Effects of a multicomponent exercise program combined with calcium–vitamin D3-enriched milk on health-related quality of life and depressive symptoms in older men: secondary analysis of a randomized controlled trial
- 5 Downloads
Osteoporosis is associated with both lower health-related quality of life and depression in older people. We examined the independent and combined effects of a multi-component exercise program and calcium–vitamin D3 fortified milk on health-related quality of life (HR-QoL) and depression in older men.
In this 12-month, factorial design randomized controlled trial, 180 healthy community-dwelling men aged 50–79 years with normal to below average bone mineral density were allocated into one of four groups: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of high-intensity resistance training with weight-bearing exercise (3 days per week; 60–75 min per session). Men assigned to fortified milk consumed 400 ml/day of low-fat milk containing 1000 mg/day calcium and 800IU/day vitamin D3. Questionnaires were used to assess HR-QoL (SF-36) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) at baseline, and 6 and 12 months. A linear mixed model analysis was used to test whether there was a synergistic interaction between exercise and calcium–vitamin D3. If no significant interactions were detected, the main effects of exercise and fortified milk were examined.
Mean adherence to the exercise program and fortified milk was 67% (95% CI 61, 73%) and 90% (95% CI 86, 93%), respectively. There were no exercise-by-fortified milk interactions nor main effects of exercise or calcium–vitamin D for any of the HR-QoL measures or depressive symptoms.
In healthy community-dwelling older men, exercise training and/or calcium–vitamin D fortified milk did not improve HR-QoL or depressive symptoms.
KeywordsCalcium Vitamin D3 Progressive resistance training Elderly men Health-related quality of life Depression
We acknowledge all the participants involved and the staff responsible for conducting the GENTS study. We thank Murray Goulburn, Cooperative Co., Ltd., for providing the calcium–vitamin D3 low-fat ultrahigh temperature fortified milk used in the study and the City of Greater Geelong and Ocean View Health Club for their generous provision of the gymnasium facilities used throughout the study.
JM and SJT performed the data analysis and wrote the manuscript with RMD. IH performed the data analysis. SJT, CMM and RMD conceived the research question. SK was responsible for the implementation of the entire trial and collection of all data under the guidance of RMD and CAN. RMD with CAN conceived the original GENTS study, received funding to conduct the study and were chief investigators for the overall trial. All authors critically reviewed the manuscript, and read and approved the final version.
Compliance with ethical standards
This study was conducted according to the guidelines laid down in the 1964 Declaration of Helsinki and its later amendments. All procedures involving human subjects were reviewed and approved by the Deakin University Human Ethics Committee and Barwon Health Research and Ethics Advisory Committee (no. 03/17). Written informed consent was obtained from all participants.
Conflict of Interest
The authors declare no conflict of interest.
- 1.Australian Institute of Health and Welfare (2014) Australia’s health 2014. Australia’s health series no. 14. Cat. no. AUS 178. CanberraGoogle Scholar
- 2.United Nations, Department of Economic and Social Affairs, Population Division (2017) World Population Prospects: The 2017 Revision. Key Findings and Advance Tables, United Nations, New YorkGoogle Scholar
- 3.Economics Access (2001) The burden of brittle bones: costing osteoporosis in Australia. Access Economics Pty Ltd, CanberraGoogle Scholar
- 6.College The Royal Australian of General Practitioners and Osteoporosis Australia (2017) Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age, 2nd edn. RACGP, MelbourneGoogle Scholar
- 8.Canuto Wanderley FA, Oliveira NL, Marques E, Moreira P, Oliveira J, Carvalho J (2015) Aerobic versus resistance training effects on health-related quality of life, body composition, and function of older adults. J Appl Gerontol 34:Np143–165Google Scholar
- 10.Rizzoli R, Reginster JY, Arnal JF, Bautmans I, Beaudart C, Bischoff-Ferrari H, Biver E, Boonen S, Brandi ML, Chines A, Cooper C, Epstein S, Fielding RA, Goodpaster B, Kanis JA, Kaufman JM, Laslop A, Malafarina V, Manas LR, Mitlak BH, Oreffo RO, Petermans J, Reid K, Rolland Y, Sayer AA, Tsouderos Y, Visser M, Bruyere O (2013) Quality of life in sarcopenia and frailty. Calcif Tissue Int 93:101–120CrossRefGoogle Scholar
- 14.Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA (2009) Exercise for depression. Cochrane Database Syst Rev 2009:CD004366Google Scholar
- 17.Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T, Baverstock M, Birks Y, Dumville J, Francis R, Iglesias C, Puffer S, Sutcliffe A, Watt I, Torgerson DJ (2005) Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 330:1003CrossRefGoogle Scholar
- 20.Kjaergaard M, Waterloo K, Wang CE, Almas B, Figenschau Y, Hutchinson MS, Svartberg J, Jorde R (2012) Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial. Br J Psychiatry 201:360–368CrossRefGoogle Scholar
- 22.Miki T, Kochi T, Eguchi M, Kuwahara K, Tsuruoka H, Kurotani K, Ito R, Akter S, Kashino I, Pham NM, Kabe I, Kawakami N, Mizoue T, Nanri A (2015) Dietary intake of minerals in relation to depressive symptoms in Japanese employees: the Furukawa Nutrition and Health Study. Nutrition 31:686–690CrossRefGoogle Scholar
- 26.Abizanda P, Lopez MD, Garcia VP, Estrella Jde D, da Silva Gonzalez A, Vilardell NB, Torres KA (2015) Effects of an oral nutritional supplementation plus physical exercise intervention on the physical function, nutritional status, and quality of life in Frail institutionalized older adults: the ACTIVNES study. J Am Med Dir Assoc 16:439.e439–439.e416CrossRefGoogle Scholar
- 28.Ware JE, Snow KK, Kosinski M, Gandek B (1993) SF-36 Health Survey Manual and Interpretation Guide. The Health Institute, New England Medical Center, MassachusettsGoogle Scholar
- 29.Australian Bureau of Statistics (1995) National Health Survey. SF-36 Population Norms. Commonwealth of Australia, CanberraGoogle Scholar
- 30.Ware JE, Kosinski M (2001) Physical & mental health summary scales: a manual for users of version 1, 2nd edn. QualityMetric, LincolnGoogle Scholar
- 32.McHorney CA, Ware JE, Jr., Rogers W, Raczek AE, Lu JF (1992) The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Med Care 30:Ms253–265Google Scholar
- 35.McDowell I, Newell C (1996) National Institute of Mental Health: The Center for Epidemiologic Studies Depression Scale (CES-D). Measuring Health: a guide to rating scales and questionnaires, 2nd edn. Oxford University Press, New York, pp 254–259Google Scholar
- 41.Alonso J, Ferrer M, Gandek B, Ware JE Jr, Aaronson NK, Mosconi P, Rasmussen NK, Bullinger M, Fukuhara S, Kaasa S, Leplège A (2004) Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res 13:283–298CrossRefGoogle Scholar
- 43.Ramirez-Campillo R, Diaz D, Martinez-Salazar C, Valdés-Badilla P, Delgado-Floody P, Méndez-Rebolledo G, Cañas-Jamet R, Cristi-Montero C, García-Hermoso A, Celis-Morales C (2016) Effects of different doses of high-speed resistance training on physical performance and quality of life in older women: a randomized controlled trial. Clin Interv Aging 11:1797CrossRefGoogle Scholar
- 44.Socha M, Fraczak P, Jonak W, Sobiech KA (2016) Effect of resistance training with elements of stretching on body composition and quality of life in postmenopausal women. Prz Menopauzalny 15:26–31Google Scholar
- 50.Kurlansik SL, Ibay AD (2012) Seasonal affective disorder. Am Fam Physician 86:1037–1041Google Scholar
- 52.Institute of Medicine (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, DCGoogle Scholar