Effects Of Nutrition Combined With Exercise Interventions On Measures Of Sarcopenia In Community Older Adults:A Randomized,Controlled Trial

Objective To explore the effects of lifestyle modification based on nutrition combined exercise management on muscle protein synthesis(including skeletal muscle mass,muscle strength and physical performance)among elderly patients with sarcopenia in community.Methods A randomized,controlled design study.During the period from December 2017 to July 2018,five communities in a certain region where the residents' health records database had been established were selected as consecutive points to screen the elderly aged>=60 years with sarcopenia.Finally,a total of 241 patients who met the inclusion/exclusion criteria and signed the informed consent were selected into this study.By using the random number table generated from SPSS 22.0 software,the subjects were randomly divided into four groups as follows:(1)nutrition group(n=61),(2)nutrition combined exercise group(n=59),(3)exercise group(n=62)and(4)control group(n=59).Nutritional intervention was the supplement of whey protein combined with fish oil and vitamin D;exercise intervention was resistance exercise,30 minutes each time,3 times a week.The study lasted for 12 weeks and was followed up for 3 times.Body composition analysis,relative skeletal muscle mass index,grip strength,6-m walking time,anthropometric parameters and other indicators were measured,calculated and recorded respectively before enrollment,at week 4,8 and 12 of the intervention.The primary outcomes were analyzed by using an intention-to-treat analysis and mixed model repeated the measurement.Results Compared with the control group,the difference of appendicular skeletal muscle and lower skeletal muscle mass before and after intervention in the nutrition group,nutrition combined exercise group and exercise group were statistically significant(all P<0.05).The superior hand grip strength of the nutrition group,the nutrition combined exercise group,the exercise group,and the control group were improved in the late stage of the intervention,with the increments of A=2.738 kg,A=2.004 kg,A=0.877 kg,?=0.670 kg,respectively.However,the difference was only statistically significant in the nutrition intervention group,the nutrition combined exercise intervention group.Compared with the control group,the walking time of the nutrition group,the nutrition combined exercise group,and the exercise group decreased in varying degrees.The change amount ? was 1.255 s,1.147s,and 0.679s respectively.In the nutrition group,nutrition combined exercise group,the factors of intervention and time had some interaction effects on the calf circumference:the mean change of the calf circumference in the first follow-up and the last follow-up had statistical significance(P<0.05).Changes in other body composition:Fixed-effect analysis of result variables such as waist circumference,body fat percentage showed that,compared with control group,the effects of different interventions on waist circumference and body fat percentage were different(all P<0.05).In addition,the effect of exercise intervention group on the percentage of body fat was statistically significant(P<0.05).Conclusion(1)Nutritional intervention and nutrition combined exercise intervention could improve the appendicular skeletal muscle mass and the muscle strength among elderly patients with sarcopenia,especially lower limb skeletal muscle mass;Exercise intervention could also improve muscl mass in elderly patients with sarcopenia.(2)Nutrition intervention,nutrition combined exercise intervention,and exercise intervention could improve the indicators of body fat with sarcopenia,and make their content and distribution in the body more reasonable.