Effect of Exercise Modality during Weight Loss on Bone Health in Older Adults with Obesity and Cardiovascular Disease or Metabolic Syndrome: A Randomized Controlled Trial

摘要

The objective of this study was to determine the ability of either aerobic or resistance training to counter weight loss associated bone loss in older adults. 187 older adults (67 years, 70% women, 64% Caucasian) with obesity (body mass index: 34.5±3.7 kg/m²) and cardiovascular disease and/or metabolic syndrome were randomized to participate in an 18 month, community-based trial, with a follow-up assessment occurring at 30 months. Intervention arms included: weight loss alone (WL; 7–10% baseline weight), WL plus aerobic training (WL+AT), and WL plus resistance training (WL+RT). Dual energy x-ray absorptiometry (DXA) acquired total hip, femoral neck, and lumbar spine areal bone mineral density (aBMD) and trabecular bone score (TBS); and biomarkers of bone turnover (Procollagen Type 1 N-Terminal Propeptide, C-Terminal Telopeptide of Type 1 Collagen) were measured at baseline, six, 18, and 30 (aBMD and TBS, only) months. Computed tomography (CT) acquired hip and spine volumetric BMD (vBMD), cortical thickness, and bone strength was measured in a subset at baseline (n=55) and 18 months. Total hip aBMD was reduced by 2% in all groups at 18 months, with primary analysis showing no significant treatment effects for any DXA, biomarker, or CT outcome. After adjustment for weight loss and followed to 30 months, secondary analyses reveal total hip [−0.018 (−0.023 to −0.012) g/cm² vs −0.025 (−0.031 to −0.019) g/cm²; p=0.05] and femoral neck [−0.01 (−0.009 to 0.008) g/cm² vs −0.011 (−0.020 to −0.002) g/cm²; p=0.06] aBMD estimates were modestly attenuated in WL+RT compared to WL. Additionally, lumbar spine aBMD was increased in WL [0.015 (0.007 to 0.024) g/cm²] and WL+RT [0.009 (0.000 to 0.017) g/cm²] compared to WL+AT [−0.003 (−0.012 to 0.005) g/cm²]; both p≤0.01. Community-based exercise does not prevent bone loss during active weight loss in older adults; however, adding resistance training may help minimize long-term hip bone loss.Trial Registration: Identifier:.