Protein-Added Healthy Lunch-Boxes Combined with Exercise for Improving Physical Fitness and Vascular Function in Pre-Frail Older Women: A Community-Based Randomized Controlled Trial

Q: What are the key findings of this study?

Protein-added meals combined with aerobic exercise (with or without EMS) for 8 weeks significantly increased flow-mediated dilation by 25-25.8% (interaction p=0.003) and SPPB scores in pre-frail older women.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Pre-frailty in older women (n=60). Intervention: Multi-component intervention: protein-added healthy lunch-boxes alone (DG), with stepping aerobic exercise (ADG), or with stepping aerobic exercise plus electromyostimulation (AEDG) vs. Control group maintaining usual daily activities. Primary outcome: Brachial artery flow-mediated dilation (FMD) and physical fitness (Short Physical Performance Battery [SPPB], 6-minute walk distance, and grip strength) at 8 weeks (p=0.003).

Q: What does this research mean for the field?

Protein-added meals combined with aerobic exercise significantly improve physical fitness and vascular endothelial function, increasing flow-mediated dilation by 25% to 25.8%, in pre-frail older women. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Wonil Park; Jae‐Sung Lee; Kwangseok Hong; Hun‐Young Park; Saejong Park; Na-Hyun Kim; Jonghoon Park

doi:10.2147/cia.s391700

January 1, 2023Clinical Interventions in AgingOpen Access

Protein-Added Healthy Lunch-Boxes Combined with Exercise for Improving Physical Fitness and Vascular Function in Pre-Frail Older Women: A Community-Based Randomized Controlled Trial

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Key result

Protein-supplemented diet plus aerobic exercise increases flow-mediated dilation ~25% in pre-frail older women.

P=0.003
n=60

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Why the study?

Preventive or therapeutic interventions are key to maintaining independence in pre-frail or frail elderly, but the efficacy of multi-component interventions on physical fitness and vascular function in pre-frail older women needed investigation.

Does an 8-week multi-component intervention of protein-added healthy lunch-boxes combined with stepping aerobic exercise (with or without electromyostimulation) improve physical fitness and vascular function in community-dwelling pre-frail older women?

Key Points

To evaluate whether multi-component interventions combining protein-added meals with aerobic exercise and electromyostimulation improve physical fitness and vascular function in pre-frail older women.
Randomized controlled trial of 60 pre-frail women aged ≥ 65 years (mean age 81.5 ± 4.3 years) divided equally into control, diet, aerobic exercise plus diet, and aerobic exercise with electromyostimulation plus diet groups.
Over 8 weeks, intervention groups received protein-added meals twice daily on weekdays; exercise groups performed 45 minutes of stepping exercise at 50% to 70% maximal heart rate 3 days per week with or without limb electromyostimulation.
Outcomes included handgrip strength, Short Physical Performance Battery (SPPB), 6-minute walking distance, brachial flow-mediated dilation (FMD), pulse wave velocity, and cardiovascular blood biomarkers measured before and after 8 weeks.
Right-hand grip strength and high-density lipoprotein-cholesterol levels significantly increased across all dietary intervention groups after 8 weeks (p < 0.05), accompanied by a significant reduction in frailty status (interaction p = 0.007).
Short Physical Performance Battery scores, 6-minute walking distance, and flow-mediated dilation significantly improved in the aerobic exercise and diet group (FMD: 3.1 ± 0.9% to 3.9 ± 0.8%, Δ25.8%) and the aerobic exercise with electromyostimulation and diet group (FMD: 3.1 ± 0.9% to 4 ± 1.2%, Δ25%) (p < 0.05).
Blood pressure, pulse wave velocity, glucose, HbA1c, total cholesterol, low-density lipoprotein-cholesterol, triglycerides, insulin, HOMA-IR, nitric oxide, and C-reactive protein levels showed no significant differences between interventions.

Study Design

Type

RCT (n=60)

Blinding

Single-blind

Randomization

Four-arm, equal random allocation (1:1:1:1) using a random sequence generator

Multicenter

Yes

Structured PICO

Does an 8-week multi-component intervention of protein-added healthy lunch-boxes combined with stepping aerobic exercise (with or without electromyostimulation) improve physical fitness and vascular function in community-dwelling pre-frail older women?

P

Population

60 community-dwelling pre-frail older women (mean age 81.5 years, 100% female) in South Korea, free of severe cardiovascular disease or cancer, followed for 8 weeks.

I

Intervention

8-week supervised multi-component intervention divided into three active arms: 1) Diet group (DG): personalized protein-added healthy lunch-boxes (20 g, 30 g, or 40 g protein per serving; target ~1500 kcal/day and 0.8 g/kg/day protein) twice daily (lunch and dinner) on weekdays; 2) Aerobic exercise + diet group (ADG): same dietary intervention plus 45-min supervised stepping aerobic exercise at 50-60% HRmax (reported as 50-70% in abstract) 3 days/week; 3) Aerobic exercise with electromyostimulation + diet group (AEDG): same diet and aerobic stepping exercise plus simultaneous limb electromyostimulation (4 Hz, 2-s stimulation/2-s recess, moderate intensity RPE 5-6 on upper and lower extremities).

C

Comparator

Control group (CG) instructed to maintain their usual level of daily activities during the 8-week intervention period without dietary supplementation or supervised exercise.

O

Outcome

Changes in physical fitness (handgrip strength, Short Physical Performance Battery [SPPB], walking speed, and 6-minute walk test) and vascular function (brachial-ankle pulse wave velocity [baPWV] and brachial artery flow-mediated dilation [FMD]) at 8 weeks.surrogate

Main Result

p-value: p=0.003

An 8-week community-based program combining protein-enriched meals with stepping aerobic exercise improves endothelial function (FMD), HDL-C, physical performance, and frailty status in pre-frail older women, whereas adding limb electromyostimulation provides no incremental benefit.

Limitations

Small sample size limiting generalizability to all pre-frail elderly women
Relatively short intervention period of 8 weeks
Dietary intervention was only provided on weekdays (5 days/week) and not on weekends due to financial and management constraints
Inability to control for chronic diseases such as diabetes, obesity, and high blood pressure
Lack of an exercise-only group to evaluate the independent dose-response relationship of exercise
Single-blind design only partially applied as participants spent time together at the senior community center
Small sample size (n=60 enrolled, n=56 completed), limiting generalizability
Relatively short intervention duration of 8 weeks
Lunch-boxes were provided only on weekdays (twice daily for 5 days/week) and not on weekends
Chronic diseases such as diabetes, obesity, and hypertension were not controlled
No exercise-alone group was included for comparison
Blinding was limited because participants spent time together at the senior community center

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Supports protein-enriched meals with aerobic exercise for pre-frail older women; extends RCT evidence for multi-component interventions on endothelial function and physical performance.

Abstract

Purpose: Preventive or therapeutic interventions are key to maintaining independence in pre-frail and/or frail elderly. Therefore, we investigated whether multi-component interventions were effective in physical fitness levels and vascular functions in pre-frail older women. Patients and Methods: Sixty participants aged ≥ 65 years (81.5 ± 4.3 yrs) were divided equally into control group, diet group, aerobic exercise and diet group, and aerobic exercise with electromyostimulation and diet group. For 8 weeks, the participants received a set of protein-added meals twice daily on weekdays. The aerobic exercise groups performed 45 mins of stepping exercise at 50-70% of the maximal heart rate for 3 days/week, and the aerobic exercise with electromyostimulation was applied on each limb in 8 weeks. Blood pressure, physical fitness, cardiovascular biomarkers, pulse wave velocity, and flow-mediated dilation were measured before and after the 8-week. Results: There were no group differences in age, height, weight, body mass index, free fat mass, and %body fat at baseline. The right grip strength significantly increased in the diet group, aerobic exercise and diet group, and aerobic exercise with electromyostimulation and diet group (p < 0.05). Short physical performance battery, 6-min walking distance, and flow-mediated dilation significantly increased in the aerobic exercise and diet group and aerobic exercise with electromyostimulation and diet group (p < 0.05). Blood pressure and pulse wave velocity did not differ between interventions. High-density lipoprotein-cholesterol levels significantly increased after 8 weeks in all intervention groups (p < 0.05). There were no significant differences in glucose, HbA1c, total cholesterol, low-density lipoprotein-cholesterol, triglyceride, insulin, Homeostatic Model Assessment for Insulin Resistance, nitric oxide, and C-reactive protein levels. Conclusion: These results show that multi-component interventions appear to improve physical fitness and vascular function in pre-frail older women. Thus, possible strategies to prevent early frailty including proper nutrition and exercise may be needed.

Discussion

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Cite This Study

Park et al. (2023) conducted an RCT in Pre-frailty in older women (n=60). Multi-component intervention: protein-added healthy lunch-boxes alone (DG), with stepping aerobic exercise (ADG), or with stepping aerobic exercise plus electromyostimulation (AEDG) vs. Control group maintaining usual daily activities was evaluated on Brachial artery flow-mediated dilation (FMD) and physical fitness (Short Physical Performance Battery [SPPB], 6-minute walk distance, and grip strength) at 8 weeks (p=0.003). Protein-added meals combined with aerobic exercise (with or without EMS) for 8 weeks significantly increased flow-mediated dilation by 25-25.8% (interaction p=0.003) and SPPB scores in pre-frail older women.

synapsesocial.com/papers/6a787e3d1400807f0f1f0e58 https://doi.org/10.2147/cia.s391700

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Protein-Added Healthy Lunch-Boxes Combined with Exercise for Improving Physical Fitness and Vascular Function in Pre-Frail Older Women: A Community-Based Randomized Controlled Trial

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Protein-Added Healthy Lunch-Boxes Combined with Exercise for Improving Physical Fitness and Vascular Function in Pre-Frail Older Women: A Community-Based Randomized Controlled Trial

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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