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Table 1 Summary of included study characteristics

From: Does the combination of resistance training and a nutritional intervention have a synergic effect on muscle mass, strength, and physical function in older adults? A systematic review and meta-analysis

First author (year), study location

Sample characteristics: n, mean age ± SD, sex (female ratio)

Intervention group

Control groupa

Follow-up period (weeks)b

Body composition assessment method

Muscle strength assessment method

Physical performance assessment method

Exercise

Nutrition

Aguiar (2013) [28], Brazil

Ic: 9, 64 ± 4, female

Cd: 9, 65 ± 6, female

Resistance training using machines, 60 min sessions, 3 times a week, for 24 weeks

5 g Creatine monohydrate, once a day, for 12 weeks

Placebo: maltodextrin

24

Body mass

Fat free mass

Muscle mass

Bench press

Biceps curl

Knee extension

Chair stand

Aoki (2018) [29], Japan

I: 43, 68.8 ± 5.3, mixed (74.4%)

C: 45, 71.2 ± 6.8, mixed (75.6%)

Lower body resistance training, daily

25mcg vitamin D3 (1000 IUe), divided into 3 times, daily

Usual diet

24

BMIf

Lower limb muscle mass

Hip flexion

Knee extension

Chair stand

Single leg stance

Two step test

Functional reach test

Arnarson (2013) [30], Iceland

I: 83, 73.3 ± 6, mixed (unknown)

C: 78, 74.6 ± 5.8, mixed (unknown)

Resistance training using machines, 3 times a week

20 g of whey protein 3 times a week

Placebo: 250 ml isocaloric carbohydrate drink

12

ASMMg

Lean body mass

Grip strength

Knee extension

TUGh

6-min walk

Bermon (1998) [31], France

I: 8, 71.0 ± 5.4, mixed (50%)

C: 8, 69.3 ± 1.1, mixed (50%)

Resistance training using machines, 3 times a week, for 7 weeks

First 5 days: 5 g creatine monohydrate and 2 g glucose, 4 times a day

Following 47 days: 3 g creatine monohydrate and 2 g glucose once a day

Placebo:

First 5 days:7 g glucose 4 times a day

Following 47 days: 5 g glucose once a day

8

Body mass

BMI

Lower limb muscle volume

Leg press

Chest press

Knee extension

–

Bjørnsen (2016) [32], Norway

I: 17, 69 ± 7, male

C: 17, 67 ± 5, male

Free weight exercises, 3 times a week

500 mg vitamin C and 117.5 mg vitamin E, twice a day

Placebo: cellulose and dicalsium phosphate

12

Lean body mass

Muscle thickness

Biceps curl

Knee extension

Leg press

–

Bobeuf (2011) [33], Canada

I: 14, 64.3 ± 3.8, mixed (50%)

C: 17, 67 ± 3.7, mixed (52.9%)

Resistance training, 60 min sessions, 3 times a week

1000 mg vitamin C ascorbate and vitamin E, once a day

Placebo: 100 mg lactose

24

ASMM

Muscle mass

–

–

Brose (2003) [34], Canada

I: 14, 69.6 ± 5.4, mixed (42.8%)

C: 14, 69.1 ± 4.8, mixed (50%)

Resistance training using machines, 3 times a week

5 g creatine and 2 g dextrose, once a day

Placebo:

7 g dextrose

14

Fat free mass

Grip strength

Knee extension

Leg press

–

Chrusch (2001) [35], Canada

I:16, 70.4 ± 6.4, male

C:14, 71.1 ± 6.7, male

Resistance training using machines, 3 times a week

Creatine supplement: 0.3 g/kg/day for the first 5 days (loading phase) and 0.07 g/kg/day thereafter, once a day, for 11 weeks

Placebo: sucrose-flour mixture

12

Lean body mass

Bench press

Knee extension

Leg press

–

Cornish (2018) [36], Canada

I:11, 71.4 ± 6.2, male

C:12, 70.9 ± 5, male

Resistance training, 60 min sessions, 3 times a week

3.0 g omega-3 fatty acid

combined 1.98 g EPAi and 0.99 g DHAj, once a day

Placebo:

3.0 g omega 3–6-9 blend

12

Body mass

Lean body mass

Chest press

Leg press

TUG

6-min walk

Da Boit (2017) [37], UK

I: 27, 70.1 ± 4, mixed (48.1%)

C: 23, 70.9 ± 4.2, mixed (43.4%)

Lower body resistance training, twice a week

3.0 g omega–3 fatty acids containing 2.1 g EPA and 0.6 g DHA, once a day

Placebo:

3.0 g safflower oil

18

Muscle anatomic cross-sectional area

Knee extension

Chair stand

SPPBk

4 m walk

Edholom (2017) [38], Sweden

I: 20, 67.2 ± 1.3, female

C: 17, 67.9 ± 2.1, female

Resistance training, 60 min sessions, twice a week

Healthy diet:

following a dietary consultation and a diet plan with the current dietary guidelines in Europe and US

Usual diet

24

Lean body mass

Knee extension

Leg press

Chair stand

Single leg stance

Squat jump

TUG

Holwerda (2018) [39], Netherlands

I: 21, 69 ± 4.6, male

C: 20, 71 ± 4.5, male

Resistance exercise training,

3 times a week

21 g leucine-enriched whey protein (3 g total leucine), once a day

Placebo

12

ASMM

BMI

Body mass

Lean body mass

Knee extension

Leg press

Chair stand

SPPB

4 m walk

Kawada (2013) [40], Japan

Ia: 10, 65 ± 1, mixed (50%)

Ib: 11, 67 ± 3, mixed (72.3%)

C: 8, 70 ± 1, mixed (50%)

Low-intensity resistance training, twice a week

Ia: 3.0 g essential amino acid supplements with milk, twice a day

Ib: 6.0 g essential amino acid supplements with milk, twice a day

Placebo:

3 g dextrin-contained powder with milk, once a day

24

Cross sectional area of Psoas major muscle

–

Gait speed

Obstacle course walk

6-min walk

Leenders (2013) [41], Netherlands

I: 27,70.9 ± 5.4, mixed (44.4%)

C: 26, 69.5 ± 3.6, mixed (46.2%)

Resistance training, 3 times a week

15 g milk protein, once a day

Placebo:

7.13 g lactose and 0.42 g calcium only

24

BMI

Lean body mass

Lower limb lean mass

Grip strength

Leg press

Chair stand

Mori (2018) [42], Japan

I: 25, 70.6 ± 4.2, female

C: 25, 70.6 ± 4.2, female

Resistance training, twice a week

25 g leucine enriched whey protein, once a day

Usual diet

24

BMI

Lower limb lean mass SMIl

Upper limb lean mass

Grip strength

Knee extension

Gait speed

Nabuco (2018) [43], Brazil

Ia: 23, 66.2 ± 9.4, female

Ib: 24, 67.5 ± 5.2, female

C: 23, 66.5 ± 7.2, female

Resistance training, 3 times a week

Ia: 27.1 g whey protein after resistance training, 3 times a week

Ib: 27.1 g whey protein before resistance training, 3 times a week

Placebo:

maltodextrin drink

12

Lower limb lean mass

Skeletal muscle mass

Upper limb lean mass

Biceps curl

Chest press

Knee extension

Chair stand

Gait speed

Nagai (2019) [44], Japan

I: 17, 72.7 ± 1.4, mixed (64.7%)

C: 19, 73.5 ± 2.3, mixed (68.4%)

Latex band training, squat, and tai chi, 90 min sessions, once a week

60 mg maslinic acid, once a day

Placebo:

jelly without maslinic acid

12

BMI

Body mass

Fat free mass

Skeletal muscle mass

Segmental muscle mass

Grip strength

Chair stand

Gait speed

Nakayama (2020) [45], Japan

I: 61, 71.4 ± 6.2, mixed (74%)

C: 61, 70.4 ± 5.5, mixed (77%)

Body weight exercises and 5 medicine ball exercises, daily

Low-dose milk protein:

10.1 g protein, once a day

Placebo:

Isocaloric carbohydrate

24

Body mass

Lean body mass

Grip strength

Knee extension

Knee flexion

Push up

Chair stand

Gait speed

TUG

Nilsson (2020) [46], Canada

I: 16, 77.4 ± 11.2, male

C: 16, 74.4 ± 5.2, male

Home based resistance training with elastic bands, 3 times a week

Multi nutrients: 24 g whey protein, 16 g micellar casein contained 416 mg calcium, 3 g creatine, vitamin D 1000 IU, and omega-3 fish-oil containing 1.51 g EPA and 0.95 g DHA, once a day

Placebo: collagen and sunflower oil

12

ASMM

Body mass BMI

Lean body mass

Grip strength Knee extension

Leg press

Chair stand

SPPB

Stair climb

TUG

4 m walk

Pinto (2016) [47], Brazil

I: 13, 67.4 ± 4.7, mixed (unknown)

C: 14, 67.1 ± 6.3, mixed (unknown)

Resistance training, 3 times a week

5 g Creatine monohydrate, once a day

Placebo: 5 g maltodextrin

12

Body mass

Lean body mass

SMI

Bench press

Leg press

–

Seino (2018) [48], Japan

I: 40, 73.4 ± 4.3, mixed (85%)

C: 40, 73.7 ± 4.3, mixed (82.5%)

Weight-bearing exercise and exercises using a resistance band and Pilates ball, 60 min sessions, twice a week

Fortified milk containing 10.5 g total milk protein, 3.9 g fat, 9.3 g carbohydrate, and 337 mg calcium at lunch and micronutrient beverage at breakfast, daily

Usual diet

12

Body mass

Lean body mass

Lower limb lean mass SMI

Grip strength Knee extension

Chair stand

Gait speed

One leg standing with eyes open

TUG

Stout (2013) [49], USA

I: 24, 73 ± 4.9, mixed (54.2%)

C: 24, 73 ± 4.9, mixed (54.2%)

Resistance exercise, 3 times a week for 21 weeks

1.5 g calcium and 4 g carbohydrate, twice a day

Placebo: 200 mg calcium and 4 g carbohydrate

24

Lean body mass

Lower limb lean mass Upper limb lean mass

Grip strength

Chair stand

Sugihara Junior (2018) [50],  Brazil

I: 15, 67.4 ± 4.1, female

C: 16, 67.8 ± 4.1, female

Resistance training using a combination of free weights and machines, 45 ~ 50 min sessions, 3 times a week

35 g whey protein, immediately after each resistance training

Placebo:

35 g maltodextrin

12

Body mass

BMI

Lower limb lean mass SMI

Upper limb lean mass

Biceps curl Chest press

Knee extension

–

Tarnopolsky (2007) [51], Canada

I: 21,70.7 ± 4.5, mixed (47.6%)

C: 18, 71.1 ± 5.5, mixed (55.6%)

Resistance exercise using machines, twice a week

5 g creatine monohydrate and 6 g conjugated linoleic acid, once a day

Placebo: dextrose and safflower oil

24

Body mass BMI

Fat free mass

Biceps curl Chest press

Knee extension

Leg press

Chair stand

Gait speed

Stair climb

Standing balance

Villanueva (2014) [52], USA

I: 7, 68.7 ± 6.8, male

C: 7, 68.7 ± 6.6, male

Progressive overload, total body periodized resistance program, 3 times a week

First 5 days: 0.1 g/kg body weight of creatine 3 times a day and 35 g whey protein once a day

Following days: 0.07 g/kg body weight of creatine and 35 g whey protein, once a day

Usual diet

12

Lean body mass

Bench press

Leg press

Stair climb

400 m walk

  1. aThe resistance exercise of the control group applied in the same manner as in the experimental group
  2. b The duration of intervention in most studies were the same as the follow-up period
  3. c I, intervention group d C, control group e IU, international unit f BMI, body mass index g ASMM, appendicular skeletal muscle mass, h TUG, timed up and go i EPA, eicosapentaenoic acid j DHA, docosahexaenoic acid k SPPB, short physical performance battery l SMI, skeletal muscle mass index