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Introduction: The loss of muscle mass and function with ageing is a major cause for falls, disability and morbidity in older people. We have previously shown that angiotensin-converting enzyme inhibitors (ACEi) improve physical function in older people and evidence suggests that ACEi may potentially improve the response to exercise training. We therefore designed a study to examine the effects of ACEi therapy in older people undergoing exercise training.

Methods: In a double-blind trial, community-dwelling functionally impaired older people (age ≥65 years) were randomised to receive either 4 mg perindopril daily or matching placebo for 20 weeks. Additionally all participants received 20 weeks of exercise training (10 weeks of supervised hospital-based progressive resistance training followed by 10 weeks of unsupervised training). The primary outcome measure was 6 minute walk distance; secondary outcomes included Short physical performance battery, hand-grip and quadriceps strength, self-reported quality-of-life using the EuroQol-5D and the functional limitation profile.

Results: A total of 170 participants were randomised, mean age 75.7 (SD 6.8) years; 42% were male. Baseline 6-minute walk distance was 306 m (SD: 99). Both groups increased their walk distance (by 29.6 m in the exercise + ACEi group and 36.4 m in the exercise only group) at 20 weeks, but the treatment effect between groups was not statistically significant (between group difference at 20 weeks, 8.6 m (95% CI: −30.1, 12.9, P = 0.43). Short Physical Performance Battery scores improved by a similar amount in both groups (1.0 in the exercise + ACEi group, 1.1 in the exercise only group), with no significant treatment effect (between group difference at 20 weeks: −0.09, 95% CI: −0.74 to 0.57, P = 0.79). There were no significant treatment effects in any of the other outcome measures between groups.

Conclusion: ACEi for 20 weeks did not improve measures of physical function beyond that achieved by exercise training in functionally impaired older people.

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