Table 3.
Characteristics of exercise and nutrition intervention and controls of included studies
| Study | Exercise intervention | Nutrition intervention | Control intervention |
| Arrieta et al39 | Type: strength—intensity range from low to high, starting at 10 repetition per exercise (UL, LL) with option of progressive loading. Aerobic, flexibility, balance—intensity individualised. Frequency: 2 sessions/week, duration per session NR+home exercises duration NR. Setting: inpatient (supervised, individual)+postdischarge (unsupervised, individual). Additional support reported: phone consults (by trainer 2×/month for first 6 months then monthly for 1 year); education resource. |
Self-guided education resource: provided with French National Nutrition Health Program education booklet—Programme National Nutrition Santé (PNNS). | Usual care: NR, variable between study sites. Self-guided education resource: provided with French National Nutrition Health Program education booklet—PNNS. |
| Rodriguez-Manas et al45 | Type: strength—40%–80% of estimated 1 RM, 8–10 repetitions (LL). Frequency: 2 weeks pretraining followed by 16-week programme of 2 days/week; 20–30 min/sessions. Setting: inpatient (supervised, individual). |
Nutrition counselling: 7 educational sessions, each 45 min, delivered by a trained researcher or nutritional therapist, twice a week over 3.5–4 weeks. Therapy focused on behavioural change, nutrition optimisation and diabetes. | Usual care: usual healthcare from local health system and/or general practitioner. |
| Niccoli et al40 | Type: strength, aerobic, flexibility, balance—intensity and target muscle group individualised based on patient’s baseline assessment. Frequency: individualised based on patient’s baseline assessment. Setting: inpatient (supervised, individual). |
Supplements: daily ONS with 24 g whey protein per day (9 g breakfast, 7.5 g at lunch and dinner) in addition to usual diet. | Usual care: usual medical care, no whey protein supplementation. Individual supervised exercise: individualised exercises as per intervention. |
| Luger et al33* | Type: strength—2 sets of 15 repetitions (UL, LL) until muscular exhaustion. Frequency: 2×/week, >30 min each session. Setting: postdischarge (supervised, individual). Additional support reported: physical education (2–3 times/week, 30 min each session); exercise education resource (demonstration DVD); motivational interviewing. |
Nutrition counselling: trained, supervised lay volunteers visit twice/week for dietary discussions aimed at achieving adequate energy, protein and other nutrients. Taught how to enrich food with protein, recipes, healthy for life plate which consists of food-cards and a play board. | Usual care with attention control: trained lay ‘buddies’ visit twice a week but doing a portfolio of possible activities (go out, have a chat and sharing interest), especially cognitive training. |
| Milte et al41 | Type: strength, balance (Otago exercise programme)—intensity and repetitions NR, at the discretion of the treating physiotherapist (LL). Frequency: 3 x/week, 20–30 min/session for 12 weeks. Setting: inpatient (supervised, individual)+postdischarge (supervised, individual). |
Nutrition counselling: individualised nutrition therapy aimed at improving energy and protein intake to meet requirements by dietitian who visits fortnightly. Meal programme: ordered as deemed necessary by dietitian. Supplements: commercial ONS recommended if needed by dietitian. |
Usual care: usual rehabilitation programme recommended during hospitalisation, social visits weekly from trial staff and generic nutrition, exercise and falls prevention information. |
| Cameron et al29† | Type: strength, balance, aerobic+WEBB programme—intensity and target muscle groups NR. Frequency: exercises prescribed 3–5×/week (with two sessions for mobility training) for 1 year, supported by up to 10 home visits. Setting: postdischarge (supervised, individual)+(unsupervised, individual). |
Nutrition counselling: clinical evaluation of nutritional intake at home. A series of diet intervention as needed by dietitian. Meal programme: ordered as deemed necessary by dietitian. Supplements: commercial ONS recommended if needed by dietitian. |
Usual care: usual healthcare during hospitalisation and from their general practitioner and community services after discharge. |
| Singh et al42 | Type: strength—80% of most recent 1 RM or RPE <15, 3 sets of 8 repetitions (UL, LL). Frequency: 2 sessions/week, session duration NR, over average of 80 sessions in 1 year, start as early as postassessment in hospital or at home. Setting: inpatient (supervised, individual)+(supervised, group-based). Additional support reported: monthly phone consults. |
Nutrition counselling: counselling on increase in diet quality, frequency NR. Supplements: ONS±dietary advice to increase daily energy (400–600 kcal) and protein (20 g/day) intake. For those calcium or vitamin D deficient (52%), 12 months of vitamin D orally (1000 IU/day) or calcium (1200 mg/day) and vitamin D combination supplement. Self-guided nutrition resource: food sources of calcium, vitamin D and sun exposure. |
Usual care: standard service offered for hip fracture in the area health service, including orthogeriatric care, rehabilitation service, other medical and allied health consultation as required and physiotherapy. |
| Villareal et al27‡ | Type: strength—65% of 1 RM; 8–12 repetitions of each exercise (UL, LL) with options for progression. Aerobic, ~65% of peak HR with gradual progression to 70%–85%. Flexibility, balance frequency: 90 min, 3 sessions/week. Setting: inpatient (supervised, group-based). |
Nutrition counselling: prescribed a balanced diet with energy deficit of 500–750 kcal/day from daily energy requirement, 1 g of high-quality protein/kg BW/day. Weekly group consultation with dietitian for adjustments of their caloric intake, goals and behavioural therapy. Supplements: 1500 mg calcium/day and ~1000 IU vitamin D/day. |
Usual care: general healthy lifestyle advice. Supplements: 1500 mg calcium/day and ~1000 IU vitamin D/day. |
| Azad et al46 | Type: ‘comprehensive exercise programme’; type, intensity and target muscle groups NR. Frequency: 11 sessions over 6 weeks+NR home exercises. Setting: inpatient (supervised, group-based), postdischarge (unsupervised, individual). |
Nutrition counselling: 3 sessions of individualised counselling about diet and nutrition in the management of CHF by dietitian. | Usual care: optimal medical care. |
| Blanc-Bisson et al43 | Type: strength—intensity (RM) NR, 10× repetitions each exercise (LB). Frequency: 30 min, twice/day, 5 days/week. Setting: inpatient (supervised, individual). |
Meal programme: geriatric hospital meals of 1800–2000 kcal/day. Supplements: 1 daily ONS of 200 kcal and 15 g protein. |
Usual care: from day 3 to 6, patients started to walk with human help with or without technical assistance in the physiotherapy room for three sessions per week until discharge. Individual supervised exercise: physiotherapy continued at home for 1 month. |
| Miller et al44 | Type: strength—intensity (RM) NR, 2 sets of 8 repetitions (LL) with progressive loading, at the discretion of the treating physiotherapist. Frequency: x/week, 20–30 min/session for 12 weeks. Setting: inpatient (supervised, individual)+postdischarge (supervised, individual). |
Nutrition counselling: individualised nutrition therapy by dietitian. Supplements: single type of ONS to cover the shortfall between individual estimated energy and protein requirements and actual intake over 42 days. |
Usual care with attention control group—received tri-weekly visits weeks 1–6, then weekly visits 7–12 to account for the possibility of the attention effect. |
Multiple articles reported from same study, study chosen to represent other reports from the same study are mentioned in footnotes *, † and ‡.
BW, body weight; CHF, chronic heart failure; DVD, digital versatile disc; HR, heart rate; LL, lower limb; NR, not reported; ONS, oral nutrition supplements; Otago exercise programme, series of 17 strength and balance at-home exercises for fall prevention programme in frail older adults; RM, repetition max; UL, upper limb; WEBB, Weight-Bearing for Better Balance exercise programme is designed to improve mobility, increase physical activity and prevent falls.