Effect of Aerobic or Resistance Exercise, or Both, on Intermuscular and Visceral Fat and Physical and Metabolic Function in Older Adults With Obesity While Dieting

Abstract

Background Obesity exacerbates age-related effects on body composition, physical and metabolic function. Which exercise mode is most effective in mitigating these deleterious changes in dieting obese older adults is unknown. Methods In a randomized controlled trial, we performed a head-to-head comparison of aerobic (AEX), resistance (REX), or combination (COMB) exercise during matched weight loss in 160 obese older adults. Prespecified analyses compared 6-month changes in intermuscular adipose tissue (IMAT) and visceral adipose tissue (VAT) assessed using MRI, insulin sensitivity index (ISI) by oral glucose tolerance test, physical function using Modified Physical Performance Test (PPT), VO2peak, gait-speed, and knee strength by dynamometry. Results IMAT and VAT decreased more in COMB than AEX and REX groups (IMAT; -41% vs. -28% and -23% and VAT: -36% vs. -19% and -21%; p=.003 to .01); IMAT and VAT decreased in all groups more than control (CON) (between-group p<.001). ISI increased more in COMB than AEX and REX groups (86% vs. 50% and 39%; p=.005 to .03). PPT improved more in COMB than AEX and REX groups, while VO2peak improved more in COMB and AEX than REX group (all p<.05). Knee strength improved more in COMB and REX than AEX group (all p<.05). Changes in IMAT and VAT correlated with PPT (r=-.28 and -.39), VO2peak (r=-.49 and -.52), gait-speed (r=-.25 and -.36), and ISI (r=-.49 and -.52) (all p<.05). Conclusions Weight loss plus combination aerobic and resistance exercise was most effective in improving ectopic fat deposition and physical and metabolic function in older adults with obesity.

Weight strategy in older adults with obesity: calorie restriction or not?

“…Furthermore, the between-group differences in HbA1c were also eliminated after adjusting data for changes in fat mass, pointing to the importance of improvement in body composition as a potential mediator of improvement in glucometabolic health [8]. These findings are in line with the recent report from the LITOE that 10% calorie restriction-induced weight loss in combination with aerobic and resistance exercise reduced ectopic fat deposition (visceral and intermuscular fat), findings that correlated with improvement in cardiometabolic profile (i.e., insulin sensitivity index) [16 ▪ ]. Visceral and ectopic fat deposition are in fact associated with low-grade inflammation and insulin resistance in humans and animal models [8].…”

“…This evidence emphasizes the importance of prescribing calorie restriction in combination with both resistance and aerobic exercise among older adults with obesity [14,15,16 ▪ ,17]. Calorie restriction is in fact necessary to achieve a significant reduction in fat mass content, while exercise is crucial to improve frailty outcomes and prevent the calorie restriction-induced reduction in muscle and bone mass.…”

“…Based on the Lifestyle Intervention Trial in Obese Elderly (LITOE) conducted on 160 frail, older adults with obesity, the same calorie restriction protocol combined with resistance and aerobic exercise training resulted in the greatest preservation of muscle and bone mass, and in the greatest improvement in muscle strength and physical function compared with calorie restriction and aerobic or resistance training alone [14,15]. The same lifestyle intervention led to the greatest reduction in ectopic fat deposition in visceral depots and in skeletal muscle [16 ▪ ], suggesting the greatest amelioration of muscle quality among the interventions tested. Accordingly, a substudy of the LITOE conducted on 47 individuals also reported the greatest improvement in muscle quality among the calorie-restricted individuals performing both exercise types – greatest reduction in the expression of atrophy-related genes ( LAMP2 ) and of inflammatory ( TLR2 and CD68 ) and mitochondrial stress ( FIS1, PARL, and OPA1 ) markers in the vastus lateralis , indicating an attenuated myocellular stress due to the intervention [17].…”

Gender differences in risk factors for the 2 year development of sarcopenia in community‐dwelling older adults

“…Here, we demonstrated that the most important modifiable factor in the development of sarcopenia in elderly men was engaging in RT at least two times per week. Importance of RT is recently being revitalized, as it has been proposed that while aerobic exercise may attenuate the loss of skeletal muscle during energy restriction in obese adults, a single mode of aerobic exercise alone does not promote muscle hypertrophy to the same extent as RT 31–35 . Along the same line, while there was an increasing trend in the onset of sarcopenia according to a decrease in the physical activity level, this association was modest and did not independently contribute to the development of sarcopenia in men.…”

MRI characterization of skeletal muscle size and fatty infiltration in long‐term trained and untrained individuals

“…Additionally, decreased muscle CSA and increased fat content in the lumbar paravertebral muscles have been strongly related to lower back pain in adult men and women (Kjaer et al, 2007; Parkkola et al, 1993; Shahidi et al, 2017). Considering the higher fat content in untrained males across multiple muscle groups in this study, it may be suggested that therapeutic interventions should target whole‐body resistance and/or endurance exercise to reduce skeletal muscle fat fraction and, thus, improve skeletal muscle insulin sensitivity, decrease low back pain, and increase muscle CSA (Parkkola et al, 1993; Schumann et al, 2022; Waters et al, 2022).…”