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      Exercise training and nutritional supplementation for physical frailty in very elderly people.

      The New England journal of medicine
      Aged, Aged, 80 and over, Body Composition, Energy Intake, Exercise Therapy, Female, Food, Fortified, Frail Elderly, Gait, Humans, Male, Muscles, physiology, Nutritional Status, Physical Endurance

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          Abstract

          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. 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. 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. 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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          Most cited references22

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          Leg extensor power and functional performance in very old men and women.

          1. Residents of a chronic care hospital (13 men of mean age 88.5 +/- 6 SD years and 13 women of mean age 86.5 +/- 6 SD years) who had multiple pathologies were assessed for leg extensor capability in several ways. 2. A custom-built rig was used to assess leg extensor power, that is, maximal power output over less than 1 s in a single extension of one leg. Performance measures were obtained by timing chair rises (from a standard chair 0.43 m high), stair climbing (four risers, total height 0.635 m) and a walk (6.1 m). For each measurement the best of several trials were recorded as definitive. 3. Leg extensor power was significantly correlated with all performance measures, but the performance measures were not related to each other except for chair rising and walking speed. 4. Women had significantly less extensor power than men, but their power explained more of the variance in performance, e.g. power accounted for 86% of the variance in walking speed. 5. There was no relation within the group between age and any of the variables measured. 6. Measurement of leg extensor power in frail elderly people may prove useful in focusing effective rehabilitation programmes.
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            Number of days of food intake records required to estimate individual and group nutrient intakes with defined confidence.

            The number of days of food intake data needed to estimate the intake of 29 male (n = 13) and female (n = 16) adult subjects, individually and as a group, was determined for food energy and 18 nutrients. The food intake records were collected in a year-long study conducted by the U.S. Department of Agriculture's Beltsville Human Nutrition Research Center. Each individual's average intake of nutrients and standard deviation over the year were assumed to reflect his or her "usual" intake and day-to-day variability. Confidence intervals (P less than 0.05) for each individual's usual intake were constructed, and from these the number of days of dietary records needed for estimated individual and group intake to be within 10% of usual intake was calculated. The results indicated that the number of days of food intake records needed to predict the usual nutrient intake of an individual varied substantially among individuals for the same nutrient and within individuals for different nutrients; e.g., food energy required the fewest days (averaging 31) and vitamin A the most (averaging 433). This was considerably higher than the number of days needed to estimate mean nutrient intake for this group, which ranged from 3 for food energy to 41 for vitamin A. Fewer days would be needed for larger groups.
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              Muscle strength and speed of movement in relation to age and muscle morphology.

              Maximum values for isometric strength, dynamic strength, and speed of movement (MEV) in the quadriceps muscle were measured in 114 male subjects who were between 11 and 70 yr. Biopsy samples were taken from the quadriceps muscle in 51 of the subjects (22-65 yr. old). Isometric and dynamic strength increased up to the third decade, remained almost constant to the fifth decade, and then decreased with increasing age. However, no measurable external atrophy of the quadriceps muscle, explaining the decline in strength, could be seen in old age. Histochemical changes in the muscle tissue such as decreased proportion of type II fibers and a selective atrophy of type II fibers, were seen with increasing age. The strength decline in old age was also observed to correlate significantly with the type II fiber area. Multiple regression analyses indicated, however, that mechanisms other than the type II fiber atrophy might be responsible for the decline in strength performance during aging. The implications of these findings are discussed.
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