ObjectiveTo examine the long-term effects of exercise modality during weight loss on body composition and associations between body composition and physical function changes.Methods249 older adults (66.9±4.7 years, 71% women, 32% African American, BMI: 34.4±3.7 kg/m2) were randomized to weight loss (WL; n=82), WL plus aerobic training (WL+AT; n=86), or WL plus resistance training (WL+RT; n=81) for 18-months. DXA-acquired body composition, 400-m walk time, and knee extensor strength were measured at baseline, 6-, and 18-months.ResultsTotal body mass loss was enhanced when WL was combined with exercise (WL: −5.7±0.7 kg, WL+AT: −8.5±0.7 kg, WL+RT: −8.7±0.7 kg; p<0.01). Total body fat mass loss was significantly greater in WL+AT (−6.8±0.6 kg, −16.4%) and WL+RT (−7.8±0.5 kg, −19.0%) than WL (−4.8±0.6 kg, −10.9%); both p<0.01. Lean mass loss was greatest in WL+AT (−1.6±0.3 kg, −3.1%) compared to WL+RT (−0.8±0.3 kg, −1.5%) or WL (−1.0±0.3 kg; −2.0%); both p≤0.02). Change in 400-m walk time was associated with change in fat mass (β/SD=+6.1 sec; p<0.01), while change in knee extensor strength was associated with change in lean mass (β/SD=+1.6 Nm; p<0.01).ConclusionsWL+RT results in less lean mass lost than WL+AT; WL plus exercise yields greater fat mass loss than WL alone.

Chronic, multisite pain is a common phenomenon in aging and is associated with a host of negative health outcomes. It is a complex and multifaceted condition that may be exacerbated by weight gain and long periods of inactivity. Unfortunately, older adults suffering from chronic pain have unique barriers limiting access to center-based behavior change interventions. The MORPH study first adapted and iteratively refined an evidence-based group-mediated intervention for delivery in the home via mHealth tools (a smartphone app, teleconferencing software, wearable activity monitor, smart weight scale). This was followed by a pilot randomized controlled trial (RCT) meant to assess feasibility of the MORPH intervention, and to examine initial effects on physical function, pain, weight, and sedentary behavior. We recruited low-active and obese older adults with multisite pain to partake in a series of N-of-1 refinement studies (N = 5 total) or a 12-week pilot RCT delivered largely in the home (N = 28 assigned to active intervention or wait-list control). The refinement phase identified several key technological (e.g., selection of a new smart weight scale) and user interface (e.g., clarification of in-app phrasing) modifications that were made before initiating the RCT phase. Analyses of covariance, controlling for baseline values, sex, and age indicated effects favoring the intervention across all domains of interest: there was a substantially clinically meaningful difference in short physical performance battery scores (0.63 points, η2 = 0.08), a moderate-to-large difference in PROMIS pain intensity scores (5.52 points, η2 = 0.12), a large difference in body weight (2.90 kg, η2 = 0.207), and a moderate effect on adjusted ActivPAL-assessed sedentary time (64.90 min, η2 = 0.07) with a small effect on steps (297.7 steps, η2 = 0.01). These results suggest a largely-home delivered movement and weight loss program for older adults with pain is feasible and recommendations are provided for future programs of this nature.Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT03377634.

Background: Increasing protein content of the diet might be an effective strategy to preserve muscle mass in older adults undergoing caloric restriction, thereby preserving muscle function. Methods: Ninety-six older adults (70.3 ± 3.7 years, 74% women, 27% African American) with obesity (35.4 ± 3.3 kg/m 2 ; 47% total body fat) were randomized to a 6-month higher protein (providing 1.2-1.5 g/kg/d) weight loss (WL) program, utilizing the Medifast 4&2&1 Plan, or to weight stability (WS). Dual-energy x-ray absorptiometry-acquired total body mass and composition, and fast gait speed over 400 m was assessed at baseline, 3, and 6 months. Results: At baseline, dual-energy x-ray absorptiometry-acquired total body, fat, and lean masses were 95.9 ± 14.6, 44.6 ± 7.6, and 48.7 ± 9.5 kg, respectively, and 400-m gait speed was 1.17 ± 0.20 m/s. Total body mass was significantly reduced in the WL group (−8.17 [−9.56, −6.77] kg) compared with the WS group (−1.16 [−2.59, 0.27] kg), with 87% of total mass lost as fat (WL: −7.1 [−8.1, −6.1] kg; −15.9% change from baseline). A differential treatment effect was not observed for change in lean mass (WL: −0.81 [−1.40, −0.23] kg vs WS: −0.24 [−0.85, 0.36] kg). Four-hundred-meter gait speed was also unchanged from baseline although trends suggest slightly increased gait speed in the WL group [0.01 (−0.02, 0.04) m/s] compared with the WS group [−0.02 (−0.05, 0.01) m/s]. Conclusion: Intentional weight loss using a high-protein diet is effective in producing significant total body mass and fat mass loss, while helping preserve lean body mass and mobility, in relatively high-functioning older adults with obesity.

Objective Our primary objective was to determine the long-term effects of physical activity (PA) and weight loss (WL) on body composition in overweight/obese older adults. Secondarily, we evaluated the association between change in body mass and composition on change in several cardiometabolic risk factors and mobility. Design and Methods 288 older (X±SD: 67.0±4.8 years), overweight/obese (BMI 32.8±3.8 kg/m2) men and women participated in this 18 month randomized, controlled trial. Treatment groups included PA+WL (n=98), PA-only (n=97), and a successful aging (SA) health education control (n=93). DXA-acquired body composition measures (total body fat and lean mass), conventional biomarkers of cardiometabolic risk, and 400-m walk time were obtained at baseline and 18 months. Results Fat mass was significantly reduced from (X±SE) 36.5±8.9 kg to 31.7±9.0 kg in the PA+WL group (p<0.01), but remained unchanged from baseline in the PA-only (−0.8±3.8 kg) and SA (−0.0±3.9 kg) groups. Lean mass losses were three times greater in the PA+WL group compared to PA-only or SA groups (−2.5±2.8 kg vs. −0.7±2.2 kg or −0.8±2.4 kg, respectively; p<0.01); yet due to a larger decrease in fat mass, percent lean mass was significantly increased over baseline in the PA+WL group (2.1%±2.6%; p<0.01). Fat mass loss was primarily responsible for WL-associated improvements in cardiometabolic risk factors, while reduction in body weight, regardless of compartment, was significantly associated with improved mobility. Conclusion This 18 month PA+WL program resulted in a significant reduction in percent body fat with a concomitant increase in percent body lean mass. Shifts in body weight and composition were associated with favorable changes in clinical parameters of cardiometabolic risk and mobility. Moderate PA without WL had no effect on body composition.

A complication of cardiovascular disease (CVD) and the metabolic syndrome (MetS) among older adults is loss of mobility. The American Heart Association has identified weight management as a core component of secondary prevention programs for CVD and is an important risk factor for physical disability. The American Society for Nutrition and the Obesity Society have highlighted the need for long-term randomized clinical trials to evaluate the independent and additive effects of diet-induced weight loss (WL) and physical activity in older persons on outcomes such as mobility, muscle function, and obesity related diseases. Here we describe the rationale, design, and methods of a translational study, the Cooperative Lifestyle Intervention Program-II (CLIP-II). CLIP-II will randomize 252 obese, older adults with CVD or MetS to a weight loss only treatment (WL), aerobic exercise training (AT)+WL, or resistance exercise training (RT)+WL for 18 months. The dual primary outcomes are mobility and knee extensor strength. The interventions will be delivered by YMCA community partners with our staff as trainers and advisers. This study will provide the first large scale trial to evaluate the effects of diet-induced WL on mobility in obese, older adults with CVD or MetS as compared to WL combined with two different modes of physical activity (AT and RT). Because uncertainty exists about the best approach for promoting WL in older adults due to concerns with the loss of lean mass, the design also permits a contrast between AT+WL and RT+WL on muscle strength.