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Cited by 58Physical Activity and HealthNutrition and Health in AgingCardiovascular and exercise physiology

Community Weight Loss to Combat Obesity and Disability in At-Risk Older Adults

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Rejeski, W. Jack, Ambrosius, Walter T., Burdette, Jonathan H., Walkup, Michael P., Marsh, Anthony P.·2017·The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
DOI 10.1093/gerona/glw252PMC PMC5861918
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Abstract

BACKGROUND: Among older, overweight, and obese adults with either cardiovascular disease or the metabolic syndrome, reduced mobility and loss of leg strength are important risk factors for morbidity, disability, and mortality. It is unclear whether community-based approaches to weight loss may be an effective solution to this public health challenge. METHODS: An 18-month three-site, randomized controlled trial conducted by YMCA staff, with blinded assessors, enrolled 249 older, overweight, and obese adults with either cardiovascular disease or metabolic syndrome with randomization to three interventions: weight loss alone (WL), weight loss + aerobic training (WL + AT), and weight loss + resistance training (WT + RT). The dual primary outcomes were 400-m walk time in seconds and knee extensor strength in Newton meters. RESULTS: All groups lost weight from baseline: average baseline adjusted change of -6.1% (95% confidence interval [CI]: -7.5 to -4.7) for WL only, -8.6% (95% CI: -10.0 to -7.2) for WL + AT, and -9.7% (95% CI: -11.1 to -8.4) for WL + RT. Combined, the two physical activity + WL training groups had greater improvement in walk time than WL alone (mean difference 16.9 seconds [95% CI: 9.7 to 24.0], p < .0001). Baseline adjusted change in knee extensor strength was no greater with WL + RT than WL + AT (mean difference -3.6 Nm [95% CI: -7.5 to 0.3], p = .07). CONCLUSIONS: At risk, older, overweight and obese adults can achieve clinically significant reductions in body weight with community-based weight loss programs. The change in percent weight loss and improvements in mobility are significantly enhanced when either RT or AT is combined with dietary WL.

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  • Many studies from the authors' group and others show improvements in muscle strength and function in older adults participating in lifestyle-based weight loss interventions, despite significant weight and lean mass loss.

    “Likewise, many studies from our group (31, 32, 33), and others (34, 35), show improvements in muscle strength and function in older adults participating in lifestyle-based weight loss interventions, despite experiencing significant weight and LM loss (36, 37).”

    From <scp>G</scp> <scp>LP1Ra</scp> ‐based therapies and <scp>DXA</scp> ‐acquired musculoskeletal health outcomes: a focused meta‐analysis of placebo‐controlled trials (2025) · cites this paper as [32]

    The Results (Retention and Response to Treatment; page unavailable) report significant weight loss in all three groups, and the Discussion reports preserved knee-extensor strength with aerobic or resistance training. But the Discussion describes lean-tissue loss only as a possible explanation for a strength finding; it does not establish that participants experienced significant lean-mass loss. The broader claim about many studies is not established by this trial. (LLM, conf=0.88)

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  • In ten trials, a weight-reducing diet alone resulted in the desired weight loss, which consisted of fat mass as well as lean mass.

    “In ten trials, a weight-reducing diet alone resulted in the desired weight loss, which consisted of fat mass as well as lean mass (290)(291)(292)(294)(295)(296)(297)(298)(299).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [293]

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  • Twelve RCTs compared the effects of a dietary weight loss intervention alone to a combination of the same dietary intervention with an exercise intervention in older persons.

    “Twelve RCTs were identified that compared the effects of a dietary weight loss intervention alone to a combination of the same dietary intervention with an exercise intervention in older persons (288)(289)(290)(291)(292)(293)(294)(295)(296)(297)(298)(299).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [293]

  • For several physical and strength-performance measures, greater improvements were observed in the combined groups than in the diet-only groups.

    “Moreover, for several physical and strengthperformance measures, greater improvements were observed in the combined groups than in the diet-only groups (288-291, 293-297, 299).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [293]

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Authors
Rejeski, W. J., Ambrosius, W. T., Burdette, J. H., Walkup, M. P., & Marsh, A. P.
Affiliations
  • Wake Forest University (US)
  • Wake Forest University Health Sciences (US)
Corresponding author
Rejeski, W. Jack
ORCID
Venue
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
Publisher
Oxford University Press (OUP)
Published
2017-01-06
Volume
72
Issue
11
Pages
glw252
ISSN
  • 1079-5006 (ISSN-L)
  • 1758-535X
DOI
10.1093/gerona/glw252
PMC
PMC5861918
OpenAlex
W2568314250
Cited by
58
References
45
Citations by year
2026: 3 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 6 · 2020: 8 · 2019: 5 · 2018: 13 · 2017: 4 · 2016: 1
FWCI
6.07
Type
journal article
Language
en
Open access
Locations
  • The Journals of Gerontology Series A (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
obesity in older adults, overweight, cardiovascular disease, metabolic syndrome, aerobic exercise, resistance training, mobility (physical function), walking speed, quadriceps strength, leg strength, disability prevention, dietary weight loss
MeSH terms
Aged, Disability Evaluation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Quality of Life, Retrospective Studies, Risk Factors, Weight Loss, Single-Blind Method, Walking, Muscle Strength, Resistance Training, Weight Reduction Programs

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