F, Reynish W, Rivière D, Vellas B, Grandjean H. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc 2003;51:1120–1124CrossRefPubMedGoogle Scholar
  26. 26.
    Landi F, Onder G, Russo A, Liperoti R, Tosato M, Martone AM, Capoluongo E, Bernabei R. Calf circumference, frailty and physical performance among older adults living in the community. Clin Nutr 2014;33:539–544CrossRefPubMedGoogle Scholar
  27. 27.
    Shimokata H, Ando F. Association of daily physical performance with muscle volume and strength. Nihon Ronen Igakkai Zasshi 2012;49:195–198CrossRefPubMedGoogle Scholar
  28. 28.
    Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992;40:922–935CrossRefPubMedGoogle Scholar
  29. 29.
    Miyai I, Sonoda S, Nagai S, Takayama Y, Inoue Y, Kakehi A, Kurihara M, Ishikawa M. Results of new policies for inpatient rehabilitation coverage in Japan. Neurorehabil Neural Repair 2011;25:540–547CrossRefPubMedGoogle Scholar
  30. 30.
    Cabinet Office, Government of Japan. The aging society: current situation and implementation measures FY. Annual report on the aging society., 2013. Accessed 24 December 2014Google Scholar
  31. 31.
    Tokunaga M, Watanabe S, Nakanishi R, Yamanaga H, Sannomiya K, Hirata Y. Comparison between convalescent rehabilitation hospitals participating in the stroke liaison critical pathway with respect to the gain of Nichijo-seikatsu-kino-hyokahyo score. Jpn J Compr Rehabil Sci 2012;3: 11–17 (article in Japanese)Google Scholar
  32. 32.
    Gaillard C, Alix E, Sallé A, Berrut G, Ritz P. Energy requirements in frail elderly people: a review of the literature. Clin Nutr 2007;26:16–24CrossRefPubMedGoogle Scholar
  33. 33.
    O’Sullivan S, Schmitz T. Physical rehabilitation 5th edition. F.A. Davis Company, USA, 2006Google Scholar
  34. 34.
    Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC. MNA-International Group. Validation of the Mini Nutritional Assessment short-form (MNA®-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 2009;13:782–788CrossRefPubMedGoogle Scholar
  35. 35.
    Sakuma K, Yamaguchi A. Molecular mechanisms in aging and current strategies to counteract sarcopenia. Curr Aging Sci 2010;3:90–101CrossRefPubMedGoogle Scholar
  36. 36.
    Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care 2009;12:86–90PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Bergström J, Fürst P, Norée LO, Vinnars E. Intracellular free amino acid concentration in human muscle tissue. J Appl Physiol 1974;36:693–697PubMedGoogle Scholar
  38. 38.
    Marshall S, Bauer J, Isenring E. The consequences of malnutrition following discharge from rehabilitation to the community: a systematic review of current evidence in older adults. J Hum Nutr Diet. 2014;27:133–141.CrossRefPubMedGoogle Scholar
  39. 39.
    Foley NC, Salter KL, Robertson J, Teasell RW, Woodbury MG. Which reported estimate of the prevalence of malnutrition after stroke is valid? Stroke 2009;40:66–74CrossRefGoogle Scholar
  40. 40.
    Anker SD, John M, Pedersen PU, Raguso C, Cicoira M, Dardai E, Laviano A, Ponikowski P, Schols AM, Becker HF, Böhm M, Brunkhorst FM, Vogelmeier C. ESPEN Guidelines on enteral nutrition: cardiology and pulmonology. Clin Nutr 2006;25:311–318CrossRefPubMedGoogle Scholar
  41. 41.
    Doley J. Nutrition management of pressure ulcers. Nutr Clin Pract 2010;25:50–60CrossRefPubMedGoogle Scholar
  42. 42.
    Akner G, Cederholm T. Treatment of protein-energy malnutrition in chronic nonmalignant disorders. Am J Clin Nutr 2001;74:6–24PubMedGoogle Scholar
  43. 43.
    Eneroth M, Olsson UB, Thorngren KG. Insufficient fluid and energy intake in hospitalised patients with hip fracture. A prospective randomised study of 80 patients. Clin Nutr 2005;24:297–303PubMedGoogle Scholar
  44. 44.
    Carlsson M, Littbrand H, Gustafson Y, Lundin-Olsson L, Lindelöf N, Rosendahl E, Håglin L. Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial. J Nutr Health Aging. 2011;15:554–560.CrossRefPubMedGoogle Scholar
  45. 45.
    Jyväkorpi SK, Puranen T, Suominen M. Effect of high-intensity exercise and protein supplementation on muscle mass in ADL dependent older people with and without malnutrition-a randomized controlled trial. J Nutr Health Aging. 2012;16:736CrossRefPubMedGoogle Scholar
  46. 46.
    Kim HK, Suzuki T, Saito K, Yoshida H, Kobayashi H, Kato H, Katayama M. Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. J Am Geriatr Soc. 2012;60:16–23CrossRefPubMedGoogle Scholar
  47. 47.
    Kim H, Suzuki T, Saito K, Kojima N, Hosoi E, Yoshida H. Long-term effects of exercise and amino acid supplementation on muscle mass, physical function and falls in community-dwelling elderly Japanese sarcopenic women: A 4-year follow-up study. Geriatr Gerontol Int, 2015. doi:  10.1111/ggi.12448 Google Scholar
  48. 48.
    Gariballa S, Alessa A. Sarcopenia: prevalence and prognostic significance in hospitalized patients. Clin Nutr 2013;32:772–776CrossRefPubMedGoogle Scholar
  49. 49.
    Frank AW, Farthing JP, Chilibeck PD, Arnold CM, Olszynski WP, Kontulainen SA. Community-dwelling female fallers have lower muscle density in their lower legs than non-fallers: Evidence from the Saskatoon Canadian multicentre osteoporosis study (CaMos) cohort. J Nutr Health Aging. 2015;19:113–120. doi:  10.1007/s12603-014-0476-6 CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2016

Authors and Affiliations

  • Yoshihiro Yoshimura
    • 1
    Email author
  • K. Uchida
    • 2
  • S. Jeong
    • 3
  • M. Yamaga
    • 1
  1. 1.Department of Rehabilitation MedicineKumamoto Rehabilitation HospitalKumamotoJapan
  2. 2.Department of RehabilitationSakurajyuji HospitalKumamoto City, KumamotoJapan
  3. 3.Department of Social ScienceNational Center for Geriatrics and GerontologyMorioka, Obu, AichiJapan

Personalised recommendations