Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial

Objective: To describe the independent and combined effects of oral nutrition supplementation and resistance training on health outcomes in nutritionally at risk older adults following lower limb fracture. Design: Randomized controlled trial with 12-week masked outcome assessment. Setting: Teaching hospital. Participants: One hundred nutritionally at risk older adults hospitalized following a fall-related lower limb fracture. Intervention: Commenced seven days after injury. Consisted of daily multinutrient energy-dense oral supplement ( 6.3 kJ/mL) individually prescribed for six weeks ( n =/ 25), tri-weekly resistance training for 12 weeks ( n = 25), combined treatment ( n = 24) or attention control plus usual care and general nutrition and exercise advice ( n = 26). Measurements: Weight change, quadriceps strength, gait speed, quality of life and health care utilization at completion of the 12-week intervention. Results: At 12 weeks, all groups lost weight: nutrition -6.2% ( -/8.4, -4.0); resistance training -6.3% ( -8.3, -4.3); nutrition and resistance training -4.7% ( -7.4, -2.0); attention control -5.2% ( -9.0, -1.5). Those receiving resistance training alone lost more weight than those receiving the combined treatment ( P = 0.029). Significant weight loss was prevented if supplement was consumed for at least 35 days. Groups were no different at 12 weeks for any other outcome. Conclusion: Frail, undernourished older adults with a fall-related lower limb fracture experience clinically significant weight loss that is unable to be reversed with oral nutritional supplements. Those receiving a programme of resistance training without concurrent nutrition support are at increased risk of weight loss compared with those who receive a combined nutrition and resistance training intervention. In this high-risk patient group it is possible to prevent further decline in nutritional status using oral nutritional supplements if strategies are implemented to ensure prescription is adequate to meet energy requirements and levels of adherence are high.