Introduction
Methods
Literature search
1. Sarcopenia/ |
2. Sarcopeni$.tw |
3. Muscle atrophy/ |
4. Muscle weakness/ |
5. Fat free mass.tw |
6. Lean body mass.tw |
7. Muscle mass.tw |
8. Exp hand strength/ |
9. Grip strength.tw |
10. Anthropometry/ |
11. Body composition/ |
12. Lean mass.tw |
13. Or/1-12 |
14. Exp exercise/ |
15. Exp Movement/ |
16. Muscle contraction/ |
17. Muscle Development/ |
18. Physical exertion/ |
19. Exp Physical endurance/ |
20. Exp muscle strength/ |
21. Physical fitness/ |
22. Exp Exercise test/ |
23. Exercise therapy.tw |
24. Exp Exercise movement techniques/ |
25. Exp Psychomotor performance/ |
26. Muscle contraction/ |
27. Resistance exercise.tw |
28. Aerobic exercice.tw |
29. Endurance.tw |
30. Physical exercise.tw |
31. Physical performance.tw |
32. Physical training.tw |
33. Exercise programme.tw |
34. Exercise technique.tw |
35. Muscle mass.tw |
36. Or/14-35 |
37. Nutrition.tw |
38. Exp nutrition therapy/ |
39. Exp Nutritional physiological phenomena/ |
40. Exp Diet/ |
41. Exp Diet therapy/ |
42. Exp Dietary fats/ |
43. Exp Dietary proteins/ |
44. Exp Food/ |
45. Exp Food, fortified/ |
46. Exp Micronutrients/ |
47. Exp Dietary supplements/ |
48. Energy intake/ |
49. Nutrition.tw |
50. Nutrition trial.tw |
51. Dietary lipids.tw |
52. Or/37-51 |
53. Randomized controlled trials/ |
54. Randomised controlled trial.tw |
55. Randomized controlled trial.tw |
56. Controlled clinical trial/ |
57. Controlled study.tw |
58. Random allocation/ |
59. Random$.tw |
60. Randomly allocated.tw |
61. Double blind method/ |
62. Single blind method/ |
63. Clinical trials.tw |
64. Clinical trial/ |
65. Trial$.tw |
66. Intervention studies/ |
67. Intervention study.tw |
68. Interventional study.tw |
69. Placebo.tw |
70. Placebo$.tw |
71. Or/53-70 |
72. And/36,52 |
73. And/13, 71, 72 |
74. (73 and humans/) or (73 not (humans/ or animals/)) |
75. Limit 74 to English language |
76. Limit 75 to yr. = “2013-Current” (344 results on PubMed (308 after deleting duplicates)– 859 with Embase (819 after remove duplicates)) – total 992 after remove duplicates between the 2 databases |
Study selection
Design | Randomized controlled trials |
Participants | Human, men, and women aged 60 years and older |
Exposure | Studies which include at least two groups of comparison: a control group with only exercise intervention and a treated group with combined exercise intervention and nutritional intervention. Exercise intervention can be resistance exercise, aerobic exercise, or other. Nutrition intervention involves the provision of nutrients supplied with either a supplement or food |
Outcome | Outcomes on muscle mass, on muscle strength, or on physical performance |
Language | English only |
Date | Studies published between April 2013 and end of October 2015 |
Data extraction
Methodology quality assessment
Presentation of results
Results
Included studies
Reference | Settings, study participants, mean age ± SD | Study design | Exercise training intervention | Nutritional supplement | Outcome measures | Quality score (Jadad scale) |
---|---|---|---|---|---|---|
Gryson et al. 2014 [8] | France. 35 healthy sedentary men 60.7 ± 0.4 years | 16-week intervention. Participants randomized in 5 groups: (i) no exercise + placebo, (ii) exercise + placebo, (iii) exercise + fortified milk, (iv) no exercise + fortified leucine, (v) exercise + fortified leucine. Treatments were administrated double blind | Resistance and aerobic exercises.3 sessions per week, non-consecutive days, 45–60 min for each session | Protein. Milk-based supplement drinks containing, proteins (total milk proteins 10 g/day or fast digested soluble milk proteins 10 g/day), carbohydrates, and fat. Placebo drinks contains 4 g of total milk protein | MM: appendicular muscle mass and fat-free mass in the dominant legMS: isometric strength of the knee extensors | 4 |
Canada. 34 postmenopausal women 59.5 ± 4.5 years | 6-month intervention. Participants randomized in two groups: (i) exercise and isoflavone, (ii) exercise and placebo. Treatments were administered double blind | Combined aerobic and resistance training, 3 sessions per week (1 h, 30 min of aerobic, 30 min of resistance) | Other (soy isoflavones). 4 capsules daily with either soy isoflavones or placebo. The 70-mg daily dose of isoflavones contained 44 mg of daidzein, 16 mg of glycitein, and 10 mg of genistein extracted from natural soy. Placebos contained cellulose | MM: waist and hip circumference, muscle mass indexMS: grip strength, 1RM (leg press, bench press, lat pulldown) PP: chair stand test | 5 | |
Gualano et al. 2014 [11] | Brazil. 60 vulnerable older women. Treated 67.1 ± 5.6 years/control 63.6 ± 3.6 years | 24-week intervention. Participants were randomized in four groups: (i) placebo, (ii) creatine, (iii) placebo + exercise, (iv) creatine + exercise. Treatments were administered double blind | Supervised resistance training. Two sessions per week | Creatine. Supplements packages 20 g/day of creatine monohydrate for 5 days divided into four equal doses, followed by single daily doses of 5 g for the next 23 weeks. Placebo was dextrose | MM: appendicular lean mass MS: leg press, bench pressPP: timed-stands tests., Timed up and go test | 4 |
Villanueva et al. 2014 [12] | USA. 22 healthy men, recreationally active 68.1 ± 6.1 years | 12-week intervention. Participants were randomized in three groups: (i) exercise + creatine and protein supplementation, (ii) exercise only, (iii) control. Treatment administration was not double blinded | Resistance training. 3 sessions per week | Protein + creatine. Supplemented group (encapsulated powder) consumed 0.3 g/kg/day of creatine for 5 days followed by 0.07 g/kg/day until completion of the study. The supplemented group also consumed one 35-g liquid protein ready-to-drink daily | MM: lean body massMS: leg press, chest press, strength endurance. PP: stair climbing power, dynamic power, 400-m walk | 2 |
Stout et al. 2013 [13] | USA. 48 ambulatory participants (22 men and 26 women) 73 ± 1 years | 24-week intervention. Participants were randomized in two groups: (i) exercise + placebo, (ii) exercise + HMB. Treatments were administered double blind | Supervised resistance training. Three sessions per week | β-hydroxy-β-methylbuthyrate.CaHMB (HMB, 1,5 g CaHMB + 4 g carbohydrate) twice daily. Placebo (200 mg calcium + 4 g carbohydrates) twice daily.Participants were asked to mix their product in non-alcoholic beverages and drink it | MM: total lean mass, reginal leg lean mass, regional arm lean massMS: handgrip strength, leg extension, bench press, leg press, leg extension strength. PP: Get up and Go | 5 |
Okazaki et al. 2013 [14] | Japan. 35 healthy middle-aged and older women. Treated 60 ± 3 years/control 61 ± 3 years | 5-month intervention. Participants were randomized in two groups: (i) exercise only, (ii) exercise + post-exercise macronutrient. Treatment administration was not double blinded | Home-based interval walking training. 4 or more days per week | Multi-nutrient (macrunutrient mixture). 215 g of a macronutrient mixture within 30 min after each training session (composition 200 kcal; 7,6 g protein ; 32,5 g CHO ; 4,4 g fat) | MM: total muscle tissue areaMS: isometric knee extension, isometric knee flexion, isokinetic knee extension, isokinetic knee flexion | 2 |
Narotzki et al. 2013 [15] | Israel. 13 elderly men and 9 elderly women. 71.1 ± 1.2 years | 12-week intervention. Participants were randomized in two groups: (i) exercise + green tea and vitamin E, (ii) exercise + vitamin E only. Treatment administration was not double blinded | Fitness-guided exercises. 6 times a week. 30 min of daily walks | Other (green tea). Participants were asked to brew tea sachets 3 times a day in 240 ml of boiling water for 3 min. One vitamin E capsule composed of 400 IU of d-alpha-tocopherol a day. Placebo group did not drink tea and consumed a capsule of vitamin E placebo a day | MM: waist and hip circumference | 2 |
Deutz et al. 2013 [16] | USA. 24 older adults confined to complete bed rest for 10 days. Treated 67.4 ± 1.4 years/control 67.1 ± 1.7 years | 8-week intervention. Participants were randomized in two groups: (i) exercise + HMB, (ii) exercise + placebo. Treatments were administered double blind. Tests were performed before bedrest, after bed rest, and after the 8 weeks of rehabilitation | Resistance exercise training rehabilitation. 3 days per week. Strength training during 1 h | β-hydroxy-β-methylbuthyrate. 2 sachets of Ca-HMB per day. Each sachet contained 1.5 g of Ca-HMB, 4 g maltodextrin, and 200 mg calcium. The composition of placebo was identical with the exclusion of Ca-HMB | MM: lean body massMS: knee extension, flexor force, leg press, standing plantar flexor force, and stair ascent and descent power. PP: SPPB test, Get up and Go test, 5-item SPPB | 5 |
Chalé et al. 2013 [17] | USA. 80 mobility-limited women aged 70–85 years. Treated 78.0 ± 4.0 years/control 77.3 ± 3.9 years | 6-month intervention. Participants randomized in two groups: (i) exercise and proteins, (ii) exercise and isocaloric control. Treatments were administered double blind | Supervised progressive program. 3 times per week which entailed leg press, seated row, leg extension, chest press and leg curl | Protein (whey protein). Whey protein in powder form 40 g/day (one serving contains 20 g protein, 25 g maltodextrin, 1 g fat, 189 kcal) Isocaloric control in powder form (45 g maltodextrin, 1 g fat, 189 kcal) | MM: lean mass, total muscle CSAMS: Leg press, knee extension strength, peak power PP: Stair climbing, chair rise performance, SPPB test, 400 m walk time | 5 |
Kim et al. 2013 [18] | Japan. 128 community-dwelling elderly sarcopenic women Treated 81.1 ± 3.7 years /control 79.6 ± 4.2 years | 3-month intervention. Participants were randomized in four groups: (i) exercise and tea catechin, (ii) exercise only, (iii) tea catechin only, (iv) health education, control. Treatments were administered double blind | Stretching, muscle strengthening, balance and gait training. Two sessions per week. Each session 60 mins | Other (tea catechin). One bottle per day containing 350 mL of tea fortified with 540 mg of catechin | MM: lean body mass, appendicular lean mass and leg muscle mass MS: grip strength, knee extension strength PP: usual and maximum walking speed, TUG, balance ability | 4 |
Aguiar et al. 2013 [19] | Brazil. 18 healthy women 64.9 ± 5.0 years | 12-week intervention. Participants were randomized in two groups: (i) exercise + creatine, (ii) exercise + placebo. Treatments were administered double blind | Resistance training. Three sessions per week. The training volume was progressive throughout the training program | Creatine. One capsule (5.0 g/day). The placebo group ingested an identical-looking equivalent amount of placebo, maltodextrin | MM: appendicular muscle mass MS: bench press, knee extension, biceps curl strength PP: 30-s chair stand and arm curl test and a test of getting up from lying on the floor | 4 |
Leenders et al. 2014 [20] | The Netherlands. 29 healthy elderly men and 24 healthy elderly women 70 ± 1 years | 24-week intervention. Participants were randomized in two groups: (i) exercise + placebo, (ii) exercise + protein. Treatments were administered double blind | Supervised resistance training. Three sessions per week | Protein. 250 ml beverages per day. Protein beverages contains 15 g of protein, 0.5 g fat, 7.13 g lactose, 0.42 g calcium. Placebo beverages contain no protein or fat, 7.13 g lactose, 0.42 g calcium | MM: total body lean mass, leg lean mass, quadriceps CSA MS: leg press, leg extension, handgrip testPP: sit-to-stand test | 3 |
Veronese et al. 2014 [21] | Italy. 139 healthy elderly women. 71.5 ± 5.2 years | 12-week intervention. Participants were randomized in two groups: (i) exercise + magnesium oxide, (ii) exercise only. Treatment administration was not double blinded | Mild fitness program. Two sessions per week | Other (magnesium oxide)sachets. 900 mg/d of oral magnesium oxide corresponding to 300 mg bioavailable magnesium | MM: appendicular skeletal muscle mass indexMS: isometric knee extension, handgrip strength PP: SPPB test | 3 |
Daly et al. 2014 [22] | Australia. 100 women residing in retirement villages. Treated 72.1 ± 6.4 years/control 73.6 ± 7.7 years | 4-month intervention. Participants were randomized in two groups: (i) exercise + meat, (ii) exercise only. Treatment administration was not double blinded | Supervised progressive resistance and balance-agility training program. 2 sessions per week | Protein (lean red meat). 220 g lean red meat to be consumed 6days/week = 160 g cooked meat/day (45 g protein). Control 75 g cooked rice and/or pasta/day (that provides 25–35 carbohydrates/day) | MM: lean tissue mass MS: leg extensionPP: 4-square step test, Timed Up and Go, 30-s sit-to-stand test | 5 |
Cooke et al. 2014 [23] | Australia. 20 middle to older males Treated 61.4 ± 5.0 years/control 60.7 ± 5.4 years | 12-week intervention. Participants were randomized in two groups: (i) exercise + CHO, (ii) exercise only. Treatments were administered double blind | High-intensity resistance training program. 3 days per week | Creatine monohydrate-carbohydrates. Treated group 20 g of CrM combined with 5 g of glucose for 7 days followed by 0.1 g kg−1 (average dosage of ∼8.8 g) of CrM with 5 g of glucose on training days. Placebo 20 g of glucose only for 7 days followed by 5 g of glucose on training days | MM: fat-free mass MS: leg press, bench press | 4 |
Oesen et al. 2015 [24] | Italy. 82 older adults living in retirement care facilities 82.8 ± 6.0 years | 6-month intervention. Participants were randomized in three groups: (i) exercise only, (ii) exercise + nutrient supplementation, (iii) cognitive training group. Treatment administration was not double blinded | Supervised resistance exercise with elastic band. Two sessions per weeks on non-consecutive days (separately min 48 h) | Protein and essential amino acids. Two nutrient supplement drink per day. Each drink had a caloric value of 150 kcal, 20.7 g protein (3 g leucine, >10 g essential amino acids), 9.3 g carbohydrates, 3 g fat, vitamins and minerals | MS: knee extensor peak torque, knee flexor peak torque, handgrip strengthPP: chair stand test, gait speed, six-minute walking test, functional reach test, arm lifting test | 2 |
Zdzieblik et al. 2015 [25] | Germany. 53 elderly men with sarcopenia. 72.2 ± 4.68 | 12-week intervention. Participants were randomized in two groups: (i) exercise + collagen peptide, (ii) exercise + placebo. Treatments were administered double blind | Guided training program on fitness devices. Three sessions a week over a period of 60 min | Protein (collagen peptide).Treated group received 15 g of collagen peptides each day. Placebo group received silicon dioxide as placebo. Both were given in powder to dissolve in 250 ml of water. | MM: fat-free mass MS: isokinetic quadriceps strength of the right leg | 5 |
Yamada et al. 2015 [26] | Japan. 222 community-dwelling older adults (142 women and 80 men). Treated 76.3 ± 5.9 years/control 75.8 ± 5.2 years | 6-month intervention. Participants were randomized in three groups: (i) walking and nutrition, (ii) walking only, (iii) control. Treatment administration was not double blinded | Walking program. Use of pedometer-based walking programs. Participants were instructed to increase the number of daily steps by 10% each month | Protein and vitamin D. Daily supplements composed of 200 kcal, 10.0 g of protein with branched chain amino acids 12.5 mg of vitamin D, and 300 mg of calcium | MM: skeletal muscle index | 2 |
Trabal et al. 2015 [27] | Spain. 24 older adults in nursing homes and adult day care centers (16 women and 8 men). Treated 85 ± 8 years/control 84 ± 4 years | 4-week intervention. Participants were randomized in two groups: (i) exercise and leucine, (ii) exercise only. Treatments were administered double blind | Resistance training. Three sessions of progressive resistance training adapted for older adults and one session of balance exercise per week | Essential amino acid (leucine). Leucine 10 g/day or the same amount of maltodextrin as placebo. Both supplements and placebo were accompanied with a lemon and lime flavor to disguise the characteristic taste of leucine | MM: calf circumference, waist circumference. MS: maximal isometric leg strength. PP: standing balance, 4 m walk, chair stands test and TUG test | 5 |
Kim et al. 2015 [28] | Japan. 130 community-dwelling frail women. Treated 81.0 ± 2.6 years/control 81.1 ± 2.8 years | 3-month intervention. Participants were randomized in four groups: (i) exercise and milk fat globule membrane, (ii) exercise only, (iii) milk fat globule membrane only, (iv) health education, control. Treatments were administered double blind | Physical comprehensive training program of moderate intensity. Each class was 60 min, twice per week | Other (milk fat globule membrane). The composition was 21.5% protein, 44% fat, 26.5% carbohydrate, 33.3% phospholipids, 6.4% ash, and 1.6% moisture. Six pills (1 g of MFGM) ingested daily. The placebo consisted of pills of similar shape, taste, and texture and included milk powder instead of MFGM. Milk powder was composed of 26.3% protein, 25.2%fat, 39.5% carbohydrate, 0.286 phospholipids, 5.7% ash, and 3,3% moisture | MM: appendicular muscle mass, leg muscle mass MS: grip strength, knee extension PP: usual walking speed, timed up and go | 5 |
Shahar et al. 2013 [29] | Malaysia. 65 elderlies with sarcopenia (18 women and 47 men). 67.1 ± 5.3 years | 12-week intervention. Participants were randomized in four groups: (i) control group, (ii) exercise group, (iii) protein supplementation, (iv) exercise + protein supplementation. Treatment administration was not double blinded | Moderately intensive, well-rounded activities in facilitated group sessions. During 60 min, two sessions per week | Protein (soy protein). 20 g/day and 40 g/day of high protein supplementation in a powder form to men and women, respectively. Control group did not received placebo but a relaxation exercise program to maintain interaction and increase motivation | MM: total muscle mass and fat-free mass MS: handgrip strength, arm curl test PP: chair stand test, chair sit and reach, back scratch, 8-ft and go, 6-min walk | 1 |
Arnarson et al. 2013 [30] | Iceland. 161 healthy community-dwelling men and women. (94 women and 67 men) Treated 73.3 ± 6.0/control: 74.6 ± 5.5,8 | 12-week intervention. Participants were randomized in two groups: (i) exercise + whey protein supplement or (ii) exercise only. Treatment administration was not double blinded | Resistance exercise program. Participants exercised three times per week | Protein (whey protein). Drink (250 mL) providing 20 g protein, 20 g carbohydrate, 1 g fat (169 kcal) (intervention) or isocaloric drink containing 40 g carbohydrate, 1 g fat (control) consumed immediately after exercise | MM: lean body mass, appendicular lean mass MS: quadriceps muscle strength PP: timed up and go; 6-min walk for distance | 5 |
Sweden. 191 older men and women in residential care. (139 women and 52 men) 84.7 ± 6.5 years | 3-month intervention. Participants randomized to four groups: (i) protein-enriched drink, control activity, (ii) exercise training + placebo drink, (iii) protein-enriched drink + exercise training, or (iv) neither (control activity, placebo drink). Treatment administration was not double blinded | High-intensity multicomponent exercise program, including resistance exercise training and balance exercises. Participants exercised five times per fortnight | Protein (milk-based protein-enriched drink). Drink (200 mL), providing 7.4 g protein, 15.7 g carbohydrate, 408 kJ per 100 g. Placebo drink (200 mL) contained 0.2 g protein, 10.8 g carbohydrate, 191 kJ per 100 g. Drinks offered within 5 min of exercise session | MM: total lean massMS: lower-limb muscle strength PP: balance (Berg Balance Scale), gait ability (2.4 m timed test) | 3 | |
Tieland et al. 2012 [33] | The Netherlands. 20 frail older men and 41 frail older women Treated 78 ± 9 years/control: 79 ± 6 years | 24-week intervention. Participants randomized in two groups: (i) exercise + protein supplementation or (ii) exercise + placebo drink. Treatments were administered double blind | Resistance-type exercise training. Participants exercised twice per week | Protein. Protein-supplemented drink (250 mL), (15 g protein, 7.1 g lactose, 0.4 g calcium) and placebo drink (no protein, 7.1 g lactose, 0.4 g calcium) consumed twice per day | MM: lean mass MS: leg press, leg extension, handgrip PP: SPPB test | 5 |
Verdijk et al. 2009 [34] | The Netherlands. 28 healthy older men, living independently 72 ± 2 years | 12-week intervention. Participants were randomized in two groups: (i) exercise + protein or (ii) exercise + water. Treatments were administered double blind | Resistance-type exercise training. Participants exercised three times per week in the morning, at same time of day | Protein. Protein drink (10 g casein hydrolysate, 250 mL) or placebo drink (250 mL water) given immediately before and following exercise sessions | MM: lean mass, leg lean mass, cross-sectional area of quadriceps MS: leg press, leg extension | 3 |
Godard et al. 2002 [35] | USA. 17 older men Treated 70.8 ± 1.5/control 72.1 ± 1.9 | 12-week intervention. Participants were randomized in two groups: (i) exercise + EAA or (ii) exercise with no dietary supplementation (control). Treatment administration was not double blinded | Progressive knee extensor resistance training program. Participants exercised three times per week | Essential amino acids. Amino acid-containing drink (400 mL) providing 12 g essential amino acids, 72 g fructose and dextrose; consumed immediately after training or at same time each day | MM: whole muscle cross-sectional area of right thigh MS: knee extension | 1 |
Kim et al. 2012 [36] | Japan. 155 sarcopenic, community-dwelling older women Treated 79.5 ± 2.9 years/control 79,2 ± 2,8 | 3-month intervention. Participants randomized to four groups: (i) EAA, (ii) exercise training, (iii) supplementation + exercise or iv) health education (once per month). Treatment administration was not double blinded | Multicomponent exercise program including resistance exercise training. Participants exercised twice per week | Essential amino acids. Powdered amino acid supplements provided to be taken twice daily with water or milk, supplying 6 g essential amino acids per day | MM: total muscle mass MS: knee extension. PP: usual and maximum walking speed | 3 |
Vukovich et al. 2001 [37] | USA. 15 healthy older men and16 healthy older women 70 ± 1 years | 8-week intervention. Participants were randomized in two groups: (i) HMB + exercise or (ii) a placebo supplement + exercise. Treatments were administered double-blind | Multicomponent exercise training including resistance exercises. Participants exercised 5 days per week (2 days strength training, 3 days walking and stretching) | β-hydroxy-β-methylbuthyrate. Supplement capsules contained 250 mg Ca-HMB; participants consumed four capsules, three times per day (3 g/day). Placebo capsules were identical in appearance, providing 3 g/day rice flour | MM: fat-free mass, muscle area. MS: upper and lower body strength | 4 |
Bonnefoy et al. 2003 [38] | France. 57 frail resident in retirement homes (50 women and 7 men) 83 years | 9-month intervention. Participants randomized to four groups: (i) nutritional drink + control activity (memory), (ii) exercise training + placebo drink, (iii) nutritional drink + exercise training, or (iv) control activity + placebo drink. Treatment administration was not double blinded | Multicomponent exercise training including resistance exercises. Participants exercised three times per week. Three weekly memory sessions served as controls for exercise | Multi-nutrient. Nutritional drinks (200 mL) (providing 200 kcal, 15 g protein, vitamins and minerals) or placebo (providing no nutrients) given twice daily | MM: fat-free mass MS: explosive leg extension (power). PP: gait speed, six-step stair climb, chair rise, balance abnormalities | 3 |
USA. 100 frail nursing home residents, 37 men and 63 women 87.1 ± 0.6 years | 10-week intervention. Participants randomized to four groups: (i) multi-nutrient supplementation, (ii) exercise training, (iii) supplementation + exercise or iv) neither (control). Treatment administration was not double blinded | Progressive resistance exercise training of hip and knee extensors. Participants exercised 3 days per week. Other participants offered alternative recreational activities | Multi-nutrient. Nutritional supplement provided as a daily drink (240 mL), supplying 360 kcal, 15 g protein and vitamins and minerals. Participants who were not supplemented were given a minimally nutritive drink of equal volume (4 kcal) | MM: thigh muscle area, fat-free mass MS: grip strength, hip and knee extensors PP: gait speed, stair climb, balance | 2 | |
Miller et al.2006 [41] | Australia. 79 older women and 21 older men hospitalized following a fall-related lower-limb fracture 83.5 (82.3–84.7) years | 12-week intervention. Participants randomized to four groups: (i) nutritional supplementation, (ii) exercise training, (iii) supplementation + exercise or iv) attention control (home visits only, general nutrition and exercise advice). Treatment administration was not double blinded | Progressive resistance exercise training program. Participants exercised three times per week | Multi-nutrient. Complete oral nutritional supplement prescribed to provide 45% of individually estimated energy requirement, administered in four daily doses while hospitalized or two doses after discharge home | MS: quadriceps strength PP: gait speed | 3 |
Chile. 108 community-dwelling poor older people (42 men and 66 women). Treated 73.7 ± 3.0/control 74.4 ± 3.3 | 18-month intervention. Evaluation at 12 and 18 months. Participants were randomized in two groups: (i) exercise + nutritional supplementation or (ii) exercise but no dietary supplementation. Treatment administration was not double blinded | Resistance exercise. Participants exercised twice per week | Multi-nutrient. Nutritional product (prepared as a soup or porridge, given as two daily snacks), to provide 400 kcal, 13 g protein, ∼25% daily requirements for micronutrients | MM: fat-free mass MS: handgrip, quadriceps, biceps strength PP: walking capacity (m) | 1 | |
The Netherlands. 217 frail community-dwelling older men and women (45 men and 172 women). Treated 78.9 ± 6.0/control 76.2 ± 4.5 | 17-week intervention. Participants randomized to four groups: (i) supplementation, (ii) exercise training, (iii) supplementation + exercise or iv) neither (control). The nutritional intervention was double-blinded | Multicomponent exercise training (gradually increasing intensity). Participants exercised twice per week | Other (vitamins and minerals). Supplemented group asked to consume one fruit and one dairy product enriched with vitamins and minerals per day. Other participants received same products that were not enriched | MM: lean body mass, waist circumference, hip circumference MS: handgrip, quadriceps strength PP: gait speed, chair rise, balance, flexibility | 4 | |
Binder et al. 1995 [46] | USA. 25 nursing home residents with dementia (16 men and 9 women). Treated 87 ± 4.4 years/control 88.7 ± 6.9 years | 8-week intervention. Participants were randomized in two groups: (i) exercise + calcium carbonate + vitamin D supplementation, or (ii) exercise + calcium carbonate only. Treatment administration was not double blinded | Multicomponent but mainly resistance-type exercise. Participants exercised three times per week | Vitamin D. Intervention group given bolus dose (orally) of 100,000 U vitamin D3 at start of study, then weekly supplements 50,000 U | MS: knee extensor, lower extremity PP: gait speed, balance | 2 |
Bunout et al. 2006 [47] | Chile. 96 community-dwelling older men and women, with low vitamin D status (86 women, 10 men) 76 ± 4 years | 9-month intervention. Participants randomized to receive exercise training or no training, and further randomized to receive supplementation (double blind) with vitamin D/calcium or calcium alone. Treatments were administered double blind | Resistance exercise training; participants exercised twice per week | Vitamin D. Combined oral vitamin D/calcium supplement (400 IU/800 mg) or calcium-only supplement (800 mg) provided, to be taken in the evening | MM: lean mass MS: handgrip, quadriceps strength PP: TUG, SPPB | 5 |
Brose et al. 2003 [48] | Canada. 30 healthy-community-dwelling older men and women (15 women and 15 men) 65+ years. | 14-week intervention. Participants were randomized in two groups: (i) exercise + creatine supplement or (ii) exercise + placebo. Treatments were administered double blind | Resistance exercise training. Participants exercised three times per week | Creatine. Daily creatine monohydrate supplement (5 g + 2 g dextrose) (intervention) or placebo (7 g dextrose) (control) | MM: fat-free mass MS: handgrip, ankle dorsiflexion, knee extension, dynamic 1RM PP: chair rise, stair climb, walking speed | 4 |
Tarnopolsky et al. 2012 [49] | Canada. 39 community-dwelling older men and women (10 women, 19 men) 65+ years | 6-month intervention. Participants were randomized in two groups: (i) exercise + supplementation with creatine monohydrate and conjugated linoleic acid, (ii) exercise + placebo. Treatments were administered double blind | Resistance exercise training program; participants exercised twice per week | Creatine. Daily supplementation with creatine monohydrate (5 g) + conjugated linoleic acid (6 g) + 2 g dextrose or placebo (7 g dextrose + 6 g safflower oil) | MM: fat-free mass MS: handgrip, ankle dorsiflexion, knee extension strength, endurance PP: chair rise, stair climb, walking speed, balance | 5 |
Types of nutritional intervention
Muscle mass | Muscle strength | Physical performance | ||||
---|---|---|---|---|---|---|
Significant increase with exercises | Significant added effect with nutrition | Significant increase with exercises | Significant added effect with nutrition | Significant increase with exercises | Significant added effect with nutrition | |
Protein | 11/12 RCTs | 3/12 RCTs | 12/12 RCTs | 3/12 RCTs | 9/9 RCTs | 0/9 RCTs |
EAA | 2/3 RCTs | 0/3 RCTs | 2/3 RCTs | 0/3 RCTs | 2/2 RCTs (only for SPPB and TUG) | 0/2 RCTs |
HMB | 3/3 RCTs | 1/3 RCTs | 2/3 RCTs | 0/3 RCTs | 2/2 RCTs (only for TUG) | 0/2 RCTs |
Multi-nutrient | 2/4 RCTs | 0/4 RCTs | 3/5 RCTs | 1/5 RCTs | 3/4 RCTs | 0/4 RCTs |
Creatine | 5/5 RCTs | 4/5 RCTs | 5/5 RCTs | 4/5 RCTs (for some of muscle strength outcomes) | 3/4 RCTs | 1/4 RCTs |
Vitamin D | 0/1 RCTs | 0/1 RCTs | 2/2 RCTs | 0/2 RCTs | 2/2 RCTs (for some of physical performance outcomes) | 1/2 RCTs (only for TUG) |
Other | 4/6 RCTs | 0/6 RCTs | 3/5 RCTs | 0/5 RCTs | 4/5 RCTs | 2/5 RCTs |