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Most Effective Type of Exercise for Obese Older Adults who are Dieting

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Monday, Mar 15, 2021

What is the Most Effective Type of Exercise for Obese Older Adults who are Dieting?
 

It is well-documented that over one-third of individuals over the age of 65 in the United States are obese. Obesity in this population carries with it an increased rate of decline in physical function as well as an increased risk of frailty; which is defined as an inability to carry out activities of daily living. At the same time, weight loss in this population could potentially worsen age-related declines in bone density and muscle mass, with a resultant worsening of frailty. Needless to say, this presents quite a dilemma for the obese older adult! Fortunately, exercise may offer a solution. In this blog, we will summarize results from the Lifestyle Intervention Trial in Obese Elderly (LITOE).

LITOE took place between 2010-2015 at the University of New Mexico school of Medicine and the New Mexico Veterans Affairs Health Care System. A total of 160 obese and sedentary adults aged 65 years or older were enrolled in the study. At baseline, all subjects had mild to moderate frailty as defined by the modified Physical Performance Test (PPT). Participants also completed a treadmill exercise test to assess cardiorespiratory fitness level. Additional tests of dynamic balance, gait speed, muscular strength, functional status (ability to perform activities of daily living), fat mass, lean mass, and bone density were performed at baseline as well.   

Participants were then randomly assigned to one of four groups as follows:

  • Group 1: Control group; no weight management or exercise intervention
  • Group 2: Aerobic exercise and weight management program
  • Group 3: Resistance training and weight management program
  • Group 4: Aerobic exercise and resistance training program, as well as weight management program

The study took place over a 26-week period. The interventions were as follows:

 Weight Management Program 
Participants in Groups 2-4 were prescribed a balanced diet that led to an energy deficit of 500-750 calories per day, and contained 1 gram of protein per kilogram of body weight per day. Individual meetings with a registered dietitian were held weekly; these included behavior therapy, weigh-ins, and goal setting.

 Aerobic Exercise 
Participants in Group 2 participated in aerobic exercise sessions three times per week. These 60 minute sessions included 10 minutes of flexibility training, 40 minutes of aerobic exercise at 65-85% of peak heart rate, and 10 minutes of balance training.

 Resistance Training 
Participants in Group 3 participated in resistance training sessions three times per week. These 60 minute sessions included 10 minutes of flexibility training, 40 minutes of resistance training (2-3 sets of 9 exercises using 65-85% of the 1RM), and 10 minutes of balance training.

 Aerobic Training and Resistance Training 
Participants in Group 4 participated in combined aerobic and resistance exercise training sessions three times per week. These 75-90 minute sessions included 10 minutes of flexibility training, 30-40 minutes of aerobic exercise, 30-40 minutes of resistance training, and 10 minutes of balance training. All exercise sessions for Groups 2-4 were closely supervised by experienced trainers.

Baseline tests were repeated after 26 weeks. The results are shown below in Table 1. All numbers in the table represent the percent improvement as compared to the baseline scores.

Table 1.  Percent Improvement from Baseline Scores.

 

Group 1
(Control)

Group 2
(Aerobic)

Group 3 (Resistance)

Group 4
(Aerobic &  Resistance)

PPT Score

        3%

        14%

       14%

21%

Functional Status

        1%

         7%

        8%

12%

Cardiorespiratory Fitness

0%

18%

8%

17%

Body Weight

~1%

9%

9%

9%

Fat Mass

2%

16%

17%

17%

Lean Mass

0%

 -5%

-2%

-3%

Bone Mineral Density

 0%

0%    

0%

0%

Muscular Strength

 <1%

   2%

   19%

18%

Gait Speed

         0%

9%

         13%

14%

Dynamic Balance

0%

10%

13%

17%


As shown in the Table and as expected, there was no significant improvement in scores among Group 1 (control group). Because bone mineral density (BMD) changes very slowly, it was not surprising that there was no significant change in BMD in any Group over the 6 month period. Although Groups 2 and 3 experienced significant beneficial changes in several of the variables measured, the changes tended to be more substantial in Group 4. This was particularly true for the PPT and Functional Status scores, which are indicators of physical function and frailty, respectively. Thus, in obese older adults who are actively striving to lose weight via exercise and diet, an exercise program that combined aerobic and resistance training was more effective than either type of training by itself.

It is not unusual for some loss of lean mass to occur when individuals are in significant negative caloric balance. You will notice in the Table that all 3 exercise groups lost lean mass during the 6 month study. However, the degree of lean mass lost was less in Groups 3 and 4, suggesting that resistance training helps to minimize the loss of lean mass that occurs during weight loss.

So, if you are an obese older adult who wants to lose weight as well as become more fit and functional, then you will receive the most bang for your buck by incorporating both aerobic training and resistance training into your workout routine.    
 

Reference

Villareal, D., Aguirre, L., Gurne, A., Waters, D., Sinacore, D., Colombo, E….Qualls, C. Aerobic or resistance exercise, or both, in dieting obese older adults. (2017). N Engl J Med, 376:1943-1955.  DOI: 10.1056/NEJMoa1616338