Intervening on exercise and daylong movement for weight loss maintenance in older adults: A randomized, clinical trial

Abstract

Objective This study aimed to determine the impact of dietary weight loss (WL) plus aerobic exercise (EX) and a “move more, more often” approach to activity promotion (SitLess; SL) on WL and maintenance. Methods Low‐active older adults (age 65‐86 years) with obesity were randomized to WL+EX, WL+SL, or WL+EX+SL. Participants received a social‐cognitive group‐mediated behavioral WL program for 6 months, followed by a 12‐month maintenance period. EX participants received guided walking exercise with the goal of walking 150 min/wk. SL attempted to achieve a step goal by moving frequently during the day. The primary outcome was body weight at 18 months, with secondary outcomes including weight regain from 6 to 18 months and objectively assessed physical activity and sedentary behavior at each time point. Results All groups demonstrated significant WL over 6 months (p < 0.001), with no group differences. Groups that received SL improved total activity time (p ≤ 0.05), and those who received EX improved moderate‐to‐vigorous activity time (p = 0.003). Over the 12‐month follow‐up period, those who received WL+EX demonstrated greater weight regain (5.2 kg; 95% CI: 3.5‐6.9) relative to WL+SL (2.4 kg; 95% CI: 0.8‐4.0). Conclusions Pairing dietary WL with a recommendation to accumulate physical activity contributed to similar WL and less weight regain compared with traditional aerobic exercise.

Outcomes addressed in randomized controlled lifestyle intervention trials in community‐dwelling older people with (sarcopenic) obesity—An evidence map

“…Of 57,721 unique records, 109 articles of 54 studies were included in the evidence map as they provided information on outcomes assessed (Figure 1 and Table S4). 34–87 The unique accession numbers from all database searches are available upon request.…”

“…No study in individuals with SO lasted longer than 26 weeks. Seven studies, all in individuals of the obesity phenotype, included a post‐intervention follow‐up period ranging from 5 to 19 months for at least some study outcomes 45,57,63,64,70,76,81 . The study's participants' age ranged from 65.3 to 77.4 years across studies, with only four RCTs reporting a mean age of 75 years and older.…”

“…19 months for at least some study outcomes. 45,57,63,64,70,76,81 of life (n = 13, 24.1%), psychological (n = 10, 18.5%), risk for adverse health event and medical conditions (n = 5, 9.3%), medications (n = 3, 5.6%), pain (n = 4, 7.4%), and sleep (n = 2, 3.7%).…”

“…The timing of measurement varied between RCTs; however, in the majority of the studies, outcomes were assessed between 12 and 26 weeks after randomization. Since only four RCTs provided data beyond 52 weeks, almost no information on the sustainability of lifestyle interventions in older people exist 41,45,55,59 . Only few trials and none in individuals with SO included follow‐up assessments after the respective interventions.…”

Aging and neural vulnerabilities in overeating: A conceptual overview and model to guide treatment

“…Indeed, low levels of physical activity, and thus high sedentary time, has been shown to be related to hedonic eating 60 . Studying older adults in a weight regain study, we recently found that coupling of a SitLess intervention with weight loss was superior to exercise with weight loss in curbing 12‐month weight regain following an intensive 6‐month program of weight loss 61 . Because the SitLess intervention involved movement across the day, an important question for future study is how the distribution of movement across the day may influence neural networks involved in hedonic eating.…”