Objective: To examine the long‐term effects of exercise modality during weight loss on body composition and associations between body composition and physical function changes.Methods: Two hundred forty‐nine 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. Dual‐energy x‐ray absorptiometry–acquired body composition, 400‐m walk time, and knee extensor strength were measured at baseline and at 6 and 18 months.Results: Total 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 with 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 s; P < 0.01), while change in knee extensor strength was associated with change in lean mass (β/SD = +1.6 Nm; P < 0.01).Conclusions: WL + RT results in less lean mass lost than WL + AT; WL plus exercise yields greater fat mass loss than WL alone.

Objectives: To determine the independent effect of long‐term physical activity ( PA ) and the combined effects of long‐term PA and weight loss ( WL ) on inflammation in overweight and obese older adults. Design: Eighteen‐month randomized, controlled trial. Setting: The community infrastructure of cooperative extension centers. Participants: Overweight and obese (body mass index >28.0 kg/m ² ) community‐dwelling men and women aged 60 to 79 at risk for cardiovascular disease ( CVD ). Intervention: Physical activity + weight loss (PA + WL) (n = 98), PA only (n = 97), or successful aging ( SA ) health education (n = 93) intervention. Measurements: Biomarkers of inflammation (adiponectin, leptin, high‐sensitivity interleukin (hs IL )‐6, IL ‐6s R , IL ‐8, and soluble tumor necrosis factor receptor 1) were measured at baseline and 6 and 18 months. Results: After adjustment for baseline biomarker, wave, sex, and visit, leptin and hsIL‐6 showed a significant intervention effect. Specifically, leptin was significantly lower in the PA + WL group (21.3 ng/mL, 95% confidence interval ( CI ) = 19.7–22.9 ng/mL) than in the PA (29.3 ng/mL, 95% CI = 26.9–31.8 ng/mL) or SA (30.3 ng/mL, 95% CI = 27.9–32.8 ng/mL) group (both P  <   .001), and hs IL ‐6 was significantly lower in the PA + WL group (2.1 pg/mL, 95% CI = 1.9–2.3 pg/mL) than in the PA (2.5 pg/mL, 95% CI = 2.3–2.7 pg/mL) or SA (2.4 pg/mL, 95% CI = 2.2–2.6 pg/mL) group ( P = .02). Conclusion: Addition of dietary‐induced WL to PA reduced leptin and hs IL ‐6 more than PA alone and more than a SA intervention in older adults at risk for CVD . Results suggest that WL , rather than increased PA , is the lifestyle factor primarily responsible for improvement in the inflammatory profile.

The objective of this study was to determine the ability of either aerobic or resistance training to counter weight‐loss‐associated bone loss in older adults. There were 187 older adults (67 years, 70% women, 64% white) with obesity (BMI = 34.5 ± 3.7 kg/m²) and cardiovascular disease and/or metabolic syndrome who were randomized to participate in an 18‐month, community‐based trial, with a follow‐up assessment at 30 months. Intervention arms included: weight loss alone (WL; 7% to 10% baseline weight), WL plus aerobic training (WL + AT), and WL plus resistance training (WL + RT), as well as DXA‐acquired total hip, femoral neck, and lumbar spine areal bone mineral density (aBMD), and trabecular bone score (TBS). Biomarkers of bone turnover (procollagen type 1 N‐terminal propeptide, C‐terminal telopeptide of type 1 collagen) were measured at baseline, 6, 18, and 30 (aBMD and TBS only) months. CT‐acquired hip and spine volumetric BMD (vBMD), cortical thickness, and bone strength were measured in a subset at baseline (n = 55) and 18 months. Total hip aBMD was reduced by 2% in all groups at 18 months, with a primary analysis showing no significant treatment effects for any DXA, biomarker, or CT outcome. After adjustment for WL and follow‐up at 30 months, secondary analyses revealed that total hip [−0.018 (−0.023 to −0.012) g/cm² versus −0.025 (−0.031 to −0.019) g/cm²; p = 0.05] and femoral neck [−0.01 (−0.009 to 0.008) g/cm² versus −0.011 (−0.020 to −0.002) g/cm²; p = 0.06] aBMD estimates were modestly attenuated in the WL + RT group compared with the WL group. Additionally, lumbar spine aBMD was increased in the WL [0.015 (0.007 to 0.024) g/cm²] and the WL + RT [0.009 (0.000 to 0.017) g/cm²] groups compared with the WL + AT [−0.003 (−0.012 to 0.005)g/cm²] group; both p ≤ 0.01. Community‐based exercise does not prevent bone loss during active WL in older adults; however, adding RT may help minimize long‐term hip bone loss. © 2018 American Society for Bone and Mineral Research.

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, the association between change in body mass and composition on change in several cardiometabolic risk factors and mobility was evaluated. 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) group. Lean mass losses were three times greater in the PA + WL groups 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 groups (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.

To examine the effect of exercise modality during weight loss on hip and spine bone mineral density (BMD) in overweight and obese, older adults. This analysis compared data from two 5-month, randomized controlled trials of caloric restriction (CR; inducing 5–10% weight loss) with either resistance training (RT) or aerobic training (AT) in overweight and obese, older adults. Participants in the RT + CR study underwent 3 days/week of 8 upper/lower body exercises (3 sets, 10 repetitions at 70% 1 RM) and participants in the AT+CR study underwent 4 days/week of treadmill walking (30 min at 65–70% heart rate reserve). BMD at the total hip, femoral neck, and lumbar spine was assessed via dual-energy X-ray absorptiometry at baseline and 5 months. A total of 123 adults (69.4 ± 3.5 years, 67% female, 81% Caucasian) participated in the RT+CR (n = 60) and AT+CR (n = 63) interventions. Average weight loss was 5.7% (95% CI: 4.6–6.7%) and 8.2% (95% CI: 7.2–9.3%) in RT+CR and AT+CR groups, respectively. After adjustment for age, gender, race, baseline BMI and BMD, and weight change, differential treatment effects were observed for total hip and femoral neck (both p < .05), but not lumbar spine. Total hip (1.83 [−3.90, 7.55] mg/cm²) and femoral neck (9.14 [−0.70, 18.98] mg/cm²) BMD was unchanged in RT+CR participants, and modestly decreased in AT+CR participants (total hip: −7.01 [−12.73, −1.29] mg/cm²; femoral neck: −5.36 [−14.92, 4.20] mg/cm²). Results suggest performing resistance, rather than aerobic, training during CR may attenuate loss of hip and femoral neck BMD in overweight and obese older adults. Findings warrant replication from a long-term, adequately powered, RCT.