Older Overweight Research Articles

Serum 25‐hydroxyvitamin D and physical function in older adults with knee osteoarthritis

Vitamin D is necessary for optimal musculoskeletal function; however, many older adults are vitamin D insufficient putting them at risk of poor physical function. Baseline associations between serum 25‐hydroxyvitamin D (25[OH]D) and physical function were examined in older overweight and obese adults with knee osteoarthritis (OA) participating in the Intensive Diet and Exercise for Arthritis Study (n=420; mean age 65.6, 72% women, 17% black). At baseline, 17% of participants had 25(OH)D<50 nmol/L while 45% had 25(OH)D≥75 nmol/L. Serum 25(OH)D status was associated with 6 min walk distance and self‐reported physical function (SF‐36) using multi‐linear regression models adjusted for age, gender, race, education, and season (p≤0.05). Compared to participants with 25(OH)D≥75 nmol/L, those with 25(OH)D<50 nmol/L covered less distance on the 6 min walk (LS means ± SE: 458.8±9.2 vs. 477.9±7.1 meters; p=0.09) and had lower SF‐36 Physical Function scores (52.0±2.5 vs. 58.6±1.9; p=0.03). In summary, vitamin D deficiency was associated with lower physical function among older overweight and obese adults with knee OA. Supported by grants from NIH (R01 AR052528, P30 AG21332, M01 RR00211, and K01 AG030506).

A systematic review of the separate and combined effects of energy restriction and exercise on fat‐free mass in middle‐aged and older adults: Implications for sarcopenic obesity

PurposeThis systematic review assessed the effects of energy restriction (ER) and exercise (EX) on fat‐free mass (FFM) in overweight and obese middle‐aged and older adults.MethodsPubmed was searched using “weight loss or energy restriction” AND “skeletal muscle or body composition” as keywords, with limitations “human” and “middle‐aged and aged.” 52 studies met inclusion criteria that included men and/or postmenopausal women aged ≥ 50 y, BMI > 25 kg/m2, and interventions ≥ 8 wk. Body weight (BW) loss was induced via ER, ER+EX, or EX. ER was achieved by counseling without (n=35) or with (n=7) some food provided, or all food provided (n=3). EX included aerobic (n=31), resistance (n=3), or both (n=5). Results are reported as % of the ER, ER+EX, or EX groups that had a specified change in BW and FFM, since insufficient data were provided to perform a meta‐analysis.Results94% of the ER groups and 89% of the ER+EX groups lost ≥ 5 kg BW. 75% of the ER groups, but only 30% of the ER+EX groups, lost ≥ 1.5 kg FFM. 81% and 39% of the ER and ER+EX groups, respectively, lost ≥ 15% of BW as FFM. The EX groups had modest BW (94% lost < 5 kg) and FFM (100% lost < 1.5 kg) losses.ConclusionExercise is an effective tool to help middle‐aged and older overweight and obese adults preserve FFM after moderate energy restriction‐induced weight loss, and may be effective in combating sarcopenic obesity.Support: T32AG025671; US Whey Protein Research ConsortiumGrant Funding Source: T32AG025671; US Whey Protein Research Consortium

The Effect of Randomization to Weight Loss on Total Mortality in Older Overweight and Obese Adults: The ADAPT Study

Although weight loss reduces risk for comorbid diseases, many observational studies suggest that weight loss is associated with increased mortality risk, leading to reluctance by clinicians to consider weight reduction as a strategy to maintain health and independence in older adults. However, whether the observed weight loss is intentional is difficult to determine and may not accurately represent the mortality risk associated with intentional weight reduction. Data from the Arthritis, Diet, and Activity Promotion Trial (ADAPT) were used to determine whether randomization to a weight reduction program was associated with total mortality in overweight/obese older adults. ADAPT (n = 318; mean age 69 +/- 6 years, body mass index 34 +/- 5 kg/m2, 72% female) assessed the influence of weight loss (achieved through dietary counseling and lifestyle modification) and/or exercise on function in overweight/obese older adults with knee osteoarthritis. ADAPT ended in December 1999. Participant vital was ascertained status through December 2006 using the National Death and Social Security Indexes. The mortality rate for those randomized to the 18-month weight loss intervention (n = 159, mean weight loss = -4.8 kg, 15 deaths) was lower than that for those not randomized to the weight loss intervention (n = 159, mean weight loss = -1.4 kg, 30 deaths; hazard rate ratio = 0.5, 95% confidence interval 0.3-1.0). Results were not appreciably changed when analyses were stratified by age, gender, baseline weight status, or magnitude of weight loss. In older adults, intentional weight loss was not associated with increased total mortality and may reduce mortality risk. Observational studies of weight loss, especially when intentionality cannot be rigorously established, may be misleading with respect to the effect of weight loss on mortality.

Functional Outcomes of Older Overweight Cancer Survivors After Diet and Exercise

Functional Outcomes of Older Overweight Cancer Survivors After Diet and Exercise

Functional Outcomes of Older Overweight Cancer Survivors After Diet and Exercise—Reply

Functional Outcomes of Older Overweight Cancer Survivors After Diet and Exercise—Reply

Are Sexual Dissatisfaction and Sexual Abuse Associated with Obesity? A Population‐Based Study

To investigate whether there is any association between obesity and sexual satisfaction and sexual abuse in a normal population. A representative sample of 2810 subjects from a population study was interviewed about sexual satisfaction, sexual abuse, and life satisfaction. The answers from normal weight, overweight, and obese participants were compared. Univariate and multivariate analyses were performed. Data were presented separately for two age groups, 18 to 49 and 50 to 74 years, and gender. The older group of obese men reported a greater decrease of sexual desire compared with 5 years prior than normal weight men [odds ratios (OR), 2.44; 95% confidence interval (CI), 1.4 to 4.3]. The older group of overweight men reported involuntary participation in sexual activities more often than normal weight men (OR, 2.06; 95% CI, 1.1 to 3.8). Although older overweight and obese women were diagnosed with a lingering disease (defined as >1 month) more often than normal weight women (overweight: OR, 2.41; 95% CI, 1.3 to 4.4; obese: OR, 4.45; 95% CI, 1.7 to 11.5), there was no difference between BMI groups in satisfaction with physical health. Overweight and obese groups seem to be heterogeneous with respect to sexual satisfaction and experiences of sexual abuse. No significant differences were detected between BMI groups, which does not exclude the possibility of significant differences between BMI groups among patients seeking medical attention.

Effects of exercise and diet on knee strength in older overweight and obese adults with knee osteoarthritis.

0638 INTRODUCTION: Previous studies have shown a strong association between obesity and knee osteoarthritis (OA). Felson and colleagues (2000) identified biomechanical factors associated with OA in weight-bearing joints, including obesity, muscular weakness, and joint laxity. Studies indicate that both obese adults (Kitagawa, 1978) and adults with knee OA (Messier et. al., 1992) are weaker than age-matched healthy controls. Short term resistance training has been shown to improve strength in older adults (Morganti, 1995), and long term resistance training in older adults with knee OA has shown significant, but modest improvements in function and strength compared to walking or a control group (Ettinger et.al.,1997). PURPOSE: Therefore, the purpose of our study was to determine the effects of exercise and dietary weight loss on muscular strength in older overweight (BMI = 28–30) and obese (BMI > 30) adults with knee OA. METHODS: A cohort of 316 older overweight and obese adults (BMI > 28) with radiographic evidence of knee OA were randomized to one of four groups: diet (D), exercise (E), diet and exercise (D&E), or healthy lifestyle control (HL) (The Arthritis Diet and Activity Promotion Trial (ADAPT)). Exercise sessions consisted of two 15-minute bouts of walking separated by 20 minutes of moderate intensity resistance training. The E and D&E groups underwent 6 months of facility-based exercise. Subsequently, participants had the option to continue in the facility-based program for an additional 12 months, transition to a home based exercise program, or combine the facility and home based programs. Dietary intervention focused on reducing fat and total calories. Weight loss goal was 5% of body weight. Bi-lateral knee strength data (concentric/eccentric flexion, concentric/eccentric extension) were collected on a randomized subset of this cohort (n = 156 at baseline) using a Kin-Com isokinetic dynamometer set at a speed of 30 deg/s. Data were collected at baseline (BAS), 6 months (FU6), and upon completion of the intervention (FU18). DATA ANALYSIS: Data were averaged over a range of 80–40 deg knee flexion (0 = extension). Knee flexion/extension strength were analyzed using the average values over this range of motion. The effects of diet and/or exercise programs on muscular strength measured at 6 and 18 months post-randomization were determined by twoway repeated measures analysis of covariance. Estimates of intervention effects were obtained at each follow-up observation. When group-by-time interactions were nonsignificant, average intervention effects over the follow-up period were estimated and tested for significance.

Effects of exercise and diet on knee strength in older overweight and obese adults with knee osteoarthritis.

0638 INTRODUCTION: Previous studies have shown a strong association between obesity and knee osteoarthritis (OA). Felson and colleagues (2000) identified biomechanical factors associated with OA in weight-bearing joints, including obesity, muscular weakness, and joint laxity. Studies indicate that both obese adults (Kitagawa, 1978) and adults with knee OA (Messier et. al., 1992) are weaker than age-matched healthy controls. Short term resistance training has been shown to improve strength in older adults (Morganti, 1995), and long term resistance training in older adults with knee OA has shown significant, but modest improvements in function and strength compared to walking or a control group (Ettinger et.al.,1997). PURPOSE: Therefore, the purpose of our study was to determine the effects of exercise and dietary weight loss on muscular strength in older overweight (BMI = 28–30) and obese (BMI > 30) adults with knee OA. METHODS: A cohort of 316 older overweight and obese adults (BMI > 28) with radiographic evidence of knee OA were randomized to one of four groups: diet (D), exercise (E), diet and exercise (D&E), or healthy lifestyle control (HL) (The Arthritis Diet and Activity Promotion Trial (ADAPT)). Exercise sessions consisted of two 15-minute bouts of walking separated by 20 minutes of moderate intensity resistance training. The E and D&E groups underwent 6 months of facility-based exercise. Subsequently, participants had the option to continue in the facility-based program for an additional 12 months, transition to a home based exercise program, or combine the facility and home based programs. Dietary intervention focused on reducing fat and total calories. Weight loss goal was 5% of body weight. Bi-lateral knee strength data (concentric/eccentric flexion, concentric/eccentric extension) were collected on a randomized subset of this cohort (n = 156 at baseline) using a Kin-Com isokinetic dynamometer set at a speed of 30 deg/s. Data were collected at baseline (BAS), 6 months (FU6), and upon completion of the intervention (FU18). DATA ANALYSIS: Data were averaged over a range of 80–40 deg knee flexion (0 = extension). Knee flexion/extension strength were analyzed using the average values over this range of motion. The effects of diet and/or exercise programs on muscular strength measured at 6 and 18 months post-randomization were determined by twoway repeated measures analysis of covariance. Estimates of intervention effects were obtained at each follow-up observation. When group-by-time interactions were nonsignificant, average intervention effects over the follow-up period were estimated and tested for significance.