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Adequate protein intake and resistance training are effective strategies to maintain muscle mass, but the effect of their combination on metabolic profile during weight loss remains to be determined in older adults. The main objective of this study was to determine the effect of a 16-week high-protein caloric restriction combined with resistance training on chronic disease risk factors in obese older individuals with metabolic impairments. A total of 26 overweight adults aged between 60 and 75 years (BMI 32.4 ± 3.9 kg/m2) with at least 2 factors of the metabolic syndrome participated in this study and were randomized into two groups: 1) high-protein caloric restriction (HP; n= 12) and 2) high-protein caloric restriction combined with dynamic-resistance training (HP+RT; n=14). Caloric intake was reduced by 500 kcal/d in all participants and protein intake equated 25-30% of total calories (~1.4 g/kg/d). Exercise training consisted of 3 session/week of resistance training on pulley machines. Outcome measures included total and trunk fat mass (FM), total and appendicular lean body mass (LBM), fasting glucose level, lipid profile and blood pressure. Our results showed that total and trunk FM (all p<0.0001) as well as fasting glucose (p<0.0001), triglycerides (p=0.002) and total cholesterol (p=0.03) levels decreased similarly in both groups. However, total (p=0.04) and appendicular (p=0.02) LBM decreased in the HP group only. Our data show that high-protein energy restriction improves health profile of obese elderly at high risk of chronic disease but needs to be combined with resistance training to maintain LBM.

The aim of this study was to compare the acute hemodynamic responses during high-intensity intermittent exercise (HIIE) session compared with moderate-intensity continuous exercise (MICE) session in patients with heart failure and reduced ejection fraction (HFREF). Thirteen patients with HFREF (age, 59 ± 6 years; left ventricular ejection fraction, 27% ± 6%; New York Heart Association class I to III) were randomly assigned to a single session of HIIE (2 × 8 min) corresponding to 30 s at 100% of peak power output (PPO) and 30 s passive recovery intervals or to a MICE (22 min) at 60% of PPO. Gas exchange and central hemodynamic parameters (cardiac bioimpedance) were measured continuously during exercise. Oxygen uptake, stroke volume (SV), cardiac output (CO), and arterio-venous difference (C(a-v)O(2)) were compared. Mean oxygen uptake and ventilation were lower during HIIE vs. MICE. CO, SV, and C(a-v)O(2)) were not different between MICE and HIIE. Optimized HIIE was well tolerated (similar perceived exertion) and no significant ventricular arrhythmias and (or) abnormal blood pressure responses occurred during HIEE session. Compared with MICE, optimized HIIE elicited similar central hemodynamic and C(a-v)O(2) responses in HFREF patients with lower oxygen uptake and ventilation. HIIE may be an efficient exercise training modality in patients with HFREF.

Purpose The prevalence of metabolic syndrome is greatest in older obese adults and effective evidence-based treatment strategies are lacking. This study determined the efficacy of adding caloric restriction (CR) for weight loss to resistance training (RT) on metabolic syndrome (MetS) and its individual components in older overweight and obese adults. Methods We performed a 5-month randomized controlled trial in 126 older (65–79 yrs) overweight and obese (Body Mass Index: 27–35 kg/m2) men and women who were assigned to progressive 3-d/wk, moderate-intensity RT with (RT+CR) or without caloric restriction (RT). MetS components, according to the National Cholesterol Education Program Adult Treatment Panel III, were determined before and immediately after the interventions. Results Body mass decreased in RT+CR (−5.67% loss of initial mass) but was unchanged in RT (−0.15%). Compared to RT, RT+CR resulted in reduced very low-density lipoprotein cholesterol (VLDL-chol), triglycerides (TG), and systolic and diastolic blood pressures (p between 0.000 and 0.013). The RT group showed no significant within group changes in MetS criteria. Abdominal obesity, hypertension, the number of metabolic abnormalities and the presence of MetS significantly decreased with RT+CR. There were significant group differences for abdominal obesity, hypertension, and number of metabolic abnormalities. Conclusion RT+CR is an effective strategy for improving some of the metabolic abnormalities associated with MetS among older overweight and obese adults.

Most evidence for the health benefits of prescribing caloric restriction (CR) for weight loss is derived from randomized, controlled trials (RCTs) in young/middle-aged adults; there are very few RCTs in older adults in which the isolated effects of CR can be deciphered. The purpose of this review is to summarize the RCT evidence of the benefits (and potential risks) of CR for the treatment of obesity in older adults. We identified only 19 published papers from 10 RCTs ranging from 3 to 18 months that met the criteria of independent effects of a CR component and were conducted in adults with a mean age ≥65 yrs. Overall, the results show a beneficial treatment effect for improving some metabolic, functional and body composition outcomes with few documented risks. However, all outcomes were assessed immediately after treatment cessation. Thus, until additional scientifically rigorous evidence with long-term follow-up is available, the risk-to-benefit ratio of CR for the treatment of obesity in older adults remains unclear.

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Background: While intentional weight loss in older adults with obesity yields clinically important health benefits there is a need to minimize the negative effects of weight loss on concomitant loss of muscle mass and strength. Data show wearing weighted vests during exercise improves lean mass and lower extremity strength, however the efficacy of wearing a weighted vest during a period of weight loss to mitigate muscle and strength loss is not known. Objectives: This study examined the feasibility of daily weighted vest use during a dietary weight loss intervention, and examined effects of vest use on body composition and physical function in well-functioning older adults with obesity. Design: Randomized, controlled pilot study. Setting: Wake Forest Baptist Medical Center in Winston-Salem, NC. Participants: 37 older (age=65-79 yrs), obese (BMI=30-40 kg/m2) sedentary men and women. Interventions: 22-week behavioral diet intervention (targeting 10% weight loss, 1100-1300 kcals/day) with (Diet+Vest; n=20) or without (Diet; n=17) weighted vest use (goal of 10 hours/day with weight added weekly according to individual loss of body mass). Measurements: Body composition by dual-energy x-ray absorptiometry and measures of physical function, mobility, and muscle strength/power. Results: Average weighted vest use was 6.7±2.2 hours/day and the vest-wear goal of 10 hrs/day was achieved for 67±22% of total intervention days. Five participants reported adverse events from wearing the vest (all back pain or soreness). Both groups lost a similar amount of weight (Diet= -11.2±4.4 kg; Diet+Vest = -11.0±6.3 kg; p<0.001), with no differences between groups (p=0.25). Fat mass, lean mass, and % body fat decreased significantly (p<0.0001), with no differences between groups. Compared to Diet+Vest, the Diet intervention resulted in greater decreases in leg power (p<0.02), with no other between group differences in physical function. Conclusion: This pilot study showed that vest use during dietary weight loss is feasible and safe in well-functioning older adults with obesity. Larger studies are needed to definitively determine whether external replacement of lost weight during caloric restriction may preserve lower extremity muscle strength and power.

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