Effect of weight loss, exercise, or both on cognition and quality of life in obese older adults.
BACKGROUND
Obesity impairs cognition and health-related quality of life (HRQOL) in older adults; however, the appropriate treatment of obese older adults remains controversial.


OBJECTIVE
The objective was to determine the independent and combined effects of weight loss and exercise on cognition, mood, and HRQOL in obese older adults.


METHODS
One hundred seven frail, obese older adults were randomly assigned to a control, weight-management (diet), exercise, or weight-management-plus-exercise (diet-exercise) group for 1 y. In this secondary analysis, main outcomes were Modified Mini-Mental State Examination (3MS) and total Impact of Weight on Quality of Life-Lite (IWQOL) scores. Other outcomes included Word Fluency Test, Trail Making Test Parts A and B, and Geriatric Depression Scale (GDS) scores.


RESULTS
Scores on the 3MS improved more in the diet (mean ± SE: 1.7 ± 0.4), exercise (2.8 ± 0.4), and diet-exercise (2.9 ± 0.4) groups than in the control group (0.1 ± 0.4) (between-group P = 0.0001-0.04); scores in the diet-exercise group improved more than in the diet group but not more than in the exercise group. Scores on the Word Fluency Test improved more in the exercise (4.1 ± 0.8) and diet-exercise (4.2 ± 0.7) groups than in the control group (-0.8 ± 0.8; both P = 0.001). For the Trail Making Test Part A, scores in the diet-exercise group (-11.8 ± 1.9) improved more than in the control group (-0.8 ± 1.9) (P = 0.001); a similar finding was observed for the Trail Making Test Part B. Scores on the IWQOL improved more in the diet (7.6 ± 1.6), exercise (10.1 ± 1.6), and diet-exercise (14.0 ± 1.4) groups than in the control group (0.3 ± 1.6) (P = 0.0001-0.03); scores in the diet-exercise group improved more than in the diet group but not more than in the exercise group. In the diet-exercise group, peak oxygen consumption and strength changes were independent predictors of 3MS changes; weight and strength changes were independent predictors of IWQOL changes. GDS scores did not change.


CONCLUSIONS
Weight loss and exercise each improve cognition and HRQOL, but their combination may provide benefits similar to exercise alone. These findings could inform practice guidelines with regard to optimal treatment strategies for obese older adults. This trial was registered atclinicaltrials.govas NCT00146107.
From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV).
Nicola
N
Napoli
From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV).
Krupa
K
Shah
From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV).
Debra L
DL
Waters
From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV).
David R
DR
Sinacore
From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV).
Clifford
C
Qualls
From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV).
Dennis T
DT
Villareal
D000203:Activities of Daily Living; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight; D003071:Cognition; D002149:Energy Intake; D015444:Exercise; D005260:Female; D006801:Humans; D007249:Inflammation / Q000628:therapy; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D016014:Linear Models; D008297:Male; D009751:Nutritional Requirements; D009765:Obesity / Q000628:therapy*; D010101:Oxygen Consumption; D011788:Quality of Life; D015431:Weight Loss
D001786:Blood Glucose; D007334:Insulin-Like Growth Factor I