Weight loss, exercise, or both and physical function in obese older adults.
Weight loss, exercise, or both and physical function in obese older adults.
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DOI：
10.1056/nejmoa1008234
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发表时间：
2011-03-31
期刊：
影响因子：
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通讯作者：
Shah K
中科院分区：
文献类型：
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作者：
Villareal DT;Chode S;Parimi N;Sinacore DR;Hilton T;Armamento-Villareal R;Napoli N;Qualls C;Shah K
肥胖加剧了与年龄相关的身体功能下降，并导致老年人虚弱;然而，肥胖老年人的适当治疗是有争议的。在这项为期1年的随机对照试验中，我们评估了107名65岁或以上肥胖成年人的减肥和运动的独立和联合作用。参与者被随机分配到对照组，体重管理（饮食）组，运动组或体重管理加运动（饮食运动）组。主要结局是改良体能测试评分的变化。次要结果包括其他虚弱指标、身体成分、骨矿物质密度、特定身体功能和生活质量。共有93名参与者（87%）完成了研究。在意向治疗分析中，饮食锻炼组的体能测试分数（分数越高表示身体状况越好）比饮食组或锻炼组增加得更多（较基线分别增加21% vs. 12%和15%）;所有三组中的得分增加均大于对照组中的得分（其中得分增加1%）（组间差异P<0.001）。此外，饮食运动组的峰值耗氧量比饮食组或运动组改善更多（分别增加17%对10%和8%; P<0.001）;在功能状态问卷中，分数越高表明身体功能越好，饮食锻炼组的分数比饮食组增加得更多（增加10%比4%，P<0.001）。饮食组体重下降10%，饮食运动组体重下降9%，但运动组和对照组体重没有下降（P<0.001）。饮食运动组的瘦体重和髋部骨密度下降幅度小于饮食组（饮食运动组分别下降3%和1%，饮食组分别下降5%和3%;两项比较P<0.05）。饮食运动组的力量、平衡和步态持续改善（所有比较P<0.05）。不良事件包括少量运动相关的肌肉骨骼损伤。这些研究结果表明，减肥和运动的结合比单独干预更能改善身体功能。
Obesity exacerbates the age-related decline in physical function and causes frailty in older adults; however, the appropriate treatment for obese older adults is controversial. In this 1-year, randomized, controlled trial, we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese. Participants were randomly assigned to a control group, a weightmanagement (diet) group, an exercise group, or a weight-management-plus-exercise (diet–exercise) group. The primary outcome was the change in score on the modified Physical Performance Test. Secondary outcomes included other measures of frailty, body composition, bone mineral density, specific physical functions, and quality of life. A total of 93 participants (87%) completed the study. In the intention-to-treat analysis, the score on the Physical Performance Test, in which higher scores indicate better physical status, increased more in the diet–exercise group than in the diet group or the exercise group (increases from baseline of 21% vs. 12% and 15%, respectively); the scores in all three of those groups increased more than the scores in the control group (in which the score increased by 1%) (P<0.001 for the between-group differences). Moreover, the peak oxygen consumption improved more in the diet–exercise group than in the diet group or the exercise group (increases of 17% vs. 10% and 8%, respectively; P<0.001); the score on the Functional Status Questionnaire, in which higher scores indicate better physical function, increased more in the diet–exercise group than in the diet group (increase of 10% vs. 4%, P<0.001). Body weight decreased by 10% in the diet group and by 9% in the diet–exercise group, but did not decrease in the exercise group or the control group (P<0.001). Lean body mass and bone mineral density at the hip decreased less in the diet–exercise group than in the diet group (reductions of 3% and 1%, respectively, in the diet–exercise group vs. reductions of 5% and 3%, respectively, in the diet group; P<0.05 for both comparisons). Strength, balance, and gait improved consistently in the diet–exercise group (P<0.05 for all comparisons). Adverse events included a small number of exercise-associated musculoskeletal injuries. These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone.