Dietary protein and resistance exercise training for community-dwelling older adults : Intervention adaptation, implementation and effectiveness

The number of older adults is increasing worldwide, and more emphasis is placed on aging in place in good health and with good quality of life. The age related loss of muscle mass, strength and function can negatively impact the ability of older adults to live independently and perform activities of daily living. Dietary protein and resistance exercise training are strategies to counteract these age related declines. In this research, we adapted an efficacious clinical intervention combining protein supplementation and resistance exercise to practice, and evaluated the implementation and effectiveness of this intervention in Dutch healthcare practice in a randomised controlled multicentre study. Community-dwelling older adults participated in resistance exercise training under supervision of a physiotherapist, and received counselling by a dietitian to increase their dietary protein intake using protein-rich foods. A moderate support intervention period was added to assist participants in continuing their adapted lifestyle. The intervention was effective in improving aspects of physical functioning, muscle strength and lean body mass as compared to a control group. In addition, the intervention was well received by participants and healthcare professionals, and was perceived feasible to implement in Dutch healthcare practice. The research described in this thesis shows that it is possible to systematically adapt an efficacious lifestyle intervention to practice. Future attention is warranted for ensuring optimal intervention intensity and implementation, achieving long-term intervention success, and specifying the target population in practice.