title: Community Weight Loss to Combat Obesity and Disability in At-Risk Older Adults.
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.
authors.affiliation: Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.|Department of Geriatric Medicine.
authors.forename: W Jack
authors.initials: WJ
authors.lastname: Rejeski
authors.affiliation: Department of Biostatistical Sciences.
authors.forename: Walter T
authors.initials: WT
authors.lastname: Ambrosius
authors.affiliation: Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Burdette
authors.affiliation: Department of Biostatistical Sciences.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Walkup
authors.affiliation: Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Marsh
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D009765:Obesity / Q000534:rehabilitation*; D011788:Quality of Life; D055070:Resistance Training / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D016138:Walking / Q000502:physiology*; D015431:Weight Loss / Q000502:physiology*; D061217:Weight Reduction Programs / Q000379:methods*
keywords: Obesity; Physical activity; Resistance training; Weight loss