Advertisement

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

  • Joshua Matthews
  • Susan J. TorresEmail author
  • Catherine M. Milte
  • Indee Hopkins
  • Sonja Kukuljan
  • Caryl A. Nowson
  • Robin M. Daly
Original Contribution
  • 5 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

In healthy community-dwelling older men, exercise training and/or calcium–vitamin D fortified milk did not improve HR-QoL or depressive symptoms.

Keywords

Calcium Vitamin D3 Progressive resistance training Elderly men Health-related quality of life Depression 

Notes

Acknowledgements

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.

Author contributions

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

Ethical statement

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.

References

  1. 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. 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. 3.
    Economics Access (2001) The burden of brittle bones: costing osteoporosis in Australia. Access Economics Pty Ltd, CanberraGoogle Scholar
  4. 4.
    Al-Sari UA, Tobias J, Clark E (2016) Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int 27:2891–2900CrossRefGoogle Scholar
  5. 5.
    Aloumanis K, Mavroudis K (2013) The "depressive" face of osteoporosis and the "osteoporotic" face of depression. Hormones 12:350–362CrossRefGoogle Scholar
  6. 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
  7. 7.
    Buchner DM, Cress ME, de Lateur BJ, Esselman PC, Margherita AJ, Price R, Wagner EH (1997) The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol A Biol Sci Med Sci 52:M218–224CrossRefGoogle Scholar
  8. 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
  9. 9.
    Nicholson VP, McKean MR, Burkett BJ (2015) Low-load high-repetition resistance training improves strength and gait speed in middle-aged and older adults. J Sci Med Sport 18:596–600CrossRefGoogle Scholar
  10. 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
  11. 11.
    Singh NA, Clements KM, Fiatarone MA (1997) A randomized controlled trial of progressive resistance training in depressed elders. J Gerontol A Biol Sci Med Sci 52:M27–35CrossRefGoogle Scholar
  12. 12.
    Singh NA, Clements KM, Singh MA (2001) The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci 56:M497–504CrossRefGoogle Scholar
  13. 13.
    Singh NA, Stavrinos TM, Scarbek Y, Galambos G, Liber C, Fiatarone Singh MA (2005) A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. J Gerontol A Biol Sci Med Sci 60:768–776CrossRefGoogle Scholar
  14. 14.
    Mead GE, Morley W, Campbell P, Greig CA, McMurdo M, Lawlor DA (2009) Exercise for depression. Cochrane Database Syst Rev 2009:CD004366Google Scholar
  15. 15.
    Gao LH, Zhu WJ, Liu YJ, Gu JM, Zhang ZL, Wang O, Xing XP, Xu L (2015) Physical performance and life quality in postmenopausal women supplemented with vitamin D: a two-year prospective study. Acta Pharmacol Sin 36:1065–1073CrossRefGoogle Scholar
  16. 16.
    Costan AR, Vulpoi C, Mocanu V (2014) Vitamin D fortified bread improves pain and physical function domains of quality of life in nursing home residents. J Med Food 17:625–631CrossRefGoogle Scholar
  17. 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
  18. 18.
    Brunner RL, Cochrane B, Jackson RD, Larson J, Lewis C, Limacher M, Rosal M, Shumaker S, Wallace R (2008) Calcium, vitamin D supplementation, and physical function in the Women's Health Initiative. J Am Diet Assoc 108:1472–1479CrossRefGoogle Scholar
  19. 19.
    Jorde R, Sneve M, Figenschau Y, Svartberg J, Waterloo K (2008) Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med 264:599–609CrossRefGoogle Scholar
  20. 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
  21. 21.
    Bae YJ, Kim SK (2012) Low dietary calcium is associated with self-rated depression in middle-aged Korean women. Nutr Res Pract 6:527–533CrossRefGoogle Scholar
  22. 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
  23. 23.
    Eyles DW, Smith S, Kinobe R, Hewison M, McGrath JJ (2005) Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J Chem Neuroanat 29:21–30CrossRefGoogle Scholar
  24. 24.
    Bertone-Johnson ER (2009) Vitamin D and the occurrence of depression: causal association or circumstantial evidence? Nutr Rev 67:481–492CrossRefGoogle Scholar
  25. 25.
    Knapp S, Mandell AJ, Bullard WP (1975) Calcium activation of brain tryptophan hydroxylase. Life Sci 16:1583–1593CrossRefGoogle Scholar
  26. 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
  27. 27.
    Kukuljan S, Nowson C, Bass S, Sanders K, Nicholson G, Seibel M, Salmon J, Daly R (2009) Effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density in older men: a randomised controlled trial. Osteoporos Int 20:1241–1251CrossRefGoogle Scholar
  28. 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. 29.
    Australian Bureau of Statistics (1995) National Health Survey. SF-36 Population Norms. Commonwealth of Australia, CanberraGoogle Scholar
  30. 30.
    Ware JE, Kosinski M (2001) Physical & mental health summary scales: a manual for users of version 1, 2nd edn. QualityMetric, LincolnGoogle Scholar
  31. 31.
    Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305:160–164CrossRefGoogle Scholar
  32. 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
  33. 33.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483CrossRefGoogle Scholar
  34. 34.
    Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRefGoogle Scholar
  35. 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
  36. 36.
    Beekman ATF, Deeg DJH, Van Limbeek J, Braam AW, De Vries MZ, Van Tilburg W (1997) Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in the Netherlands. Psychol Med 27:231–235CrossRefGoogle Scholar
  37. 37.
    Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL (2001) CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 33:1126–1141CrossRefGoogle Scholar
  38. 38.
    Hekler EB, Buman MP, Haskell WL, Conway TL, Cain KL, Sallis JF, Saelens BE, Frank LD, Kerr J, King AC (2012) Reliability and validity of CHAMPS self-reported sedentary-to-vigorous intensity physical activity in older adults. J Phys Act Health 9:225–236CrossRefGoogle Scholar
  39. 39.
    Hoenig JM, Heisey DM (2001) The abuse of power: the pervasive fallacy of power calculations for data analysis. Am Stat 55:19–24CrossRefGoogle Scholar
  40. 40.
    Hawthorne G, Osborne RH, Taylor A, Sansoni J (2007) The SF36 Version 2: critical analyses of population weights, scoring algorithms and population norms. Qual Life Res 16:661–673CrossRefGoogle Scholar
  41. 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
  42. 42.
    Levinger I, Goodman C, Hare DL, Jerums G, Selig S (2007) The effect of resistance training on functional capacity and quality of life in individuals with high and low numbers of metabolic risk factors. Diabetes Care 30:2205–2210CrossRefGoogle Scholar
  43. 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. 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
  45. 45.
    Henwood TR, Riek S, Taaffe DR (2008) Strength versus muscle power-specific resistance training in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 63:83–91CrossRefGoogle Scholar
  46. 46.
    de Vreede PL, van Meeteren NL, Samson MM, Wittink HM, Duursma SA, Verhaar HJ (2007) The effect of functional tasks exercise and resistance exercise on health-related quality of life and physical activity. A randomised controlled trial. Gerontology 53:12–20CrossRefGoogle Scholar
  47. 47.
    Krist L, Dimeo F, Keil T (2013) Can progressive resistance training twice a week improve mobility, muscle strength, and quality of life in very elderly nursing-home residents with impaired mobility? A pilot study. Clin Interv Aging 8:443–448CrossRefGoogle Scholar
  48. 48.
    Sillanpää E, Häkkinen K, Holviala J, Häkkinen A (2012) Combined strength and endurance training improves health-related quality of life in healthy middle-aged and older adults. Int J Sports Med 33:981–986CrossRefGoogle Scholar
  49. 49.
    Andresen EM, Rothenberg BM, Panzer R, Katz P, McDermott MP (1998) Selecting a generic measure of health-related quality of life for use among older adults. A comparison of candidate instruments. Eval Health Prof 21:244–264CrossRefGoogle Scholar
  50. 50.
    Kurlansik SL, Ibay AD (2012) Seasonal affective disorder. Am Fam Physician 86:1037–1041Google Scholar
  51. 51.
    Nowson CA, McGrath JJ, Ebeling PR, Haikerwal A, Daly RM, Sanders KM, Seibel MJ, Mason RS, Working Group of A, New Zealand B, Mineral Society ESoA, Osteoporosis A (2012) Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 196:686–687CrossRefGoogle Scholar
  52. 52.
    Institute of Medicine (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press, Washington, DCGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongAustralia

Personalised recommendations