Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults

Abstract

Purpose: To evaluate the effect of adding exercise to a hypocaloric diet on changes in appendicular lean mass and strength in frail obese older adults undergoing voluntary weight loss.

Methods: Thirty frail older (age, 70 +/- 5 yr) obese (body mass index, 37 +/- 5 kg.m) adults were randomly assigned to 6 months of diet/behavioral therapy (diet group, n = 15) or diet or behavioral therapy plus exercise that incorporated progressive resistance training (PRT; diet + exercise group; n = 15). Body composition was assessed using dual-energy x-ray absorptiometry, and muscle strength was assessed using one-repetition maximum. The volume of upper extremity (UE) and lower extremity (LE) exercise training was determined by multiplying the average number of repetitions performed by the average weight lifted during the first three exercise sessions and during the last three exercise sessions of the study.

Results: The diet and the diet + exercise groups had similar (P > 0.05) decreases in weight (10.7 +/- 4.5 vs 9.7 +/- 4.0 kg) and fat mass (6.8 +/- 3.7 vs 7.7 +/- 2.9 kg). However, the diet + exercise group lost less fat-free mass (FFM; 1.8 +/- 1.5 vs 3.5 +/- 2.1 kg), LE lean mass (0.9 +/- 0.8 vs 2.0 +/- 0.9 kg), and UE lean mass (0.1 +/- 0.2 vs 0.2 +/- 0.2 kg) than the diet group (P < 0.05). The diet + exercise group had greater increases in percent of weight as FFM (FFM / weight x 100) than the diet group (7.9 +/- 3.3 vs 5.4 +/- 3.7%; P < 0.05). Despite lean mass losses, the diet + exercise group increased UE and LE strength in response to exercise (17-43%), whereas the diet group maintained strength. The volume of UE and LE exercises correlated with the amount of UE and LE lean mass (r = 0.64-0.84; P < 0.05).

Conclusion: Exercise added to diet reduces muscle mass loss during voluntary weight loss and increases muscle strength in frail obese older adults. Regular exercise that incorporates PRT should be used to attenuate muscle mass loss in frail obese older adults on weight-loss therapy.

FIGURE 1

A. Changes in body weight, fat mass, and FFM in older obese adults randomized to 6 months of diet alone or 6 months of diet + exercise. *Significant change from baseline, P < 0.05. Values are mean ± SE. B. Change in appendicular lean mass, UE lean mass, and LE lean mass in older obese adults randomized to 6 months of diet alone or 6 months of diet + exercise. *Significant change from baseline, P < 0.05. Values are mean ± SE.

FIGURE 2

A. Relationships between UE lean skeletal mass and exercise-training volumes at 6 months: bench press (r = 0.84; P < 0.01), seated row (r = 0.84; P < 0.01), biceps curl (r = 0.76; P = 0.001), and UE lean mass (kg) after 6 months of intervention for the diet plus exercise group. B. Relationships between LE lean mass and exercise-training volumes at 6 months: leg extension (r = 0.72; P = 0.01), leg flexion (r = 0.67; P = 0.02), and leg press (r = 0.34, P = 0.28).

FIGURE 3

Changes in 1-RM strength in older obese adults randomized to 6 months of diet alone or 6 months of diet + exercise. *Significant change from baseline, P < 0.05. Values are mean ± SE.