The morbidity and mortality resulting from falls in the elderly is substantial. Diminished muscular strength contributes to the propensity of an older adult to sustain a fall. During hospitalization the stress of illness, bed rest and inadequate nutrition can combine to accelerate loss of muscle mass and strength, which often fails to recover several months after discharge. Perhaps this need not be the case. Recent studies demonstrate that even frail elderly have the capacity to increase muscle strength using progressive strength training techniques. However, the efficacy and safety of progressive muscle strengthening have not been examined in the post-hospital period where it may be most efficacious in improving function and decreasing the risk of falls. Many older patients recently discharged from an acute hospitalization have lost muscle protein due to catabolic effects of illness and inadequate nutrition during hospitalization. Previous studies have suggested that nutritional supplementation during hospitalization improves rehabilitation outcomes. However, the use of nutritional supplementation to augment strength training in the post- hospitalization period has not been previously examined. It is our hypothesis that protein/calorie supplementation combined with progressive resistance training will result in improved strength, mobility, and function and will ultimately decreased the risk of falls. In this pilot study, we will examine the safety and feasibility of combining progressive strength training of quadriceps and hip extensors with nutritional supplements in elderly patients upon hospital discharge after an acute medical illness. If this regimen seems well tolerated, the next endeavor would be to use endpoints of change in strength, mobility, balance and functional status for a power analysis to determine the feasibility of a randomized clinical trial. Progress Through November 30, 1997: A preliminary pilot study was performed to validate a tool to assess perceived difficulty with balance and mobility tasks. This tool was incorporated into the study assessment protocol. Ten patients have been enrolled in the study and have received the progressive resistance training protocol. Two patients have yet to complete the post-training assessment.
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