Effect of a combined exercise and nutrition program on sarcopenia in older adults: a randomised controlled trial in primary care
Sunghwan Ji
A B # , Ji Yeon Baek A # , Jin Go C , Chang Ki Lee D , Sang Soo Yu E , Hee-Won Jung A , Eunju Lee A * Il-Young Jang A *
A
B
C
D
E
# These authors contributed equally to this paper
Abstract
Sarcopenia, marked by the progressive decline of skeletal muscle mass and strength, is a significant health issue in aging populations. Primary care-based interventions may offer effective management strategies, yet randomised controlled trials evaluating these interventions are limited.
We conducted an unblinded, parallel-group randomised controlled trial at a public health centre in Korea responsible for primary care, enrolling participants aged ≥65 years with sarcopenia. Participants were randomised to either an intervention group (receiving a 12-week program of group exercises and nutritional support) or a control group (receiving lifestyle management education). The primary outcome was the change in gait speed over the intervention period. Secondary outcomes included changes in physical performance, grip strength, muscle mass, quality of life and frailty index.
A total of 86 participants were enrolled and randomised (intervention group: n = 43; control group: n = 43). The intervention group demonstrated significant improvements in gait speed (0.14 m/s (95% CI: 0.10–0.18) vs −0.04 m/s (95% CI: −0.08–0.00), P < 0.001), Short Physical Performance Battery scores, grip strength, quality of life and frailty index compared with the control group.
The 12-week exercise and nutrition intervention yielded significant gains in physical performance, grip strength, quality of life and frailty reduction among community-dwelling older adults with sarcopenia. These findings support the value of community-based, multicomponent interventions for managing sarcopenia. The trial is registered at Clinical Research Information Service (http://cris.nih/go.kr, registration number: KCT0008952).
Keywords: exercise, frailty, geriatrics, nutrition, older adults, preventive medicine, primary health, sarcopenia.
References
Aragon AA, Tipton KD, Schoenfeld BJ (2023) Age-related muscle anabolic resistance: inevitable or preventable? Nutrition Reviews 81(4), 441-454.
| Crossref | Google Scholar |
Baek JY, Lee E, Oh G, Park YR, Lee H, Lim J, Park H, Park CM, Lee CK, Jung H-W, Jang I-Y, Kim DH (2021a) The aging study of pyeongchang rural area (ASPRA): findings and perspectives for human aging, frailty, and disability. Annals of Geriatric Medicine and Research 25(3), 160-169.
| Crossref | Google Scholar |
Baek JY, Lee E, Jung H-W, Jang I-Y (2021b) Geriatrics fact sheet in Korea 2021. Annals of Geriatric Medicine and Research 25(2), 65-71.
| Crossref | Google Scholar |
Baek JY, Jung H-W, Kim KM, Kim M, Park CY, Lee K-P, Lee SY, Jang I-Y, Jeon OH, Lim J-Y (2023) Korean working group on sarcopenia guideline: expert consensus on sarcopenia screening and diagnosis by the Korean society of sarcopenia, the Korean society for bone and mineral research, and the Korean geriatrics society. Annals of Geriatric Medicine and Research 27(1), 9-21.
| Crossref | Google Scholar | PubMed |
Bernabei R, Landi F, Calvani R, Cesari M, Signore SD, Anker SD, Bejuit R, Bordes P, Cherubini A, Cruz-Jentoft AJ, Bari MD, Friede T, Ayestarán CG, Goyeau H, Jónsson PV, Kashiwa M, Lattanzio F, Maggio M, Mariotti L, Miller RR, Rodriguez-Mañas L, Roller-Wirnsberger R, Rýznarová I, Scholpp J, Schols AMWJ, Sieber CC, Sinclair AJ, Skalska A, Strandberg T, Tchalla A, Topinková E, Tosato M, Vellas B, Von Haehling S, Pahor M, Roubenoff R, Marzetti E (2022) Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project). BMJ 377, e068788.
| Crossref | Google Scholar | PubMed |
Brown JC, Harhay MO, Harhay MN (2016) Sarcopenia and mortality among a population-based sample of community-dwelling older adults. Journal of Cachexia, Sarcopenia and Muscle 7(3), 290-298.
| Crossref | Google Scholar | PubMed |
Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E (2014) Sarcopenia and physical frailty: two sides of the same coin. Frontiers in Aging Neuroscience 6, 192.
| Crossref | Google Scholar | PubMed |
Chan D-D, Tsou H-H, Chang C-B, Yang R-S, Tsauo J-Y, Chen C-Y, Hsiao C-F, Hsu Y-T, Chen C-H, Chang S-F, Hsiung CA, Kuo KN (2017) Integrated care for geriatric frailty and sarcopenia: a randomized control trial. Journal of Cachexia, Sarcopenia and Muscle 8(1), 78-88.
| Crossref | Google Scholar | PubMed |
Chen L-K, Woo J, Assantachai P, Auyeung T-W, Chou M-Y, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee W-J, Lee Y, Liang C-K, Lim J-Y, Lim WS, Peng L-N, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H (2020) Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. Journal of the American Medical Directors Association 21(3), 300-307.e302.
| Crossref | Google Scholar |
Cruz-Jentoft AJ, Sayer AA (2019) Sarcopenia. The Lancet 393(10191), 2636-2646.
| Crossref | Google Scholar |
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M, Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2 (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing 48(1), 16-31.
| Crossref | Google Scholar | PubMed |
Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, Bauer JM, Pahor M, Clark BC, Cesari M, Ruiz J, Sieber CC, Aubertin-Leheudre M, Waters DL, Visvanathan R, Landi F, Villareal DT, Fielding R, Won CW, Theou O, Martin FC, Dong B, Woo J, Flicker L, Ferrucci L, Merchant RA, Cao L, Cederholm T, Ribeiro SML, Rodríguez-Mañas L, Anker SD, Lundy J, Gutiérrez Robledo LM, Bautmans I, Aprahamian I, Schols JMGA, Izquierdo M, Vellas B (2018) International clinical practice guidelines for sarcopenia (ICFSR): screening, diagnosis and management. The Journal of nutrition, health and aging 22(10), 1148-1161.
| Crossref | Google Scholar | PubMed |
Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, Woo J, Aprahamian I, Sanford A, Lundy J, Landi F, Beilby J, Martin FC, Bauer JM, Ferrucci L, Merchant RA, Dong B, Arai H, Hoogendijk EO, Won CW, Abbatecola A, Cederholm T, Strandberg T, Gutiérrez Robledo LM, Flicker L, Bhasin S, Aubertin-Leheudre M, Bischoff-Ferrari HA, Guralnik JM, Muscedere J, Pahor M, Ruiz J, Negm AM, Reginster JY, Waters DL, Vellas B (2019) Physical frailty: ICFSR international clinical practice guidelines for identification and management. The Journal of nutrition, health and aging 23(9), 771-787.
| Crossref | Google Scholar | PubMed |
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of Gerontology 49(2), M85-M94.
| Crossref | Google Scholar | PubMed |
Ji S, Jung H-W, Baek JY, Jang I-Y, Lee E (2023) Geriatric medicine in South Korea: a stagnant reality amidst an aging population. Annals of Geriatric Medicine and Research 27(4), 280-285.
| Crossref | Google Scholar | PubMed |
Ji S, Baek JY, Go J, Lee CK, Yu SS, Lee E, Jung H-W, Jang I-Y (2025) Effect of exercise and nutrition intervention for older adults with impaired physical function with preserved muscle mass (functional sarcopenia): a randomized controlled trial. Clinical Interventions in Aging 20, 161-170.
| Crossref | Google Scholar |
Ko R-E, Moon SM, Kang D, Cho J, Chung CR, Lee Y, Hong YS, Lee SH, Lee JH, Suh GY (2021) Translation and validation of the Korean version of the clinical frailty scale in older patients. BMC Geriatrics 21(1), 47.
| Crossref | Google Scholar | PubMed |
Levis B, Benedetti A, Thombs BD (2019) Accuracy of patient health questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. Bmj 365, l1476.
| Crossref | Google Scholar | PubMed |
Lim WS, Cheong CY, Lim JP, Tan MMY, Chia JQ, Malik NA, Tay L (2022) Singapore clinical practice guidelines for sarcopenia: screening, diagnosis, management and prevention. The Journal of Frailty & Aging 11(4), 348-369.
| Crossref | Google Scholar | PubMed |
Noh K-W, Park S (2023) Effects of resistance exercise on older individuals with sarcopenia: sex differences in humans. Exercise Science 32(3), 255-265.
| Crossref | Google Scholar |
Oh M-K, Yoo J-I, Byun H, Chun S-W, Lim S-K, Jang YJ, Lee CH (2020) Efficacy of combined antigravity treadmill and conventional rehabilitation after hip fracture in patients with sarcopenia. The Journals of Gerontology: Series A 75(10), e173-e181.
| Crossref | Google Scholar |
Park S-H, Roh Y (2023) Which intervention is more effective in improving sarcopenia in older adults? A systematic review with meta-analysis of randomized controlled trials. Mechanisms of Ageing and Development 210, 111773.
| Crossref | Google Scholar | PubMed |
Park J, Kwon Y, Park H (2017) Effects of 24-week aerobic and resistance training on carotid artery intima-media thickness and flow velocity in elderly women with sarcopenic obesity. Journal of Atherosclerosis and Thrombosis 24(11), 1117-1124.
| Crossref | Google Scholar | PubMed |
Perera S, Mody SH, Woodman RC, Studenski SA (2006) Meaningful change and responsiveness in common physical performance measures in older adults. Journal of the American Geriatrics Society 54(5), 743-749.
| Crossref | Google Scholar | PubMed |
Phillips A, Strobl R, Vogt S, Ladwig K-H, Thorand B, Grill E (2017) Sarcopenia is associated with disability status – results from the KORA-Age study. Osteoporosis International 28(7), 2069-2079.
| Crossref | Google Scholar | PubMed |
Reginster J-Y, Beaudart C, Al-Daghri N, Avouac B, Bauer J, Bere N, Bruyère O, Cerreta F, Cesari M, Rosa MM, Cooper C, Cruz Jentoft AJ, Dennison E, Geerinck A, Gielen E, Landi F, Laslop A, Maggi S, Prieto Yerro MC, Rizzoli R, Sundseth H, Sieber C, Trombetti A, Vellas B, Veronese N, Visser M, Vlaskovska M, Fielding RA (2021) Update on the ESCEO recommendation for the conduct of clinical trials for drugs aiming at the treatment of sarcopenia in older adults. Aging Clinical and Experimental Research 33(1), 3-17.
| Crossref | Google Scholar | PubMed |
Sánchez JLC, Gallardo-Gómez D, Alfonso-Rosa RM, Cruz BdP, Ramos-Munell J, del Pozo-Cruz J (2025) Effectiveness of different types of exercise based-interventions in sarcopenia: a systematic review and meta-analysis. Geriatric Nursing 63, 635-642.
| Crossref | Google Scholar |
Seo M-W, Jung S-W, Kim S-W, Lee J-M, Jung H-C, Song J-K (2021) Effects of 16 weeks of resistance training on muscle quality and muscle growth factors in older adult women with sarcopenia: a randomized controlled trial. International Journal of Environmental Research and Public Health 18(13), 6762.
| Crossref | Google Scholar |
Shen Y, Shi Q, Nong K, Li S, Yue J, Huang J, Dong B, Beauchamp M, Hao Q (2023) Exercise for sarcopenia in older people: a systematic review and network meta-analysis. Journal of Cachexia, Sarcopenia and Muscle 14(3), 1199-1211.
| Crossref | Google Scholar | PubMed |
Tsekoura M, Kastrinis A, Katsoulaki M, Billis E, Gliatis J (2017) Sarcopenia and its impact on quality of life. In ‘GeNeDis 2016. Advances in experimental medicine and biology, Vol. 987’. (Ed. P Vlamos) pp. 213–218. (Springer) 10.1007/978-3-319-57379-3_19
Won CW (2023) Management of sarcopenia in primary care settings. Korean Journal of Family Medicine 44(2), 71-75.
| Crossref | Google Scholar | PubMed |
Won CW, Yang KY, Rho YG, Kim SY, Lee EJ, Yoon JL, Cho KH, Shin HC, Cho BR, Oh JR, Yoon DK, Lee HS, Lee YS (2002) The development of Korean activities of daily living(K-ADL) and Korean instrumental activities of daily living (K-IADL) scale. Journal of the Korean Geriatrics Society 6(2), 107-120.
| Google Scholar |
Wright AEH, Harrell HE (2022) Physical examination in the evaluation of dementia. Medical Clinics of North America 106(3), 471-482.
| Crossref | Google Scholar | PubMed |
Yeung SSY, Reijnierse EM, Pham VK, Trappenburg MC, Lim WK, Meskers CGM, Maier AB (2019) Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta-analysis. Journal of Cachexia, Sarcopenia and Muscle 10(3), 485-500.
| Crossref | Google Scholar | PubMed |
Yun JH, Kim DH, Chang MC (2021) A simple bedside exercise method to enhance lower limb muscle strength in moderate alzheimer’s disease patients with sarcopenia. Healthcare 9(6), 680.
| Crossref | Google Scholar |
Zhu L-Y, Chan R, Kwok T, Cheng KC-C, Ha A, Woo J (2019) Effects of exercise and nutrition supplementation in community-dwelling older Chinese people with sarcopenia: a randomized controlled trial. Age and Ageing 48(2), 220-228.
| Crossref | Google Scholar | PubMed |
