Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults
Open accessAbstract
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.
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In frail adults with obesity, adding resistance training to a hypocaloric diet resulted in less fat-free mass reduction than diet-only (1.8 vs 3.5 kg, difference 1.7 kg) with similar weight and fat loss.
“similar body weight loss occurred between diet and diet 1 RT groups (10.7 vs. 9.7 kg), along with similar fat loss (6.8 vs. 7.7 kg), but the diet 1 RT group experienced less fat-free mass reduction than the diet-only group (1.8 vs. 3.5 kg, a difference of 1.7 kg) (71).”
From Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? (2024) · cites this paper as [71]
The Results report similar weight and fat loss in both groups and less fat-free mass loss in the diet-plus-exercise group (1.8 versus 3.5 kg). However, the Methods (Experimental Protocol) describe an exercise program that included aerobic, flexibility, and balance activities as well as resistance training, so the study cannot attribute the difference to resistance training alone. (LLM, conf=0.86)
Experimental — accuracy not yet measuredProgressive resistance exercise training in conjunction with a hypocaloric diet attenuates the weight-loss-associated loss of muscle mass in middle-aged and older men and women.
“Several investigators found that a progressive resistance exercise training program in conjunction with a hypocaloric diet attenuated the weight-loss-associated loss of muscle mass in middle-aged and older men and women (55,65,66).”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [65]
The Discussion reports that adding exercise incorporating progressive resistance training to a weight-loss diet reduced lean-tissue loss by about half. The Methods identify the participants as frail obese older adults (mean age 70 ± 5 years), so this paper does not establish the claim for middle-aged adults. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor 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 [291]
The Results report greater improvements in several strength measures in the diet-plus-exercise group: one-repetition maximum strength increased for five exercises, while the diet-only group showed no change. The paper gives baseline physical-frailty measures, but the passages found do not report follow-up changes in physical-performance measures, so that part of the claim is not supported by this source. (LLM, conf=0.84)
Experimental — accuracy not yet measuredResistance-type exercise helps preserve muscle mass during weight loss.
“both endurance-and resistance-type exercise help preserve muscle mass during weight loss”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [65]
Diet-induced weight loss reduces muscle lipid content and does not affect or slightly decreases leg muscle strength.
“Diet-induced weight loss reduces muscle lipid content (assessed by X-ray attenuation or MRI) (52,62,63,74) and does not affect (55,65,93), or slightly decreases (48,52,56), leg muscle strength.”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [65]
Resistance-type exercise improves muscle strength during weight loss.
“resistance-type exercise also improves muscle strength”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [65]
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 [291]
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 [291]
The combination with exercise training had comparable if not greater effects than the singular weight-reducing diets regarding the reduction of body weight and fat mass, while often preserving lean mass better than diet alone.
“The combination with J o u r n a l P r e -p r o o f exercise training had comparable if not greater effects than the singular weight-reducing diets regarding the reduction of BW and fat mass, while often preserving lean mass better than diet alone (289-291, 295-297, 299).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [291]
Randomised controlled trials demonstrate the benefit of resistance training in older adults.
“with randomised controlled trials (RCTs) demonstrating the benefit of resistance training in older adults [53].”
From Obesity pharmacotherapy in older adults: a narrative review of evidence (2025) · cites this paper as [53]
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- Authors
- FRIMEL, T. N., SINACORE, D. R., & VILLAREAL, D. T.
- Affiliations
- Washington University in St. Louis (US)
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2008-07
- Volume
- 40
- Issue
- 7
- Pages
- 1213-1219
- ISSN
- 0195-9131 (ISSN-L)
- PMC
- PMC2650077
- OpenAlex
- W2071217609
- Cited by
- 230
- References
- 40
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 16 · 2023: 6 · 2022: 9 · 2021: 15 · 2020: 16 · 2019: 13 · 2018: 12 · 2017: 13 · 2016: 12 · 2015: 11 · 2014: 18 · 2013: 22 · 2012: 11
- FWCI
- 6.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (7r01ag025501-06)
- National Institute on Aging (R01-AG025501)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK056341)
- National Center for Research Resources (M01RR000036)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- muscle mass loss, frailty, obesity, older adults, progressive resistance training, hypocaloric diet, lean body mass, muscle strength, appendicular lean mass, fat-free mass
- MeSH terms
- Aged, Aged, 80 and over, Analysis of Variance, Behavior Therapy, Body Composition, Diet, Reducing, Female, Humans, Male, Muscular Diseases, Obesity, Oxygen Consumption, Weight Loss, Exercise, Absorptiometry, Photon, Frail Elderly, Muscle, Skeletal, Muscle Strength
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