HEAL [HMB + Exercise in Institutionalized Older Adults]

Goal: To assess the effects of the combination of a daily multicomponent exercise and resistance training (VIVIFRAIL program) intervention in addition to HMB supplementation on institutionalized older adults' health ( Identifier: NCT03827499).

Methods: Randomized Controlled Trial, Meta-analysis, Systematic Review

Date: 1 February 2019

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Project log

Ángel Buendía-Romero
added a research item
We aimed to analyze the isometric knee extension test (IKE) test in terms of i) intra- and inter-session repeatability, and ii) relationship with functional and body composition factors of sarcopenia among institutionalized older adults. Thirteen institutionalized older adults (age = 87 ± 10 years, body mass [BM] = 73.1 ± 10.9 kg, body mass index [BMI] = 28.5 ± 3.8 kg·m2) were recruited from a nursing home. Variability of maximal isometric force registered in three IKE trials performed on the same day was used to examine intra-session repeatability, whereas inter-session repeatability was analyzed by comparing maximal isometric force from two different days. Furthermore, functional (Handgrip, 6-m Gait Speed, Time Up and Go [TUG], and Sit-to-stand tests) and body composition (appendicular lean mass adjusted by BMI, ALM/BMI) evaluations were conducted. Statistics included the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM), expressed in both absolute (N·kg-1) and relative terms (coefficient of variation, CV = 100 × SEM / mean). High to very high intra-session repeatability was found for both the dominant and non-dominant legs (CV ≤ 6.0%, ICC ≥ 0.989). Similarly, both legs showed high inter-session repeatability (SEM ≤ 0.26 N·kg-1, ICC ≥ 0.959). On the other hand, significant relationships were found between Dominant and Non-dominant IKE tests and 6-m Gait Speed (r = 0.77; r = 0.58), ALM/BMI (r = 0.62; r = 0.58), and Non-dominant Handgrip/BM (r = 0.60; r = 0.68). In addition, a significant association was found between Dominant IKE/BM and TUG (r = -0.74), as well as between Non-dominant IKE/BM and Dominant Handgrip/BM (r = 0.67). These findings suggest that the IKE test is a repeatable and suitable strategy for lower-limb screening in institutionalized older adults.
Javier Courel Ibáñez
added a research item
Objectives: We aimed to determine whether the benefits of long (24 weeks) and short (4 weeks) training programs persisted after short (6 weeks) and long (14 weeks) periods of inactivity in elderly nursing home residents with sarcopenia. Design: Multicenter randomized trial. Intervention: The Vivifrail tailored, multicomponent exercise programme ( was conducted to individually prescribe exercise for frail older adults, depending on their functional capacity. The training included four levels combining strength/power, balance, flexibility and cardiovascular endurance exercises. Setting and Participants: Twenty-four institutionalized older adults (87.1±7.1 years, 58.3% women) diagnosed with sarcopenia were allocated into two groups: the Long Training-Short Detraining (LT-SD) group completed 24 weeks of supervised Vivifrail training followed by 6 weeks of detraining; the Short Training-Long Detraining (ST-LD) group completed 4 weeks of training and 14 weeks of detraining. Measures: Changes in functional capacity and strength were evaluated at baseline, and after short and long training and detraining periods. Results: Benefits after short and long exercise interventions persisted when compared with baseline. Vivifrail training was highly effective in the short term (4 weeks) in increasing functional and strength performance (effects size=0.32–1.44, p<0.044) with the exception of handgrip strength. Continued training during 24 weeks produced 10–20% additional improvements (p<0.036). Frailty status was reversed in 36% of participants, with 59% achieving high self-autonomy. Detraining resulted in a 10–25% loss of strength and functional capacity even after 24 weeks of training (effects size=0.24–0.92, p<0.039). Conclusions and Implications: Intermittent strategies such as 4 weeks of supervised exercise 3 times yearly with no more than 14 weeks of inactivity between exercise periods appears as an efficient solution to the global challenge of maintaining functional capacity and can even reverse frailty in vulnerable institutionalized older adults.
Javier Courel Ibáñez
added an update
Free Access to our last paper "Supervised exercise (Vivifrail) protects institutionalized older adults against severe functional decline after 14 weeks of COVID confinement" until 12/02/2021:
Javier Courel Ibáñez
added 5 research items
This is a randomized trial on sarcopenic older adults aged ≥ 75 years living in nursing homes. Participants completed 4 weeks of the tailored multicomponent exercise training program Vivifrail© ( group continued the intervention for a further 14 weeks, while the other interrupted the intervention for 14 weeks because of the COVID-19 lockdown. Functional capacity and strength were evaluated at baseline, after 4 weeks of exercise and after 14 weeks of training or detraining. This study is part of an ongoing multicenter trial (NCT03827499). The main findings are: i) The Vivifrail© multicomponent tailored exercise program was very effective in the short-term (4 weeks) and produced a similar response to training in two groups of sarcopenic, frail and institutionalized adults aged ≥ 75 years from two different nursing homes. This uniform improvement demonstrates the robustness of the Vivifrail© tailored prescription guidelines (; ii) short-term health improvements after 4 weeks of Vivifrail© seemed to persist after 14 weeks of inactivity due to COVID-19 confinement, and may have prevented severe functional decline and strength loss in institutionalized older adults; iii) while overall functional capacity and strength declined along the 14-week confinement, the benefits of the previous exercise training persisted, with older adults in a better physical condition as compared with baseline; iv) frailty reversion (i.e., recovery of autonomy) after 4 weeks of exercise was mostly maintained during the 14-week training cessation period
This study determined the effects of a 4-week individualized multicomponent exercise program (Vivifrail) on physical frailty and functional disability in older adults living in nursing homes. Fourteen institutionalized older adults (aged 81.7 ± 9.7 years) volunteered to completed 4 weeks of the individualized Vivifrail exercise program (5 days a week) according to their initial level: A, disability; B, frailty; C, pre-frailty and D, robust. Training sessions were directed by strength and conditioning trainers. Eleven participants completed the pre and post evaluations with very high levels of attendance (96% of the training sessions). Functional capacity (SPPB scores) significantly improved in all the participants (+48.2%, p < 0.001) and tests: sit-to-stand (24.1% faster, p = 0.003), gait speed 4 m (9.8% faster, p = 0.033) and 6 m (7.2% faster, p = 0.017) and Up and Go (11.2% faster, p = 0.004). Disability and sarcopenia decreased significantly (SARC-F, p = 0.026; Lawton index, p = 0.013). People with initial levels of disability (A), frailty (B) and pre-fragility (C) shown the greatest improvements. Six of the nine participants who started with physical frailty or pre-frailty status (66.7%) reversed this condition after the intervention. In addition, 33% of participants with disability, who were unable to perform the functional tests (sit-stand and walk), became able to complete them after the intervention. These important benefits found in such a shorter period of time (4 weeks) could be related to three key elements: individualization of the program, daily frequency and face-to-face coaching motivation by physical conditioning professionals.
Javier Courel Ibáñez
added a project goal
To assess the effects of the combination of a daily multicomponent exercise and resistance training (VIVIFRAIL program) intervention in addition to HMB supplementation on institutionalized older adults' health ( Identifier: NCT03827499).