title: Combined effects of functionally-oriented exercise regimens and nutritional supplementation on both the institutionalised and free-living frail elderly (double-blind, randomised clinical trial).
abstract: BACKGROUND
  Consistently swelling proportion of the frail elderly within a modern society challenges the overstrained public health sector to provide both adequate medical care and comprehensive assistance in their multiple functional deficits of daily living. Easy-to-apply and task-specific ways of addressing this issue are being sought out, with a view to proposing systemic solutions for nationwide application.
  
  
  METHODS
  The present randomised, double-blind, placebo-controlled, 7-week clinical trial aimed to determine whether specifically structured, intensive exercise regimens, combined with nutritional supplementation, might improve and help sustain individual muscle strength and mobility, and possibly enhance individual functional capabilities in an on-going quest for active prevention of care-dependency. Ninety-one frail elderly (F 71 M 20; mean age 79 years) were recruited from both nursing home residents and community dwellers and randomly split into four groups: Group I - progressive resistance exercises (PRE) + functionally-oriented exercises (FOE) + nutritional supplementation (NS), Group II - PRE + FOE + placebo, Group III--standard exercises (SE) + FOE + NS, Group IV - SE + FOE + placebo. Each group pursued a 45 min. exercise session 5 times weekly. The subjects' strength with regard to four muscle groups, i.e. hip and knee extensors and flexons, was assessed at 80% (1 RM) weekly, whereas their balance and mobility at baseline and at the end of the study.
  
  
  RESULTS
  The study was completed by 80 subjects. Despite its relatively short duration significant differences in muscle strength were noted both in Group I and Group II (p = 0.01; p = 0.04; respectively), although this did not translate directly into perceptible improvement in individual mobility. Notable improvements in individual mobility were reported in Group III and Group IV (p = 0.002), although without positive impact on individual muscle strength.
  
  
  CONCLUSIONS
  Comprehensively structured, high-intensity regimen made up of diverse exercise types, i.e. functionally-oriented, progressive resistance and standard ones, preferably if combined with nutritional supplementation in adequate volume, demonstrates clear potential for appreciably improving overall functional status in the frail elderly in terms of individual walking capacity and muscle strength.
  
  
  BACKGROUND
  Central Register of Clinical Trials, Poland--CEBK180/2000.
authors.affiliation: University School of Physical Education, Krakow, Poland. mzak1@onet.eu
authors.forename: Marek
authors.initials: M
authors.lastname: Zak
authors.forename: Christian
authors.initials: C
authors.lastname: Swine
authors.forename: Tomasz
authors.initials: T
authors.lastname: Grodzicki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003131:Combined Modality Therapy; D019587:Dietary Supplements; D004311:Double-Blind Method; D015444:Exercise / Q000502:physiology*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D009043:Motor Activity; D053580:Muscle Strength / Q000502:physiology; D009735:Nursing Homes; D044623:Nutrition Therapy / Q000379:methods*; D009751:Nutritional Requirements; D011044:Poland; D011336:Probability; D012111:Residence Characteristics; D016896:Treatment Outcome