Protein Intake and Resistance Training Across Clinical Populations: A PRISMA-Guided Rapid Review of Observational and Randomized Evidence.

Background/

Objectives

Guidance on protein and physical activity rests on population-wide minima with little differentiation by age or disease. We examined how protein intake and resistance training relate to muscle, function and mortality across clinical populations.

Methods

PRISMA-guided rapid review: Fifty-eight logged PubMed queries returned 7544 unique records for screening (the analytic corpus); Europe PMC, Semantic Scholar and ClinicalTrials.gov were tested for coverage only. Estimates were extracted by a deterministic script and adjudicated by the authors; random-effects models were fitted within strata sharing an effect measure and contrast, and randomized evidence was tabulated, not pooled. Screening was single-reviewer outside a duplicate-screened sample (889 records); risk of bias was rated in duplicate.

Results

In randomized trials, added protein increased strength with resistance training (+2.01%) but not without it (+0.13%); no trial of protein with resistance training reported mortality. Meeting activity guidelines was associated with lower mortality (HR 0.76, 95% CI 0.72-0.79; k = 16; I2 = 64%; low certainty). Plant protein was associated with lower mortality (HR 0.76, 0.63-0.93; k = 4; very low certainty). After excluding studies at high risk of bias, the protein strata fell to single studies. The direction of protein-outcome associations differed between populations.

Conclusions

Protein with resistance training is a plausible strategy for preserving muscle and function; effects on survival are untested, and population-specific protein ranges are provisional and hypothesis-generating.