Wright J, et al. - This meta-analysis was performed to evaluate whether exercise combined with oral nutritional support (ONS) offered greater improvements in physical functioning, quality of life and nutritional status than nutrition intervention alone in nutritionally vulnerable older adults. Results indicated that combined exercise with ONS probably provide additional improvements in muscle strength but had no effect on other measures of physical functioning, nutritional status or morbidity in nutritionally vulnerable older adults.

Methods

• 3 electronic databases were explored for randomised controlled trials of older adults judged to be: sarcopenic, cachexic, frail, malnourished, and/or at risk of malnutrition, receiving ONS and exercise compared to nutrition intervention alone.
• Using a fixed-effect model, meta-analyses were performed to calculate standardised mean difference (SMD) (hand-grip strength, limb strength, gait speed, timed up-and-go test (TUG), physical activity level and fat-free mass) or relative risk (hospitalisation) with 95% confidence intervals (CIs).

Results

• This analysis consisted of 11 studies (n=1459 participants).
• ONS and exercise interventions varied considerably between studies.
•  There was very low quality evidence that exercise combined with ONS compared to nutrition intervention alone resulted in significant improvements in limb strength, (SMD = 0.33; 95% CI 0.13 to 0.53; P = 0.001) but low quality evidence of no effect on fat-free mass (SMD = -0.05; 95% CI -0.27 to 0.18; P = 0.70), physical activity level (SMD = 0.04; 95% CI -0.26 to 0.33; P = 0.81) and TUG (mean difference = -0.80; 95% CI -2.06 to 0.47; P = 0.22).
• Moderate quality evidence from a small number of studies found no effect on handgrip strength and QOL.
• Low quality evidence of faster gait speeds were found in participants receiving ONS alone compared to combined intervention (SMD = 0.38; 95% CI 0.19 to 0.56; P < 0.0001).