title: Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Tiffany N
authors.initials: TN
authors.lastname: Frimel
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Villareal
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001521:Behavior Therapy; D001823:Body Composition; D004038:Diet, Reducing; D015444:Exercise / Q000502:physiology*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000502:physiology*; D009135:Muscular Diseases / Q000517:prevention & control / Q000534:rehabilitation; D009765:Obesity / Q000178:diet therapy* / Q000628:therapy; D010101:Oxygen Consumption; D015431:Weight Loss