Effect of Aerobic or Resistance Exercise, or Both, on Intermuscular and Visceral Fat and Physical and Metabolic Function in Older Adults With Obesity While Dieting
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Background: Obesity exacerbates age-related effects on body composition and physical and metabolic function. Which exercise mode is most effective in mitigating these deleterious changes in dieting older adults with obesity is unknown. Methods: In a randomized controlled trial, we performed a head-to-head comparison of aerobic (AEX), resistance (REX), or combination (COMB) exercise during matched ~10% weight loss in 160 obese older adults. Prespecified analyses compared 6-month changes in intermuscular adipose tissue (IMAT) and visceral adipose tissue (VAT) assessed using MRI, insulin sensitivity index (ISI) by oral glucose tolerance test, physical function using Modified Physical Performance Test (PPT), VO2peak, gait speed, and knee strength by dynamometry. Results: IMAT and VAT decreased more in COMB than AEX and REX groups (IMAT; −41% vs −28% and −23% and VAT: −36% vs −19% and −21%; p = .003 to .01); IMAT and VAT decreased in all groups more than control (between-group p < .001). ISI increased more in COMB than AEX and REX groups (86% vs 50% and 39%; p = .005 to .03). PPT improved more in COMB than AEX and REX groups, while VO2peak improved more in COMB and AEX than REX group (all p < .05). Knee strength improved more in COMB and REX than AEX group (all p < .05). Changes in IMAT and VAT correlated with PPT (r = −0.28 and −0.39), VO2peak (r = −0.49 and −0.52), gait speed (r = −0.25 and −0.36), and ISI (r = −0.49 and −0.52; all p < .05). Conclusions: Weight loss plus combination aerobic and resistance exercise was most effective in improving ectopic fat deposition and physical and metabolic function in older adults with obesity.
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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 [328]
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 [328]
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- Authors
- Waters, D. L., Aguirre, L., Gurney, B., Sinacore, D. R., Fowler, K., Gregori, G., Armamento-Villareal, R., Qualls, C., & Villareal, D. T.
- Affiliations
- University of New Mexico (US)
- High Point University (US)
- New Mexico VA Health Care System (US)
- Michael E. DeBakey VA Medical Center (US)
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, Texas, USA
- Corresponding author
- Villareal, Dennis T
- Venue
- The Journals of Gerontology: Series A
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-04-11
- Volume
- 77
- Issue
- 1
- Pages
- 131-139
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC8751785
- OpenAlex
- W3154093594
- Cited by
- 99
- References
- 50
- Citations by year
- 2026: 22 · 2025: 36 · 2024: 21 · 2023: 10 · 2022: 8 · 2021: 2
- FWCI
- 6.43
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- The Journals of Gerontology Series A (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, public-domain)
- Funders
- National Institutes of Health (RO1-AG031176, UL1-TR000041, P30-DK020579)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- obesity in older adults, aerobic exercise, resistance training, intermuscular adipose tissue, visceral adipose tissue, ectopic fat deposition, weight loss, insulin sensitivity, physical function, peak oxygen uptake, walking speed, knee muscle strength, dieting
- MeSH terms
- Aged, Humans, Obesity, Weight Loss, Exercise, Intra-Abdominal Fat, Resistance Training
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