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Combining a protein supplement with exercise improved strength, mobility, and balance after transcatheter aortic valve replacement.
In elderly, frail patients undergoing transcatheter aortic valve replacement (TAVR), the combination of a protein supplement and an exercise intervention with a supervised component significantly improved strength, mobility, and balance 3 months after the procedure. The effect size of this home-based intervention was comparable with a cardiac rehabilitation program.
Previous research has linked frailty to poor outcomes in older adults undergoing TAVR. Therefore, Jonathan Afilalo, MD, MSc, and colleagues conducted the PERFORM-TAVR trial (NCT03522454) at 11 hospitals in Canada to explore whether a combination of nutritional supplementation and exercise could improve this situation.
The participants were aged at least 70 years and had objective evidence of physical frailty in standardized scores. The control group received lifestyle education only, while those in the intervention group received lifestyle education in addition to a protein-rich oral nutritional supplement that they consumed twice daily starting 4 weeks before TAVR and continuing for 12 weeks after TAVR. In addition, they took part in a home-based exercise intervention with a supervised component entailing home visits of an hour by a therapist twice a week for 12 weeks after TAVR complimented with an unsupervised walking program.
The primary study endpoint was the short physical performance battery (SPPB) scale (range 0–12) at 12 weeks, which consists of a 3-part balance test, a gait speed test, and a chair stand test. “We’re really looking at strength, mobility, and balance,” Dr. Afilalo explained. The analysis included 180 participants with a mean age of 83 years.
The mean SPPB score at baseline was 7.1 for both groups. At 12 weeks, it improved to 8.1 in the intervention group versus 7.1 in the control group, a multivariable-adjusted difference of 0.9 points (95% CI, 0.3–1.6; P=0.006). “A 1-point improvement is approximately the same effect size observed with a full-blown cardiac rehabilitation program. Improving frailty is going to improve the outcomes of patients undergoing all sorts of interventional procedures,” Dr. Afilalo concluded.
Medical writing support was provided by Dr Susanne Kammerer.
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