ADL要介助高齢者への高負荷運動と蛋白補給

ADL要介助高齢者に対する高負荷の運動と蛋白補給の効果をみたランダム化比較試験の論文を紹介します。

Carlsson M, Littbrand H, Gustafson Y, Lundin-Olsson L, Lindelöf N, Rosendahl E, Håglin L. Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial. J Nutr Health Aging. 2011 Aug;15(7):554-60.

リサーチクエスチョンは以下の通りです。

P：ADL要介助高齢者177人に対して（低栄養と栄養状態良好の両者）
I：高負荷の運動と運動直後の蛋白補給を行うと
C：コントロールの活動とプラセボの栄養剤補給を行う場合と比較して
O：3-6か月後の筋肉量と体重が増加する
D：ランダム化比較試験

抄録しか読めていないので詳細は分かりませんが、結果は3か月後では運動の有無、蛋白補給の有無で筋肉量と体重に有意差を認めませんでした。6か月後には運動群で筋肉量と体重の減少を認めました。

以上より、高負荷の運動と運動直後の蛋白補給の両者とも、筋肉量と体重の増加を示さないという結論です。運動群で6か月後に筋肉量と体重の減少を認めたことより、高負荷の運動を行う際には運動によるエネルギー消費に見合った十分なエネルギー補給が必要な可能性があります。

ある意味、「栄養ケアなくしてリハなし」を示した論文かもしれません。高負荷の運動直後には、蛋白のみでなくエネルギーも十分に補給することが重要な可能性があります。回復期リハ病棟で高負荷の機能訓練を行っている患者には、十分な食事摂取とともに、機能訓練室での栄養剤摂取が重要と考えます。

Abstract
BACKGROUND: Loss of muscle mass is common among old people living in institutions but trials that evaluate interventions aimed at increasing the muscle mass are lacking. Objective, participants and intervention: This randomized controlled trial was performed to evaluate the effect of a high-intensity functional exercise program and a timed protein-enriched drink on muscle mass in 177 people aged 65 to 99 with severe physical or cognitive impairments, and living in residential care facilities.

DESIGN: Three-month high-intensity exercise was compared with a control activity and a protein-enriched drink was compared with a placebo drink. A bioelectrical impedance spectrometer (BIS) was used in the evaluation. The amount of muscle mass and body weight (BW) were followed-up at three and six months and analyzed in a 2 x 2 factorial ANCOVA, using the intention to treat principle, and controlling for baseline values.

RESULTS: At 3-month follow-up there were no differences in muscle mass and BW between the exercise and the control group or between the protein and the placebo group. No interaction effects were seen between the exercise and nutritional intervention. Long-term negative effects on muscle mass and BW was seen in the exercise group at the 6-month follow-up.

CONCLUSION: A three month high-intensity functional exercise program did not increase the amount of muscle mass and an intake of a protein-enriched drink immediately after the exercise did not induce any additional effect on muscle mass. There were negative long-term effects on muscle mass and BW, indicating that it is probably necessary to compensate for an increased energy demand when offering a high-intensity exercise program.