title: Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial.
abstract: BACKGROUND
  It is important to establish whether frailty among older individuals is reversible with nutritional, physical, or cognitive interventions, singly or in combination. We compared the effects of 6-month-duration interventions with nutritional supplementation, physical training, cognitive training, and combination treatment vs control in reducing frailty among community-dwelling prefrail and frail older persons.
  
  
  METHODS
  We conducted a parallel group, randomized controlled trial in community-living prefrail and frail old adults in Singapore. The participants' mean age was 70.0 years, and 61.4% (n = 151) were female. Five different 6-month interventions included nutritional supplementation (n = 49), cognitive training (n = 50), physical training (n = 48), combination treatment (n = 49), and usual care control (n = 50). Frailty score, body mass index, knee extension strength, gait speed, energy/vitality, and physical activity levels and secondary outcomes (activities of daily living dependency, hospitalization, and falls) were assessed at 0 months, 3 months, 6 months, and 12 months.
  
  
  RESULTS
  Frailty score and status over 12 months were reduced in all groups, including control (15%), but were significantly higher (35.6% to 47.8%) in the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), and physical (OR 4.05) and combination (OR 5.00) intervention groups. Beneficial effects were observed at 3 months and 6 months, and persisted at 12 months. Improvements in physical frailty domains (associated with interventions) were most evident for knee strength (physical, cognitive, and combination treatment), physical activity (nutritional intervention), gait speed (physical intervention), and energy (combination intervention). There were no major differences with respect to the small numbers of secondary outcomes.
  
  
  CONCLUSIONS
  Physical, nutritional, and cognitive interventional approaches were effective in reversing frailty among community-living older persons.
authors.affiliation: Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore. Electronic address: pcmngtp@nus.edu.sg.
authors.forename: Tze Pin
authors.initials: TP
authors.lastname: Ng
authors.affiliation: Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore.
authors.forename: Liang
authors.initials: L
authors.lastname: Feng
authors.affiliation: Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore.
authors.forename: Ma Shwe Zin
authors.initials: MS
authors.lastname: Nyunt
authors.affiliation: Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore.
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.affiliation: Performance and Technology Assessment, Ministry of Health, Singapore.
authors.forename: Mathew
authors.initials: M
authors.lastname: Niti
authors.affiliation: St Luke's Hospital, Singapore.
authors.forename: Boon Yeow
authors.initials: BY
authors.lastname: Tan
authors.affiliation: St Luke's Hospital, Singapore.
authors.forename: Gribson
authors.initials: G
authors.lastname: Chan
authors.affiliation: Khoo Teck Puat Hospital, Singapore.
authors.forename: Sue Anne
authors.initials: SA
authors.lastname: Khoo
authors.affiliation: Khoo Teck Puat Hospital, Singapore.
authors.forename: Sue Mei
authors.initials: SM
authors.lastname: Chan
authors.affiliation: Khoo Teck Puat Hospital, Singapore.
authors.forename: Philip
authors.initials: P
authors.lastname: Yap
authors.affiliation: Alexandra Hospital, Singapore.
authors.forename: Keng Bee
authors.initials: KB
authors.lastname: Yap
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003131:Combined Modality Therapy; D019587:Dietary Supplements; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment; D006293:Health Promotion / Q000379:methods*; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Cognitive training; Frailty; Nutritional supplementation; Physical exercise