title: Do ACE inhibitors improve the response to exercise training in functionally impaired older adults? A randomized controlled trial.
abstract: BACKGROUND
  Loss of muscle mass and strength with ageing is a major cause for falls, disability, and morbidity in older people. Previous studies have found that angiotensin-converting enzyme inhibitors (ACEi) may improve physical function in older people. It is unclear whether ACEi provide additional benefit when added to a standard exercise training program. We examined the effects of ACEi therapy on physical function in older people undergoing exercise training.
  
  
  METHODS
  Community-dwelling people aged ≥ 65 years with functional impairment were recruited through general (family) practices. All participants received progressive exercise training. Participants were randomized to receive either 4 mg perindopril or matching placebo daily for 20 weeks. The primary outcome was between-group change in 6-minute walk distance from baseline to 20 weeks. Secondary outcomes included changes in Short Physical Performance Battery, handgrip and quadriceps strength, self-reported quality of life using the EQ-5D, and functional impairment measured using the Functional Limitations Profile.
  
  
  RESULTS
  A total of 170 participants (n = 86 perindopril, n = 84 placebo) were randomized. Mean age was 75.7 (standard deviation [SD] 6.8) years. Baseline 6-minute walk distance was 306 m (SD 99). Both groups increased their walk distance (by 29.6 m perindopril, 36.4 m placebo group) at 20 weeks, but there was no statistically significant treatment effect between groups (-8.6m [95% confidence interval: -30.1, 12.9], p = .43). No statistically significant treatment effects were observed between groups for the secondary outcomes. Adverse events leading to withdrawal were few (n = 0 perindopril, n = 4 placebo).
  
  
  CONCLUSIONS
  ACE inhibitors did not enhance the effect of exercise training on physical function in functionally impaired older people.
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, University of Dundee, UK. d.sumukadas@dundee.ac.uk.
authors.forename: Deepa
authors.initials: D
authors.lastname: Sumukadas
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, University of Dundee, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Band
authors.affiliation: Department of Physiotherapy and.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Miller
authors.affiliation: Department of Care of the Elderly, National Health Service Fife, Kirkcaldy, UK.
authors.forename: Vera
authors.initials: V
authors.lastname: Cvoro
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, University of Dundee, UK.
authors.forename: Miles
authors.initials: M
authors.lastname: Witham
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, University of Dundee, UK.
authors.forename: Allan
authors.initials: A
authors.lastname: Struthers
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow, UK.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Lloyd
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, University of Dundee, UK.
authors.forename: Marion
authors.initials: M
authors.lastname: McMurdo
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D053580:Muscle Strength / Q000187:drug effects*; D020913:Perindopril / Q000627:therapeutic use; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D016138:Walking / Q000502:physiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril
keywords: ACE inhibitors; Exercise.; Physical function