Rejeski W Jack, Ambrosius Walter T, Burdette Jonathan H, Walkup Michael P, Marsh Anthony P
Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.
Department of Geriatric Medicine.
J Gerontol A Biol Sci Med Sci. 2017 Oct 12;72(11):1547-1553. doi: 10.1093/gerona/glw252.
Among older, overweight, and obese adults with either cardiovascular disease or the metabolic syndrome, reduced mobility and loss of leg strength are important risk factors for morbidity, disability, and mortality. It is unclear whether community-based approaches to weight loss may be an effective solution to this public health challenge.
An 18-month three-site, randomized controlled trial conducted by YMCA staff, with blinded assessors, enrolled 249 older, overweight, and obese adults with either cardiovascular disease or metabolic syndrome with randomization to three interventions: weight loss alone (WL), weight loss + aerobic training (WL + AT), and weight loss + resistance training (WT + RT). The dual primary outcomes were 400-m walk time in seconds and knee extensor strength in Newton meters.
All groups lost weight from baseline: average baseline adjusted change of -6.1% (95% confidence interval [CI]: -7.5 to -4.7) for WL only, -8.6% (95% CI: -10.0 to -7.2) for WL + AT, and -9.7% (95% CI: -11.1 to -8.4) for WL + RT. Combined, the two physical activity + WL training groups had greater improvement in walk time than WL alone (mean difference 16.9 seconds [95% CI: 9.7 to 24.0], p < .0001). Baseline adjusted change in knee extensor strength was no greater with WL + RT than WL + AT (mean difference -3.6 Nm [95% CI: -7.5 to 0.3], p = .07).
At risk, older, overweight and obese adults can achieve clinically significant reductions in body weight with community-based weight loss programs. The change in percent weight loss and improvements in mobility are significantly enhanced when either RT or AT is combined with dietary WL.
在患有心血管疾病或代谢综合征的老年超重及肥胖成年人中，活动能力下降和腿部力量丧失是发病、残疾和死亡的重要危险因素。尚不清楚基于社区的减肥方法是否可能是应对这一公共卫生挑战的有效解决方案。
由基督教青年会工作人员开展的一项为期18个月的三中心随机对照试验，评估人员设盲，纳入了249名患有心血管疾病或代谢综合征的老年超重及肥胖成年人，随机分为三种干预措施：单纯减肥（WL）、减肥+有氧训练（WL+AT）和减肥+抗阻训练（WL+RT）。两个主要结局指标为400米步行时间（以秒为单位）和膝关节伸肌力量（以牛顿米为单位）。
所有组体重均较基线下降：单纯WL组基线调整后平均变化为-6.1%（95%置信区间[CI]：-7.5至-4.7），WL+AT组为-8.6%（95%CI：-10.0至-7.2），WL+RT组为-9.7%（95%CI：-11.1至-8.4）。综合来看，两个体育活动+WL训练组的步行时间改善程度大于单纯WL组（平均差异16.9秒[95%CI：9.7至24.0]，p<.0001）。WL+RT组膝关节伸肌力量的基线调整变化并不比WL+AT组更大（平均差异-3.6牛米[95%CI：-7.5至0.3]，p=0.07）。
处于风险中的老年超重及肥胖成年人通过基于社区的减肥项目可实现临床上显著的体重减轻。当抗阻训练或有氧训练与饮食减肥相结合时，体重减轻百分比的变化和活动能力的改善会显著增强。
