The impact of interventions combining nutrition and physical exercise on frailty in old age: A systematic literature review and Synthesis Without Meta-analysis (SWiM).

Abstract

BackgroundFrailty is common in older adults and associated with inadequate nutrition, reduced physical function, and increased vulnerability. While physical exercise benefits frailty outcomes, evidence on combined nutrition and exercise interventions remains unclear.AimTo systematically review evidence on the impact of interventions combining nutrition and physical exercise on frailty status among community-dwelling frail older adults (≥65 years).MethodsThe review followed the Cochrane Handbook, Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020, and Synthesis Without Meta-analysis guidelines. Searches were conducted in PubMed, CINAHL, and Scopus. Randomised controlled trials explicitly defining frailty were eligible. Two reviewers independently screened and assessed methodology using RoB 2.0. Certainty of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. Due to heterogeneity, a narrative synthesis without meta-analysis was performed.SummaryOf 2447 records identified, 10 publications met the inclusion criteria. Two trials directly assessed frailty reversal and reported improvements favouring structured exercise, with one showing additional benefit when combined with a nutritional supplement. Odds of frailty reversal ranged from two- to fivefold. Additional studies reported modest improvements in mobility disability risk, lean body mass, and functional performance. Certainty of evidence ranged from low to high, limited by small samples and heterogeneity.Although some studies reported favourable effects of combined nutrition and exercise interventions, the available evidence is insufficient to determine whether nutrition adds benefits beyond exercise alone. Structured exercise consistently benefited frailty-related outcomes. However, due to few studies and substantial heterogeneity, firm conclusions cannot be drawn. Further standardised trials are needed to clarify the role of nutritional components within combined nutrition-exercise interventions in frailty management.