Background There is a need for effective primary care interventions that help older people combat frailty and build resilience. Objective To study the effectiveness of an optimised exercise and dietary protein intervention. Design Multicentre, randomised-controlled, parallel-arm trial. Setting Six primary care practices, Ireland. Methods Six general practitioners enrolled adults aged 65+ with Clinical Frailty Scale score ≤5 from December 2020 to May 2021. Participants were randomised to intervention or usual care with allocation concealed until enrolment. Intervention comprised a 3-month home-based exercise regime, emphasising strength, and dietary protein guidance (1.2 g/kg/day). Effectiveness was measured by comparing frailty levels, based on the SHARE-Frailty Instrument, on an intention-to-treat basis. Secondary outcomes included bone mass, muscle mass and biological age measured by bioelectrical impedance analysis. Ease of intervention and perceived health benefit were measured on Likert scales. Results Of the 359 adults screened, 197 were eligible and 168 enrolled; 156 (92.9%) attended follow-up (mean age 77.1; 67.3% women; 79 intervention, 77 control). At baseline, 17.7% of intervention and 16.9% of control participants were frail by SHARE-FI. At follow-up, 6.3 and 18.2% were frail, respectively. The odds ratio of being frail between intervention and control groups post-intervention was 0.23 (95% confidence interval: 0.07–0.72; P = 0.011), adjusting for age, gender and site. Absolute risk reduction was 11.9% (CI: 0.8%–22.9%). Number needed to treat was 8.4. Grip strength (P < 0.001) and bone mass (P = 0.040) improved significantly. 66.2% found the intervention easy, 69.0% reported feeling better. Conclusion A combination of exercises and dietary protein significantly reduced frailty and improved self-reported health.

In 1961, Sir Isaiah Berlin, the eminent British historian of ideas and philosopher, in an article entitled "Does Political Theory Still Exist?" noted that "no commanding work of political philosophy has appeared in the twentieth century." 1 In the last six years, however, two works have been published that bid fair to occupy a dominant place in the development of political thought in our time, at least in the Anglo-American philosophical world: John Rawls's A Theory of Justice (Cambridge, Mass.: Harvard University, 1971) and Robert Nozick's Anarchy, State, and Utopia (New York: Basic Books, 1974). Both books have been widely discussed, far more so than is usual for contemporary philosophical treatises. A substantial body of critical literature has already grown up around Rawls's book, 2 and Nozick's book received the 1975 National Book Award in the category of science, philosophy, and religion. My purpose is to provide an introduction to these important works and to indicate their significance for those who work for social justice from a Christian perspective. RAWLSJustice, for Rawls, is the first and indispensable virtue of social institutions (p. 3); and the primary function of a theory of justice is not to determine a particular form of political or economic organization, but to arrive at principles "that free and rational persons concerned to further their own interests would accept in an initial position of equality as defining the fundamental terms of their association" (11). Rawls later distinguishes a four-stage sequence of the judgments that citizens make in applying principles of justice to the structure and institutions of their society. These stages are (a) the adoption of the principles of justice in the original position, (6) the constitutional convention, which aims at designing a just procedure for government and requires guarantees of the liberties of equal citizenship, (c) just legislation enacted by the government thus established, and (d) the application of rules to particular cases by judges and administrators (195)(196)(197)(198)(199)(200)(201)). Rawls does not claim that the working of this sequence yields a uniquely just outcome for all cases; for instance, he does not believe that the theory of justice yields a 1 In Philosophy, Politics, and Society, Second Series, ed. Peter Laslett and W. G. Runciman (Oxford: Blackwell, 1962) 1. 2 The most useful collection of philosophical appraisals of Rawls's work is Reading Rawls, ed. Norman Daniels (New York: Basic Books, 1974). A comprehensive philosophical critique is Brian Barry, The Liberal Theory of the State (Oxford: Clarendon, 1973). The most recent study is Robert Paul Wolff, Understanding Rawls (Princeton: Princeton Univ. Press, 1977). 346 at Kungl Tekniska Hogskolan / Royal Institute of Technology on July 14, 2015 tsj.sagepub.com Downloaded from SEARCH FOR SOCIAL JUSTICE347 definite universal answer for the question whether the means of production should be publicly or privately owned (273-74).The general conception of justice with which R...

Introduction: Resistance exercises and dietary protein have been shown to reverse frailty, yet they are not commonly offered in clinical practice. We aim to measure changes in health outcomes, including physical frailty status (SHARE-FI), clinical frailty status (CFS) and muscle mass, as a result of an optimised exercise and dietary intervention versus usual care in a primary care (PC) setting. The intervention has been derived from our systematic review and meta-analysis findings and optimised through patient and public involvement and multidisciplinary team input. Methods: This study is a multicentre randomised controlled parallel arm trial with a three month follow up. 210 eligible people aged 65 and over, no more than mildly frail, will be recruited in seven PC practices in Ireland and randomly assigned to ‘intervention’ or ‘usual care’. Intervention participants will be provided a leaflet with strength exercises, protein dietary guidance and educational discussion. Baseline measurements will include demographics, health indicators, comorbidities, malnutrition universal screening tool (MUST), frailty status (SHARE-FI, CFS) and muscle mass (bioelectrical impedance). Primary outcome will be frailty status measured by SHARE-FI at three months. Secondary outcomes include CFS, muscle mass, in-patient hospitalisation, long term care admission, and subjective ease of intervention and difference to general health. Statistical analysis will be undertaken by an independent statistician. Discussion: The diversity of tested frailty interventions and lack of clear guidance may contribute to low implementation rates. The REFEREE trial focusses on an optimised intervention for a syndrome that poses growing individual and societal challenges. It is hoped results can encourage mainstream adoption of interventions to reverse clinical frailty and build resilience in primary care. Trial registration: ClinicalTrials.gov ID NCT04628754; registered on 13 November 2020.

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Introduction: Resistance exercises and dietary protein have been shown to reverse frailty, yet they are not commonly offered in clinical practice. We aim to measure changes in health outcomes, including physical frailty status (SHARE-FI), clinical frailty status (CFS) and muscle mass, as a result of an optimised exercise and dietary intervention versus usual care in a primary care (PC) setting. The intervention has been derived from our systematic review and meta-analysis findings and optimised through patient and public involvement and multidisciplinary team input. Methods: This study is a multicentre randomised controlled parallel arm trial with a three month follow up. 210 eligible people aged 65 and over, no more than mildly frail, will be recruited in seven PC practices in Ireland and randomly assigned to ‘intervention’ or ‘usual care’. Intervention participants will be provided a leaflet with strength exercises, protein dietary guidance and educational discussion. Baseline measurements will include demographics, health indicators, comorbidities, malnutrition universal screening tool (MUST), frailty status (SHARE-FI, CFS) and muscle mass (bioelectrical impedance). Primary outcome will be frailty status measured by SHARE-FI at three months. Secondary outcomes include CFS, muscle mass, in-patient hospitalisation, long term care admission, and subjective ease of intervention and difference to general health. Statistical analysis will be undertaken by an independent statistician. Discussion: The diversity of tested frailty interventions and lack of clear guidance may contribute to low implementation rates. The REFEREE trial focusses on an optimised intervention for a syndrome that poses growing individual and societal challenges. It is hoped results can encourage mainstream adoption of interventions to reverse clinical frailty and build resilience in primary care. Trial registration: ClinicalTrials.gov ID NCT04628754; registered on 13 November 2020.