title: Effect of weight loss and exercise on frailty in obese older adults.
abstract: BACKGROUND
  Obesity exacerbates the age-related decline in physical function and causes frailty in older persons. However, appropriate treatment for obese older persons is unknown. We evaluated the effects of weight loss and exercise therapy on physical function and body composition in obese older persons.
  
  
  METHODS
  We screened 40 obese older volunteers and eventually randomized 27 frail obese older volunteers to treatment or control groups. Treatment consisted of 6 months of weekly behavioral therapy for weight loss in conjunction with exercise training 3 times per week. Physical function was evaluated with measurements of frailty (Physical Performance Test, peak oxygen consumption, and Functional Status Questionnaire); strength, gait, and balance tests; body composition with dual-energy x-ray absorptiometry; and quality of life using the Medical Outcomes Survey 36-Item Short-Form Health Survey. Results are reported as mean +/- SD.
  
  
  RESULTS
  Two subjects in the treatment group did not comply with the intervention, and 1 subject in the control group withdrew. Analyses included all 27 subjects originally randomized to the treatment and control groups. The treatment group lost 8.4% +/- 5.6% of body weight, whereas weight did not change in the control group (+0.5% +/- 2.8%; P<.001). Compared with the control group, fat mass decreased (-6.6 +/- 3.4 vs +1.7 +/- 4.1 kg; P<.001), without a change in fat-free mass (-1.2 +/- 2.1 vs -1.0 +/- 3.5 kg; P = .75) in the treatment group. The Physical Performance Test score (2.6 +/- 2.5 vs 0.1 +/- 1.0; P = .001), peak oxygen consumption (1.7 +/- 1.6 vs 0.3 +/- 1.1 mL/min per kilogram; P = .02), and Functional Status Questionnaire score (2.9 +/- 3.7 vs -0.2 +/- 3.9; P = .02) improved in treated subjects compared with control subjects. Treatment also improved strength, walking speed, obstacle course, 1-leg limb stance time, and health survey physical subscale scores (all P<.05).
  
  
  CONCLUSIONS
  These findings suggest that weight loss and exercise can ameliorate frailty in obese older adults. Trial Registration clinicaltrials.gov Identifier: NCT00146133.
authors.affiliation: Center for Human Nutrition, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St Louis, MO 63110, USA. dvillare@im.wustl.edu
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Villareal
authors.forename: Marian
authors.initials: M
authors.lastname: Banks
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
authors.forename: Catherine
authors.initials: C
authors.lastname: Siener
authors.forename: Samuel
authors.initials: S
authors.lastname: Klein
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015992:Body Mass Index; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D009765:Obesity / Q000503:physiopathology / Q000534:rehabilitation*; D010349:Patient Compliance; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*