背景:衰弱是影响老年人的常见综合征,使他们有住院的风险。需要照顾或死亡。虚弱的最初迹象包括肌肉力量下降和活动能力下降。随着年龄增长,活动能力下降的主要原因是肌肉减少症(与年龄相关的肌肉力量和质量降低)。营养不良会导致肌肉减少症。蛋白质的短缺与肌肉质量和力量的减少有关。这可能是由于摄入不足,也是因为老年人对蛋白质的需求较高,尤其是那些多重性的。我们需要开发有效的治疗方法来减少或减缓虚弱和活动能力下降的发生。锻炼是一种推荐的治疗方法。解决蛋白质不足的蛋白质补充剂有可能增强虚弱或虚弱前老年人定期运动的益处。这一点尚未得到明确证明。目的建立对60岁以上体弱或体弱且蛋白质摄入量低的人进行RCT评估有或没有蛋白质补充剂的移动性和力量训练的可行性。方法多中心,平行,2组,可行性RCT。参与者(招募目标=50)行走有问题,将从四个NHS物理治疗社区服务中招募低蛋白质摄入量并分类为虚弱或虚弱前。参与者将被随机分配(安全计算机生成:1:1)接受24周的流动性和力量训练(以16组课程和家庭练习进行)或24周的流动性和力量训练,每天补充蛋白质。主要可行性目标是估计1)筛选和招募合格参与者的能力,2)干预保真度,坚持,和耐受性,以及3)参与者在随访中的保留。次要目标是1)测试数据收集程序,2)评估数据的完整性和3)确认确定的RCT的样本量计算。注册ISRCTN注册(ISRCTN30405954;18/10/2022)。
随着年龄的增长,他们可能会变得虚弱,无法应对疾病或伤害。虚弱的人更有可能跌倒或需要护理。我们需要找到方法来阻止人们变得虚弱或减缓虚弱的进展,以便老年人能够独立生活。运动是一种治疗虚弱的方法,可以改善肌肉力量和行走。在老年人的饮食中加入额外的蛋白质也可能有所帮助。蛋白质为肌肉提供了基石,但是许多老年人没有吃足够的蛋白质。运动时摄入额外的蛋白质可能会增加运动的好处,但是我们不知道它是否可以减少虚弱或改善步行和生活质量。我们希望进行一项大型临床试验,将移动性和力量训练加上额外的蛋白质与单独训练进行比较。这项研究旨在通过以下发现来测试是否可以进行大型试验:•我们可以招募足够的蛋白质摄入量低的参与者吗?•参与者是否参加了运动课程并服用了蛋白质补充剂?•参与者是否参加了后续评估?我们的目标是招募多达50名虚弱/有虚弱风险且蛋白质摄入量低的老年人。我们将通过NHS社区信托基金确定参与者,从现有的队列研究和社区广告。参与者被随机分配到训练加蛋白质或仅训练。训练包括肌肉加强,balance,步行练习。参与者将与物理治疗师一起参加每周一次的运动课程,为期16周,并每周在家锻炼一次。然后要求他们每周两次在家锻炼,再持续8周。一半的参与者在运动时会摄取额外的蛋白质。入学时和8个月后,我们收集关于脆弱的信息,行走能力,肌肉力量和生活质量。
Background Frailty is a common syndrome affecting older people and puts them at risk of hospitalisation, needing care or death. First signs of frailty include reduced muscle strength and
mobility decline. A key cause of
mobility decline as we age is sarcopenia (age related reduction in muscle strength and mass). Poor nutrition contributes to sarcopenia. A shortfall in protein is associated with reduced muscle mass and strength. This may be due to inadequate intake but also because older people have higher protein needs, especially those with multimorbidity. We need to develop effective treatment to reduce or slow the onset of frailty and mobility decline. Exercise is a recommended treatment. Protein supplements to address the shortfall in protein have the potential to enhance the benefit of regular exercise in frail or pre-frail older adults. This has yet to be definitively demonstrated. Aim To establish the feasibility of conducting an RCT evaluating mobility and strength training with or without protein supplements for people over 60 years old who are frail or pre-frail with a low protein intake. Methods A multicentre, parallel, 2-group, feasibility RCT. Participants (recruitment target = 50) with problems walking, low protein intake and classified as frail or pre-frail will be recruited from four NHS Physiotherapy community services. Participants will be randomised (secure computer-generated: 1:1) to receive 24 weeks of mobility and strength training (delivered in 16 group sessions plus home exercises) or 24 weeks of mobility and strength training with daily protein supplements. Primary feasibility objectives are to estimate 1) ability to screen and recruit eligible participants, 2) intervention fidelity, adherence, and tolerance and 3) retention of participants at follow up. Secondary objectives are to 1) test data collection procedures, 2) assess data completeness and 3) confirm sample size calculation for a definitive RCT. Registration ISRCTN Registry (ISRCTN30405954; 18/10/2022).
As people get older, they may become frail and become less able to deal with illness or injury. People with frailty are more likely to fall or need care. We need to find ways to stop people becoming frail or slow the progress of frailty so older people can live independently. Exercise is a treatment for frailty that can improve muscle strength and walking. Including extra protein in an older person’s diet may also help. Protein provides the building blocks for muscles, but many older people do not eat enough protein. Taking extra protein while exercising may increase the benefits of exercise, but we do not know if it reduces frailty or improves walking and quality of life. We want to conduct a large clinical
trial comparing
mobility and strength training plus extra protein to training alone. This
study aims to test if it is possible to carry out a large
trial by finding out: • Can we recruit enough participants with low protein intake? • Do participants attend the exercise classes and take the protein supplements? • Do participants attend follow-up assessments? We aim to recruit up to 50 older people who are frail/at risk of frailty and have low protein intake. We will identify participants via NHS Community Trusts, from an existing cohort
study and by advertising in the community. Participants are randomly allocated to training plus protein or training only. Training involves muscle strengthening, balance, and walking exercises. Participants will attend a weekly exercise class with a physiotherapist for 16 weeks and do exercises at home once/week. They are then asked to exercise at home twice weekly for a further 8 weeks. Half the participants will take extra protein while exercising. At enrolment and 8 months later, we collect information on frailty, walking ability, muscle strength and quality of life.