Document Detail


Weight loss, exercise, or both and physical function in obese older adults.
MedLine Citation:
PMID:  21449785     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Obesity exacerbates the age-related decline in physical function and causes frailty in older adults; however, the appropriate treatment for obese older adults is controversial.
METHODS: In this 1-year, randomized, controlled trial, we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese. Participants were randomly assigned to a control group, a weight-management (diet) group, an exercise group, or a weight-management-plus-exercise (diet-exercise) group. The primary outcome was the change in score on the modified Physical Performance Test. Secondary outcomes included other measures of frailty, body composition, bone mineral density, specific physical functions, and quality of life.
RESULTS: A total of 93 participants (87%) completed the study. In the intention-to-treat analysis, the score on the Physical Performance Test, in which higher scores indicate better physical status, increased more in the diet-exercise group than in the diet group or the exercise group (increases from baseline of 21% vs. 12% and 15%, respectively); the scores in all three of those groups increased more than the scores in the control group (in which the score increased by 1%) (P<0.001 for the between-group differences). Moreover, the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group (increases of 17% vs. 10% and 8%, respectively; P<0.001); the score on the Functional Status Questionnaire, in which higher scores indicate better physical function, increased more in the diet-exercise group than in the diet group (increase of 10% vs. 4%, P<0.001). Body weight decreased by 10% in the diet group and by 9% in the diet-exercise group, but did not decrease in the exercise group or the control group (P<0.001). Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group (reductions of 3% and 1%, respectively, in the diet-exercise group vs. reductions of 5% and 3%, respectively, in the diet group; P<0.05 for both comparisons). Strength, balance, and gait improved consistently in the diet-exercise group (P<0.05 for all comparisons). Adverse events included a small number of exercise-associated musculoskeletal injuries.
CONCLUSIONS: These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00146107.).
Authors:
Dennis T Villareal; Suresh Chode; Nehu Parimi; David R Sinacore; Tiffany Hilton; Reina Armamento-Villareal; Nicola Napoli; Clifford Qualls; Krupa Shah
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  364     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-31     Completed Date:  2011-04-05     Revised Date:  2012-05-07    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1218-29     Citation Subset:  AIM; IM    
Affiliation:
Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, USA. dennis.villareal@va.gov
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00146107
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living*
Aged
Body Composition
Bone Density
Diet, Reducing*
Exercise / physiology*
Exercise Test
Female
Frail Elderly*
Humans
Intention to Treat Analysis
Male
Obesity / diet therapy,  physiopathology*,  therapy
Quality of Life
Weight Loss / physiology*
Grant Support
ID/Acronym/Agency:
DK20579/DK/NIDDK NIH HHS; HD007434/HD/NICHD NIH HHS; P30 DK056341-09/DK/NIDDK NIH HHS; P30-DK56341/DK/NIDDK NIH HHS; P60 DK020579-25/DK/NIDDK NIH HHS; R01 AG025501-06/AG/NIA NIH HHS; R01-AG025501/AG/NIA NIH HHS; T32 HD007434-17/HD/NICHD NIH HHS; UL1 RR024992-05/RR/NCRR NIH HHS; UL1-RR024992/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
N Engl J Med. 2011 Jun 23;364(25):2467; author reply 2467-8   [PMID:  21696316 ]
N Engl J Med. 2011 Jun 23;364(25):2466-7; author reply 2467-8   [PMID:  21696317 ]

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