Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults
Open accessAbstract
BACKGROUND: Obesity causes frailty in older adults; however, weight loss might accelerate age-related loss of muscle and bone mass and resultant sarcopenia and osteopenia. METHODS: In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs - aerobic training, resistance training, or combined aerobic and resistance training - or to a control group (no weight-management or exercise program). The primary outcome was the change in Physical Performance Test score from baseline to 6 months (scores range from 0 to 36 points; higher scores indicate better performance). Secondary outcomes included changes in other frailty measures, body composition, bone mineral density, and physical functions. RESULTS: A total of 141 participants completed the study. The Physical Performance Test score increased more in the combination group than in the aerobic and resistance groups (27.9 to 33.4 points [21% increase] vs. 29.3 to 33.2 points [14% increase] and 28.8 to 32.7 points [14% increase], respectively; P=0.01 and P=0.02 after Bonferroni correction); the scores increased more in all exercise groups than in the control group (P<0.001 for between-group comparisons). Peak oxygen consumption (milliliters per kilogram of body weight per minute) increased more in the combination and aerobic groups (17.2 to 20.3 [17% increase] and 17.6 to 20.9 [18% increase], respectively) than in the resistance group (17.0 to 18.3 [8% increase]) (P<0.001 for both comparisons). Strength increased more in the combination and resistance groups (272 to 320 kg [18% increase] and 288 to 337 kg [19% increase], respectively) than in the aerobic group (265 to 270 kg [4% increase]) (P<0.001 for both comparisons). Body weight decreased by 9% in all exercise groups but did not change significantly in the control group. Lean mass decreased less in the combination and resistance groups than in the aerobic group (56.5 to 54.8 kg [3% decrease] and 58.1 to 57.1 kg [2% decrease], respectively, vs. 55.0 to 52.3 kg [5% decrease]), as did bone mineral density at the total hip (grams per square centimeter; 1.010 to 0.996 [1% decrease] and 1.047 to 1.041 [0.5% decrease], respectively, vs. 1.018 to 0.991 [3% decrease]) (P<0.05 for all comparisons). Exercise-related adverse events included musculoskeletal injuries. CONCLUSIONS: Of the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Funded by the National Institutes of Health; LITOE ClinicalTrials.gov number, NCT01065636 .).
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Acute calorie restriction can downregulate muscle protein synthesis and increase proteolysis, contributing to reduced muscle mass.
“Energy deficits created by acute calorie restriction could downregulate muscle protein synthesis and increase proteolysis, which contributes to reduced muscle mass247,253,254”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [247]
The Results (Body Composition; page not available in our copy) report decreased lean mass during the six-month weight-loss intervention, supporting the reduced-mass portion of the claim. The Methods describe a sustained dietary energy deficit, but the paper does not report whether acute calorie restriction downregulates muscle protein synthesis or increases proteolysis. (LLM, conf=0.88)
Experimental — accuracy not yet measuredStrategies that optimize protein anabolism during weight loss, such as consumption before exercise or spreading out protein during the day, can prevent weight loss-induced sarcopenia.
“Strategies that optimize protein anabolism during weight loss, such as consumption before exercise or spreading out of protein during the day, can prevent weight loss-induced sarcopenia247,250.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [247]
The Discussion (page not provided) suggests improving the efficiency of protein intake as a possible future strategy to preserve lean mass during weight loss. It does not mention protein consumption before exercise or distributing protein across the day, and reports that lean-mass loss was attenuated, not prevented. (LLM, conf=0.88)
Experimental — accuracy not yet measuredResistance training and aerobic training have complementary benefits, and combining both during calorie restriction gives the best body composition and physical function outcomes.
“The individual benefits of RT and AT are complementary, and combining both exercise training modalities during CR provides the most optimal benefits for body composition and physical function.”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
The Discussion reports complementary effects of aerobic and resistance training and the greatest improvement in physical function with combined training during weight loss in obese older adults. But the Results (Body Composition; Bone Mineral Density, pages not available) do not establish that the combination produced the best body-composition outcomes: resistance training alone preserved more lean mass and better prevented hip bone-density loss. (LLM, conf=0.89)
Experimental — accuracy not yet measuredIn that trial, one-repetition maximum muscle strength increased similarly in resistance training (17%) and combination training (17%), while it was only maintained in aerobic training.
“Muscle strength assessed according to an individual's one-repetition maximum (referred to as one-rep max or 1RM) also increased similarly in RT (17%) and CT (17%), while it was only maintained in AT.”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
The Results section (Strength, Balance, Gait, and Quality of Life; page not supplied) reports that one-repetition maximum strength rose in the resistance and combination groups and was maintained in the aerobic group. The reported increases were 19% and 18%, respectively, not 17% in both groups. (LLM, conf=0.92)
Experimental — accuracy not yet measuredIn that trial, dynamic balance evaluated by obstacle course completion time and gait speed improved more with combination training than with aerobic or resistance training.
“Additionally, dynamic balance, evaluated with the obstacle course completion time and gait speed, improved more with CT than with AT or RT.”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
The Results section (page not provided) reports greater improvement in obstacle-course time and gait speed with combination training than with aerobic training. It does not report those comparisons against resistance training. The Methods section (page not provided) also defines dynamic balance by obstacle-course time, while assessing gait speed separately. (LLM, conf=0.87)
Experimental — accuracy not yet measured
In 160 elderly individuals with overweight or obesity undergoing diet, despite similar weight and fat loss, resistance training resulted in less lean mass loss (-1 kg or -2%) than combination therapy (-1.7 kg or -3%) and endurance training (-2.7 kg or -5%).
“Despite similar and significant body weight loss (9% average) and fat mass loss (6.9% average) compared with baseline values between groups, RT resulted in less LM loss (À1 kg or À2%) than combination therapy (À1.7 kg or À3%) and ET (À2.7 kg or À5%) (60).”
From Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? (2024) · cites this paper as [60]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredResearch specifically examining skeletal muscle mass, as estimated by MRI or computed tomography, has supported a protective effect both of endurance and resistance exercise during energy restriction.
“research specifically examining skeletal muscle mass, as estimated by MRI or computed tomography, has also supported a protective effect both of endurance and resistance exercise during energy restriction [28, 38-40].”
From Fundamental Body Composition Principles Provide Context for Fat-Free and Skeletal Muscle Loss With GLP-1 RA Treatments (2024) · cites this paper as [28]
The Methods (Baseline Assessments; page unavailable) say thigh muscle volume was measured by MRI, and the Results (Body Composition; page unavailable) report less muscle loss with resistance or combined training than with aerobic training during weight loss. The paper does not establish a protective effect of aerobic training alone: its aerobic group lost more lean mass, and it had no energy-restriction-only comparison group. (LLM, conf=0.87)
Experimental — accuracy not yet measuredAbe et al demonstrated that corrections changed an apparent loss of FFM, relative to body mass lost, of 12% for weight loss in combination with resistance exercise to an increase of 4%.
“Abe et al [27] demonstrated how these corrections changed an apparent loss of FFM, relative to body mass lost, of 12% for weight loss in combination with resistance exercise to an increase of 4% [27, 28].”
From Fundamental Body Composition Principles Provide Context for Fat-Free and Skeletal Muscle Loss With GLP-1 RA Treatments (2024) · cites this paper as [28]
The Results > Body Composition section (page unavailable) reports a 1.0 kg lean-mass loss alongside 8.5 kg body-weight loss in the resistance group—approximately 12% of the weight lost. It does not report corrections that turn this into a 4% increase, or attribute such a correction to Abe et al. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe incorporation of high-velocity contractions in power training (PT) may have played a key role in counteracting muscle loss associated with aging and obesity.
“The incorporation of high-velocity contractions in PT may have played a key role in counteracting muscle loss associated with aging and obesity [32,33].”
From Efficacy of Power Training on Sarcopenic Obesity in Community-Dwelling Older Women: A 32-Week Randomized Clinical Trial (2025) · cites this paper as [33]
The Results (Body Composition; page unavailable) show that dieting obese older adults lost less lean mass with resistance or combined training than with aerobic training. But the Methods (Intervention; page unavailable) describe conventional resistance exercise, not power training or high-velocity contractions. The paper therefore does not support attributing the reduced muscle loss to contraction velocity. (LLM, conf=0.85)
Experimental — accuracy not yet measuredWeight loss plus combined aerobic and resistance exercise is the most effective method for improving functional status of adults aged 65 years and older with obesity.
“weight loss plus combined aerobic and resistance exercise was the most effective method for improving functional status of adults aged 65 years and older with obesity247”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [247]
A trial of older adults with obesity found increases in physical performance test scores, more so in the combined aerobic and resistance exercise group (27.9 to 33.4 points, 21% increase) than in the aerobic (29.3 to 33.2 points, 14% increase) or resistance group (28.8 to 32.7 points, 14% increase) alone.
“The findings demonstrated increases in physical performance test scores (higher score equals higher level of function), more so in the combined aerobic and resistance exercise group (27.9 to 33.4 points (21% increase)) than in the aerobic (29.3 to 33.2 points (14% increase)) or resistance group (28.8 to 32.7 points (14% increase)) alone.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [247]
These findings indicate complementary effects of resistance and aerobic training on physical function without interference effects from concurrent training.
“Overall, these findings indicate complementary effects of RT and AT on physical function without interference effects from concurrent training.”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
In that trial, lean body mass loss was less with resistance training (-2%) and combination training (-3%) than with aerobic training (-5%).
“Similarly, less lean body mass was lost with RT (À2%) and CT (À3%) than with AT (À5%).”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
In that trial, hip bone mineral density decreased in all groups, but the decline was less with resistance training (-0.5%) and combination training (-1%) than with aerobic training (-3%).
“Although BMD at the hip decreased across all intervention groups, the decline was less pronounced with RT (À0.5%) and CT (À1%) than with AT (À3%).”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
In a 6-month randomized controlled trial of older adults with obesity and average calorie-restriction-induced weight loss of 9% of total body weight, combination training produced greater physical function improvement (21%) than aerobic training (14%) or resistance training (14%) alone, assessed with the Physical Performance Test.
“greater improvement in physical function was seen with CT (increase of 21%) than AT (14%) or RT (14%) alone, assessed with the PPT (22).”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
Combination training yields the most significant advantages for functional improvement and preservation of lean mass.
“the simultaneous incorporation of both exercise types, known as combination training (CT), yields the most significant advantages for functional improvement and preservation of lean mass (22) (Fig. 1).”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
In that trial, cardiorespiratory fitness improved in all groups, but improvements in aerobic training (18%) and combination training (17%) were significantly greater than in resistance training (8%).
“although cardiorespiratory fitness improved across all groups, the improvement seen in AT (18%) and CT (17%) groups was significantly more than in RT (8%).”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [22]
A study directly comparing different modalities of exercise found that exercise programs including resistance training may be particularly effective at reducing the loss of thigh skeletal muscle volume during weight loss.
“However, a study directly comparing different modalities of exercise found that exercise programs including resistance training may be particularly effective at reducing the loss of thigh skeletal muscle volume during weight loss. 19”
From Preservation of lean soft tissue during weight loss induced by GLP-1 and GLP-1/GIP receptor agonists: A case series (2025) · cites this paper as [19]
A study directly comparing exercise modalities during a weight management program eliciting approximately 9% weight loss reported that loss of thigh skeletal muscle volume was attenuated with resistance and concurrent training as compared to endurance training.
“a study directly comparing exercise modalities during a weight management program eliciting approximately 9% weight loss reported that the loss of thigh skeletal muscle volume was attenuated with resistance and concurrent training as compared to endurance training [28].”
From Fundamental Body Composition Principles Provide Context for Fat-Free and Skeletal Muscle Loss With GLP-1 RA Treatments (2024) · cites this paper as [28]
Resistance training can mitigate losses of FFM during weight loss.
“resistance training can nonetheless mitigate losses of FFM during weight loss [28, 46].”
From Fundamental Body Composition Principles Provide Context for Fat-Free and Skeletal Muscle Loss With GLP-1 RA Treatments (2024) · cites this paper as [28]
Weight loss combined with exercise improves functional status and reduces some features of frailty in obese older individuals, improves cardiovascular risk profile, and reduces risk of CVD.
“Weight loss combined with exercise improves functional status and reduces some of the features of frailty in obese older individuals, improves the cardiovascular risk profile, and reduces the risk of CVD, although whether these beneficial effects are caused by reduced inflammation remains unclear63–65.”
From Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty (2018) · cites this paper as [65]
One of the most common undesired effects of hypocaloric diets to lose weight in older people is an impairment in functioning due to the loss of skeletal muscle, with the highest impact in older people with sarcopenia and frailty.
“One of the most common undesired effects of the hypocaloric diets to lose weight in older people is an impairment in functioning due to the loss of skeletal muscle, with the highest impact in older people with sarcopenia and frailty [320,321].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [320]
Energy restriction results in significant loss of muscle and bone.
“Importantly, energy restriction results in significant loss of muscle and bone [320,321].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [320]
The combination of aerobic and PRT has demonstrated superiority in reducing trunk fat in older men compared to aerobic training alone.
“The combination of aerobic and PRT has demonstrated superiority in reducing trunk fat in older men compared to aerobic training alone [320,328,329].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [320]
Resistance training is effective for reducing the amount of muscle mass lost during hypocaloric weight loss in obese and overweight older adults, while aerobic exercise is not.
“Resistance training is also effective for reducing the amount of muscle mass lost during hypocaloric weight loss in obese and overweight older adults, while aerobic exercise is not [320,370].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [320]
Hypocaloric diets for weight loss in older people commonly cause impaired functioning due to loss of skeletal muscle, with the highest impact in older people with sarcopenia and frailty.
“One of the most common undesired effects of the hypocaloric diets to lose weight in older people is an impairment in functioning due to the loss of skeletal muscle, with the highest impact in older people with sarcopenia and frailty [320,321].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [320]
The combination of aerobic and PRT is superior to aerobic training alone in reducing trunk fat in older men.
“The combination of aerobic and PRT has demonstrated superiority in reducing trunk fat in older men compared to aerobic training alone [320,328,329].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [320]
There are indications that the combination of aerobic and resistance training in obese older individuals may be even more effective than resistance training alone.
“The effectiveness of aerobic training is less clear, but there are indications that the combination of aerobic and resistance training in obese older individuals may be even more effective than resistance training alone.54”
From Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: a systematic review and meta-analysis (2023) · cites this paper as [54]
A program combining resistance and aerobic activities may be more beneficial than either intervention alone for sarcopenic obesity.
“A program that includes a combination of resistance and aerobic activities may be more beneficial than either intervention alone (82).”
From Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management (2023) · cites this paper as [82]
In that study, strength increased more in the resistance group (19% increase) than in the combination group (18% increase) and aerobic group (4% increase).
“But strength increased more in the resistance group (19% increase) than in the combination group (18% increase) and aerobic group (4% increase).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [171]
In a clinical study of obese older people, the physical performance test score was highest in the combination group (21% increase) compared to the resistance group (14% increase) and aerobic group (14% increase).
“It has revealed that the physical performance test score was the highest in the combination group (21% increase) compared to the resistance group (14% increase) and aerobic group (14% increase).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [171]
Resistance training combined with aerobic training is the most effective way to alleviate physical disability.
“Thus, resistance training combined aerobic training is the most effective way to alleviated physical disability (171).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [171]
In that study, peak oxygen consumption increased most in the aerobic group (18% increase) compared to the combination group (17% increase) and resistance group (8% increase).
“While peak oxygen consumption (milliliters per kilogram of body weight per minute) increased most in the aerobic group (18% increase) compared to the combination group (17% increase) and resistance group (8% increase).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [171]
Muscle loss after intentional diet-induced weight loss is more frequently observed in older adults with pre-existing sarcopenia.
“muscle loss following diet-induced intentional weight loss may be more frequently observed in older adults with pre-existing sarcopenia159,165,167.”
From Sarcopenic obesity in older adults: a clinical overview (2024) · cites this paper as [159]
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“A large randomized trial in obese older adults showed that combined aerobic and resistance exercise during weight management produced broader improvements in physical function than either mode alone, while also supporting favorable body-composition change (31).”
- Authors
- Villareal, D. T., Aguirre, L., Gurney, A. B., Waters, D. L., Sinacore, D. R., Colombo, E., Armamento-Villareal, R., & Qualls, C.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-05-18
- Volume
- 376
- Issue
- 20
- Pages
- 1943-1955
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5552187
- OpenAlex
- W2615792377
- Cited by
- 754
- References
- 38
- Citations by year
- 2026: 103 · 2025: 79 · 2024: 74 · 2023: 87 · 2022: 98 · 2021: 116 · 2020: 56 · 2019: 61 · 2018: 60 · 2017: 19 · 2016: 1
- FWCI
- 39.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000041, UL1TR001449)
- National Institute on Aging (R01AG031176)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK056341, P30DK020579)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- aerobic exercise, resistance training, concurrent training, obesity, older adults, weight loss, frailty, sarcopenia, osteopenia, bone mineral density, lean body mass, muscle strength, physical performance, peak oxygen uptake, dieting, exercise intervention, body composition, bone loss prevention, weight management interventions, physical performance tests
- MeSH terms
- Aged, Body Composition, Combined Modality Therapy, Exercise Therapy, Female, Humans, Male, Obesity, Oxygen Consumption, Weight Loss, Exercise, Bone Density, Single-Blind Method, Frail Elderly, Resistance Training
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