4. Discussion
dietary behavior
In this cluster-randomized controlled trial, we randomized 13 community strongholds into 2 treatment groups—exercise alone (control group) and exercise and nutrition combined (experimental group)—conducting a 3-month intervention using group activity sessions. This study assessed whether adding a dietary intervention on top of an exercise session could regress the development of frailty and related geriatric parameters via favorable dietary intake changes. The results showed that the 3-month intervention significantly improved the frailty status, as well as working memory in the forward digit span, along with the improvement in the dietary intakes of non-refined grains and roots, dairy products, and nuts and seeds (at borderline). The dietary improvements in the experimental group were also accompanied by more advanced dietary behavior change stages. However, the beneficial effects only persisted for the forward digit span and dietary intake of dairy products and nuts and seeds, not for the frailty status, which suggests that continuous boosting activities might be needed for a long-term maintenance effect.The literature has demonstrated the effects of nutrition and/or physical activity treatment on physical frailty status [Most intervention studies targeting frailty prevention were designed at the individual level—in which participants took their oral supplements, performed physical exercise, or were counseled by dieticians—whereas very few of them were at the group level [Intervention through group activity sessions might have induced some peer effects in individual participants [This study had several limitations. First of all, the participants in the present study were able to walk 14-m independently, indicating that they were likely better than average in physical functioning. In fact, the majority of the participants were at a robust and pre-frail status, and only about 5% of them were frail at baseline. Therefore, we cannot extrapolate our findings to elders with severe frailty. Second, no health behavior data were available to assess the stages of behavior change for the control group. This information should be collected in the future for making firm conclusions on the relationships among changes of the behavioral stage and changes of the dietary and health outcomes.