EXERCISE TRAINING AND NUTRITIONAL SUPPLEMENTATION FOR PHYSICAL FRAILTY LN VERY ELDERLY PEOPLE

Background. Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly peo ple, the efficacy of interventions targeted specifically at these defi cits has not been carefully studied. Methods. We conducted a randomize d, placebo-controlled trial comparing progressive resistance exercise training, multinutrient supplementation, both interventions, and neith er in 100 frail nursing home residents over a 10-week period.Results. The mean (+/-SE) age of the 63 women and 37 men enrolled in the study was 87.1+/-0.6 years (range, 72 to 98); 94 percent of the subjects com pleted the study. Muscle strength increased by 113+/-8 percent in the subjects who underwent exercise training, as compared with 3+/-9 perce nt in the nonexercising subjects (P<0.001). Gait velocity increased by 11.8+/-3.8 percent in the exercisers but declined by 1.0+/-3.8 percen t in the nonexercisers (P = 0.02). Stair-climbing power also improved in the exercisers as compared with the nonexercisers (by 28.4+/-6.6 pe rcent vs. 3.6+/-6.7 percent, P = 0.01), as did the level of spontaneou s physical activity. Cross-sectional thigh-muscle area increased by 2. 7+/-1.8 percent in the exercisers but declined by 1.8+/-2.0 percent in the nonexercisers (P = 0.11). The nutritional supplement had no effec t on any primary outcome measure. Total energy intake was significantl y increased only in the exercising subjects who also received nutritio nal supplementation. Conclusions. High-intensity resistance exercise t raining is a feasible and effective means of Counteracting muscle weak ness and physical frailty in very elderly people. in contrast, multinu trient supplementation without concomitant exercise does not reduce mu scle weakness or physical frailty.