Intervening on exercise and daylong movement for weight loss maintenance in older adults: A randomized, clinical trial

Abstract

Objective: This study aimed to determine the impact of dietary weight loss (WL) plus aerobic exercise (EX) and a "move more, more often" approach to activity promotion (SitLess; SL) on WL and maintenance.

Methods: Low-active older adults (age 65-86 years) with obesity were randomized to WL+EX, WL+SL, or WL+EX+SL. Participants received a social-cognitive group-mediated behavioral WL program for 6 months, followed by a 12-month maintenance period. EX participants received guided walking exercise with the goal of walking 150 min/wk. SL attempted to achieve a step goal by moving frequently during the day. The primary outcome was body weight at 18 months, with secondary outcomes including weight regain from 6 to 18 months and objectively assessed physical activity and sedentary behavior at each time point.

Results: All groups demonstrated significant WL over 6 months (p < 0.001), with no group differences. Groups that received SL improved total activity time (p ≤ 0.05), and those who received EX improved moderate-to-vigorous activity time (p = 0.003). Over the 12-month follow-up period, those who received WL+EX demonstrated greater weight regain (5.2 kg; 95% CI: 3.5-6.9) relative to WL+SL (2.4 kg; 95% CI: 0.8-4.0).

Conclusions: Pairing dietary WL with a recommendation to accumulate physical activity contributed to similar WL and less weight regain compared with traditional aerobic exercise.

Figure 1.

Participant Consort Diagram. BP = blood pressure, BMI =body mass index, MoCA=Montreal Cognitive Assessment, GXT = graded exercise test, DXA= dual-energy X-ray absorptiometry, WL=weight loss, EX = aerobic exercise.

Figure 2.

Adjusted change in body weight (top panel), average minutes of moderate-to-vigorous activity (MVPA; middle panel), and sitting time (bottom panel) within weight loss + exercise (n=13), weight loss + SitLess (n = 14), and weight loss + exercise + SitLess (n = 15).