Frontiers in Nutrition · Nov 2, 2026
Association of Combined Nutrition and Exercise Management with Frailty Progression, Functional Performance, and Cardiovascular Outcomes in Community-Dwelling Older Adults: A Retrospective Cohort Study
By Rui Meng, Xiangnan Li, Yan Yu
Background: Frailty is a multifactorial geriatric syndrome associated with functional decline, cardiovascular impairment, hospitalization, and mortality. Objective: To investigate the association between combined nutrition-exercise management and frailty progression, functional performance, and cardiovascular outcomes in older adults. Methods: This retrospective cohort study used electronic health records (January 2020–December 2024) of community-dwelling adults aged ≥60 years followed at the geriatric outpatient clinic of a tertiary hospital in Beijing, China. Of 1,820 eligible adults, 1,584 with complete baseline and six-month data were analysed. They were grouped by documented lifestyle management: combined nutrition and exercise (CNE, n=480), exercise only (EX, n=425), nutrition only (NU, n=375), and standard care (CON, n=304). Primary outcomes were frailty progression and cardiac dysfunction at six months. Secondary outcomes included activities of daily living (ADL), grip strength, gait speed, skeletal muscle mass, falls, hospitalizations, emergency department visits, left ventricular ejection fraction (LVEF), heart rate variability (HRV), NT-proBNP, and blood pressure. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using multivariable logistic regression. Results: Demographic and clinical characteristics were generally balanced. However, protein intake, caloric intake, and serum albumin (and, to a lesser extent, CRP, zinc, and diastolic blood pressure) differed significantly across groups, so serum albumin was included as a covariate. At six months, the CNE group showed the greatest reduction in frailty score (-0.18 ± 0.66) versus EX (-0.11 ± 0.73), NU (-0.09 ± 0.75), and CON (+0.06 ± 0.82) (p<0.001). Frailty progression was lowest with CNE (14.2%) versus EX (21.5%), NU (23.8%), and CON (36.4%) (p<0.001). CNE participants also had greater improvements in ADL, grip strength, gait speed, skeletal muscle mass, LVEF, HRV, NT-proBNP, and blood pressure. They also had fewer falls, hospitalizations, and emergency visits (all p<0.001). In multivariable analyses, CNE was independently associated with lower odds of frailty progression (adjusted OR 0.62, 95% CI 0.51–0.78) and cardiac dysfunction (adjusted OR 0.58, 95% CI 0.45–0.73). Conclusion: Over six months, combined nutrition and exercise management was associated with reduced frailty progression, improved physical function, and better cardiovascular outcomes compared with single interventions or standard care.