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Digitally supported dietary counseling increases protein intake in community dwelling older adults

Purpose: For prevention of sarcopenia and functional decline in community dwelling older adults, a higher daily protein intake is needed in addition to increased exercise. A new e-health strategy for dietary counseling was usedwith the aim to increase total daily protein intake to optimal levels (minimal 1.2 g/kg/day, optimal 1.5 g/kg/day) through use of regular food products.Methods: The VITAMIN (VITal AMsterdam older adults IN the city) RCT included 245 community dwelling older adults (age ≥ 55y): control, exercise, and exercise plus dietary counseling (protein) group. The dietary counselingintervention was based on behavior change and personalization was offered by a dietitian coach, by use of face-to-face contacts and videoconferencing during a 6-month intervention. Dietary intake was measured by a 3d dietaryrecord at baseline, after 6-month intervention and 12-month follow-up. The primary outcome was average daily protein intake (g/kg/day). Sub-group analysis and secondary outcomes included daily protein distribution, sources,product groups. A Linear Mixed Models (LMM) of repeated measures was performed with STATA v13.Results: Mean age of the 224 subjects was 72.0(6.5) years, a BMI of 26.0(4.2) and 71% were female. The LMM showed a significant effect of time and time*group (p<0.001). The dietary counseling group showed higher protein intakethan either control (1.41 vs 1.13 g/kg/day; β +0.32; p<0.001) or exercise group (1.41 vs 1.11 g/kg/day; β +0.33; p<0.001) after 6-month intervention and 12-month follow-up (1.24 vs 1.05; β +0.23; p<0.001 | 1.24 vs 1.07 β +0.19;p<0.001). Additional analysis revealed the higher protein intake was fully accounted for by animal protein intake.Conclusions: This study shows digitally supported dietary counseling improves protein intake sufficiently incommunity dwelling older adults with use of regular food products. Protein intake increase by personalizedcounseling with e-health is a promising strategy for dietitians with the upcoming rising ageing population.Keywords: Ageing, Behavior change, Nutrition, Physical Functioning, Sarcopenia

Blended Counseling And Protein Supplementation Increase Protein Intake In Community Dwelling Older Adults During A Resistance Exercise Program: Preliminary Results Of The Teams Rct

Rationale: In order to optimize training effects for prevention of sarcopenia and frailty in community dwelling older adults a higher daily protein intake is required. To increase total daily protein intake to optimal levels (minimal 1.2 g/kg/d, optimal 1.5 g/kg/d) during a resistance exercise training of 12 weeks we use blended dietary counseling and protein supplementation with protein enriched food products. This study focusses on 1) first effects; 2) the adherence to this protein intervention.Methods: Preliminary data of the TEAMS RCT is available for 41 community dwelling older adults with physical limitations or receiving home-care (age ≥ 65y): 23 in exercise only (EX) and 18 in exercise+protein (EXpro) group. Dietary intake was measured by a 3d dietary record at baseline and after 12 weeks of intervention. A two-way mixed ANOVA with time, group, and time*group interaction was performed. Adherence data was logged by a dietician coach.Results: The mean age of the subjects was 74±6y, of which 73% were females. SPPB score was 9.5±1.9, BMI 28.9±5.0 and protein intake 0.9±0.3 g/kgBW/d. Table 1 shows improved protein intake over time in the EXpro compared to EX group (p=0.014). ANOVA revealed significant effect of time, and time*group (p<0.05). Adherence to the blended coaching sessions was high (95%), with the face-to-face sessions (88%) and tele-coaching (100%). In the EXpro group 59% of the subjects increased protein intake above the minimum intake level, compared to 38% in the EX group.Conclusion: This study shows that blended dietary counseling with use of protein supplementation improves protein intake sufficiently in exercising community dwelling older adults. Blended counseling and the use of protein enriched food products is a promising strategy for dieticians in the prevention of sarcopenia and frailty.

Blended Counseling And Protein Supplementation Increase Protein Intake In Community Dwelling Older Adults During A Resistance Exercise Program: Preliminary Results Of The Teams Rct

Rationale: In order to optimize training effects for prevention of sarcopenia and frailty in community dwelling older adults a higher daily protein intake is required. To increase total daily protein intake to optimal levels (minimal 1.2 g/kg/d, optimal 1.5 g/kg/d) during a resistance exercise training of 12 weeks we use blended dietary counseling and protein supplementation with protein enriched food products. This study focusses on 1) first effects; 2) the adherence to this protein intervention.Methods: Preliminary data of the TEAMS RCT is available for 41 community dwelling older adults with physical limitations or receiving home-care (age ≥ 65y): 23 in exercise only (EX) and 18 in exercise+protein (EXpro) group. Dietary intake was measured by a 3d dietary record at baseline and after 12 weeks of intervention. A two-way mixed ANOVA with time, group, and time*group interaction was performed. Adherence data was logged by a dietician coach.Results: The mean age of the subjects was 74±6y, of which 73% were females. SPPB score was 9.5±1.9, BMI 28.9±5.0 and protein intake 0.9±0.3 g/kgBW/d. Table 1 shows improved protein intake over time in the EXpro compared to EX group (p=0.014). ANOVA revealed significant effect of time, and time*group (p<0.05). Adherence to the blended coaching sessions was high (95%), with the face-to-face sessions (88%) and tele-coaching (100%). In the EXpro group 59% of the subjects increased protein intake above the minimum intake level, compared to 38% in the EX group.Conclusion: This study shows that blended dietary counseling with use of protein supplementation improves protein intake sufficiently in exercising community dwelling older adults. Blended counseling and the use of protein enriched food products is a promising strategy for dieticians in the prevention of sarcopenia and frailty.

The implementation of a physical activity counseling program in rehabilitation care

Purpose: This study aimed to evaluate the implementation of a physical activity counseling program in rehabilitation and to study heterogeneity in received counseling and investigate its association with changes in patients' physical activity outcomes. Methods: This prospective cohort study was conducted in 18 rehabilitation institutions. Data were collected using surveys completed by professionals (n= ±70) and patients (n = 1719). Implementation was evaluated using different process outcomes: reach, dosage, satisfaction, maintenance. Patients' physical activity outcomes included changes in total minutes/week of physical activity. Latent class analyses were conducted to identify profiles of received counseling characteristics and multilevel models were used to investigate associations with physical activity outcomes. Results: 5873 Patients were provided with motivational interviewing-based counseling after rehabilitation. Professionals and patients were positive about the program. Sixteen institutions (89%) formally agreed to continue the program. The four identified profiles of counseling characteristics illustrate a large variation in received counseling among patients. No substantial differences in physical activity outcomes were found between profiles. Conclusion: After a three-year program period, the physical activity counseling centers were sustainably implemented in Dutch rehabilitation care. This study illustrated an innovative approach to assess heterogeneity in implementation outcomes (e.g., counseling profiles) in relation to program outcomes (e.g., physical activity). Implications for rehabilitation Physical activity counseling after rehabilitation is important to support people with disabilities in making the step from rehabilitation-based physical activities to community-based physical activities. Establishing "Physical Activity Counseling Centers" is a promising "disability-overarching" strategy to promote physical activity after rehabilitation. Although the actual received counseling (dosage) varied among patients, this did not coincide with large differences in physical activity outcomes. The training in Motivational Interviewing, the financial incentives, and the advisory support were considered as important or essential ingredients for a successful implementation of the counseling program in rehabilitation practice.

The implementation of a physical activity counseling program in rehabilitation care

Purpose: This study aimed to evaluate the implementation of a physical activity counseling program in rehabilitation and to study heterogeneity in received counseling and investigate its association with changes in patients' physical activity outcomes. Methods: This prospective cohort study was conducted in 18 rehabilitation institutions. Data were collected using surveys completed by professionals (n= ±70) and patients (n = 1719). Implementation was evaluated using different process outcomes: reach, dosage, satisfaction, maintenance. Patients' physical activity outcomes included changes in total minutes/week of physical activity. Latent class analyses were conducted to identify profiles of received counseling characteristics and multilevel models were used to investigate associations with physical activity outcomes. Results: 5873 Patients were provided with motivational interviewing-based counseling after rehabilitation. Professionals and patients were positive about the program. Sixteen institutions (89%) formally agreed to continue the program. The four identified profiles of counseling characteristics illustrate a large variation in received counseling among patients. No substantial differences in physical activity outcomes were found between profiles. Conclusion: After a three-year program period, the physical activity counseling centers were sustainably implemented in Dutch rehabilitation care. This study illustrated an innovative approach to assess heterogeneity in implementation outcomes (e.g., counseling profiles) in relation to program outcomes (e.g., physical activity). Implications for rehabilitation Physical activity counseling after rehabilitation is important to support people with disabilities in making the step from rehabilitation-based physical activities to community-based physical activities. Establishing "Physical Activity Counseling Centers" is a promising "disability-overarching" strategy to promote physical activity after rehabilitation. Although the actual received counseling (dosage) varied among patients, this did not coincide with large differences in physical activity outcomes. The training in Motivational Interviewing, the financial incentives, and the advisory support were considered as important or essential ingredients for a successful implementation of the counseling program in rehabilitation practice.

A foundation for dietitians to effectively carry out dietary counseling