Developing and assessing the effectiveness of a participatory, nutritional, and physical activity intervention on muscle function and quality of life among older adults with overnutrition in nursing homes—The IFEBO cluster randomized control trial

Background: Overnutrition, defined as overweight and obesity, is a growing concern among older adults, increasing the risk of comorbidity, disabilities, and mortality. However, the optimal management of overnutrition in this population remains unclear. Purpose: The aim is to develop and assess the effectiveness of a nutritional and physical activity intervention on muscle function and quality of life (QoL) among older adults with overnutrition in nursing homes (NHs). 
Methods: A 12-mo cluster randomized participatory trial was conducted in six Danish NHs. The NHs were assigned following a 1:1 allocation ratio for control and intervention. Using the Plan-Do-Study-Act model, intervention components were participatorily developed over the first 6 mo and implemented over the remaining 6 mo. Muscle strength was measured via hand grip strength and a 30-second chair stand test. The Adult Social Care Outcomes Toolkit assessed the care-related QoL. Mixed-effects models analyses were used to evaluate the intervention effects. 
Results: Ninety-three residents participated; 59% were overnourished. The intervention included daily/weekly physical and social activities, protein-rich bread, “Snack-on-Wheels,” systematic weighing, nutritional tasks for trained staff, and communication standards. Hand grip strength improved among men across weight statuses in the intervention group compared to the control group (P = 0.039). QoL was maintained in the overweight group, whereas it improved in the normal weight group (P = 0.019), with significant gains in social participation for both subgroups (P = 0.026). Conclusions: Participatorily developed nutrition and physical activity interventions can improve all NH residents’ physical function and well-being.