I NTERACTION BETWEEN NUTRITION AND EXERCISE Olivier Bruyre - - PowerPoint PPT Presentation

INTERACTION BETWEEN NUTRITION

AND EXERCISE

Olivier Bruyère

University of Liege, Belgium

EUGMS-IOF-ESCEO Symposium

 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
• n which to base public health and clinical recommendations

OBJECTIVE:

To provide an update to that systematic review and to focus on whether additional benefits arose if dietary supplementation was combined with exercise training

 DATABASES: MEDLINE/Ovid and EMBASE/Ovid  INCLUSION CRITERIA: Same inclusion criteria as the previous SR  EXCLUSION CRITERIA: Nutritional intervention = energy restriction to promote weight loss ; populations with a specific health condition (e.g. cirrhosis, cancer, diabetes, chronic kidney disease, etc.)  STUDY SELECTION AND DATA EXTRACTION : Two independant researchers  STUDY QUALITY: Jadad score

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

 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  PRESENTATION 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 Countries

• 12/37 Europe
• 11/37 USA/Canada
• 7/37 Asia
• 4/37 South America
• 3/37 Australia

Mean age of participants

• 60 – 87 years

Sex

• 22/37 mixed men/women
• 10/37 only women
• 5/37 only men

Sample 17-222 subjects Follow-up 4 weeks – 18 months Jadad score

• 12/37 excellent quality
• 15/37 good quality
• 10/37 poor quality

Methodology

• 22/37 two-group comparison (exercise + nutrition / exercise only)
• 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

PROTEINS

 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 increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect 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

ESSENTIAL 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 increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect 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

(only for SPPB and TUG)

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

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 increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect 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

(only for TUG)

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

MULTI-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 increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect 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

CREATINE

 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 increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect 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

some of muscle strength outcomes)

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

VITAMIN D

 2 studies

• 1/2 assessed effect on muscle mass
• 2/2 assessed effect on muscle strength
• 2/2 assessed effect on physical performance

 400IU/day during 9 months / 50000IU during 8 weeks (with 100000IU once at study entry)  1 good quality / 1 low quality  Results:

Muscle mass Muscle strength Physical performance Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect 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 (for

some of physical performance

• utcomes)

1/2 RCTs (only

for TUG)

Other 4/6 RCTs 0/6 RCTs 3/5 RCTs 0/5 RCTs 4/5 RCTs 2/5 RCTs

OTHER

 6 studies

• 6/6 assessed effect on muscle mass
• 5/6 assessed effect on muscle strength
• 5/6 assessed effect on physical performance

 12 weeks – 6 months  Green tea, magnesium oxide, milk fat globule membrane, soy isoflavones, vitamin and mineral-enhanced dairy and fruit products, tea catechin  Good quality of studies  Results:

Muscle mass Muscle strength Physical performance Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect with nutrition Significant increase with exercises Significant added effect 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

Effet of interventions on:

 Muscle mass:

• Increase with physical exercises : 80% of RCTs (27/34)
• No results: frail subjects with limited mobility
• Additional effect of nutrition : 23.5 % of RCTs (8/34)
• 4 using creatine, 3 using proteins, 1 using HMB

 Muscle strenght:

• Increase with physical exercises : 83% of RCTs (29/35)
• Additional effect of nutrition : 23 % of RCTs (8/35)
• 4 using creatine, 3 using proteins, 1 using multi-nutrient

 Physical performance

• Increase with physical exercises : 93% of RCTs (26/28)
• No results : frail subjects / hospitalized subjects
• Additional effect of nutrition : 18 % of RCTs (5/28)
• 1 using multi-nutrient, 1 using creatine, one using vitamin D, one using tea catechin, one using magnesium
• xide

High effect of physical activity Limited added effect of nutrition

 Most of studies performed on healthy subjects

 It seems likely that nutritional interventions in populations who are presenting nutritional or physical deficiencies would be more beneficial than interventions in well-nourished and replete populations.

 No studies performed on sarcopenic subjects  Specificity of the product ?  Need of a rigorous documentation of:

 subject’s baseline exercise level  nutritional status BEFORE implementation of RCTs