OBJECTIVES: To determine the effectiveness of combined exercise-nutrition interventions in prefrail/frail hospitalised older adults on frailty, frailty-related indicators, quality of life (QoL), falls and its cost-effectiveness. DESIGN: Randomised controlled trials (RCTs) of combined exercise-nutrition interventions on hospitalised prefrail/frail older adults >= 65 years were collated from Medline, Emcare, CINAHL, Ageline, Scopus, Cochrane and PEDro on 10 October 2019. The methodological quality was appraised, and data were summarised descriptively or by meta-analysis using a fixed effects model. The standardised mean difference (SMD) or difference of means (MD) with 95% CIs was calculated. RESULTS: Twenty articles from 11 RCTs experimenting exercise-nutrition interventions on hospitalised older adults were included. Seven articles were suitable for the meta-analyses. One study had low risk of bias and found improvements in physical performance and frailty-related biomarkers. Exercise interventions were mostly supervised by a physiotherapist, focusing on strength, ranging 2 to 5 times/week, of 20 to 90 min duration. Most nutrition interventions involved counselling and supplementation but had dietitian supervision in only three studies. The meta-analyses suggest that participants who received exercise-nutrition intervention had greater reduction in frailty scores (n = 3, SMD 0.25; 95% CI 0.03 to 0.46; p = 0.02) and improvement in short physical performance battery (SPPB) scores (n = 3, MD 0.48; 95% CI 0.12 to 0.84; p = 0.008) compared with standard care. Only the chair-stand test (n = 3) out of the three SPPB components was significantly improved (MD 0.26; 95% CI 0.09 to 0.43; p = 0.003). Patients were more independent in activities of daily living in intervention groups, but high heterogeneity was observed (I2 = 96%, p < 0.001). The pooled effect for handgrip (n = 3) +/- knee extension muscle strength (n = 4) was not statistically significant. Nutritional status, cognition, biomarkers, QoL, falls and cost-effectiveness were summarised descriptively due to insufficient data. CONCLUSIONS: There is evidence, albeit weak, showing that exercise-nutrition interventions are effective to improve frailty and frailty-related indicators in hospitalised older adults.
Reproduced with permission from the BMJ Publishing Group.

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