Corresponding author: Yoshihiro Yoshimura, hanley.belfus@gmail.com
DOI: 10.31662/jmaj.2026-0293
Received: June 10, 2026
Accepted: June 25, 2026
Advance Publication: August 14, 2026
Published: September 15, 2026
Cite this article as:
Yoshimura Y, Yasumoto Y, Matsumoto T, Nagano A, Nishioka S, Nagami S, Nagano F, Tanaka M, Iida Y, Hong Y, Aragane H, Kitaoka A, Nakagawa K, Yoshimi K, Takahata H, Shiraishi A, Saino Y, Ichishima H, Matsumoto A, Higashi K, Kumagae N, Fujiwara D, Omura K, Wakabayashi H. Clinical Practice Guideline for Rehabilitation Nutrition 2026: Executive Summary of the Japanese Association of Rehabilitation Nutrition Guideline 2026—A Secondary Publication. JMA J. 2026;9(5):1360-1378.
The Japanese Association of Rehabilitation Nutrition (JARN) published its first Japanese-language clinical practice guideline on rehabilitation nutrition in 2018, followed by an English-language 2020 update covering cerebrovascular disease, hip fracture, cancer, and acute illness. The JARN Clinical Practice Guideline 2026 (JARN GL 2026) expands the framework to 11 domains and incorporates updated evidence on malnutrition diagnosis using the Global Leadership Initiative on Malnutrition criteria, sarcopenia assessment, and interactions between nutritional therapy and rehabilitation. This secondary publication summarizes the scope, methods, and all statements.
JARN GL 2026 was developed in accordance with the Minds Clinical Practice Guideline Development Manual 2020 (version 3.0). Clinical questions were formulated in Population, Intervention, Comparison, and Outcome format and classified as clinical questions (CQs) with graded recommendations, background questions (BQs) providing evidence-based context, or future research questions (FRQs) identifying topics with insufficient evidence. Recommendations were graded for strength (1 = strong; 2 = weak/conditional) and certainty of evidence (A-D). Patient and public involvement and external peer review by related academic societies were incorporated.
Across 11 domains—cerebrovascular disease, proximal femur fracture, chronic obstructive pulmonary disease (COPD), cancer, dysphagia, intensive exercise therapy, enhanced nutritional care, oral management, pharmaceutical intervention, hospital-associated sarcopenia, and social determinants of health—12 CQs, five BQs, and three FRQs are presented. Enhanced nutritional care combined with rehabilitation was strongly recommended for patients with proximal femur fracture and weakly recommended for patients with acute- and convalescent-phase cerebrovascular disease, COPD, cancer, and dysphagia. Registered dietitian-led nutritional assessment and counseling and professional oral management concurrent with rehabilitation were each weakly recommended. Three topics were classified as FRQs because of insufficient evidence.
JARN GL 2026 provides a systematically developed, evidence-graded framework to support patient-centered, multidisciplinary rehabilitation nutrition across care settings.
Key words: cerebrovascular disease, proximal femur fracture, chronic obstructive pulmonary disease, cancer, dysphagia, pharmaceutical intervention, hospital-associated sarcopenia, social determinants of health
JARN published its first clinical practice guideline on rehabilitation nutrition in 2018 (1), (2), (3), (4), covering four clinical domains and establishing a systematic framework that integrates nutritional therapy with rehabilitation medicine. An English-language 2020 update (5) was subsequently published, providing evidence-based recommendations for rehabilitation nutrition in four domains: cerebrovascular disease, hip fracture, cancer, and acute illness. Rehabilitation nutrition is a patient-centered, multidisciplinary clinical approach that integrates nutritional management with rehabilitation to simultaneously address nutritional disorders—malnutrition, sarcopenia, frailty, and cachexia—and functional impairment. Its core process comprises assessment, diagnosis, goal setting, intervention, and monitoring, with individualized decisions based on disease status, comorbidities, living circumstances, patient values, and available resources.
Since then, population aging, community-integrated care, Global Leadership Initiative on Malnutrition -based malnutrition diagnosis, revised sarcopenia criteria, and accumulating evidence on exercise–nutrition interactions have increased the need for updated rehabilitation nutrition guidance.
JARN GL 2026 (6) reassesses the evidence for domains covered in the 2018 guideline and extends coverage to 11 domains in total. The guideline aims to (1) promote patient-centered care that supports functional recovery and improvements in activities of daily living (ADL), quality of life (QOL), and prognosis; (2) provide a practicable framework for multidisciplinary collaboration; and (3) identify priorities for future research.
JARN GL 2026 addresses the rehabilitation nutrition process—assessment, diagnosis, goal-setting, intervention, and monitoring—across acute, recovery, home, and community settings.
Three of the four disease domains from the 2018 edition (cerebrovascular disease, proximal femur fracture, and cancer; acute illness was not carried forward) were retained and updated. Eight additional domains were incorporated: dysphagia, COPD, enhanced nutritional care, intensive exercise therapy, oral management, pharmaceutical intervention, hospital-associated sarcopenia, and social determinants of health (SDH). Interventions include multidisciplinary nutritional therapy and rehabilitation, with pharmacotherapy and social resource coordination as appropriate. Primary outcomes of interest include physical function, ADL, QOL, complications, prognosis, and patient-reported outcomes.
The guideline is intended primarily for multiprofessional rehabilitation nutrition providers, including physicians, dentists, nurses, registered dietitians, pharmacists, physical therapists, occupational therapists, speech-language-hearing therapists, and dental hygienists. It also informs care managers, social workers, patients, families, and individualized decision-making.
JARN GL 2026 was developed by JARN in accordance with the Minds Clinical Practice Guideline Development Manual 2020 (ver. 3.0). The scope was prespecified, and CQs were formulated in Population, Intervention, Comparison, and Outcome format and prioritized by clinical importance, feasibility, and evidence availability. Questions without sufficient evidence for CQ-based recommendations were classified as BQs or FRQs.
The development structure comprised a supervisory committee, a multidisciplinary guideline development group, a systematic review team, and a secretariat. The systematic review team screened and appraised evidence independently from the recommendation panel. For each CQ, the panel deliberated on evidence certainty, the balance of benefits and harms, patient values and preferences, feasibility, and resource implications, and reached consensus on the statement, recommendation strength, and certainty rating. BQs were addressed through narrative evidence synthesis, and FRQs were formulated to guide future research agendas without constituting recommendations. Supplementary Figures and Supplementary Tables provide PRISMA flow diagrams and structured evidence summaries for each relevant question.
Patient and public involvement was embedded in the development process: a patient and family representative participated in the guideline panel. External peer review was conducted by four evaluators representing related academic societies, and opinions were solicited from relevant professional organizations. JARN provided all funding, and COIs were declared, managed, and disclosed in accordance with Minds and JARN regulations.
Institutional review board approval was not obtained because it was not required. This manuscript is an English executive summary and secondary publication of a previously published Japanese clinical practice guideline based on systematic literature review, evidence synthesis, guideline panel deliberation, patient and public involvement, and external peer review. No new human participants were recruited, no intervention was performed, and no individual-level or identifiable patient data were collected, analyzed, or reported.
Statements are organized by the 11 domains. For CQs, recommendation strength and certainty of evidence are shown; BQs provide contextual evidence, and FRQs indicate insufficient evidence for recommendation. Table 1 summarizes all 20 items (Table 1).
Table 1. Clinical Questions, Background Questions, and Future Research Questions Addressed in this Guideline.
| Domain | No. | Question type | Question |
|---|---|---|---|
| Cerebrovascular Disease | 1 | CQ1 | Should enhanced nutritional care be provided to patients with acute cerebrovascular disease undergoing rehabilitation? |
| Cerebrovascular Disease | 2 | CQ2 | Should enhanced nutritional care be provided to patients with cerebrovascular disease in the convalescent phase undergoing rehabilitation? |
| Proximal Femoral Fracture | 3 | CQ3 | Should enhanced nutritional care be provided to patients with proximal femoral fracture undergoing rehabilitation? |
| Chronic Obstructive Pulmonary Disease (COPD) | 4 | CQ4 | Should enhanced nutritional care be provided to outpatients and inpatients with chronic obstructive pulmonary disease undergoing rehabilitation? |
| Cancer | 5 | CQ5 | Should a combined rehabilitation and nutritional therapy program be provided to adult patients with solid tumors before or after treatment or with advanced or recurrent disease, excluding refractory cachexia? |
| Dysphagia | 6 | BQ1 | What exercise therapies are available for patients with dysphagia? |
| Dysphagia | 7 | BQ2 | What nutritional therapies are available for patients with dysphagia? |
| Dysphagia | 8 | BQ3 | What clinical problems are associated with malnutrition in patients with dysphagia? |
| Dysphagia | 9 | CQ6 | Should exercise therapy be provided to patients with dysphagia? |
| Dysphagia | 10 | CQ7 | Should exercise therapy and nutritional therapy be combined to improve swallowing function in patients with dysphagia? |
| Dysphagia | 11 | CQ8 | Should nutritional therapy, including enteral nutrition, parenteral nutrition, oral nutritional supplements, and nutritional counseling, be provided to patients with dysphagia? |
| Intensive Exercise Therapy | 12 | FRQ1 | Should intensive exercise therapy be provided to patients with malnutrition receiving nutritional therapy? |
| Enhanced Nutritional Care | 13 | BQ4 | What is the range of energy expenditure in older adults aged 65 years or older undergoing rehabilitation, and are there simple methods for estimating energy expenditure? |
| Enhanced Nutritional Care | 14 | CQ9 | Should registered dietitians perform nutritional assessment for older adults undergoing rehabilitation in outpatient and inpatient settings, older adults requiring long-term care, and frail older adults? |
| Enhanced Nutritional Care | 15 | CQ10 | Should registered dietitians provide nutritional counseling to older adults undergoing rehabilitation in outpatient and inpatient settings, older adults requiring long-term care, and frail older adults? |
| Oral Management | 16 | CQ11 | Does combining professional oral management with rehabilitation improve outcomes compared with rehabilitation alone in rehabilitation inpatients? |
| Pharmaceutical Intervention | 17 | CQ12 | Is pharmacist-led pharmaceutical intervention effective in patients undergoing rehabilitation? |
| Hospital-Associated Sarcopenia | 18 | BQ5 | What is the incidence of hospital-associated sarcopenia, and what are its causes and risk factors? |
| Social Determinants of Health | 19 | FRQ2 | Is screening for social determinants of health useful for improving outcomes in adults receiving rehabilitation treatment or exercise therapy? |
| Social Determinants of Health | 20 | FRQ3 | Do interventions that take social determinants of health into account improve outcomes, including treatment continuation, activities of daily living, and healthcare costs, in adults receiving rehabilitation treatment or exercise therapy? |
| BQ: background question; COPD: chronic obstructive pulmonary disease; CQ: clinical question; FRQ: future research question. | |||
In this summary, “enhanced nutritional care” refers to nutritional interventions implemented with the aim of increasing energy or nutrient intake in addition to a regular diet or standard nutritional management. This includes ONS, nutrient fortification, increased enteral or parenteral delivery, and individualized management by registered dietitians or equivalent professionals.
Statement: In patients with acute cerebrovascular disease undergoing rehabilitation, enhanced nutritional care using oral nutritional supplements or early enteral nutrition is weakly recommended, with careful attention to blood glucose levels.
Summary of rationale: Stroke is a leading cause of death and disability worldwide, and because malnutrition from the acute phase is associated with poor outcomes, maintaining adequate nutrition alongside exercise-based interventions is essential (7), (8), (9), (10), (11). In 34 randomized controlled trials (RCTs) involving patients with acute cerebrovascular disease, enhanced nutritional care showed trends toward improvement in ADL, body composition, body weight, and mortality; however, consistent statistically significant effects were not observed across most outcomes, and the certainty of evidence was low (12), (13), (14), (15), (16), (17), (18), (19), (20), (21), (22), (23), (24), (25), (26), (27), (28), (29), (30), (31), (32), (33), (34), (35), (36), (37), (38), (39), (40), (41), (42), (43), (44), (45). Oral nutritional supplements and early enteral nutrition may be useful, but adverse events, including diarrhea and hyperglycemia or hypoglycemia, have been reported; therefore, careful monitoring, including glycemic management, is required.
Statement: In patients with cerebrovascular disease in the convalescent phase undergoing rehabilitation, enhanced nutritional therapy, such as additional protein provision based on adequate energy intake, is weakly recommended.
Summary of rationale: In recovery-phase cerebrovascular disease, malnutrition is highly prevalent in rehabilitation wards and may adversely affect ADL outcomes and home discharge, underscoring the need for proactive nutritional therapy to support maximal recovery (10), (46). In three RCTs involving mixed acute/convalescent populations and 10 RCTs in the convalescent phase, enhanced nutritional care using oral nutritional supplements—particularly energy- and protein-enriched formulations—showed trends toward improvement in ADL, physical function, and muscle strength, but effects were inconsistent across nutrient types and interventions, and clear statistically significant differences were not observed for many outcomes (47), (48), (49), (50), (51), (52), (53), (54), (55), (56), (57), (58), (59). Few adverse events were reported, and oral nutritional supplements are relatively low-cost and feasible. Implementation should be individualized.
Statement: In patients with proximal femoral fracture undergoing rehabilitation, enhanced nutritional care improves ADL and physical function, shortens length of hospital stay, and reduces the incidence of complications, with an expected improvement in mortality. Considering the economic burden on healthcare facilities and patient preferences, its feasibility in clinical practice is considered high. Therefore, enhanced nutritional care is strongly recommended.
Summary of rationale: In patients with proximal femoral fracture undergoing rehabilitation, pooled analyses of RCTs showed significant improvement in ADL, grip strength, and body mass index (BMI), shortening of length of hospital stay, and reduction in complications (60), (61), (62), (63), (64), (65), (66), (67), (68), (69), (70), (71), (72), (73), (74), (75), (76), (77), (78), (79). Mortality also tended to decrease. No clear adverse events were reported, and the benefits were judged to outweigh the harms. Although the certainty of evidence was low, outcomes related to functional recovery and prognosis are important to patients, and the therapy is considered acceptable in many cases. Uncertainty remains regarding cost-effectiveness; however, feasibility is generally high, and implementation should take into account the continuity of nutritional intake and patient motivation.
Statement: In outpatients and inpatients with COPD undergoing rehabilitation, enhanced nutritional care is weakly recommended.
Summary of rationale: COPD imposes a substantial disease burden in Japan (80), and pulmonary rehabilitation is a comprehensive intervention that includes exercise, education, and nutritional management (81), (82), (83), (84). The present review built on the previous systematic review by Aldhahir et al. (85). In 10 RCTs involving patients with COPD (86), (87), (88), (89), (90), (91), (92), (93), (94), (95), enhanced nutritional care improved muscle strength, body weight, and BMI; however, consistent effects were not observed for exercise tolerance, QOL, or pulmonary function. Because of heterogeneity and risk-of-bias concerns, certainty of evidence was rated as C. Safety data were limited, so indications should be individualized.
Statement: In adult patients with solid tumors before or after treatment or with advanced or recurrent disease, excluding the refractory cachexia stage, no serious adverse events have been reported for programs combining rehabilitation and nutritional therapy. These programs have been suggested to be useful for increasing protein intake, improving body composition, and alleviating cancer-related symptoms, such as fatigue, nausea, and vomiting. Therefore, because improvements in beneficial outcomes, including muscle strength, body composition, and fatigue, can be expected, a combined rehabilitation and nutritional therapy program is weakly recommended.
Summary of rationale: Patients with cancer face a high risk of malnutrition and sarcopenia induced by the disease and by treatment-related factors; integration of rehabilitation and nutritional therapy is therefore recognized as a vital strategy to preserve ADL and QOL, even from the pre-cachexia stage. In an assessment of five RCTs, combined rehabilitation and nutritional therapy significantly improved muscle strength, body composition, and fatigue. Consistent results were not obtained for overall QOL, survival, or general nutritional status, and certainty was low. No serious adverse events were reported. Many positive studies were limited to patients with prostate cancer receiving androgen deprivation therapy, who are predisposed to sarcopenic obesity, limiting generalizability (96), (97), (98), (99), (100), (101), (102), (103), (104).
Statement: Exercise therapies for patients with dysphagia include suprahyoid muscle-strengthening exercises, such as head-lift exercise and chin-tuck against resistance, tongue resistance training, and expiratory resistance training. Studies involving patients after surgery for head and neck cancer, post-stroke patients, patients with Parkinson disease, and institutionalized older adults have reported effects such as increased hyoid excursion, increased suprahyoid muscle mass, and reduced aspiration risk. Improvements in swallowing function have also been reported with comprehensive exercise therapy, including whole-body exercise.
Summary of rationale: Weakness of swallowing-related muscles contributes to impairment across the phases of swallowing, and exercise therapies targeting the suprahyoid muscles and tongue are expected to improve swallowing function. Comprehensive approaches that include interventions for respiratory function and whole-body function may also be effective. Exercise load should be individualized (105), (106), (107), (108), (109), (110), (111), (112), (113), (114), (115), (116), (117), (118), (119), (120), (121), (122), (123), (124), (125), (126), (127), (128), (129), (130), (131), (132).
Statement: For patients with dysphagia who are able to take food orally, nutritional therapy includes modification of food texture according to swallowing function, provision of nutrient-dense foods, and oral nutritional supplements; these approaches have been reported to increase body weight, improve nutritional status, and improve physical function. For patients with dysphagia in whom oral intake is difficult, alternative nutritional routes, such as nasogastric tube feeding and percutaneous endoscopic gastrostomy (PEG), are options and may reduce mortality risk and improve nutritional status in the acute phase. However, in older patients with dysphagia, aspiration pneumonia and mortality have been reported to be higher in those receiving alternative nutrition; therefore, transition to oral intake should also be considered when appropriate.
Summary of rationale: When oral intake is possible, texture modification and nutritional fortification are expected to improve nutritional status and function. When oral intake is difficult, alternative nutrition should be used appropriately as a safe means of securing nutritional intake. However, it should not be assumed that patients will remain dependent on alternative nutrition over the long term. It is important to concurrently provide dysphagia rehabilitation while repeatedly assessing swallowing function over time, taking into account the patient’s overall condition, prognosis, and living circumstances (36), (133), (134), (135), (136), (137), (138), (139), (140), (141), (142), (143), (144), (145), (146), (147), (148).
Statement: Malnutrition in patients with dysphagia is associated with deterioration in nutritional indicators, such as weight loss and low BMI. It is also associated with poor prognostic factors, including reduced swallowing function and increased mortality. Therefore, early nutritional assessment and appropriate nutritional intervention are required for patients with dysphagia.
Summary of rationale: The evidence review showed a certain prevalence of malnutrition among patients with dysphagia (149), as well as low BMI and reduced energy and protein intake (150), (151), (152), (153), (154). In addition, dysphagia severity, duration of dysphagia, and physical function measures were associated with malnutrition (153). The evidence also suggested that nutritional supplementation alone may be insufficient to improve body composition (150).
Statement: Exercise therapy is weakly recommended for patients with dysphagia undergoing rehabilitation in outpatient and inpatient settings, older adults requiring long-term care, and frail older adults, because improvement in swallowing function can be expected.
Summary of rationale: The evidence review included 34 RCTs. Exercise therapies, including head-lift exercise, chin-tuck against resistance, tongue resistance training, and respiratory muscle training, showed improvements in tongue pressure, the Videofluoroscopic Dysphagia Scale, and the Functional Oral Intake Scale. Although the target populations and intervention methods varied, the effects were small but consistently indicated improvement in swallowing function. The Penetration–Aspiration Scale showed only a trend toward improvement; nevertheless, many studies reported improvements in swallowing-related outcomes. Because of heterogeneity in populations, interventions, and outcome measures, as well as risk of bias, the certainty of evidence was rated as D (105), (106), (108), (109), (110), (111), (112), (113), (114), (115), (116), (117), (118), (120), (121), (122), (123), (124), (127), (128), (129), (155), (156), (157), (158), (159), (160), (161), (162), (163), (164), (165), (166), (167), (168), (169), (170). Exercise selection and load should be individualized.
Statement: For patients with dysphagia undergoing rehabilitation in outpatient and inpatient settings, older adults requiring long-term care, and frail older adults, the combined use of exercise therapy and nutritional therapy is weakly recommended because improvements in swallowing function and the rate of transition to oral intake can be expected.
Summary of rationale: In older adults requiring long-term care, malnutrition is directly and indirectly associated with dysphagia, and sarcopenia itself is an important risk factor (171), (172), (173). The evidence review included 3 RCTs. The combined use of exercise therapy and nutritional therapy improved oral and swallowing function, increased the rate of transition to oral intake, and improved QOL (174), (175), (176). However, quantitative synthesis was difficult because of heterogeneity in target populations and intervention components, as well as the small number of studies. Therefore, the certainty of evidence was rated as D. When implementing combined therapy, individualized intervention according to the patient’s condition and nutritional status, as well as appropriate timing and intensity, is important.
Statement: For patients with dysphagia undergoing rehabilitation in outpatient and inpatient settings, older adults requiring long-term care, and frail older adults, nutritional therapy, including enteral nutrition, parenteral nutrition, oral nutritional supplements, and nutritional counseling, is weakly recommended because improvement in swallowing function and nutritional status can be expected.
Summary of rationale: The evidence review included 8 RCTs. Nutritional therapy improved swallowing function (175), (177), nutritional intake (133), (140), nutritional indicators (40), (133), (177), and QOL (175). However, because outcome measures and intervention components varied across studies, quantitative synthesis was limited. No clear effects were demonstrated for mortality (36), (40) or length of hospital stay (36). No adverse events were reported, and undesirable effects were considered small. Content and timing should be individualized by a multidisciplinary team.
Statement: There is insufficient evidence to support the efficacy and safety of intensive exercise therapy for patients with malnutrition receiving nutritional therapy. At present, the definition of intensive exercise therapy is unclear, and no conclusion can be drawn regarding the conditions, timing, or exercise components under which it should be implemented. Therefore, no guideline recommendation is made for this item, and it is designated as a Future Research Question.
Summary of rationale: Evidence on intensive exercise therapy in patients with malnutrition is extremely limited, and definitions and implementation conditions have not been established (178), (179), (180). Future high-quality RCTs are needed to examine appropriate exercise intensity and timing according to disease category and nutritional status, as well as safety and effects on ADL and QOL.
Statement: Resting energy expenditure estimated using indirect calorimetry in older adults aged 65 years or older ranges from 967.5 to 1,703 kcal. Simple methods for estimating energy expenditure in populations have been reported. However, no estimation method can be recommended for use at the individual level.
Summary of rationale: Studies using indirect calorimetry have reported that energy expenditure in older adults aged 65 years or older ranges from 967.5 to 1,703 kcal. The validity of estimation methods, including the Harris–Benedict equation, Nachmani equation, Owen equation, and recommended energy requirements proposed by the World Health Organization and the Food and Agriculture Organization of the United Nations, has been examined. However, these methods have been evaluated at the population level, and their validity at the individual level has not been established (181), (182), (183), (184), (185), (186), (187), (188).
Statement: In older adults undergoing rehabilitation in outpatient and inpatient settings, older adults requiring long-term care, and frail older adults, although consistent effects have not been demonstrated, improvements in skeletal muscle mass, physical and mental function, ADL, and QOL have been suggested. Therefore, it is suggested that registered dietitians perform nutritional assessment before providing nutritional support.
Summary of rationale: The literature search identified six eligible studies, of which two were included in the meta-analysis. Quantitative synthesis was possible only for 180-day mortality, and no statistically significant improvement in mortality was observed with nutritional assessment followed by nutritional support (risk ratio, 0.48; 95% confidence interval, 0.14-1.70). Some studies reported favorable effects on skeletal muscle mass, 6-minute walk distance, the proportion of patients with decline in the Barthel Index, Functional Independence Measure scores, and EuroQol 5-Dimension. Based on these findings, nutritional assessment by registered dietitians is suggested. However, it should be noted that the eligible studies evaluated nutritional assessment together with subsequent nutritional intervention, rather than nutritional assessment alone (43), (189), (190), (191), (192), (193), (194), (195), (196), (197), (198), (199), (200), (201), (202), (203).
Statement: In older adults undergoing rehabilitation in outpatient and inpatient settings, older adults requiring long-term care, and frail older adults, nutritional counseling by registered dietitians is suggested because improvement in physical function can be expected.
Summary of rationale: The literature search identified five eligible studies, of which four were included in the meta-analysis. No statistically significant intervention effect was observed for mid-upper arm circumference, for which quantitative synthesis was possible (mean between-group difference, 0 cm; 95% confidence interval, −0.94 to 0.94), or for grip strength (mean between-group difference, 0.02 kg; 95% confidence interval, −2.14 to 2.18). However, all four studies that assessed physical function reported improvement. Based on these findings, nutritional counseling by registered dietitians is suggested. It should be noted, however, that many of the eligible studies evaluated multicomponent interventions, including exercise intervention and provision of oral nutritional supplements, rather than nutritional counseling alone (202), (204), (205), (206), (207), (208).
Statement: In hospitalized patients undergoing rehabilitation, compared with rehabilitation alone, the combined use of specialized oral management is expected to improve outcomes such as swallowing function, nutritional status, oral intake rate, activities of daily living, shortened length of hospital stay, higher home discharge rate, and lower mortality. Therefore, oral care intervention in parallel with rehabilitation is weakly recommended for hospitalized rehabilitation patients.
Summary of rationale: Oral management may improve ADL and help prevent aspiration pneumonia. A retrospective cohort study of professional oral management by dental hygienists at least twice weekly reported significantly higher ADL at discharge versus a propensity score–matched control group, with shorter stay and higher home discharge rate; another report found no short-term ADL improvement. Most evidence is observational, so causal inference is limited (209), (210), (211), (212), (213), (214).
Statement: For patients undergoing rehabilitation in outpatient and inpatient settings, pharmacist-led pharmaceutical intervention may contribute to improvement in QOL and may be effective in reducing adverse drug reactions. Therefore, its implementation is weakly recommended.
Summary of rationale: In 11 studies, including eight RCTs and before-and-after studies involving patients undergoing rehabilitation, pharmacist-led interventions—including prescription review, identification of drug-related problems, prescription change proposals, and patient education—were suggested to contribute to improvement in QOL and reduction of adverse drug reactions. Interpretation was limited by heterogeneity in outcome measures and study designs, and the certainty of evidence was rated as D (215), (216), (217), (218), (219), (220), (221), (222), (223), (224), (225).
Statement: The proportion of patients who developed sarcopenia during hospitalization or within several months after discharge ranged from 12.0% to 41.9%, depending on the target population and timing of assessment. Risk factors for developing sarcopenia included prolonged bed rest, low muscle mass, low BMI, low ADL, and prolonged length of hospital stay.
Summary of rationale: Hospital-associated sarcopenia develops in association with prolonged bed rest, inactivity, and malnutrition during hospitalization and has been observed in acute, perioperative, and convalescent settings. Estimates vary by population and diagnostic criteria, but early assessment and preventive intervention are important (226), (227), (228), (229), (230), (231), (232), (233), (234), (235), (236).
Statement: Screening tools for assessing SDH are available. However, no evidence was identified regarding the usefulness of practices in which such tools were applied to adults receiving rehabilitation treatment or exercise therapy and linked to subsequent interventions. Further studies are needed to examine the usefulness of SDH screening. Therefore, no guideline recommendation is made for this item, and it is designated as a Future Research Question.
Summary of rationale: Validated SDH screening tools exist, but no evidence was identified evaluating their use linked to subsequent interventions in adults receiving rehabilitation treatment or exercise therapy. Future studies should evaluate outcomes and cost-effectiveness of interventions based on screening results (237), (238), (239), (240), (241), (242), (243).
Statement: Interventions based on SDH, such as financial and transportation support, social support, telerehabilitation, and home environment modification, may have favorable effects on treatment continuation and healthcare costs in adults receiving rehabilitation treatment or exercise therapy. However, existing studies are limited in terms of sample size and methodological quality, and the evidence is insufficient to draw conclusions regarding the magnitude of effect or generalizability of these interventions. Therefore, no guideline recommendation is made for this item, and it is designated as a Future Research Question.
Summary of rationale: Evidence on SDH-informed interventions in adults receiving rehabilitation treatment or exercise therapy is limited. Because of the social nature of SDH, individual randomization is often difficult; future studies should clarify SDH components and intervention intensity using pragmatic trials, cluster RCTs, propensity score methods, and other appropriate designs (238), (244), (245), (246), (247), (248), (249), (250), (251), (252), (253), (254), (255).
Served as members of the guideline development organization for the Japanese primary guideline and were fully involved in the guideline development process in accordance with standard clinical practice guideline development methods: All authors. Made substantial contributions to the conception and design of the guideline, determination of the scope, formulation and review of the clinical questions, background questions, and future research questions, consideration of the evidence summaries, deliberation and approval of the statements, and review of the recommendation strengths and certainty ratings: All authors. Contributed to the preparation or critical revision of this English executive summary for important intellectual content, approved the final version for submission, and agree to be accountable for all aspects of the work: All authors.
All authors completed disclosures of financial conflicts of interest and non-financial academic interests for the Japanese primary guideline. Conflicts of interest and relevant non-financial academic interests were managed in accordance with the regulations of the Japanese Association of Rehabilitation Nutrition and Minds guidance, including restriction of voting rights for relevant clinical questions when applicable. Hidetaka Wakabayashi received lecture fees from Otsuka Pharmaceutical Factory, Inc. Hideki Aragane reported a financial conflict of interest concerning stock or profit interests of a spouse, first-degree relative, or person sharing income or assets, related to Takeda Pharmaceutical Company Limited. Yoshihiro Yoshimura, Shinta Nishioka, Ai Shiraishi, Yoko Saino, Ayaka Matsumoto, and Hidetaka Wakabayashi reported non-financial academic interests through leadership roles in academic societies and/or involvement in related clinical practice guidelines. All other authors declare no conflicts of interest.
The development of the Japanese primary guideline was funded by the Japanese Association of Rehabilitation Nutrition. The guideline content was not influenced by funding from any specific company or organization.
This manuscript is an English executive summary and secondary publication of the Japanese Association of Rehabilitation Nutrition Clinical Practice Guideline 2026. It is based on the Japanese primary publication and does not add new clinical questions, background questions, future research questions, statements, evidence, interpretations, or figure/table concepts beyond the primary guideline.
The Japanese primary publication is: Yasumoto Y, Matsumoto T, Nagano A, et al. Clinical Practice Guideline for Rehabilitation Nutrition 2026. Journal of Japanese Association of Rehabilitation Nutrition. 2026;10(1):110–190.
Primary publication URL: https://www.ishiyaku.co.jp/search/details?bookcode=265380
The Japanese primary guideline has already been published in Japanese. Permission to submit this English secondary publication to JMA Journal has been obtained from the primary publication venue and JMA Journal.
The Japanese primary publication is included in the manuscript reference list and cited in the main text. The manuscript title explicitly identifies this article as a secondary publication.
Tanaka M, Kosaka S, Nishioka S, et al. Clinical practice guideline of rehabilitation nutrition for adult cerebrovascular disease patients. J Jpn Assoc Rehabil Nutr. 2018;2(2):260-7.
Fujiwara D, Iida Y, Nishioka S, et al. Clinical practice guideline of rehabilitation nutrition for hip fracture patients. J Jpn Assoc Rehabil Nutr. 2018;2(2):268-75.
Higashi K, Yoshimura Y, Nishioka S, et al. Clinical practice guideline of rehabilitation nutrition for adult cancer patients. J Jpn Assoc Rehabil Nutr. 2018;2(2):276-83.
Nishioka S, Kosaka S, Sato C, et al. Clinical practice guideline of rehabilitation nutrition for patients with acute illness. J Jpn Assoc Rehabil Nutr. 2018;2(2):284-90.
Nishioka S, Aragane H, Suzuki N, et al. Clinical practice guidelines for rehabilitation nutrition in cerebrovascular disease, hip fracture, cancer, and acute illness: 2020 update. Clin Nutr ESPEN. 2021;43:90-103.
Yasumoto Y, Matsumoto T, Nagano A, et al. Clinical practice guideline for rehabilitation nutrition 2026. J Jpn Assoc Rehabil Nutr. 2026;10(1):110-90.
Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology. 2021;97(20) Suppl 2:S6-16.
Parry-Jones AR, Krishnamurthi R, Ziai WC, et al. World Stroke Organization (WSO): global intracerebral hemorrhage factsheet 2025. Int J Stroke. 2025;20(2):145-50.
Yoo SH, Kim JS, Kwon SU, et al. Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients. Arch Neurol. 2008;65(1):39-43.
Nishioka S, Takayama M, Watanabe M, et al. Prevalence of malnutrition in convalescent rehabilitation wards in Japan and correlation of malnutrition with ADL and discharge outcome in elderly stroke patients. Jpn J Parenter Enter Nutr. 2015;30(5):1145-51.
Yoshimura Y, Wakabayashi H, Bise T, et al. Prevalence of sarcopenia and its association with activities of daily living and dysphagia in convalescent rehabilitation ward inpatients. Clin Nutr. 2018;37(6 Pt A):2022-8.
Mohan R, Beeharry S, Petrova MV, et al. SUN-PP025: correction of Protein-energy malnutrition in mechanically ventilated patients suffering from severe ischemic stroke. Clin Nutr. 2015;34:S33.
Tajiri H, Mori T, Iwata T, et al. Short-term clinical outcome following gastrointestinal tube feeding of immunonutrition-oriented (IMPACTⓇ) or protein-oriented food (PEMVestⓇ) in acute stroke management. Jpn J Stroke. 2011;33(3):305-12.
de Aguilar-Nascimento JE, Prado Silveira BR, Dock-Nascimento DB. Early enteral nutrition with whey protein or casein in elderly patients with acute ischemic stroke: a double-blind randomized trial. Nutrition. 2011;27(4):440-4.
Zhang L, Li Z, Luo B, et al. [Effects of different intakes of protein on nutritional status in severe stroke patients]. Wei Sheng Yan Jiu. 2014;43(6):929-32. Chinese.
Gao JX, Su YY. Effects of two Enteral Nutrition Formulas with equal calorie and different carbohydrate on plasma glucose in acute stroke patients: a randomized controlled study. Chin J Clin Nutr. 2008;4:209-15.
Laviano A, Aghilone F, Colagiovanni D, et al. Metabolic and clinical effects of the supplementation of a functional mixture of amino acids in cerebral hemorrhage. Neurocrit Care. 2011;14(1):44-9.
Zhou C, Su Y. Effect of the equal non-protein-calorie but different protein intake on enteral nutritional metabolism in 51 patients with severe stroke: a randomized controlled study. Chin J Clin Nutr. 2006;14(6):351-5.
Badjatia N, Sanchez S, Judd G, et al. Neuromuscular electrical stimulation and high-protein supplementation after subarachnoid hemorrhage: a single-center phase 2 randomized clinical trial. Neurocrit Care. 2021;35(1):46-55.
Hashemilar M, Khalili M, Rezaeimanesh N, et al. Effect of whey protein supplementation on inflammatory and antioxidant markers, and clinical prognosis in acute ischemic stroke (TNS trial): a randomized, double blind, controlled, clinical trial. Adv Pharm Bull. 2020;10(1):135-40.
Berger MM, Soguel L, Shenkin A, et al. Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Crit Care. 2008;12(4):R101.
Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation enhances antioxidant capacity and mitigates oxidative damage following acute ischaemic stroke. Eur J Clin Nutr. 2005;59(12):1367-73.
Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation with or without B-group vitamins after acute ischemic stroke: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2006;30(2):108-14.
Daga MK, Madhuchhanda MTK, TK Mishra, et al. Lipid peroxide, beta-carotene and alpha-tocopherol in ischaemic stroke and effect of exogenous vitamin E supplementation on outcome. J Assoc Physicians India. 1997;45(11):843-6.
Kadri A, Sjahrir H, Juwita Sembiring R, et al. Combination of vitamin A and D supplementation for ischemic stroke: effects on interleukin-1ß and clinical outcome. Med Glas (Zenica). 2020;17(2):425-32.
Gupta A, Prabhakar S, Modi M, et al. Effect of vitamin D and calcium supplementation on ischaemic stroke outcome: a randomised controlled open-label trial. Int J Clin Pract. 2016;70(9):764-70.
Momosaki R, Abo M, Urashima M. Vitamin D supplementation and post-stroke rehabilitation: a randomized, double-blind, placebo-controlled trial. Nutrients. 2019;11(6):1295.
Ogawa K. Effect of enteral nutrition with eicosapentaenoic acids for prevention of bedsores in cerebrovascular disease patients. Clin Nutr ESPEN. 2021;46:S763.
Saito G, Zapata R, Rivera R, et al. Long-chain omega-3 fatty acids in aneurysmal subarachnoid hemorrhage: a randomized pilot trial of pharmaconutrition. Surg Neurol Int. 2017;8:304.
Li M, Xia F, Su J. Effect of enteral nutrition support on prognosis in patients with severe acute stroke. J Clin Neurol. 2008;21(3):30-2.
Zheng T, Wang S, Chen Z, et al. The effect of early enteral nutrition support on immunological function in patients with acute stroke. Chin J Cerebrovasc Dis. 2006;3(8):356-60.
Li Y, Pei Y, Sun M. Effects of early enteral nutrition support on the nutritional status and outcomes of patients with post-stroke dysphagia. Chin J Clin Nutr. 2014;22(6):334-8.
Beeharry S, Petrova MV, Butrov AV, et al. PP127-SUN: The role of high protein nutritional support on the nutritional status and in correcting hyper-catabolic syndrome in patients suffering from ischemic stroke. Clin Nutr. 2014;33:S67.
Gariballa SE, Parker SG, Taub N, et al. A randomized, controlled, a single-blind trial of nutritional supplementation after acute stroke. JPEN J Parenter Enteral Nutr. 1998;22(5):315-9.
Dennis MS, Lewis SC, Warlow C, et al. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Lancet. 2005;365(9461):755-63.
Dennis MS, Lewis SC, Warlow C, et al. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. 2005;365(9461):764-72.
Ouyang H, Wang X, Song H. Applied research on early enteral nutrition in patients with severe cerebral infarction. Chin J Clin Rehabil. 2003;7(28):3836-7.
Li Y, Dai J, Zhang S, et al. Clinical value of early enteral nutrition support in patients with acute cerebral infarction accompanied with dysphagia. World. Chin J Dig. 2016;24(4):618-22.
Zhao S. Impact of early enteral nutrition on nutritional indicators in patients with severe cerebrovascular disease. 2020;28(4):232-7.
Zheng T, Zhu X, Liang H, et al. Impact of early enteral nutrition on short term prognosis after acute stroke. J Clin Neurosci. 2015;22(9):1473-6.
Zhang JJ, Dong WF, Gu SJ, et al. [Clinical study on the early nutrition support in postoperative patients with critical hypertensive intracerebral hemorrhage]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2004;16(9):552-5. Chinese.
Das K, Dube S, Rath G, et al. Nutrition in stroke patients: comparison of indirect calorimetry vs. standard weight-based regimen. Anesth Analg. 2021;133 Suppl 2:956.
Otsuki I, Himuro N, Tatsumi H, et al. Individualized nutritional treatment for acute stroke patients with malnutrition risk improves functional independence measurement: a randomized controlled trial. Geriatr Gerontol Int. 2020;20(3):176-82.
Ha L, Hauge T, Spenning AB, et al. Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial. Clin Nutr. 2010;29(5):567-73.
Ha L, Hauge T, Iversen PO. Body composition in older acute stroke patients after treatment with individualized, nutritional supplementation while in hospital. BMC Geriatr. 2010;10:75.
Fujitaka Y, Tanaka N, Nakadai H, et al. Differences in FIM improvement rate stratified by nutritional status and age in stroke patients in kaifukuki (convalescent) rehabilitation ward. Jpn J Compr Rehabil Sci. 2017;8:98-103.
Pan WH, Lai YH, Yeh WT, et al. Intake of potassium- and magnesium-enriched salt improves functional outcome after stroke: a randomized, multicenter, double-blind controlled trial. Am J Clin Nutr. 2017;106(5):1267-73.
Rabadi MH, Coar PL, Lukin M, et al. Intensive nutritional supplements can improve outcomes in stroke rehabilitation. Neurology. 2008;71(23):1856-61.
Aquilani R, Scocchi M, Iadarola P, et al. Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischaemic stroke. Clin Rehabil. 2008;22(12):1042-50.
Yoshimura Y, Bise T, Shimazu S, et al. Effects of a leucine-enriched amino acid supplement on muscle mass, muscle strength, and physical function in post-stroke patients with sarcopenia: a randomized controlled trial. Nutrition. 2019;58:1-6.
Aquilani R, Scocchi M, Boschi F, et al. Effect of calorie-protein supplementation on the cognitive recovery of patients with subacute stroke. Nutr Neurosci. 2008;11(5):235-40.
Honaga K, Mori N, Akimoto T, et al. Investigation of the effect of nutritional supplementation with whey protein and vitamin D on muscle mass and muscle quality in subacute post-stroke rehabilitation patients: a randomized, single-blinded, placebo-controlled trial. Nutrients [Internet]. 2022 [cited 2026 Jul 30];14(3):685. Available from: https://www.cochranelibrary.com/central/doi/10.1002/central/CN-02363852/full
Torrisi M, Bonanno L, Formica C, et al. The role of rehabilitation and vitamin D supplementation on motor and psychological outcomes in poststroke patients. Medicine (Baltimore). 2021;100(45):e27747.
Toole JF, Malinow MR, Chambless LE, et al. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA. 2004;291(5):565-75.
Garbagnati F, Cairella G, De Martino A, et al. Is antioxidant and n-3 supplementation able to improve functional status in poststroke patients? Results from the Nutristroke trial. Cerebrovasc Dis. 2009;27(4):375-83.
Aquilani R, Baiardi P, Scocchi M, et al. Normalization of zinc intake enhances neurological retrieval of patients suffering from ischemic strokes. Nutr Neurosci. 2009;12(5):219-25.
Aquilani R, Boselli M, D’Antona G, et al. Unaffected arm muscle hypercatabolism in dysphagic subacute stroke patients: the effects of essential amino acid supplementation. BioMed Res Int. 2014;2014:964365.
Aquilani R, Emilio B, Dossena M, et al. Correlation of deglutition in subacute ischemic stroke patients with peripheral blood adaptive immunity: essential amino acid improvement. Int J Immunopathol Pharmacol. 2015;28(4):576-83.
Dang Y, Zhang G. Effects of early enteral nutrition on sub-acute ischemic stroke via gut microbiota reconstruction: a randomized controlled trial. J Gastroenterol Hepatol. 2018;33(4):219.
Japanese Orthopaedic Association Clinical Practice Guideline Committee, Guideline Development Committee for Hip Fractures (Femoral Neck and Trochanteric Fractures). Clinical Practice Guideline for Hip Fractures (Femoral Neck and Trochanteric Fractures). 3rd revised. Tokyo: Nankodo; 2021.
Shi H, Lu JH, Wang SN, et al. Effect of early enteral nutrition in elderly patients with hip fracture during the perioperative period. J Back Musculoskelet Rehabil. 2020;33(1):109-17.
Bastow MD, Rawlings J, Allison SP. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. BMJ. 1983;287(6405):1589-92.
Cameron ID, Kurrle SE, Uy C, et al. Effectiveness of oral nutritional supplementation for older women after a fracture: rationale, design and study of the feasibility of a randomized controlled study. BMC Geriatr. 2011;11:32.
Duncan DG, Beck SJ, Hood K, et al. Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward. Age Ageing. 2006;35(2):148-53.
Ekinci O, Yanık S, Terzioglu Bebitoglu B, et al. Effect of calcium β-hydroxy-β-methylbutyrate (CaHMB), vitamin D, and protein supplementation on postoperative immobilization in malnourished older adult patients with hip fracture: a randomized controlled study. Nutr Clin Pract. 2016;31(6):829-35.
Flodin L, Cederholm T, Sääf M, et al. Effects of protein-rich nutritional supplementation and bisphosphonates on body composition, handgrip strength and health-related quality of life after hip fracture: a 12-month randomized controlled study. BMC Geriatr. 2015;15:149.
Milte R, Miller MD, Crotty M, et al. Cost-effectiveness of individualized nutrition and exercise therapy for rehabilitation following hip fracture. J Rehabil Med. 2016;48(4):378-85.
Myint MWW, Wu J, Wong E, et al. Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Age Ageing. 2013;42(1):39-45.
Niitsu M, Ichinose D, Hirooka T, et al. Effects of combination of whey protein intake and rehabilitation on muscle strength and daily movements in patients with hip fracture in the early postoperative period. Clin Nutr. 2016;35(4):943-9.
Tidermark J, Ponzer S, Carlsson P, et al. Effects of protein-rich supplementation and nandrolone in lean elderly women with femoral neck fractures. Clin Nutr. 2004;23(4):587-96.
Renerts K, Fischer K, Dawson-Hughes B, et al. Effects of a simple home exercise program and vitamin D supplementation on health-related quality of life after a hip fracture: a randomized controlled trial. Qual Life Res. 2019;28(5):1377-86.
Wang L, Zhang G. Analysis of the effect of mini-nutrition nursing plus Baduanjin rehabilitation exercise on fracture healing, mobility and nutritional status of elderly patients with vertebral or hip fractures. Biotechnol Genet Eng Rev. 2024;40(3):2508-19.
Scaturro D, Vitagliani F, Terrana P, et al. Does the association of therapeutic exercise and supplementation with sucrosomial magnesium improve posture and balance and prevent the risk of new falls? Aging Clin Exp Res. 2022;34(3):545-53.
de Sire A, Baricich A, Renò F, et al. Myostatin as a potential biomarker to monitor sarcopenia in hip fracture patients undergoing a multidisciplinary rehabilitation and nutritional treatment: a preliminary study. Aging Clin Exp Res. 2020;32(5):959-62.
Nie N, Yin Z, Zheng J, et al. Clinical efficacy of nutritional intervention combined with muscle exercise on sarcopenia patients with femoral fracture: a pilot randomized controlled trial. BioMed Res Int. 2023;2023:3222686.
Han CY, Crotty M, Thomas S, et al. Effect of individual nutrition therapy and exercise regime on gait speed, physical function, strength and balance, body composition, energy and protein, in injured, vulnerable elderly: a multisite randomized controlled trial (INTERACTIVE). Nutrients. 2021;13(9):3182.
Baek Y, Iuliano S, Robbins J, et al. Reducing hip and non-vertebral fractures in institutionalised older adults by restoring inadequate intakes of protein and calcium is cost-saving. Age Ageing. 2023;52(6):afad114.
Han Z, Ji NN, Ma JX, et al. Effect of resistance training combined with beta-hydroxy-beta-methylbutyric acid supplements in elderly patients with sarcopenia after hip replacement. Orthop Surg. 2022;14(4):704-13.
Wyers CE, Reijven PLM, Breedveld-Peters JJL, et al. Efficacy of nutritional intervention in elderly after hip fracture: a multicenter randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2018;73(10):1429-37.
Summary of patient survey 2023 [Internet]. Ministry of Health, Labour and Welfare, Japan; 2024 [cited 2026 Mar 8]. Japanese. Available from: https://www.mhlw.go.jp/toukei/saikin/hw/kanja/23/index.html
Global strategy for prevention, diagnosis and management of COPD [2024 Report] [Internet]. Global Initiative for Chronic Obstructive Lung Disease; 2024 [cited 2026 Apr 24]. Available from: https://goldcopd.org/2024-gold-report/
Japanese Respiratory Society [COPD Guideline]. Editing committee. The JRS guideline for the management of chronic obstructive pulmonary disease 2022. 6th ed. Tokyo: Medical Review Co., Ltd.; 2022.
Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-64.
Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173(12):1390-413.
Aldhahir AM, Rajeh AMA, Aldabayan YS, et al. Nutritional supplementation during pulmonary rehabilitation in COPD: a systematic review. Chron Respir Dis. 2020;17:1479973120904953.
Fuld JP, Kilduff LP, Neder JA, et al. Creatine supplementation during pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax. 2005;60(7):531-7.
Gurgun A, Deniz S, Argın M, et al. Effects of nutritional supplementation combined with conventional pulmonary rehabilitation in muscle-wasted chronic obstructive pulmonary disease: a prospective, randomized and controlled study. Respirology. 2013;18(3):495-500.
de Bisschop C, Caron F, Ingrand P, et al. Does branched-chain amino acid supplementation improve pulmonary rehabilitation effect in COPD? Respir Med. 2021;189:106642.
Steiner MC, Barton RL, Singh SJ, et al. Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: a randomised controlled trial. Thorax. 2003;58(9):745-51.
Sugawara K, Takahashi H, Kashiwagura T, et al. Effect of anti-inflammatory supplementation with whey peptide and exercise therapy in patients with COPD. Respir Med. 2012;106(11):1526-34.
Schols AM, Soeters PB, Mostert R, et al. Physiologic effects of nutritional support and Anabolic Steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Am J Respir Crit Care Med. 1995;152(4 Pt 1):1268-74.
Deacon SJ, Vincent EE, Greenhaff PL, et al. Randomized controlled trial of dietary creatine as an adjunct therapy to physical training in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2008;178(3):233-9.
Gouzi F, Maury J, Héraud N, et al. Additional effects of nutritional antioxidant supplementation on peripheral muscle during pulmonary rehabilitation in COPD patients: a randomized controlled trial. Oxid Med Cell Longev. 2019;2019:5496346.
Baldi S, Aquilani R, Pinna GD, et al. Fat-free mass change after nutritional rehabilitation in weight losing COPD: role of insulin, C-reactive protein and tissue hypoxia. Int J Chron Obstruct Pulmon Dis. 2010;5:29-39.
Hornikx M, Van Remoortel H, Lehouck A, et al. Vitamin D supplementation during rehabilitation in COPD: a secondary analysis of a randomized trial. Respir Res. 2012;13(1):84.
Kadakia KC, Hamilton-Reeves JM, Baracos VE. Current therapeutic targets in cancer cachexia: a pathophysiologic approach. Am Soc Clin Oncol Educ Book. 2023;43:e389942.
Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489-95.
Arends J, Strasser F, Gonella S, et al. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines☆. ESMO Open. 2021;6(3):100092.
Uster A, Ruehlin M, Mey S, et al. Effects of nutrition and physical exercise intervention in palliative cancer patients: a randomized controlled trial. Clin Nutr. 2018;37(4):1202-9.
Houben LHP, Overkamp M, van Kraaij P, et al. Resistance exercise training increases muscle mass and strength in prostate cancer patients on androgen deprivation therapy. Med Sci Sports Exerc. 2023;55(4):614-24.
Bourke L, Doll H, Crank H, et al. Lifestyle intervention in men with advanced prostate cancer receiving androgen suppression therapy: a feasibility study. Cancer Epidemiol Biomarkers Prev. 2011;20(4):647-57.
Focht BC, Lucas AR, Grainger E, et al. Effects of a group-mediated exercise and dietary intervention in the treatment of prostate cancer patients undergoing androgen deprivation therapy: results from the IDEA-P trial. Ann Behav Med. 2018;52(5):412-28.
Lønbro S, Dalgas U, Primdahl H, et al. Feasibility and efficacy of progressive resistance training and dietary supplements in radiotherapy treated head and neck cancer patients--the DAHANCA 25A study. Acta Oncol. 2013;52(2):310-8.
Korczak J, Mardas M, Litwiniuk M, et al. Androgen deprivation therapy for prostate cancer influences body composition increasing risk of sarcopenia. Nutrients. 2023;15(7):1631.
Ploumis A, Papadopoulou SL, Theodorou SJ, et al. Cervical isometric exercises improve dysphagia and cervical spine malalignment following stroke with hemiparesis: a randomized controlled trial. Eur J Phys Rehabil Med. 2018;54(6):845-52.
Shaker R, Easterling C, Kern M, et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology. 2002;122(5):1314-21.
Eriksson H, Tuomi L, Finizia C. Voice outcomes following head-lift exercises in head and neck cancer: A randomized controlled study. J Voice. 2023;37(2):226-33.
Tuomi L, Dotevall H, Bergquist H, et al. The effect of the Shaker head-lift exercise on swallowing function following treatment for head and neck cancer: results from a randomized, controlled trial with videofluoroscopic evaluation. Head Neck. 2022;44(4):862-75.
Mepani R, Antonik S, Massey B, et al. Augmentation of deglutitive thyrohyoid muscle shortening by the Shaker Exercise. Dysphagia. 2009;24(1):26-31.
Logemann JA, Rademaker A, Pauloski BR, et al. A randomized study comparing the Shaker exercise with traditional therapy: a preliminary study. Dysphagia. 2009;24(4):403-11.
Park JS, Hwang NK, Oh DH, et al. Effect of head lift exercise on kinematic motion of the hyolaryngeal complex and aspiration in patients with dysphagic stroke. J Oral Rehabil. 2017;44(5):385-91.
Park JS, An DH, Kam KY, et al. Effects of resistive jaw opening exercise in stroke patients with dysphagia: a double- blind, randomized controlled study. J Back Musculoskelet Rehabil. 2020;33(3):507-13.
Jensen D, Bendsen BB, Westmark S, et al. Effect of chin tuck against resistance exercise in citizens with oropharyngeal dysphagia-a randomised controlled study. Geriatrics (Basel). 2022;7(6):129.
Park JS, Lee G, Jung YJ. Effects of game-based chin tuck against resistance exercise vs head-lift exercise in patients with dysphagia after stroke: an assessor-blind, randomized controlled trial. J Rehabil Med. 2019;51(10):749-54.
Koyama Y, Sugimoto A, Hamano T, et al. Proposal for a modified jaw opening exercise for dysphagia: A randomized, controlled trial. Tokai J Exp Clin Med. 2017;42(2):71-8.
Choi JB, Jung YJ, Park JS. Comparison of 2 types of therapeutic exercise: jaw opening exercise and head lift exercise for dysphagic stroke: a pilot study. Medicine (Baltimore). 2020;99(38):e22136.
Kim HH, Park JS. Efficacy of modified chin tuck against resistance exercise using hand-free device for dysphagia in stroke survivors: a randomised controlled trial. J Oral Rehabil. 2019;46(11):1042-6.
Moon JH, Hahm SC, Won YS, et al. The effects of tongue pressure strength and accuracy training on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia: a preliminary randomized clinical trial. Int J Rehabil Res. 2018;41(3):204-10.
Robbins J, Kays SA, Gangnon RE, et al. The effects of lingual exercise in stroke patients with dysphagia. Arch Phys Med Rehabil. 2007;88(2):150-8.
Steele CM, Bayley MT, Peladeau-Pigeon M, et al. A randomized trial comparing two tongue-pressure resistance training protocols for post-stroke dysphagia. Dysphagia. 2016;31(3):452-61.
Wang T, Tai J, Hu R, et al. Effect of tongue-pressure resistance training in poststroke dysphagia patients with oral motor dysfunction: a randomized controlled trial. Am J Phys Med Rehabil. 2022;101(12):1134-8.
Park JS, Oh DH, Chang MY, et al. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. J Oral Rehabil. 2016;43(5):364-72.
Eom MJ, Chang MY, Oh DH, et al. Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke. NeuroRehabilitation. 2017;41(4):747-52.
Claus I, Muhle P, Czechowski J, et al. Expiratory muscle strength training for therapy of pharyngeal dysphagia in Parkinson’s disease. Mov Disord. 2021;36(8):1815-24.
Troche MS, Okun MS, Rosenbek JC, et al. Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial. Neurology. 2010;75(21):1912-9.
Riboldazzi G, Spinazza G, Beccarelli L, et al. Effectiveness of expiratory flow acceleration in patients with Parkinson’s disease and swallowing deficiency: a preliminary study. Clin Neurol Neurosurg. 2020;199:106249.
Hwang NK, Kim HH, Shim JM, et al. Tongue stretching exercises improve tongue motility and oromotor function in patients with dysphagia after stroke: a preliminary randomized controlled trial. Arch Oral Biol. 2019;108:104521.
Hägglund P, Hägg M, Wester P, et al. Effects of oral neuromuscular training on swallowing dysfunction among older people in intermediate care-a cluster randomised, controlled trial. Age Ageing. 2019;48(4):533-40.
Sayaca C, Serel-Arslan S, Sayaca N, et al. Is the proprioceptive neuromuscular facilitation technique superior to Shaker exercises in swallowing rehabilitation? Eur Arch Otorhinolaryngol. 2020;277(2):497-504.
Acar G, Ejraei N, Turkdogan D, et al. The effects of neurodevelopmental therapy on feeding and swallowing activities in children with cerebral palsy. Dysphagia. 2022;37(4):800-11.
Pu D, Yao TJ. The use and effects of whole-body exercises on swallowing function: a scoping review. Int J Lang Commun Disord. 2023;58(4):1357-74.
Yoshimura Y, Wakabayashi H, Nagano F, et al. Chair-stand exercise improves post-stroke dysphagia. Geriatr Gerontol Int. 2020;20(10):885-91.
Reyes-Torres CA, Castillo-Martínez L, Reyes-Guerrero R, et al. Design and implementation of modified-texture diet in older adults with oropharyngeal dysphagia: a randomized controlled trial. Eur J Clin Nutr. 2019;73(7):989-96.
Keller HH, Chambers LW, Fergusson DA, et al. A mix of bulk and ready-to-use modified-texture food: impact on older adults requiring dysphagic food. Can J Aging. 2012;31(3):335-48.
Shimizu A, Fujishima I, Maeda K, et al. Nutritional management enhances the recovery of swallowing ability in older patients with sarcopenic dysphagia. Nutrients. 2021;13(2):596.
Wright L, Cotter D, Hickson M. The effectiveness of targeted feeding assistance to improve the nutritional intake of elderly dysphagic patients in hospital. J Hum Nutr Diet. 2008;21(6):555-62; quiz 564-5.
Duncan DR, Larson K, Davidson K, et al. Feeding interventions are associated with improved outcomes in children with laryngeal penetration. J Pediatr Gastroenterol Nutr. 2019;68(2):218-24.
Ueshima J, Maeda K, Miyoshi F, et al. Nutrition-fortified texture-modified diet enhances recovery in older adult patients with dysphagia. J Am Geriatr Soc. Forthcoming 2025.
Wu XS, Miles A, Braakhuis A. Effects of hydrolysed meat on dietary intake and nutritional status in aged care residents requiring pureed diets: a crossover randomised controlled trial. BMC Geriatr. 2022;22(1):905.
Germain I, Dufresne T, Gray-Donald K. A novel dysphagia diet improves the nutrient intake of institutionalized elders. J Am Diet Assoc. 2006;106(10):1614-23.
Zanini M, Bagnasco A, Catania G, et al. A Dedicated Nutritional Care Program (NUTRICARE) to reduce malnutrition in institutionalised dysphagic older people: a quasi-experimental study. J Clin Nurs. 2017;26(23-24):4446-55.
Dennis M, Lewis S, Cranswick G, et al. FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol Assess. 2006;10(2):iii-120.
Hamidon BB, Abdullah SA, Zawawi MF, et al. A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke. Med J Malaysia. 2006;61(1):59-66.
Norton B, Homer-Ward M, Donnelly MT, et al. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ. 1996;312(7022):13-6.
Juan W, Zhen H, Yan-Ying F, et al. A comparative study of two tube feeding methods in patients with dysphagia after stroke: a randomized controlled trial. J Stroke Cerebrovasc Dis. 2020;29(3):104602.
Mamun K, Lim J. Role of nasogastric tube in preventing aspiration pneumonia in patients with dysphagia. Singapore Med J. 2005;46(11):627-31.
Cintra MTG, de Rezende NA, de Moraes EN, et al. A comparison of survival, pneumonia, and hospitalization in patients with advanced dementia and dysphagia receiving either oral or enteral nutrition. J Nutr Health Aging. 2014;18(10):894-9.
Mitchell SL, Kiely DK, Lipsitz LA. Does artificial enteral nutrition prolong the survival of institutionalized elders with chewing and swallowing problems? J Gerontol A Biol Sci Med Sci. 1998;53(3):M207-M13.
Jukic Peladic N, Orlandoni P, Di Rosa M, et al. Multidisciplinary assessment and individualized nutritional management of dysphagia in older outpatients. Nutrients. 2023;15(5):1103.
Kimyagarov S, Turgeman D, Fleissig Y, et al. Percutaneous endoscopic gastrostomy (PEG) tube feeding of nursing home residents is not associated with improved body composition parameters. J Nutr Health Aging. 2013;17(2):162-5.
Gandolfo C, Sukkar S, on the behalf of the PreDyScore Group, et al. The predictive dysphagia score (PreDyScore) in the short- and medium-term post-stroke: a putative tool in PEG indication. Neurol Sci. 2019;40(8):1619-26.
Taguchi K, Wakabayashi H, Fujimoto M, et al. Association between malnutrition severity and swallowing function in convalescent rehabilitation wards: a multi-center cohort study in malnourished patients with sarcopenic dysphagia. J Nutr Health Aging. 2022;26(5):469-76.
Mañas-Martínez AB, Bucar-Barjud M, Campos-Fernández J, et al. Association of positive screening for dysphagia with nutritional status and long-term mortality in hospitalized elderly patients. Endocrinol Diabetes Nutr (Engl Ed). 2018;65(7):402-8.
Limpuangthip N, Komin O, Tatiyapongpaiboon T. A simplified method for evaluating swallowing ability and estimating malnutrition risk: a pilot study in older adults. PLoS One. 2022;17(2):e0263896.
Dotevall H, Tuomi L, Petersson K, et al. Treatment with head-lift exercise in head and neck cancer patients with dysphagia: results from a randomized, controlled trial with flexible endoscopic evaluation of swallowing (FEES). Support Care Cancer. 2022;31(1):56.
Park HS, Oh DH, Yoon T, et al. Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial. Int J Lang Commun Disord. 2019;54(3):479-84.
Park JS, An DH, Oh DH, et al. Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: a randomized pilot study. NeuroRehabilitation. 2018;42(2):191-7.
Don Kim K, Lee HJ, Lee MH, et al. Effects of neck exercises on swallowing function of patients with stroke. J Phys Ther Sci. 2015;27(4):1005-8.
Park JS, Kim HJ, Oh DH. Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia. J Phys Ther Sci. 2015;27(12):3631-4.
Bautmans I, Demarteau J, Cruts B, et al. Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilization. J Rehabil Med. 2008;40(9):755-60.
Krajczy E, Krajczy M, Luniewski J, et al. Assessment of the effects of dysphagia therapy in patients in the early post-stroke period: a randomised controlled trial. Neurol Neurochir Pol. 2019;53(6):428-34.
Kim HD, Choi JB, Yoo SJ, et al. Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. J Oral Rehabil. 2017;44(1):59-64.
Choi JB, Shim SH, Yang JE, et al. Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia. NeuroRehabilitation. 2017;41(4):753-7.
Gao J, Zhang HJ. Effects of chin tuck against resistance exercise versus Shaker exercise on dysphagia and psychological state after cerebral infarction. Eur J Phys Rehabil Med. 2017;53(3):426-32.
Krekeler BN, Yee J, Kurosu A, et al. Effects of device-facilitated lingual strengthening therapy on dysphagia related outcomes in patients post-stroke: a randomized controlled trial. Dysphagia. 2023;38(6):1551-67.
Wakabayashi H, Matsushima M, Momosaki R, et al. The effects of resistance training of swallowing muscles on dysphagia in older people: a cluster, randomized, controlled trial. Nutrition. 2018;48:111-6.
Liaw MY, Hsu CH, Leong CP, et al. Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial. Medicine (Baltimore). 2020;99(10):e19337.
Rosenbek JC, Robbins JA, Roecker EB, et al. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8.
Han TR, Paik NJ, Park JW, et al. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008;23(1):59-64.
Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516-20.
Banda KJ, Chu H, Chen R, et al. Prevalence of oropharyngeal dysphagia and risk of pneumonia, malnutrition, and mortality in adults aged 60 years and older: a meta-analysis. Gerontology. 2022;68(8):841-53.
Sakai K, Kinoshita S, Wakabayashi H, et al. Associations of malnutrition factors with dysphagia mediated by ADL among nursing home residents. Wien Klin Wochenschr. 2025;137(11-12):377-83.
Maeda K, Akagi J. Sarcopenia is an independent risk factor of dysphagia in hospitalized older people. Geriatr Gerontol Int. 2016;16(4):515-21.
Turra GS, Schwartz IVD, Almeida ST, et al. Efficacy of speech therapy in post-intubation patients with oropharyngeal dysphagia: a randomized controlled trial. Codas. 2021;33(2):e20190246.
Zhu X, Liu D, Zong M, et al. Effect of swallowing training combined with nutritional intervention on the nutritional status and quality of life of laryngeal cancer patients with dysphagia after operation and radiotherapy. J Oral Rehabil. 2022;49(7):729-33.
Kikutani T, Enomoto R, Tamura F, et al. Effects of oral functional training for nutritional improvement in Japanese older people requiring long-term care. Gerodontology. 2006;23(2):93-8.
Yan XL, Liu Z, Sun Y, et al. Individualized nutritional support for hospitalized patients with oropharyngeal dysphagia after stroke: a randomized controlled trial. Front Nutr. 2022;9:843945.
Sarcopenia Clinical Practice Guideline Committee. Clinical practice guideline for sarcopenia 2017. 1st ed (partially revised in 2020). Tokyo: Life Science Publishing Co, Limited; 2020.
Liu HY, Tseng MY, Li HJ, et al. Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status. J Am Med Dir Assoc. 2014;15(6):416-22.
Pison CM, Cano NJ, Chérion C, et al. Multimodal nutritional rehabilitation improves clinical outcomes of malnourished patients with chronic respiratory failure: a randomised controlled trial. Thorax. 2011;66(11):953-60.
Buch A, Diener J, Stern N, et al. Comparison of equations estimating resting metabolic rate in older adults with type 2 diabetes. J Clin Med. 2021;10(8):1644.
Pourhassan M, Daubert D, Wirth R. Measured and predicted resting energy expenditure in malnourished older hospitalized patients: a cross-sectional and longitudinal comparison. Nutrients. 2020;12(8):2240.
Lammes E, Akner G. Resting metabolic rate in elderly nursing home patients with multiple diagnoses. J Nutr Health Aging. 2006;10(4):263-70.
Jallut D, Tappy L, Kohut M, et al. Energy balance in elderly patients after surgery for a femoral neck fracture. JPEN J Parenter Enteral Nutr. 1990;14(6):563-8.
Kawase F, Masaki Y, Ozawa H, et al. New prediction equations for resting energy expenditure in older hospitalized patients: development and validation. Nutrition. 2023;115:112188.
Porter J, Ward LC, Nguo K, et al. Development and validation of new predictive equations for the resting metabolic rate of older adults aged ≥65 y. Am J Clin Nutr. 2023;117(6):1164-73.
Silver HJ, Wall R, Hollingsworth E, et al. Simple kcal/kg formula is comparable to prediction equations for estimating resting energy expenditure in older cognitively impaired long term care residents. J Nutr Health Aging. 2013;17(1):39-44.
Kawase F, Masaki Y, Ozawa H, et al. Resting energy expenditure in older inpatients: a comparison of prediction equations and measurements. Nutrients. 2022;14(24):5210.
O’Keeffe M, Kelly M, O’Herlihy E, et al. Potentially modifiable determinants of malnutrition in older adults: a systematic review. Clin Nutr. 2019;38(6):2477-98.
Friedli N, Stanga Z, Culkin A, et al. Management and prevention of refeeding syndrome in medical inpatients: an evidence-based and consensus-supported algorithm. Nutrition. 2018;47:13-20.
Felder S, Braun N, Stanga Z, et al. Unraveling the link between malnutrition and adverse clinical outcomes: association of acute and chronic malnutrition measures with blood biomarkers from different pathophysiological states. Ann Nutr Metab. 2016;68(3):164-72.
Gielen E, Beckwée D, Delaere A, et al. Nutritional interventions to improve muscle mass, muscle strength, and physical performance in older people: an umbrella review of systematic reviews and meta-analyses. Nutr Rev. 2021;79(2):121-47.
Rus GE, Porter J, Brunton A, et al. Nutrition interventions implemented in hospital to lower risk of sarcopenia in older adults: a systematic review of randomised controlled trials. Nutr Diet. 2020;77(1):90-102.
Tsuboi M, Momosaki R, Vakili M, et al. Nutritional supplementation for activities of daily living and functional ability of older people in residential facilities: a systematic review. Geriatr Gerontol Int. 2018;18(2):197-210.
van Wijngaarden JP, Wojzischke J, van den Berg C, et al. Effects of nutritional interventions on nutritional and functional outcomes in geriatric rehabilitation patients: a systematic review and meta-analysis. J Am Med Dir Assoc. 2020;21(9):1207-15.e9.
Beck AM, Dent E, Baldwin C. Nutritional intervention as part of functional rehabilitation in older people with reduced functional ability: a systematic review and meta-analysis of randomised controlled studies. J Hum Nutr Diet. 2016;29(6):733-45.
Milne AC, Potter J, Vivanti A, et al. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009;2009(2):CD003288.
Baumgartner A, Pachnis D, Parra L, et al. The impact of nutritional support on malnourished inpatients with aging-related vulnerability. Nutrition. 2021;89:111279.
White J. The role of nutrition in chronic disease. Nutrition screening initiative. A project of: American Academy of Family Physicians. American Dietetic Association and National Council on the Aging; 1999. (Nutrition Screening Initiative).
Feldblum I, German L, Castel H, et al. Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial. J Am Geriatr Soc. 2011;59(1):10-7.
Persson M, Hytter-Landahl A, Brismar K, et al. Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition. Clin Nutr. 2007;26(2):216-24.
Zhou C, Wang S, Sun X, et al. Application of food exchange portion method in home-based nutritional intervention for elderly patients with chronic heart failure. BMC Cardiovasc Disord. 2023;23(1):80.
Andersson J, Hulander E, Rothenberg E, et al. Effect on body weight, quality of life and appetite following individualized, nutritional counselling to home-living elderly after rehabilitation - an open randomized trial. J Nutr Health Aging. 2017;21(7):811-8.
Dent E, Wright ORL, Woo J, et al. Malnutrition in older adults. Lancet. 2023;401(10380):951-66.
Lin CC, Shih MH, Chen CD, et al. Effects of adequate dietary protein with whey protein, leucine, and vitamin D supplementation on sarcopenia in older adults: an open-label, parallel-group study. Clin Nutr. 2021;40(3):1323-9.
Hsieh TJ, Su SC, Chen CW, et al. Individualized home-based exercise and nutrition interventions improve frailty in older adults: a randomized controlled trial. Int J Behav Nutr Phys Act. 2019;16(1):119.
Yang PH, Lin MC, Liu YY, et al. Effect of nutritional intervention programs on nutritional status and readmission rate in malnourished older adults with pneumonia: a randomized control trial. Int J Environ Res Public Health. 2019;16(23):4758.
Rodriguez-Mañas L, Laosa O, Vellas B, et al. Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus. J Cachexia Sarcopenia Muscle. 2019;10(4):721-33.
Sakai A, Matsuo K, Sekimoto Y, et al. Changes in oral health status with dental intervention during the acute to subacute stages of stroke. Gerodontology. 2024;41(2):276-82.
Brady MC, Stott DJ, Weir CJ, et al. A pragmatic, multi-centered, stepped wedge, cluster randomized controlled trial pilot of the clinical and cost effectiveness of a complex Stroke Oral healthCare intervention pLan Evaluation II (SOCLE II) compared with usual oral healthcare in stroke wards. Int J Stroke. 2020;15(3):318-23.
Shiraishi A, Yoshimura Y, Wakabayashi H, et al. Hospital dental hygienist intervention improves activities of daily living, home discharge and mortality in post-acute rehabilitation. Geriatr Gerontol Int. 2019;19(3):189-96.
Yoshimi K, Nakagawa K, Momosaki R, et al. Effects of oral management on elderly patients with pneumonia. J Nutr Health Aging. 2021;25(8):979-84.
Fujita A, Iwata M, Hagii J, et al. The effects of combined early oral health care and early mobilisation on the incidence of stroke-associated pneumonia. J Stroke Cerebrovasc Dis. 2023;32(1):106893.
Shiraishi A, Yoshimura Y, Wakabayashi H, et al. Impaired oral health status on admission is associated with poor clinical outcomes in post-acute inpatients: a prospective cohort study. Clin Nutr. 2019;38(6):2677-83.
Willoch K, Blix HS, Pedersen-Bjergaard AM, et al. Handling drug-related problems in rehabilitation patients: a randomized study. Int J Clin Pharm. 2012;34(2):382-8.
Marra CA, Cibere J, Grubisic M, et al. Pharmacist-initiated intervention trial in osteoarthritis: a multidisciplinary intervention for knee osteoarthritis. Arthritis Care Res. 2012;64(12):1837-45.
Vastrad M, S Wali, MS Ganachari, et al. Clinical pharmacist approach towards effectiveness of pulmonary rehabilitation of the patient with COPD: a randomized controlled study. Indian J Pharm Educ Res. 2021;55(1s):s318-s24.
Hirota N, Okada H, Okamura N. The effectiveness in preventing frailty of exercise intervention provided by community pharmacists to older persons with chronic conditions: a pragmatic randomized controlled trial. BMC Geriatr. 2023;23(1):225.
Ee CAJM, Lee KH, Tan HL, et al. Effectiveness and feasibility of deprescribing of symptomatic medications in a Singapore rehabilitation hospital. Proc Singapore Healthc. 2018;28(1):31-8.
Petkova VB. Education for arthritis patients: a community pharmacy based pilot project. Pharm Pract (Granada). 2009;7(2):88-93.
Anchah L, Hassali MA, Lim MSH, et al. Health related quality of life assessment in acute coronary syndrome patients: the effectiveness of early phase I cardiac rehabilitation. Health Qual Life Outcomes. 2017;15(1):10.
Casper EA, El Wakeel LM, Saleh MA, et al. Management of pharmacotherapy-related problems in acute coronary syndrome: role of clinical pharmacist in cardiac rehabilitation unit. Basic Clin Pharmacol Toxicol. 2019;125(1):44-53.
Henriksen BT, Krogseth M, Andersen RD, et al. Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial. J Orthop Surg Res. 2023;18(1):434.
Hohmann C, Klotz JM, Radziwill R, et al. Pharmaceutical care for patients with ischemic stroke: improving the patients quality of life. Pharm World Sci. 2009;31(5):550-8.
Freyer J, Kasprick L, Sultzer R, et al. A dual intervention in geriatric patients to prevent drug-related problems and improve discharge management. Int J Clin Pharm. 2018;40(5):1189-98.
Wan SN, Thiam CN, Ang QX, et al. Incident sarcopenia in hospitalized older people: a systematic review. PLoS One. 2023;18(8):e0289379.
Guideline Development Research Group for Healthcare Services for the Prevention of Sarcopenia and Frailty. Guidelines for digital health for the prevention and improvement of sarcopenia and frailty. Tokyo: Life Science Publishing Co, Limited; 2025.
Martone AM, Bianchi L, Abete P, et al. The incidence of sarcopenia among hospitalized older patients: results from the Glisten study. J Cachexia Sarcopenia Muscle. 2017;8(6):907-14.
Malafarina V, Malafarina C, Biain Ugarte A, et al. Factors associated with sarcopenia and 7-year mortality in very old patients with hip fracture admitted to rehabilitation units: a pragmatic study. Nutrients. 2019;11(9):2243.
Yuenyongchaiwat K, Kulchanarat C, Satdhabudha O. Sarcopenia in open heart surgery patients: a cohort study. Heliyon. 2020;6(12):e05759.
Welch C, Greig C, Majid Z, et al. Induced frailty and acute sarcopenia are overlapping consequences of hospitalisation in older adults. J Frailty Sarcopenia Falls. 2022;7(3):103-16.
Nguyen M, Mukaneza Y, Tremblay M, et al. Renal dysfunction independently predicts muscle mass loss in patients following liver transplantation. Can Liver J. 2022;5(3):411-23.
Bhanji RA, Takahashi N, Moynagh MR, et al. The evolution and impact of sarcopenia pre- and post-liver transplantation. Aliment Pharmacol Ther. 2019;49(6):807-13.
Welch C, Greig CA, Hassan-Smith ZK, et al. A pilot observational study measuring acute sarcopenia in older colorectal surgery patients. BMC Res Notes. 2019;12(1):24.
Awad S, Tan BH, Cui H, et al. Marked changes in body composition following neoadjuvant chemotherapy for oesophagogastric cancer. Clin Nutr. 2012;31(1):74-7.
Levy D, Giannini M, Oulehri W, et al. Long term follow-up of sarcopenia and malnutrition after hospitalization for COVID-19 in conventional or intensive care units. Nutrients. 2022;14(4):912.
Social Determinants of Health: the Solid Facts. 2nd ed [Internet]. World Health Organization; 2003 [cited 2026 Apr 30]. Available from: https://iris.who.int/bitstream/handle/10665/326568/9789289013710-eng.pdf
Beckie TM, Beckstead JW. Predicting cardiac rehabilitation attendance in a gender-tailored randomized clinical trial. J Cardiopulm Rehabil Prev. 2010;30(3):147-56.
Andraos C, Arthur HM, Oh P, et al. Women’s preferences for cardiac rehabilitation program model: a randomized controlled trial. Eur J Prev Cardiol. 2015;22(12):1513-22.
Grace SL, Midence L, Oh P, et al. Cardiac rehabilitation program adherence and functional capacity among women: a randomized controlled trial. Mayo Clin Proc. 2016;91(2):140-8.
CLEAR Collaboration [Internet]. The CLEAR Toolkit; 2020 [cited 2026 Apr 30]. Available from: https://www.mcgill.ca/familymed/files/familymed/clear_toolkit_2020_-_japanese.pdf
The accountable health communities health-related social needs screening tool [Internet]. CMS.gov.; 2025 [cited 2026 Mar 9]. Available from: https://www.cms.gov/priorities/innovation/files/worksheets/ahcm-screeningtool.pdf
Poverty: a clinical tool for primary care providers (Ontario) [Internet]. Japan Network of Health Promoting Hospitals & Health Services; 2025 [cited 2026 Apr 30]. Available from: https://www.hphnet.jp/sys/wp-content/uploads/6e98d41048410bff4b329de67baeb3ff.pdf
Closing the gap in a generation: health equity through action on the social determinants of health [Internet]. World Health Organization; 2008 [cited 2026 Apr 30]. Available from: https://www.who.int/publications/i/item/9789241563703
Wickstrom J, Leone EJ, Sasson N, et al. Impact of social determinants of health on rehabilitation service use and outcomes in adults in the USA: a scoping review protocol. BMJ Open. 2024;14(11):e087254.
Matchar DB, Young SHY, Sim R, et al. Incentives for uptake of and adherence to outpatient stroke rehabilitation services: a 3-arm randomized controlled trial. Arch Phys Med Rehabil. 2022;103(1):1-7.e4.
Lai B, Bond K, Kim Y, et al. Exploring the uptake and implementation of tele-monitored home-exercise programmes in adults with Parkinson’s disease: a mixed-methods pilot study. J Telemed Telecare. 2020;26(1-2):53-63.
Kraal JJ, Peek N, Van den Akker-Van Marle ME, et al. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the FIT@Home study. Eur J Prev Cardiol. 2014;21(2) Suppl:26-31.
Takeda H, Takatori K. Effect of buddy-style intervention on exercise adherence in community-dwelling disabled older adults: a pilot randomized controlled trial. Clin Rehabil. 2022;36(3):379-87.
Mézière A, Oubaya N, Michel-Pellegrino V, et al. Exercise interventions with trained home helpers for preventing loss of autonomy and falls in community-dwelling older adults receiving home heath physical therapy T4H: a randomized controlled pilot study. J Geriatr Phys Ther. 2021;44(3):E138-49.
Prvu Bettger J, Green CL, Holmes DN, et al. Effects of virtual exercise rehabilitation in-home therapy compared with traditional care after total knee arthroplasty: Veritas, a randomized controlled trial. J Bone Joint Surg Am. 2020;102(2):101-9.
Maddison R, Rawstorn JC, Stewart RAH, et al. Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart. 2019;105(2):122-9.
DE Lima AP, Pereira DG, Nascimento IO, et al. Cardiac telerehabilitation in a middle-income country: analysis of adherence, effectiveness and cost through a randomized clinical trial. Eur J Phys Rehabil Med. 2022;58(4):598-605.
Salmani B, Prapavessis H, Vanderloo LM, et al. Financial incentives for physical activity in adults: systematic review and meta-analysis update. Prev Med. 2025;192:108237.
Szanton SL, Leff B, Li Q, et al. CAPABLE program improves disability in multiple randomized trials. J Am Geriatr Soc. 2021;69(12):3631-40.
Supplementary Figure 1-1. Literature search flow diagram (PRISMA 2020): patients with cerebrovascular disease in the acute phase.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 2-1. Literature search flow diagram (PRISMA 2020): patients with cerebrovascular disease in the convalescent phase.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 3-1. Literature search flow diagram (PRISMA 2020): patients with proximal femoral fracture.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 4-1. Literature search flow diagram (PRISMA 2020): patients with COPD.
*The 22 reports included in previously reported systematic reviews were rechecked at the eligibility-assessment stage and were not identified through the new search.
COPD: chronic obstructive pulmonary disease; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 5-1. Literature search flow diagram (PRISMA 2020): patients with cancer.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 6-1. Literature search flow diagram (PRISMA 2020): exercise therapy for patients with dysphagia.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 7-1. Literature search flow diagram (PRISMA 2020): nutritional therapy for patients with dysphagia.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 8-1. Literature search flow diagram (PRISMA 2020): malnutrition in patients with dysphagia.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses,
Supplementary Figure 9-1. Literature search flow diagram (PRISMA 2020): exercise therapy for patients with dysphagia.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 10-1. Literature search flow diagram (PRISMA 2020): exercise therapy and nutritional therapy for patients with dysphagia.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 11-1. Literature search flow diagram (PRISMA 2020): nutritional therapy for patients with dysphagia, including enteral nutrition, parenteral nutrition, oral nutritional supplementation, and nutritional counseling.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 12-1. Literature search flow diagram (PRISMA 2020): intensive exercise therapy for patients with malnutrition.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 14-1. Literature search flow diagram (PRISMA 2020): nutrition assessment by registered dietitians for older adults, older adults requiring long-term care, and frail older adults.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 15-1. Literature search flow diagram (PRISMA 2020): nutritional counseling by registered dietitians for older adults, older adults requiring long-term care, and frail older adults.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 16-1. Literature search flow diagram (PRISMA 2020): professional oral management.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 17-1. Literature search flow diagram (PRISMA 2020): pharmacist-led pharmaceutical interventions.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 18-1. Literature search flow diagram (PRISMA 2020): hospital-associated sarcopenia.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Supplementary Figure 19-1. Literature search flow diagram (PRISMA 2020): screening for SDH.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SDH: social determinants of health.
Supplementary Figure 20-1. Literature search flow diagram (PRISMA 2020): interventions considering SDH.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SDH: social determinants of health.
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