No abstract

VILLAREAL, DENNIS T., MARIAN BANKS, CATHERINE SIENER, DAVID R. SINACORE, AND SAMUEL KLEIN. Physical frailty and body composition in obese elderly men and women. Obes Res. 2004;12:913-920. Objective: To evaluate the prevalence of frailty and interrelationships among body composition, physical function, and quality of life in community-dwelling obese elderly (OE) persons. Research Methods and Procedures: Fifty-two OE, 52 nonobese frail, and 52 nonobese nonfrail subjects, matched for age and sex, were studied. Subjective and objective measures of functional status were evaluated by using the physical performance test, exercise stress test, lower extremity (LE) strength, gait speed, static and dynamic balance, functional status questionnaires, and health-related quality-of-life questionnaire (Medical Outcomes Short Form). Body composition was evaluated by using DXA, and muscle quality was evaluated by determining the ratio of LE strength to LE lean mass. Results: Among OE subjects, 96% met our standard criteria for mild to moderate frailty. Compared with the nonobese nonfrail group, the OE and nonobese frail groups had lower and similar scores in physical performance test, peak aerobic power, and functional status questionnaire, and exhibited similar impairments in strength, walking speed, balance, and health-related quality of life. Although absolute fat-free mass (FFM) was greater, the percentage body weight as FFM and muscle quality was lower in the OE group than in the other two groups. Discussion: Physical frailty, which predisposes to loss of independence, is common in community-living OE men and women. Physical frailty in OE subjects was associated with low percentage FFM, poor muscle quality, and decreased quality of life. These findings suggest that weight loss therapy may be particularly important in OE persons to improve physical function, in addition to improving the medical complications associated with obesity.

Background: Obesity exacerbates the age-related decline in physical function and causes frailty in older persons. However, appropriate treatment for obese older persons is unknown. We evaluated the effects of weight loss and exercise therapy on physical function and body composition in obese older persons. Methods:We screened 40 obese older volunteers and eventually randomized 27 frail obese older volunteers to treatment or control groups. Treatment consisted of 6 months of weekly behavioral therapy for weight loss in conjunction with exercise training 3 times per week. Physical function was evaluated with measurements of frailty (Physical Performance Test, peak oxygen consumption, and Functional Status Questionnaire); strength, gait, and balance tests; body composition with dualenergy x-ray absorptiometry; and quality of life using the Medical Outcomes Survey 36-Item Short-Form Health Survey. Results are reported as mean ± SD.Results: Two subjects in the treatment group did not comply with the intervention, and 1 subject in the control group withdrew. Analyses included all 27 subjects originally randomized to the treatment and control groups. The treatment group lost 8.4% ± 5.6% of body weight, whereas weight did not change in the control group (ϩ0.5% ± 2.8%; PϽ.001). Compared with the control group, fat mass decreased (−6.6 ± 3.4 vs ϩ1.7 ± 4.1 kg; PϽ.001), without a change in fat-free mass (−1.2±2.1 vs −1.0±3.5 kg; P =.75) in the treatment group. The Physical Performance Test score (2.6±2.5 vs 0.1±1.0; P=.001), peak oxygen consumption (1.7±1.6 vs 0.3±1.1 mL/min per kilogram; P =.02), and Functional Status Questionnaire score (2.9±3.7 vs −0.2±3.9; P =.02) improved in treated subjects compared with control subjects. Treatment also improved strength, walking speed, obstacle course, 1-leg limb stance time, and health survey physical subscale scores (all PϽ.05). Conclusion:These findings suggest that weight loss and exercise can ameliorate frailty in obese older adults.

The desire for AAT strongly correlates with previous pet ownership. AAT reduces loneliness in residents of long-term care facilities.

Lifestyle intervention decreases multiple metabolic CHD risk factors simultaneously in obese older adults.

Weight loss, even when combined with exercise, decreases hip BMD in obese older adults. It is not known whether the beneficial effects of weight loss and exercise on physical function lower the overall risk of falls and fractures, despite the decline in hip BMD.

objective: Obesity and aging increase the risk of type 2 diabetes (T2D). We evaluated whether weight loss therapy improves pancreatic endocrine function and insulin sensitivity in obese older adults. Methods and Procedures: Twenty-four obese (BMI: 38 ± 2 kg/m 2 ) older (age: 70 ± 2 years) adults completed a 6-month randomized, controlled trial. Participants were randomized to diet and exercise (treatment group) or no therapy (control group). β-Cell function (assessed using the C-peptide minimal model), α-cell function (assessed by the glucagon response to an oral glucose load), insulin sensitivity (assessed using the glucose minimal model), and insulin clearance rate were evaluated using a 5-h modified oral glucose tolerance test. Results: Body weight decreased in the treatment group, but did not change in the control group (−9 ± 1% vs. 0 ± 1%; P < 0.001). Insulin sensitivity doubled in the treatment group and did not change in the control group (116 ± 49% vs. −11 ± 13%; P < 0.05). Even though indices of β-cell responsivity to glucose did not change (P > 0.05), the disposition index (DI), which adjusts β-cell insulin response to changes in insulin sensitivity, improved in the treatment group compared with the control group (100 ± 47% vs. −22 ± 9%; P < 0.05). The glucagon response decreased in the treatment but not in the control group (−5 ± 2% vs. 4 ± 4%; P < 0.05). Insulin secretion rate did not change (P > 0.05), but insulin clearance rate increased (51 ± 25%; P < 0.05), resulting in lower plasma insulin concentrations. Discussion: Weight loss therapy concomitantly improves β-cell function, lowers plasma glucagon concentrations, and improves insulin action in obese older adults. These metabolic effects are likely to reduce the risk of developing T2D in this population.

Animal-assisted therapy (AAT) has been shown to reduce the loneliness of residents in long-term care facilities (LTCFs). In this study, we determined the relative contribution of socialization (human-human bonding) and human-animal bonding as mechanisms by which AAT reduces loneliness. Residents in LTCFs volunteering for AAT were randomized to receive AAT as individuals (Individual) or in groups of two to four (Group). Individual AAT was used as a measure of animal-human bonding, and Group AAT was used as a measure of the combination of animal-human bonding and socialization. Any greater effect of Group AAT in comparison toIndividual AAT would be ascribed to socialization. Thirty-seven residents of LTCFs, who were cognitively intact, volunteered for AAT, and scored as significantly lonely on the UCLA Loneliness Scale (Version 3), were studied. Six weeks of AAT, one 30minute session per week, in an individual or group setting was performed, with posttesting during week five. Two residents dropped out of each group, giving us group sizes of 17 (Individual) and 16 (Group).