EXERCISE INTERVENTIONS DURING VOLUNTARY WEIGHT LOSS IN OBESE OLDER ADULTS

肥胖老年人自愿减肥期间的运动干预

• 批准号: 7661178
• 负责人: DENNIS T. VILLAREAL
• 金额: $ 54.31万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-01 至 2009-08-11
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7661178
• 关键词: Adverse effects; Aerobic; Aerobic Exercise; Age; Aging; Attenuated; Biological Preservation; Biopsy Specimen; Body Composition; Body Weight decreased; Body fat; Bone Resorption; Communities; Control Groups; Diet; Dual-Energy X-Ray Absorptiometry; Elderly; Equilibrium; Exercise; Fasting; Fatty acid glycerol esters; Growth Factor; Health Professional; Hip region structure; Inflammation; Insulin-Like Growth Factor I; Interleukin-6; Intervention; Intramuscular; Magnetic Resonance Imaging; Measures; Mediating; Mediator of activation protein; Muscle; Muscle Proteins; Obesity; Osteogenesis; Performance; Physical Function; Plasma; Polymerase Chain Reaction; Population; Protein Biosynthesis; Protein Isoforms; Proteins; Public Health; Questionnaires; Randomized; Regression Analysis; Resistance; Risk; Skeletal Muscle; Societies; System; Techniques; Testing; Thigh structure; Time; Tracer; Training; Urine; Vertebral column; Western Blotting; age related; base; bone mass; bone turnover; clinical practice; cytokine; feeding; frailty; functional loss; functional outcomes; functional status; health care delivery; improved; mRNA Expression; muscle form; obesity management; performance tests; prevent; programs; public health relevance; response; sarcopenia; stable isotope; strength training

DESCRIPTION (provided by applicant): Obesity causes frailty in obese older adults by exacerbating the age-related decline in physical function. However, appropriate management of obesity in older adults is controversial. Weight loss without exercise could worsen frailty by accelerating the usual age-related decline in muscle and bone mass that leads to sarcopenia and osteopenia, respectively. Because of the important problem of frailty in obese older adults, it would be important to determine the most efficacious approach in reducing, or even reversing frailty in this population. The primary objective of this proposal is to evaluate which distinct type of physical exercise (resistance, aerobic, or combined) is most efficacious in preventing the weight-loss-induced reduction in muscle and bone mass and reversing frailty in obese older adults. A total of 160 obese older adults will be randomized to 1) 10% weight loss + resistance training, 2) 10% weight loss + aerobic training, 3) 10% weight loss + aerobic/resistance training, and 4) non-weight loss control group for 6 months. We hypothesize that 1) weight loss + resistance training will cause a greater improvement in physical function than weight loss + aerobic training and weight loss + aerobic/resistance training, 2) weight loss + resistance training will cause a greater preservation of muscle mass than weight loss + aerobic/resistance training, whereas weight loss + aerobic training will cause a decrease in muscle mass, 3) weight loss + resistance training will stimulate bone formation more than resorption compared to weight loss + aerobic/resistance training and, thus, preserve BMD, whereas weight loss + aerobic training will decrease bone turnover and attenuate the loss of BMD, and 4) weight loss + resistance training a) will cause a greater decrease in TNF-1 and IL-6 and a greater increase in MGF in skeletal muscles than aerobic and aerobic/resistance training and that b) these anabolic effects will correlate with preservation of muscle protein synthesis (MPS) and muscle mass during weight-loss therapy. Our overarching hypothesis across aims is that obesity and aging have additive adverse effects on body composition (sarcopenic obesity) and physical function (frailty), mediated by their additive adverse effects on inflammation and MPS, which will, thus, be significantly improved by weight loss + resistance training. Therefore, to test this central hypothesis in an integrated manner, we will use partial correlation and multiple regression analyses, to determine which of the body composition factors and/or the mechanistic skeletal muscle factors are the most important mediators for the observed changes in physical function. Obesity in older adults is a major public health problem. The number of obese older adults in our society will continue to increase, challenging existing health care delivery systems. The results of this proposed RCT will have important implications for preventing the loss of functional independence of obese older adults in our society and, therefore, will change current clinical practice for this rapidly growing segment of the population. PUBLIC HEALTH RELEVANCE: Obesity in older adults is a major public health problem that provides a challenge to health care professionals and our existing health care delivery systems. Obesity worsens the decline in physical function that occurs with age, and increases the risk for loss of independence in the community. This study will determine the most efficacious approach towards preventing the loss of functional independence of obese older adults in our society and will change current clinical practice for this rapidly increasing segment of the population.

描述(申请人提供)：肥胖会加剧与年龄相关的身体机能下降，从而导致肥胖老年人的虚弱。然而，对老年人肥胖症的适当管理是有争议的。不运动的减肥可能会加速肌肉和骨量通常与年龄相关的下降，从而加剧虚弱，从而分别导致骨量减少和骨量减少。由于肥胖老年人的虚弱这一重要问题，确定减少甚至扭转这一人群虚弱的最有效方法将是重要的。这项建议的主要目标是评估哪种不同类型的体育锻炼(阻力运动、有氧运动或组合运动)在预防减肥导致的肌肉和骨量减少以及扭转肥胖老年人的虚弱方面最有效。将160名肥胖老年人随机分为1)10%减重+阻力训练，2)10%减重+有氧训练，3)10%减重+有氧/耐力训练，4)非减肥对照组，为期6个月。我们假设1)减重+抗阻训练比减重+有氧训练和减重+有氧/抗阻训练对身体机能的改善更大；2)减重+抗阻训练比减重+有氧/抗阻训练对肌肉质量的保护作用更大，而减重+有氧训练会导致肌肉质量的下降；3)与减重+有氧/抗阻训练相比，减重+抗阻训练比减重+有氧/耐力训练更能促进骨形成，从而保护骨密度，而减重+有氧训练会降低骨转换，减轻骨密度的损失。4)与有氧和有氧/耐力训练相比，减重+抗阻训练可使骨骼肌中的肿瘤坏死因子-1和白介素6的下降幅度更大，而MGF的增加幅度更大；b)这些合成代谢作用与减肥过程中肌肉蛋白质合成和肌肉质量的保持有关。我们横跨AIMS的总体假设是，肥胖和衰老对身体成分(骨质源性肥胖)和身体功能(虚弱)具有相加的不利影响，这是通过它们对炎症和MPS的相加不利影响而调节的，因此，通过减肥+抵抗力训练将显著改善这一点。因此，为了以综合的方式检验这一中心假设，我们将使用偏相关和多元回归分析来确定身体成分因素和/或机械骨骼肌因素中哪些是对观察到的身体功能变化最重要的中介因素。老年人肥胖是一个主要的公共卫生问题。我们社会中肥胖老年人的数量将继续增加，对现有的医疗保健提供系统构成挑战。这项拟议的随机对照试验的结果将对防止肥胖老年人在我们的社会中失去功能独立性具有重要意义，因此，将改变这一快速增长的人口部分的当前临床实践。与公共卫生相关：老年人肥胖是一个主要的公共卫生问题，对卫生保健专业人员和我们现有的卫生保健提供系统提出了挑战。肥胖会加剧随年龄增长而出现的身体机能下降，并增加社区丧失独立性的风险。这项研究将确定在我们的社会中预防肥胖老年人功能独立性丧失的最有效方法，并将改变这一快速增长的人口部分的当前临床实践。