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Articles July 2011 Issue

For Obese Seniors, Combine Diet Plus Exercise to Fight Frailty

Combining diet and exercise is the most effective formula for obese seniors who want to improve physical performance, according to a new year-long study. For older people, the findings suggest, losing weight may be just as important for fighting off frailty as for avoiding obesity-related medical conditions.

Ready to start working out? Tufts’ HNRCA Nutrition, Exercise, Physiology and Sarcopenia lab recommends following the 2008 Physical Activity Guidelines for Americans. See www.health.gov/paguidelines.

Dennis Villareal, MD, of the New Mexico VA Health Care System in Albuquerque, and colleagues recruited 107 individuals age 65 and older. Participants, who averaged age 70, were obese, sedentary and suffering mild to moderate frailty. Dr. Villareal and colleagues divided them into a control group plus three intervention groups:

    • A diet group that cut intake by 500 to 750 calories with a goal of losing 10% of body weight in six months.
    • An exercise group that attended three training sessions a week including aerobics, strength-training and exercises for flexibility and balance; this group also received information about a diet designed to maintain their current weight.
    • A group that followed both the diet and exercise regimens, aiming to cut calories and lose weight while also increasing physical activity.

The control group received only general information about a healthy diet, and could not participate in any exercise or weight-loss programs for the duration of the study.

After one year, the combination diet plus exercise group showed the greatest improvement in a standard test of frailty, the modified Physical Performance Test—an average 5.4 points better, on a scale of 36. The exercise group (4.0 points) and diet group (3.4 points) also showed improvements, while the control group did not. The combination group also improved the most in several secondary measures, including peak oxygen consumption, strength, balance, gait and quality of life.

As expected, the diet group lost 10% of body weight, while the diet-plus-exercise group saw a similar 9% weight loss. Those on the exercise-only regimen didn’t lose weight, but did lose fat mass while increasing lean body mass. The other two intervention groups lost both fat and lean body mass, but lost more fat. These positive changes in body composition, researchers suggested, could underlie the improvements in physical function among all three groups.

The exercise regimen did lead to a few falls and minor injuries, leading researchers to caution, “Careful screening and safeguards before and after exercise are needed to decrease the risk of these adverse events.”

The important upside, however, was the functional improvement that went with weight loss. “Our data suggest that a major objective of weight-loss therapy in older adults may be to improve physical function,” Dr. Villareal and colleagues concluded in the New England Journal of Medicine, “and we speculate that doing so may be at least as important as treating obesity-associated medical complications, which is often the main goal in treating obese younger adults.”

TO LEARN MORE: New England Journal of Medicine, March 31, 2011; abstract at www.nejm.org/doi/full/10.1056/NEJMoa1008234.

Diet and Exercise Best for Tackling Triglycerides
“Intensive therapeutic lifestyle changes” can cut triglyceride levels in half, according to a new American Heart Association scientific statement, which recommends diet and exercise rather than drugs to lower blood levels of these fats. The expert report, based on analysis of 500 studies over 30 years, reaffirmed that high triglycerides don’t directly contribute to arterial plaque, but are an important marker of heart-disease risk. All people with levels in the borderline to high range (150-199 mg/dL) or higher should boost physical activity of at least moderate intensity to 150 minutes a week or more, the report advised. Those with high triglycerides should limit added sugars, fructose from both natural sources and processed foods, saturated fats and trans fats, while working to lose weight. Increasing healthy unsaturated fats, especially omega-3s, may also lower triglycerides. People with very high levels (over 500 mg/dL) should consider abstaining from alcohol to guard against pancreatitis. “Taken together,” the report concluded, “reductions of 50% or more in triglyceride levels may be attained through intensive therapeutic lifestyle change.”

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