Protein drinks and exercise intervention improve physical performance in frail patients undergoing TAVR

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 programme.

Previous research has linked frailty to poor outcomes in older adults undergoing TAVR. Therefore, Dr Jonathan Afilalo (McGill University, Canada) and his team conducted the PERFORM-TAVR trial (NCT03522454) at 11 hospitals across Canada to explore whether a combination of nutritional supplementation and exercise could improve this situation.

The participants were ≥70 years of age and had objective evidence of physical frailty in standardised 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 programme.

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 programme. Improving frailty is going to improve the outcomes of patients undergoing all sorts of interventional procedures,” Prof. Afilalo concluded.

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   1. Afilalo J, et al. Protein and Exercise to Reverse Frailty in Older Men and Women Undergoing Transcatheter Aortic Valve Replacement: The PERFORM-TAVR Trial. Featured Clinical Research 3, Session 413, ACC 2024 Scientific Session, 6–8 April, Atlanta, USA.

Medical writing support was provided by Dr Susanne Kammerer.
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Posted on 10 April, 202410 April, 2024