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: 8073493
• 负责人: DENNIS T. VILLAREAL
• 金额: $ 43.04万
• 依托单位: BIOMEDICAL RESEARCH INSTITUTE OF NEW MEX
• 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 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8073493
• 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; 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; Osteopenia; 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; TNF gene; 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; 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（由申请人提供）：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虚弱。然而，对老年人肥胖的适当管理存在争议。不运动而减肥可能会加速与年龄相关的肌肉和骨质下降，从而分别导致肌肉减少症和骨质减少症，从而加剧虚弱。由于肥胖老年人的衰弱问题很重要，因此确定减少甚至逆转该人群衰弱的最有效方法非常重要。该提案的主要目的是评估哪种不同类型的体育锻炼（抗阻运动、有氧运动或组合运动）对于防止减肥引起的肌肉和骨质减少以及扭转肥胖老年人的虚弱最为有效。总共 160 名肥胖老年人将被随机分配到 1) 10% 减肥 + 阻力训练，2) 10% 减肥 + 有氧训练，3) 10% 减肥 + 有氧/阻力训练，以及 4) 非减肥对照组6个月。我们假设1）减肥+阻力训练比减肥+有氧训练和减肥+有氧/阻力训练对身体机能有更大的改善，2）减肥+阻力训练比体重更能保留肌肉质量减重+有氧/阻力训练，而减重+有氧训练会导致肌肉质量减少，3）与减重+相比，减重+阻力训练更能刺激骨形成而不是骨吸收有氧/阻力训练，从而保持 BMD，而减肥 + 有氧训练将减少骨转换并减弱 BMD 的损失，并且 4) 减肥 + 阻力训练 a) 将导致 TNF-1 和 IL- 更大程度地减少6 骨骼肌中 MGF 的增加比有氧和有氧/阻力训练更大，并且 b) 这些合成代谢效应将与肌肉蛋白质合成 (MPS) 的保存相关，并且减肥治疗期间的肌肉质量。我们跨目标的总体假设是，肥胖和衰老对身体成分（肌肉减少性肥胖）和身体功能（虚弱）产生附加不利影响，这是通过对炎症和 MPS 的附加不利影响来介导的，因此，通过减肥可以显着改善这些不利影响+ 阻力训练。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，以确定哪些身体成分因素和/或机械骨骼肌因素是观察到的身体功能变化的最重要调节因素。老年人肥胖是一个重大的公共卫生问题。我们社会中肥胖老年人的数量将继续增加，对现有的医疗保健服务系统提出挑战。这项拟议的随机对照试验的结果将对防止我们社会中肥胖老年人丧失功能独立性产生重要影响，因此将改变这一快速增长的人群当前的临床实践。公共卫生相关性：老年人肥胖是一个主要的公共卫生问题，对医疗保健专业人员和我们现有的医疗保健提供系统提出了挑战。肥胖会加剧随着年龄增长而发生的身体机能下降，并增加失去社会独立性的风险。这项研究将确定防止我们社会中肥胖老年人丧失功能独立性的最有效方法，并将改变这一快速增长的人群目前的临床实践。