A study protocol of Older Person's Exercise and Nutrition Study (OPEN) - a sit-to-stand activity combined with oral protein supplement - effects on physical function and independence: a cluster randomized clinical trial

Oral Protein Supplements Might Improve Nutritional Status and Quality of Life in Elderly Patients after Standard Pancreatic Resection

Elderly patients who undergo pancreaticoduodenectomy (PPPD) or distal pancreatectomy (DP) experience not only a reduction in protein intake but also a decrease in protease secretion, leading to impaired protein digestion and absorption. This increases the risk of malnutrition and creates a dual burden of sarcopenia. This randomized, double-blind, placebo-controlled trial examined the impact of protein supplements on the nutritional status and quality of life (QoL) of elderly patients after PPPD and DP surgeries. For six weeks, the case group (CG; n = 23) consumed protein supplements containing 18 g of protein daily, while the placebo group (PG; n = 18) consumed a placebo with the same amount of carbohydrate. In elderly patients where protein digestion and intake were compromised, the CG showed significantly higher protein intake (77.3 ± 5.3 g vs. 56.7 ± 6.0 g, p = 0.049), improved QoL, better nutritional status, and faster walking speed compared to the PG. Protein intake was positively correlated with muscle mass and phase angle. Protein supplementation may not only increase protein intake but also improve clinical outcomes such as walking speed, nutritional status, and QoL in elderly post-surgical patients at high risk of sarcopenia. Further studies are needed to determine the optimal dosage and long-term effects.

The multifaceted benefits of walking for healthy aging: from Blue Zones to molecular mechanisms

Physical activity, including walking, has numerous health benefits in older adults, supported by a plethora of observational and interventional studies. Walking decreases the risk or severity of various health outcomes such as cardiovascular and cerebrovascular diseases, type 2 diabetes mellitus, cognitive impairment and dementia, while also improving mental well-being, sleep, and longevity. Dose-response relationships for walking duration and intensity are established for adverse cardiovascular outcomes. Walking's favorable effects on cardiovascular risk factors are attributed to its impact on circulatory, cardiopulmonary, and immune function. Meeting current physical activity guidelines by walking briskly for 30 min per day for 5 days can reduce the risk of several age-associated diseases. Additionally, low-intensity physical exercise, including walking, exerts anti-aging effects and helps prevent age-related diseases, making it a powerful tool for promoting healthy aging. This is exemplified by the lifestyles of individuals in Blue Zones, regions of the world with the highest concentration of centenarians. Walking and other low-intensity physical activities contribute significantly to the longevity of individuals in these regions, with walking being an integral part of their daily lives. Thus, incorporating walking into daily routines and encouraging walking-based physical activity interventions can be an effective strategy for promoting healthy aging and improving health outcomes in all populations. The goal of this review is to provide an overview of the vast and consistent evidence supporting the health benefits of physical activity, with a specific focus on walking, and to discuss the impact of walking on various health outcomes, including the prevention of age-related diseases. Furthermore, this review will delve into the evidence on the impact of walking and low-intensity physical activity on specific molecular and cellular mechanisms of aging, providing insights into the underlying biological mechanisms through which walking exerts its beneficial anti-aging effects.

Factors Associated with Health-Related Quality of Life in Older Persons Residing in Nursing Homes

PURPOSE

Health-related quality of life (HRQoL) is an important patient-related outcome for the assessment of interventions and treatments in older people. Understanding underlying mechanisms for HRQoL is crucial for improving care, rehabilitation and symptom relief. This study examined the associations between HRQoL and frailty, sarcopenia, dependence of ADL, physical function and nutritional status in older nursing home (NH) residents.

PATIENTS AND METHODS

This is a cross-sectional study employing baseline data from the Older Person's Exercise and Nutrition (OPEN) study. Residents ≥75 years and able to stand up from seated position, residing in eight nursing homes in Sweden, were recruited. The EuroQoL 5-dimension Questionnaire (EQ-5D-5L, 0-1) was used to assess HRQoL. For exposure, the FRAIL and SARC-F questionnaires, Bergs Balance Scale, Functional Independence Measure (FIM), and Mini Nutritional Assessment-Short Form (MNA-SF) were used, including chair-stand test, walking speed and some biochemical markers. Descriptive and inferential statistics including linear regression models were applied.

RESULTS

Data from 113 residents (59% women, mean age 85 years) revealed a mean EQ-5D index of 0.76. After relevant adjustments, factors associated with low HRQoL were sarcopenia (p<0.001), cognitive function (p<0.001), dependence in ADL (p=0.002), low plasma-albumin (p=0.002) and impaired nutritional status (p=0.038).

CONCLUSION

This study displays evidence that modifiable conditions like sarcopenia and malnutrition are related to HRQoL in older NH residents. Such findings indicate a potential for physical exercise, including muscle training, and improved nutritional routines, including protein supplementation, to enhance nursing home care. Future studies, in larger NH populations, on exercise and nutrition for effects on HRQoL are needed.

Prevalence and Risk Factors of Sarcopenia among Older Adults Aged ≥65 Years Admitted to Daycare Centers of Taiwan: Using AWGS 2019 Guidelines

Sarcopenia is a geriatric syndrome which is likely to cause disability, body unbalance, and mortality and thus can lead to heavy healthcare expenditure and caregiver burden. Although some studies have addressed the prevalence of sarcopenia for older adults, there are limited studies conducted in daycare centers. The present study aimed to (i) estimate the prevalence of sarcopenia and (ii) explore associated factors of sarcopenia and standing balance among older adults admitted to daycare centers in Taiwan. The cross-sectional study collected data on demographics, health status, handgrip strength, gait speed (GS), skeletal muscle mass, Taiwan-Mini Nutritional Assessment Short-Form (TW-MNA-SF), and Short Physical Performance Battery from daycare centers in northern Taiwan. The definition of sarcopenia followed the Asian Working Group for Sarcopenia 2019 guidelines. Among 173 participants ≥65 year-old, 50.9% had confirmed sarcopenia, 47.4% possible sarcopenia, and 1.7% normal. Results showed that calf circumference, TW-MNA-SF, dementia, and body mass index (BMI) were associated with sarcopenia. Moreover, BMI, GS, and sarcopenia were associated factors of standing balance. The study estimated a high prevalence of sarcopenia in daycare centers and identified some significant factors of sarcopenia and standing balance. Early nutritional and physiotherapy interventions could benefit older adults to prevent sarcopenia or unbalance.

Response and Adherence of Nursing Home Residents to a Nutrition/Exercise Intervention

OBJECTIVES

Interindividual response variability to nutrition and exercise interventions is extensive in older adults. A group of nursing home (NH) residents participated in a combined intervention. The objective of this post-hoc analysis was to identify factors associated with intervention response measured by change in physical function and body composition.

DESIGN

Post-hoc analyses in the Older Person's Exercise and Nutrition study, a 2-arm randomized trial. The primary outcomes were 30-second Chair Stand Test and composite scores combining physical function and fat-free mass. A secondary outcome was intervention adherence. A 12-week intervention of sit-to-stand exercises and protein-rich nutritional supplements did not improve chair-stand capacity vs control on intention-to-treat basis.

SETTING AND PARTICIPANTS

Residents ≥75 years of age from dementia and somatic units in eight NHs in Sweden.

METHODS

Logistic regressions were performed to define factors associated with response (maintenance/improvement) or nonresponse (deterioration) in 30-second Chair Stand Test, and with intervention adherence. Linear regressions were performed to explore factors associated with response in composite scores.

RESULTS

Mean age of participants (n = 52 intervention, n = 49 control) was 85.8 years. Sarcopenia was occurring in 74%. Sarcopenia at baseline (P = .005) and high adherence to nutritional supplements (P = .002) increased the odds of response. Higher independence in daily activities increased the odds of adherence to sit-to-stand exercises (P = .027) and the combined intervention (P = .020). Allocation to the intervention group and higher self-perceived health were associated with higher composite scores.

CONCLUSIONS AND IMPLICATIONS

NH residents with baseline sarcopenia, better self-perceived health, and high adherence to nutritional supplements benefitted most from a combined nutrition and exercise intervention regarding chair-stand capacity and composite scores of function and fat-free mass. Adherence was related to higher grade of independence. Understanding factors associated with response and adherence to an intervention will help target susceptible residents in most need of support and to optimize the outcome.

Experiences of supporting older persons in completion of an exercise and nutrition intervention: an interview study with nursing home staff

Background

The interactions between nursing home (NH) staff and their residents are crucial not only for the atmosphere at the NH but also for achieving care goals. In order to test the potential effects of daily physical activities (sit-to-stand (STS) exercises) combined with oral nutritional supplementation (ONS), a randomized intervention trial (the Older Person’s Exercise and Nutrition (OPEN) Study) was performed in NH residents. One aspect of the study was to interview and report the NH staff’s experiences of supporting the residents in fulfilling the intervention.

Methods

In this qualitative study, individual and focus group interviews were performed in eight NH facilities with NH staff who had assisted residents in performing the 12-week ONS/STS intervention. An interview guide developed for this study was used to assess staff experiences of the intervention and its feasibility. The transcribed interviews were analyzed inductively following a constant comparative method and with input from experts in the area, described in Grounded Theory as a reliable technique for researchers to form theory and hypothesis in unexplored areas.

Results

Three main themes relating to the health-promoting intervention emerged. These included: 1) insights into attitudes towards health in general and NH care specifically; 2) intervention-related challenges, frustrations and needs, and 3) aspects of collaboration and opportunities.

The overarching hypothesis derived from the analysis reads: A health-promoting intervention such as the OPEN-concept has great potential for integration into NH life if a combined empathic and encouraging attitude, and a structure to keep it sustainable, are in place.

Conclusions

NH staff experienced the health-promoting intervention as a potentially positive concept, although it was suggested that it works best if introduced as a general routine in the unit and is integrated into the daily planning of care.

Trial registration

ClinicalTrials.govIdentifier: NCT02702037. Date of trial registration February 26, 2016. The trial was registered prospectively

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02039-7.

A health concept with a social potential: an interview study with nursing home residents

BACKGROUND

A qualitative, interview-based study was embedded in a randomized intervention trial, the Older People Exercise and Nutrition (OPEN) study. Participants in the OPEN study were encouraged to conduct sessions of sit-to-stand (STS) exercises combined with Oral Nutritional Supplements (ONS) intake. The aim was to describe the older persons' perceptions and experiences of being given the daily opportunity to perform the STS exercise and drink ONS.

METHODS

In-depth interviews were conducted in six nursing homes with the participants using a semi-structured interview guide. One or two individual interviews were performed with each included participant. Twenty-three NH residents (16 women and 7 men) participated in the qualitative study. Their ages ranged between 76 and 96 years, and their Mini Mental State Examination (MMSE) scored between 8 and 29. The transcribed interviews and field notes written during the visits were analyzed inductively following a constant comparative method described in Grounded Theory.

RESULTS

The exercise and nutritional intervention was described as highly practical by the NH residents, who claimed it also had a social aspect as they felt acknowledged and empowered to engage others in the combined intervention. Experiences of the intervention ranged from neutral to mainly positive and could be sorted into 5 categories: 1. Perceived hopes and expectations, 2. Health-related driving forces, 3. Appreciated daily activities, 4. A concept easy to perform and integrate into daily life, 5. A beneficial health concept for all. The intervention created perceived benefits on various health aspects due to participants feeling energized and stronger. An overall theme was identified as A health concept with a social potential, as participants feel acknowledged and strong enough to help others.

CONCLUSIONS

The intervention was described by participants as a health concept that could potentially be beneficial for a broader spectrum of NH residents. The findings indicate that health concepts, such as STS/ONS, might contribute to a more meaningful day for older people, even vulnerable NH residents approaching the end of life.

TRIAL REGISTRATION

ClinicalTrials.govIdentifier: NCT02702037 . Date of trial registration February 26, 2016.

Effect of Sit-to-Stand Exercises Combined With Protein-Rich Oral Supplementation in Older Persons: The Older Person's Exercise and Nutrition Study

OBJECTIVES

Nursing home (NH) residents are often undernourished and physically inactive, which contributes to sarcopenia and frailty. The Older Person's Exercise and Nutrition Study aimed to investigate the effects of sit-to-stand exercises (STS) integrated into daily care, combined with a protein-rich oral nutritional supplement (ONS), on physical function, nutritional status, body composition, health-related quality of life, and resource use.

DESIGN

Residents in 8 NHs were randomized by NH units into an intervention group (IG) or a control group (CG) (n = 60/group). The IG was a combination of STS (4 times/day) and ONS (2 bottles/day providing 600 kcal and 36 g protein) for 12 weeks.

SETTING AND PARTICIPANTS

The participants resided in NH units (dementia and somatic care), were ≥75 years of age, and able to rise from a seated position.

METHODS

The 30-second Chair Stand Test was the primary outcome. Secondary outcomes were balance, walking speed, dependence in activities of daily living, nutritional status and body composition, health-related quality of life, and resource use.

RESULTS

Altogether, 102 residents (age 86 ± 5 years, 62% female) completed the study. No improvement in the physical function assessments was observed in the IG, whereas body weight increased significantly (2.05 ± 3.5 kg, P = .013) vs the CG. Twenty-one (of 52) participants with high adherence to the intervention (ie, at least 40% compliance to the combined intervention) increased their fat free mass (2.12 kg (0.13, 4.26 interquartile range), P = .007 vs CG). Logistic regression analyses indicated that the odds ratio for maintained/improved 30-second Chair Stand Test was 3.5 (confidence interval 1.1, 10.9, P = .034) among the participants with high adherence compared with the CG.

CONCLUSIONS/IMPLICATIONS

Twelve-week intervention of daily STS combined with ONS in NH residents did not improve physical function, but increased body weight. Subgroup analyses indicated that high adherence to the combined intervention was associated with maintained or improved physical function and a gain of fat free mass.