Exercise training and nutritional supplementation for physical frailty in very elderly people
Abstract
BACKGROUND: Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people, the efficacy of interventions targeted specifically at these deficits has not been carefully studied. METHODS: We conducted a randomized, placebo-controlled trial comparing progressive resistance exercise training, multinutrient supplementation, both interventions, and neither 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 completed the study. Muscle strength increased by 113 +/- 8 percent in the subjects who underwent exercise training, as compared with 3 +/- 9 percent 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 percent in the nonexercisers (P = 0.02). Stair-climbing power also improved in the exercisers as compared with the nonexercisers (by 28.4 +/- 6.6 percent vs. 3.6 +/- 6.7 percent, P = 0.01), as did the level of spontaneous 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 effect on any primary outcome measure. Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation. CONCLUSIONS: High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people. In contrast, multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty.
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With exercise, frail older people can gain muscle strength and function into their 9th and 10th decades of life, as shown in resistance-training studies.
“With exercise, frail older people can gain muscle strength and function into their 9th and 10th decades of life, as shown in resistance-training studies.133e135”
From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [134]
ACE inhibitors have been demonstrated to improve the structure and biochemical function of skeletal muscle.
“Angiotensin converting enzyme (ACE) inhibitors have been demonstrated to improve the structure and biochemical function of skeletal muscle (128)”
From Frailty in elderly people (2013) · cites this paper as [128]
Exercise interventions on gait stability in older adults with frailty have yielded conflicting results, with some studies reporting gait improvements after physical training and others finding no benefits.
“Several studies have investigated the effects of exercise interventions on gait stability in older adults with frailty, yielding conflicting results. Some studies reported gait improvements after physical training [84,145,146], while others found no benefits [84].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [145]
Resistance exercise is effective and safe to prevent muscle loss even in old (mean age 87 years) and frail individuals, potentially by also decreasing skeletal muscle apoptosis and improving mitochondrial function.
“Resistance exercise is effective and safe to prevent muscle loss even in old (mean age 87 years) and frail individuals, potentially by also decreasing skeletal muscle apoptosis and improving mitochondrial function.123”
From Age-related and disease-related muscle loss: The effect of diabetes, obesity, and other diseases (2014) · cites this paper as [123]
An 8-week resistance training programme can significantly increase muscle mass in frail men and women with a mean age of 87 years living in nursing home care.
“In a hallmark study, Fiatarone and colleagues123 showed that an 8 week resistance training programme could significantly increase muscle mass in frail men and women (mean age 87 years) living in nursing home care.”
From Age-related and disease-related muscle loss: The effect of diabetes, obesity, and other diseases (2014) · cites this paper as [123]
Previous studies regarding PS for older individuals demonstrated conflicted results: some identified effects of PS on muscle mass accretion and strength gain during exercise training in sarcopenic or frail individuals, whereas others concluded that PS provides no additional benefit in trained community-dwelling or institutionalized residents.
“the previous studies regarding PS for the older individuals demonstrated conflicted results; some authors identified the effects of PS on muscle mass accretion and strength gain during exercise training in sarcopenic or frail individuals [54,58,84,85], whereas others concluded that PS provides no additional benefit in trained community-dwelling or institutionalized residents [44,48,49,56,86]”
From Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults (2018) · cites this paper as [49]
Resistance exercise is an effective means of combating the loss of muscle mass and function in a variety of populations.
“Although not specifically evaluated in older adults during bed rest, there is clear evidence that resistance exercise is an effective means of combating the loss of muscle mass and function in a variety of populations [25-34].”
From Protecting muscle mass and function in older adults during bed rest (2010) · cites this paper as [29]
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References 38 · Cited by 2,857
- Authors
- Fiatarone, M. A., O'Neill, E. F., Ryan, N. D., Clements, K. M., Solares, G. R., Nelson, M. E., Roberts, S. B., Kehayias, J. J., Lipsitz, L. A., & Evans, W. J.
- Affiliations
- Tufts University (US)
- Tufts Medical Center (US)
- Brigham and Women's Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1994-06-23
- Volume
- 330
- Issue
- 25
- Pages
- 1769-1775
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2334583744
- Cited by
- 2,857
- References
- 38
- Citations by year
- 2026: 33 · 2025: 44 · 2024: 51 · 2023: 58 · 2022: 73 · 2021: 73 · 2020: 125 · 2019: 95 · 2018: 104 · 2017: 101 · 2016: 97 · 2015: 89 · 2014: 106 · 2013: 95 · 2012: 98
- FWCI
- 43.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u01ag009078-03)
- National Institute on Aging (AGO 4390, P01AG004390, UO1 AG09078)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- physical frailty, resistance training, oldest old, nursing home residents, muscle strength, walking speed, thigh muscle area, energy intake, malnutrition, sarcopenia
- MeSH terms
- Aged, Aged, 80 and over, Body Composition, Energy Intake, Exercise Therapy, Female, Food, Fortified, Gait, Humans, Male, Muscles, Nutritional Status, Physical Endurance, Frail Elderly
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