I NTERACTION BETWEEN NUTRITION AND EXERCISE Olivier Bruyère University of Liege, Belgium EUGMS-IOF-ESCEO Symposium
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PREVENTIVE AND THERAPEUTIC INTERVENTIONS FOR SARCOPENIA • Physical activity positive impact on muscle strenght and physical performance (muscle mass?) Best results with resistance training • Nutrition role of proteins , β -hydroxy β -methylbutyric acid, amino acid suggested by some studies Combined effect of physical activity AND nutrition on muscle mass, muscle strenght and physical performance ?? One Systematic Review published in 2015 : • Literature search performed in 2013 • 17 studies involving older adults ( ≥ 65 years) • Conclusion of the authors : further studies were required to provide adequate evidence on which to base public health and clinical recommendations
O BJECTIVE : To provide an update to that systematic review and to focus on whether additional benefits arose if dietary supplementation was combined with exercise training
D ATABASES : MEDLINE/Ovid and EMBASE/Ovid I NCLUSION CRITERIA : Same inclusion criteria as the previous SR Design Randomized controlled trials Participants Human, men and women aged 60 years and older Exposure Studies which include at least two groups of comparison: a control group with only exercise intervention and a treated group with combined exercise intervention and nutritional intervention. Exercise intervention can be resistance exercise, aerobic exercise or other. Nutrition intervention involves the provision of nutrients supplied with either a supplement or food Outcome Outcomes on muscle mass, on muscle strength, or on physical performance. Language English only Date Studies published between April 2013 and end of October 2015 E XCLUSION CRITERIA : Nutritional intervention = energy restriction to promote weight loss ; populations with a specific health condition (e.g. cirrhosis, cancer, diabetes, chronic kidney disease, etc.) S TUDY SELECTION AND DATA EXTRACTION : Two independant researchers S TUDY QUALITY : Jadad score
993 studies identified through electronic database searches 20 new RCTs published since April 2013 17 RCTS identified by Denison et al. + 20 new RCTs = 37 RCTs included in this SR P RESENTATION BY NUTRITIONAL SUPPLEMENT : Proteins (n=13) Essential amino acids (EAA) (n=3) β -hydroxy- β -methylbutyrate (HMB) (n=3) Multi-nutrient (n=5) Creatine (n=5) Vitamin D (n=2) Other (n=6)
Characteristics of included studies: Publication year 1980-2016 • 12/37 Europe Countries • 11/37 USA/Canada • 7/37 Asia • 4/37 South America • 3/37 Australia • 60 – 87 years Mean age of participants • 22/37 mixed men/women Sex • 10/37 only women • 5/37 only men Sample 17-222 subjects Follow-up 4 weeks – 18 months • 12/37 excellent quality Jadad score • 15/37 good quality • 10/37 poor quality • 22/37 two-group comparison (exercise + nutrition / exercise only) Methodology • 11/37 four-group comparison (control group with no intervention / exercise only / nutrition only / exercise + nutrition) • 3/37 three-group comparison, 1/37 five group comparison we used only results from 2 groups; one receiving exercise + nutrition and one receiving exercise only 18/37 used a double blind
P ROTEINS 13 studies • 12/13 assessed effect on muscle mass • 12/13 assessed effect on muscle strength • 9/13 assessed effect on physical performance Dose varied from 7.4g to 45g of protein per day Good quality of studies (only 4 of poor quality) Results: Muscle mass Muscle strength Physical performance Significant Significant Significant Significant Significant Significant increase with added effect increase with added effect increase with added effect exercises with nutrition exercises with nutrition exercises with nutrition Protein 11/12 RCTs 3/12 RCTs 12/12 RCTs 3/12 RCTs 9/9 RCTs 0/9 RCTs EAA 2/3 RCTs 0/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs HMB 3/3 RCTs 1/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs Multinutrient 2/4 RCTs 0/4 RCTs 3/5 RCTs 1/5 RCTs 3/4 RCTs 0/4 RCTs Creatine 5/5 RCTs 4/5 RCTs 5/5 RCTs 4/5 RCTs 3/4 RCTs 1/4 RCTs Vitamin D 0/1 RCTs 0/1 RCTs 2/2 RCTs 0/2 RCTs 2/2 RCTs 1/2 RCTs Other 4/6 RCTs 0/6 RCTs 3/5 RCTs 0/5 RCTs 4/5 RCTs 2/5 RCTs
E SSENTIAL AMINO ACIDS 3 studies • 3/3 assessed effect on muscle mass • 3/3 assessed effect on muscle strength • 2/3 assessed effect on physical performance Dose varied from 6g to 12g per day (4 weeks-12 weeks) Good quality of studies (only 1 of poor quality) Results: Muscle mass Muscle strength Physical performance Significant Significant Significant Significant Significant Significant increase with added effect increase with added effect increase with added effect exercises with nutrition exercises with nutrition exercises with nutrition Protein 11/12 RCTs 3/12 RCTs 12/12 RCTs 3/12 RCTs 9/9 RCTs 0/9 RCTs EAA 2/3 RCTs 0/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs (only for SPPB and TUG) HMB 3/3 RCTs 1/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs Multinutrient 2/4 RCTs 0/4 RCTs 3/5 RCTs 1/5 RCTs 3/4 RCTs 0/4 RCTs Creatine 5/5 RCTs 4/5 RCTs 5/5 RCTs 4/5 RCTs 3/4 RCTs 1/4 RCTs Vitamin D 0/1 RCTs 0/1 RCTs 2/2 RCTs 0/2 RCTs 2/2 RCTs 1/2 RCTs Other 4/6 RCTs 0/6 RCTs 3/5 RCTs 0/5 RCTs 4/5 RCTs 2/5 RCTs
Β - HYDROXY - Β - METHYLBUTYRATE 3 studies • 3/3 assessed effect on muscle mass • 3/3 assessed effect on muscle strength • 2/3 assessed effect on physical performance 3g of Ca-HMB per day (8 weeks – 24 weeks) Good quality of studies Results: Muscle mass Muscle strength Physical performance Significant Significant Significant Significant Significant Significant increase with added effect increase with added effect increase with added effect exercises with nutrition exercises with nutrition exercises with nutrition Protein 11/12 RCTs 3/12 RCTs 12/12 RCTs 3/12 RCTs 9/9 RCTs 0/9 RCTs EAA 2/3 RCTs 0/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs HMB 3/3 RCTs 1/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs (only for TUG) Multinutrient 2/4 RCTs 0/4 RCTs 3/5 RCTs 1/5 RCTs 3/4 RCTs 0/4 RCTs Creatine 5/5 RCTs 4/5 RCTs 5/5 RCTs 4/5 RCTs 3/4 RCTs 1/4 RCTs Vitamin D 0/1 RCTs 0/1 RCTs 2/2 RCTs 0/2 RCTs 2/2 RCTs 1/2 RCTs Other 4/6 RCTs 0/6 RCTs 3/5 RCTs 0/5 RCTs 4/5 RCTs 2/5 RCTs
M ULTI - NUTRIENT 5 studies • 4/5 assessed effect on muscle mass • 5/5 assessed effect on muscle strength • 4/5 assessed effect on physical performance Poor quality of studies Results: Muscle mass Muscle strength Physical performance Significant Significant Significant Significant Significant Significant increase with added effect increase with added effect increase with added effect exercises with nutrition exercises with nutrition exercises with nutrition Protein 11/12 RCTs 3/12 RCTs 12/12 RCTs 3/12 RCTs 9/9 RCTs 0/9 RCTs EAA 2/3 RCTs 0/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs HMB 3/3 RCTs 1/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs Multinutrient 2/4 RCTs 0/4 RCTs 3/5 RCTs 1/5 RCTs 3/4 RCTs 0/4 RCTs Creatine 5/5 RCTs 4/5 RCTs 5/5 RCTs 4/5 RCTs 3/4 RCTs 1/4 RCTs Vitamin D 0/1 RCTs 0/1 RCTs 2/2 RCTs 0/2 RCTs 2/2 RCTs 1/2 RCTs Other 4/6 RCTs 0/6 RCTs 3/5 RCTs 0/5 RCTs 4/5 RCTs 2/5 RCTs
C REATINE 5 studies • 5/5 assessed effect on muscle mass • 5/5 assessed effect on muscle strength • 4/5 assessed effect on physical performance 5g per day in general (12 weeks – 6 months) Good quality of studies Results: Muscle mass Muscle strength Physical performance Significant Significant Significant Significant Significant Significant increase with added effect increase with added effect increase with added effect exercises with nutrition exercises with nutrition exercises with nutrition Protein 11/12 RCTs 3/12 RCTs 12/12 RCTs 3/12 RCTs 9/9 RCTs 0/9 RCTs EAA 2/3 RCTs 0/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs HMB 3/3 RCTs 1/3 RCTs 2/3 RCTs 0/3 RCTs 2/2 RCTs 0/2 RCTs Multinutrient 2/4 RCTs 0/4 RCTs 3/5 RCTs 1/5 RCTs 3/4 RCTs 0/4 RCTs Creatine 5/5 RCTs 4/5 RCTs 5/5 RCTs 4/5 RCTs (for 3/4 RCTs 1/4 RCTs some of muscle strength outcomes) Vitamin D 0/1 RCTs 0/1 RCTs 2/2 RCTs 0/2 RCTs 2/2 RCTs 1/2 RCTs Other 4/6 RCTs 0/6 RCTs 3/5 RCTs 0/5 RCTs 4/5 RCTs 2/5 RCTs
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