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IntroductionResistance exercise has been shown to improve muscle health in older adults and is recommended as a front-line treatment for many health conditions, including sarcopenia and frailty. However, despite considerable research detailing the potential benefits of resistance exercise programmes, little is known about how older adults recover from individual exercise sessions. This scoping review will examine the current evidence surrounding the acute post-exercise effects of resistance exercise and the exercise recovery process in older adults to inform future research and exercise prescription guidelines for older adults.Methods and analysisThe methodological framework of Arksey and O’Malley (2005) will be applied for this scoping review. A systematic search of five online databases and the hand-searching of reference lists of identified articles will be used to identify relevant papers. Studies that aim to measure exercise-induced muscle damage or exercise recovery following a resistance exercise session in participants aged 65 years and over will be included. Qualitative and quantitative data from relevant studies will be presented in a tabular format. Results will be summarised in narrative format. Key findings will be discussed concerning resistance exercise prescription in older adults.DisseminationThis review will be used to direct further research surrounding the exercise recovery process from resistance exercise in older adults and will also aid in designing specific exercise prescription guidelines for an older population. Findings will be relevant to researchers, clinicians, health workers and policy-makers and disseminated through publications and presentations.

Background Weak grip strength is associated with a range of adverse health outcomes and an accelerated decline in grip strength confers an even greater risk. The factors associated with change in grip strength in mid-life remain to be fully determined. Methods We used data from 44,315 UK Biobank participants who had grip strength measured at baseline (2006-10) and a subsequent visit approximately nine years later. At baseline, participants’ long-term conditions (LTCs) were categorised against a hierarchy, with multimorbidity characterised by the number of LTC categories. Lifestyle factors were assessed. Change in grip strength was grouped into four patterns: decline, stable low, stable high or reference (no change or increase) and used as the outcome in multinomial logistic regression. Results Most LTC categories were associated with adverse patterns of change in grip strength (stable low and/or decline): for example, musculoskeletal / trauma conditions were associated with an increased risk of the stable low pattern (Relative Risk Ratio [RRR]=1.63; 95% confidence interval [CI]: 1.49-1.79). Multimorbidity and lifestyle factors had independent associations with grip strength change. Those with 3+ categories of LTCs were more likely to experience decline in grip strength (RRR=1.18; 95% CI: 1.08-1.28) compared to those with none. Low physical activity was associated with adverse patterns of grip strength, while raised body mass index (BMI) had divergent associations. Conclusions Individuals living with multimorbidity and those with lifestyle risk factors such as low physical activity are at increased risk of low muscle strength and the loss of strength over time.

Funding Information: Acknowledgments: M.N.L. is supported by an NIHR Doctoral Fellowship (grant code NIHR300159). D.W. is supported by a NIHR Clinical Lectureship. A.A.S., A.G., C.H., P.H., S.R. and M.D.W. acknowledge support from the NIHR Newcastle Biomedical Research Centre. C.J.S. receives funds from the M.R.C., Wellcome Trust, Chronic Disease Research Foundation. E.R.T. is supported by the Medical Research Council (MRC) and Versus Arthritis as part of the Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA) [MR/R502182/1]. Funding Information: Importantly, nutrition represents a modifiable risk factor for frailty, and as such, is a target for both prevention and treatment of this debilitating syndrome. However, to design effective dietary interventions, a clearer understanding of the key dietary components and underlying mechanisms of action are needed. Progress in understanding the role and importance of nutrition and to address how diet can be used for the prevention and treatment of frailty, requires a multi-disciplinary approach. This review evolved from a workshop held on 6 November 2020, which was attended by all authors. The workshop was one of a series funded by the Medical Research Council under the UK Nutrition Research Partnership (UK NRP) Call for Nutrition Hot Topic Workshops. It brought together a new group of experts from the fields of nutrition and frailty, from a variety of backgrounds, in order to promote dialogue to address the potential of diet within strategies to prevent and treat frailty. The workshop had two aims: firstly, to review the evidence and current understanding of the links between nutrition and frailty, and secondly, to consider the gaps in the evidence and identify unanswered questions. Funding Information: We would like to acknowledge the Medical Research Council for their support in funding the workshop which led to the production of this paper, as part of the UK Nutrition Research Part-nership (UK NRP) Call for Nutrition Hot Topic Workshops.Acknowledgments: M.N.L. is supported by an NIHR Doctoral Fellowship (grant code NIHR300159). D.W. is supported by a NIHR Clinical Lectureship. A.A.S., A.G., C.H., P.H., S.R. and M.D.W. acknowledge support from the NIHR Newcastle Biomedical Research Centre. C.J.S. re-ceives funds from the M.R.C., Wellcome Trust, Chronic Disease Research Foundation. E.R.T. is supported by the Medical Research Council (MRC) and Versus Arthritis as part of the Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA) [MR/R502182/1]. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Copyright: Copyright 2021 Elsevier B.V., All rights reserved. Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its path-ophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future. publishersversion published

Antoneta Granic,1,2 Christopher Hurst,1,2,* Lorelle Dismore,3,* Terry Aspray,1,2,4 Emma Stevenson,5,6 Miles D Witham,1,2 Avan A Sayer,1,2 Sian Robinson1,2 1AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; 2NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle Upon Tyne, UK; 3Northumbria Healthcare NHS Foundation Trust, Research and Development, North Tyneside General Hospital, North Shields, UK; 4Newcastle Upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Unit, Freeman Hospital, Newcastle Upon Tyne, UK; 5Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; 6Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK*These authors contributed equally to this workCorrespondence: Sian RobinsonNIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Biomedical Research Building, 3rd Floor, Campus for Ageing and Vitality, Newcastle Upon Tyne NE4 5PL, UKTel +44 (0) 1912081325Email sian.robinson@newcastle.ac.ukAbstract: Skeletal muscle aging manifests as a decline in muscle quantity and quality that accelerates with aging, increasing the risk of sarcopenia. Sarcopenia is characterized by a loss of muscle strength and mass, and contributes to adverse health outcomes in older adults. Intervention studies have shown that sarcopenia may be treated by higher protein intake in combination with resistance exercise (RE). In comparison, less is known about the role of whole protein-containing foods in preventing or treating sarcopenia. Liquid milk contains multiple nutrients and bioactive components that may be beneficial for muscle, including proteins for muscle anabolism that, alone or with RE, may have myoprotective properties. However, there is a lack of evidence about the role of milk and its effects on muscle aging. This narrative review considers evidence from three observational and eight intervention studies that used milk or fortified milk, with or without exercise, as an intervention to promote muscle health and function in older adults (aged 50– 99 years). The observational studies showed no association between higher habitual milk consumption and muscle-related outcomes. The results of intervention studies using fortified milk in relation to elements of sarcopenia were also negative, with further inconclusive results from the studies using a combination of (fortified) milk and exercise. Although milk contains nutrients that may be myoprotective, current evidence does not show beneficial effects of milk on muscle health in older adults. This could be due to high habitual protein intakes (> 1.0 g/kg BW/d) in study participants, differences in the type of milk (low-fat vs whole) and timing of milk consumption, length of interventions, as well as differences in the sarcopenia status of participants in trials. Adequately powered intervention studies of individuals likely to benefit are needed to test the effectiveness of a whole food approach, including milk, for healthy muscle aging.Keywords: sarcopenia, muscle health, whole foods, milk, myoprotective properties, older adults

Supplemental material, Supplementary_Materials_Dismore_et_al_2020_MIlkMAN_GGM-20-0017.R1_clean for Study of the Older Adults’ Motivators and Barriers Engaging in a Nutrition and Resistance Exercise Intervention for Sarcopenia: An Embedded Qualitative Project in the MIlkMAN Pilot Study by Lorelle Dismore, Christopher Hurst, Avan A. Sayer, Emma Stevenson, Terry Aspray and Antoneta Granic in Gerontology and Geriatric Medicine