Effectiveness of exercise and protein supplementation intervention on body composition, functional fitness, and oxidative stress among elderly Malays with sarcopenia

Figures & data

Table 1 Baseline characteristic according to intervention group

Baseline characteristics	Study groups				ANCOVA (two-way)
	CG n = 16	ExG n = 19	PrG n = 15	ExG+PrG n = 15	P-value
Age (year)	67.25 ± 5.48	69.74 ± 5.46	65.93 ± 4.37	65.20 ± 4.87	0.083
Weight (kg)	67.36 ± 11.88	60.49 ± 10.66	61.39 ± 12.73	65.53 ± 12.40	0.203
BMI (kg/m^2)	26.36 ± 3.19	23.71 ± 3.46	24.26 ± 4.37	26.47 ± 4.75	0.103
Body fat (%)	28.82 ± 6.89	25.25 ± 6.57	27.51 ± 9.17	31.97 ± 9.62	0.079
FFM (kg)	48.68 ± 8.1	44.4 ± 7.4	44.0 ± 8.1	43.9 ± 7.7	0.276
Muscle (kg)	22.94 ± 5.29	20.95 ± 4.23	20.57 ± 4.70	20.73 ± 4.69	0.462
Body water (%)	55.77 ± 4.04	57.91 ± 3.42	56.29 ± 4.96	53.75 ± 5.17	0.370
IADl score	7.59 ± 0.88	7.37 ± 0.89	8.00 ± 0.00	7.53 ± 0.64	0.094
IPAQ score	1699.35 ± 153.49	1330.48 ± 954.33	1467.20 ± 842.66	1479.18 ± 724.35	0.691
Calorie (Kcal)	1377.76 ± 153.49	1452.70 ± 192.91	1320.86 ± 111.43	1377.76 ± 153.49	0.132
Carbohydrate (Kcal)	191.75 ± 27.10	225.81 ± 35.55	187.80 ± 22.89	199.23 ± 22.65	0.001*
Protein (g)	61.07 ± 9.32	54.89 ± 8.86	49.96 ± 11.70	55.63 ± 5.85	0.014*
Fat (g)	40.79 ± 10.39	36.05 ± 4.72	41.15 ± 6.40	39.32 ± 10.91	0.261

Notes: Values are expressed as mean ± SD.

* P < 0.05 is significant with baseline measurement used as covariates on ANCOVA analysis.

Abbreviations: ANCOVA, analysis of covariance; BMI, body mass index; CG, control group; ExG, exercise group; ExG+PrG, combined exercise and protein supplementation group; FFM, fat-free mass; IADL, instrumental activity of daily living; IPAQ, international physical activity questionnaire; PrG, protein suplementation group; SD, standard deviation.

Table 2 Profile of anthropometry and body composition at baseline, 6 weeks, and 12 weeks of intervention, according to intervention group

Anthropometric measurement	Study groups				ANCOVA (two-way)
	CG n = 16	ExG n = 19	PrG n = 15	ExG+PrG n = 15	Group effect	Time effect	Interaction effect
Weight (kg)
Baseline	67.36 ± 11.88	59.49 ± 10.66	61.39 ± 12.73	65.53 ± 12.40	0.404	0.083	0.027)
6 weeks	63.98 ± 10.44	59.03 ± 10.28	63.12 ± 11.16	66.43 ± 12.56	(0.048)	(0.041)	(0.112)
12 weeks	65.99 ± 10.85	59.78 ± 10.89	60.11 ± 11.48	66.18 ± 12.70
BMI (kg/m^2)
Baseline	26.36 ± 3.19	23.71 ± 3.46	24.26 ± 4.37	26.47 ± 4.75	0.315	0.029*	0.041*
6 weeks	25.31 ± 2.47	23.38 ± 3.03	24.87 ± 3.48	26.47 ± 4.52	(0.058)	(0.058)	(0.104)
12 weeks	25.91 ± 2.96	23.93 ± 3.61	23.82 ± 4.16	26.45 ± 4.65
Body fat (%)
Baseline	28.82 ± 6.89	25.25 ± 6.57	27.51 ± 9.17	31.97 ± 9.62	0.332	0.480	0.023*
6 weeks	25.67 ± 8.38	24.32 ± 6.34	28.41 ± 9.89	29.69 ± 10.89	(0.056)	(0.012)	(0.115)
12 weeks	27.83 ± 6.99	22.32 ± 9.93	27.37 ± 10.30	32.28 ± 9.64
FFM (kg)
Baseline	48.60 ± 8.07	44.38 ± 7.38	44.02 ± 8.14	43.96 ± 7.74	0.209	0.184	0.005*
6 weeks	46.38 ± 8.15	45.04 ± 7.73	44.67 ± 7.52	46.08 ± 8.72	(0.073)	(0.028)	(0.143)
12 weeks	47.73 ± 7.39	46.74 ± 8.13	43.09 ± 7.61	44.09 ± 8.57
Muscle (kg)
Baseline	22.94 ± 5.29	20.95 ± 4.23	20.57 ± 4.70	20.73 ± 4.69	0.574	0.384	0.111
6 weeks	20.98 ± 5.27	20.82 ± 4.23	21.49 ± 4.11	21.98 ± 5.26	(0.033)	(0.016)	(0.083)
12 weeks	22.68 ± 4.22	21.29 ± 4.64	20.29 ± 4.31	21.02 ± 5.11
Body water (%)
Baseline	55.05 ± 4.04	57.91 ± 3.42	56.29 ± 4.96	53.75 ± 5.17	0.006	0.036	0.000
6 weeks	63.83 ± 13.84	58.22 ± 3.62	52.92 ± 8.75	55.73 ± 6.08	(0.190)	(0.055)	(0.240)
12 weeks	56.31 ± 3.51	65.46 ± 12.21	55.59 ± 5.68	53.27 ± 4.87

Notes: Values are expressed as mean ± SD.

* P < 0.05 significant effect using ANCOVA, with sarcopenia status and sex as covariates.

Abbreviations: ANCOVA, analysis of covariance; BMI, body mass index; CG, control group; ExG, exercise group; ExG+PrG, combined exercise and protein supplementation group; FFM, fat-free mass; PrG, protein suplementation group; SD, standard deviation.

Table 3 Functional fitness test at baseline, 6 weeks, and 12 weeks of intervention, according to intervention groups

Functional fitness test	Study groups				ANCOVA (two-way)
	CG n = 16	ExG n = 19	PrG n = 15	ExG+PrG n = 15	Group effect	Time effect	Interaction effect
Chair Stand Test (times)
Baseline	11.23 ± 4.44	14.29 ± 4.95	9.60 ± 2.26	10.32 ± 3.01	0.000*	0.000*	0.002*
6 weeks	12.15 ± 3.37	16.19 ± 4.67	11.42 ± 2.41	16.53 ± 3.31	(0.280)	(0.161)	(0.165)
12 weeks	12.39 ± 4.17	17.69 ± 6.54	16.63 ± 3.03	16.80 ± 3.93
Arm Curl Test (times)
Baseline	18.39 ± 5.88	12.20 ± 3.42	11.47 ± 2.89	13.39 ± 2.25
6 weeks	19.92 ± 8.42	23.17 ± 6.73	15.95 ± 3.37	24.87 ± 6.16	0.033*	0.001*	0.001*
12 weeks	16.37 ± 4.02	18.01 ± 5.70	15.68 ± 2.52	18.53 ± 3.76	(0.186)	(0.109)	(0.181)
Chair Sit and Reach (mm)
Baseline	5.87 ± 12.85	5.17 ± 11.98	1.52 ± 14.07	−3.27 ± 10.00
6 weeks	5.29 ± 3.06	11.16 ± 6.48	3.43 ± 11.68	2.57 ± 7.81	0.065	0.576	0.414
12 weeks	0.32 ± 10.50	2.60 ± 8.43	−2.53 ± 7.76	−1.40 ± 8.53	(0.114)	(0.009)	(0.049)
Backscratch (mm)
Baseline	−9.98 ± 16.67	−2.02 ± 12.16	−11.89 ± 13.19	−10.36 ± 10.38
6 weeks	−13.53 ± 11.39	−9.82 ± 9.70	−10.89 ± 14.41	−2.03 ± 17.84	0.252	0.542	0.112
12 weeks	−20.07 ± 12.66	−16.83 ± 9.65	−18.18 ± 8.45	−20.27 ± 12.38	(0.066)	(0.010)	(0.082)
8-Foot Up and Go (s)
Baseline	7.34 ± 2.36	8.54 ± 2.41	8.26 ± 1.91	8.39 ± 0.83
6 weeks	7.39 ± 1.61	6.55 ± 1.20	7.73 ± 1.38	5.95 ± 1.44	0.336	0.567	0.016*
12 weeks	8.65 ± 5.53	6.69 ± 1.85	5.92 ± 4.92	6.16 ± 1.39	(0.055)	(0.010)	(0.122)
Six-minute Walk (m)
Baseline	343.48 ± 117.99	360.66 ± 162.03	335.97 ± 87.63	321.17 ± 49.75
6 weeks	349.38 ± 88.19	400.82 ± 85.07	380.31 ± 63.80	366.86 ± 54.83	0.462	0.481	0.939
12 weeks	359.18 ± 152.93	412.71 ± 136.49	360.71 ± 93.23	377.23 ± 53.96	(0.042)	(0.012)	(0.015)
Handgrip Strength (kg)
Baseline	21.42 ± 8.41	20.37 ± 5.64	19.75 ± 9.02	20.80 ± 8.23
6 weeks	19.53 ± 6.85	20.18 ± 5.49	18.02 ± 7.03	24.33 ± 7.68	0.140	0.124	0.167
12 weeks	18.64 ± 5.46	19.03 ± 6.32	16.87 ± 7.61	19.27 ± 6.92	(0.088)	(0.035)	(0.073)

Notes: Values are expressed as mean ± SD.

* P < 0.05 significant effect using ANCOVA with sarcopenia status and sex as covariates.

Abbreviations: ANCOVA, analysis of covariance; CG, control group; ExG, exercise group; ExG+PrG, combined exercise and protein supplementation group; PrG, protein suplementation group; SD, standard deviation.

Figure 1 Percent changes in Chair Stand Test results, in the different intervention groups during the 12-week intervention.

Notes: Values are expressed as mean ± SD. *Significant differences at P < 0.05 from baseline.

Abbreviations: CG, control group; ExG, exercise group; ExG+PrG, combined exercise and protein supplementation group; PrG, protein suplementation group; SD, standard deviation; s, seconds.

Figure 2 Percent changes in Arm Curl Test results, in the different intervention groups during the 12-week intervention.

Notes: Values are expressed as mean ± SD. *Significant differences at P < 0.05 from baseline.

Abbreviations: CG, control group; ExG, exercise group; ExG+PrG, combined exercise and protein supplementation group; PrG, protein suplementation group; SD, standard deviation; s, seconds.

Figure 3 Percent changes in 8-Foot Up and Go Test results, in the different intervention groups during the 12-week intervention.

Notes: Values are expressed as mean ± SD. *Significant differences at P < 0.05 from baseline.
Abbreviations: CG, control group; ExG, exercise group; ExG+PrG, combined exercise and protein supplementation group; PrG, protein suplementation group; SD, standard deviation.

Table 4 Measurement of oxidative stress markers at baseline, 6 weeks, and 12 weeks, according to intervention group

	Intervention group				ANCOVA (two way)
	Control (n = l6)	Exercise (n = l9)	Protein supplementation (n = 15)	Exercise + protein supplementation (n = l5)	Group effect	Time effect	Interaction effect
Protein carbonyl (nmol/L)
Baseline	0.03 ± 0.01	0.02 ± 0.01	0.02 ± 0.01	0.02 ± 0.01	0.039*	0.026*	0.092
6 weeks	0.02 ± 0.01	0.02 ± 0.02	0.02 ± 0.01	0.01 ± 0.01	(0.133)	(0.061)	(0.088)
12 weeks	0.02 ± 0.01	0.02 ± 0.02	0.02 ± 0.01	0.01 ± 0.01
Superoxide dismutase (specific activity)
Baseline	7.4 × 10^−4 ± 4.4 ×10^−4	10.2 × 10^−4 ± 5.3 × 10^−4	5.7 × 10^−4 ± 2.6 × 10^−4	6.3 × 10^−4 ± 1.7 ×10^−4	0.169	0.000*	0.000*
6 weeks	8.2 × 10^−4 ± 4.6 × 10^−4	6.2 × 10^−4 ± 2.8 × 10^−4	8.1 × 10^−4 ± 2.8 × 10^−4	6.9 × 10^−4 ± 3.7 × 10^−4	(0.083)	(0.138)	(0.236)
12 weeks	9.1 × 10^−4 ± 3.5 × 10^−4	6.3 × 10^−4 ± 3.7 × 10^−4	10.9 × 10^−4 ± 3.7 × 10^−4	6.3 × 10^−4 ± 2.6 × 10^−4
Lipid hydroperoxide (mmol/L)
Baseline	3.48 ± 1.07	2.54 ± 0.66	3.50 ± 1.09	1.49 ± 1.59	0.010^a	0.044^a	0.180
6 weeks	2.05 ± 1.63	3.03 ± 1.37	3.64± 1.19	2.85 ± 1.75	(0.175)	(0.053)	(0.073)
12 weeks	2.15 ± 1.27	2.41 ± 1.07	2.83 ± 0.78	2.71 ± 1.14
IL-6 (pg/mL)
Baseline	2.45 ± 1.29	1.89 ± 0.64	2.22 ± 0.59	2.49 ± 0.67	0.792	0.912	0.385
12 weeks	1.76 ± 0.74	1.87 ± 0.82	1.97 ± 1.06	1.93 ± 0.83	(0.017)	(0.000)	(0.050)
IGF-I (pg/mL)
Baseline	91.31 ±33.79	80.96 ± 26.77	78.11 ±29.89	81.28 ± 17.32	0.197	0.254	0.806
12 weeks	98.74 ± 17.65	91.81 ± 32.14	77.3 1 ± 25.03	91.06 ± 34.88	(0.076)	(0.022)	(0.016)
Orexin (ng/mL)
Baseline	0.42 ± 0.12	0.66 ± 0.19	0.34 ± 0.16	0.49 ± 0.10	0.593	0.073	0.593
12 weeks	0.31 ± 0.21	0.28 ± 0.19	0.28 ± 0.3 1	0.29 ± 0.14	(0..032)	(0.054)	(0.032)

Notes: Values are expressed as mean + SD.

* P < 0.05 significant effect using ANCOVA with sarcopenia status and sex as covariates.

Abbreviations: ANCOVA, analysis of covariance; IGF, insulin-like growth factor; IL, interleukin.