The Impact of a Multimodal Intervention with Exercise and Nutritional Education on Sarcopenia and Frailty in Older Adults with HIV: a Quasi-Experimental Study Protocol

Older adults living with HIV are highly susceptible to sarcopenia and frailty. Both conditions are linked to a higher risk of mortality, hospitalizations, loss of functional independence, and a worse quality of life. This research aims to evaluate the effect of a 6-month multicomponent intervention (nutritional education, pharmacological treatment optimization, and structured multicomponent physical exercise at home) on the sarcopenia risk and frailty progression in pre-frail and frail adults aged 60 and above with HIV. This quasi-experimental study will be conducted at Hospital Clínico San Carlos (Madrid, Spain) with 12 months of follow-up. It will assess functional performance (changes in the Short Physical Performance Battery (SPPB)); frailty according to Fried phenotype; sarcopenia, using the EWGSOP-2 criteria; and changes in handgrip strength, nutritional parameters (adherence to a Mediterranean diet, malnutrition according to the GLIM criteria, and body composition parameters: bioimpedance and muscle ultrasound), quality of life (EQ-5D-5L), and biomarkers (IL-6, TNF-α, HOMA-IR). The intervention includes personalized educational nutritional sessions, as well as oral nutritional supplementation when required, and a tailored multicomponent exercise program based on the Vivifrail® protocol, with regular in-person and telephone follow-ups. The expected outcomes include significant reductions in sarcopenia and frailty, improvements in physical function and quality of life, and fewer hospital admissions. The intervention also seeks to be a cost-effective strategy applicable in clinical settings. This proposal addresses key research gaps regarding integrated, long-term interventions in frail older adults with HIV and aims to generate evidence to optimize their clinical and functional management.