Change in health-related quality of life and social cognitive outcomes in obese, older adults in a randomized controlled weight loss trial: Does physical activity behavior matter?
- 761 Downloads
This article compared the effect of dietary weight loss administered alone (WL) or in combination with aerobic training (WL + AT) or resistance training (WL + RT) on health related quality of life, walking self-efficacy, stair climb self-efficacy, and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome. Participants (N = 249; M age = 66.9) engaged in baseline assessments and were randomly assigned to one of three interventions, each including a 6-month intensive phase and a 12-month follow-up. Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly. All participants engaged in weekly group behavioral weight loss sessions with a goal of 7–10% reduction in body weight. Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL. At month 6, WL + AT reported greater walking self-efficacy relative to WL + RT and WL, and maintained higher scores compared to WL at month 18. WL + AT and WL + RT reported greater stair climbing efficacy at month 6, and WL + RT remained significantly greater than WL at month 18. The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss. This underscores the important role of exercise in WL for older adults, and suggests health care providers should give careful consideration to exercise mode when designing interventions.
KeywordsAging Weight loss Exercise Maintenance Theory Quality of life
We are thankful to our study participants, our project manager and Registered Dietician Beverly Nesbit, our lead interventionist Jillian Gaukstern, and our lead assessor Jessica Sheedy for their contributions to this trial.
This work was supported by the National Institutes of Health/National Heart, Lung, and Blood Institute (Grant Number R18 HL076441). Partial support was also provided by National Institutes on Aging (Grant Number P30 AG021332).
Compliance with ethical standards
Conflict of interest
Jason Fanning, Michael P. Walkup, Walter T. Ambrosius, Lawrence R. Brawley, Edward H. Ip, Anthony P. Marsh, and W. Jack Rejeski declares no conflicts of interest.
Human and animal rights and Informed consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- Bandura, A. (1986). Social foundations of thought and action. Englewood Clifs, NJ: Prentice Hall.Google Scholar
- Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W. H. Freeman and Company.Google Scholar
- Bandura, A. (2006). Guide for constructing self-efficacy scales. In T. C. Urdan & F. Pajares (Eds.), Self-efficacy beliefs of adolescents (pp. 307–337). Charlotte, NC: Information Age Publishing. https://doi.org/10.1017/CBO9781107415324.004
- Beavers, K. M., Beavers, D. P., Martin, S. B., Marsh, A. P., Lyles, M. F., Lenchik, L., et al. (2017). Change in bone mineral density during weight loss with resistance versus aerobic exercise training in older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 72, 1582–1585. https://doi.org/10.1093/gerona/glx048 CrossRefGoogle Scholar
- Brawley, L. R., Flora, P. K., Locke, S. R., & Gierc, M. S. (2014). Efficacy of the group-mediated cognitive behavioral intervention: A decade of physical activity research. In M. Eys & M. Beauchamp (Eds.), Group dynamics in exercise and sport psychology (2nd ed., pp. 183–202). Abingdon: Routledge/Psychology Press.Google Scholar
- Brawley, L., Rejeski, W. J., Gaukstern, J. E., & Ambrosius, W. T. (2012). Social cognitive changes following weight loss and physical activity interventions in obese, older adults in poor cardiovascular health. Annals of Behavioral Medicine, 44, 353–364. https://doi.org/10.1007/s12160-012-9390-5 CrossRefPubMedPubMedCentralGoogle Scholar
- Caroll, A. (2015). To lose weight, eating less is far more important than exercising more—the New York Times. The New York Times. https://www.nytimes.com/2015/06/16/upshot/to-lose-weight-eating-less-is-far-more-important-than-exercising-more.html. Accessed April 30, 2017.
- Clemson, L., Fiatarone Singh, M. A., Bundy, A., Cumming, R. G., Manollaras, K., O’Loughlin, P., et al. (2012). Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): Randomised parallel trial. BMJ, 345, e4547–e4547. https://doi.org/10.1136/bmj.e4547 CrossRefPubMedPubMedCentralGoogle Scholar
- Daly, R. M., Dunstan, D. W., Owen, N., Jolley, D., Shaw, J. E., & Zimmet, P. Z. (2005). Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes? Osteoporosis International, 16, 1703–1712. https://doi.org/10.1007/s00198-005-1906-4 CrossRefPubMedGoogle Scholar
- Focht, B. C., Brawley, L. R., Rejeski, W. J., & Ambrosius, W. T. (2004). Group-mediated activity counseling and traditional exercise therapy programs: Effects on health-related quality of life among older adults in cardiac rehabilitation. Annals of Behavioral Medicine, 28, 52–61.CrossRefPubMedGoogle Scholar
- Focht, B. C., Rejeski, W. J., Ambrosius, W. T., Katula, J. A., & Messier, S. P. (2005). Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Arthritis and Rheumatism, 53, 659–665. https://doi.org/10.1002/art.21466 CrossRefPubMedGoogle Scholar
- Frimel, T. N., Sinacore, D. R., & Villareal, D. T. (2008). Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults. Medicine and Science in Sports and Exercise, 40, 1213–1219. https://doi.org/10.1249/MSS.0b013e31816a85ce CrossRefPubMedPubMedCentralGoogle Scholar
- Herens, M., Bakker, E. J., van Ophem, J., Wagemakers, A., Koelen, M., Hoy, C., et al. (2016). Health-related quality of life, self-efficacy and enjoyment keep the socially vulnerable physically active in community-based physical activity programs: A sequential cohort study. PLoS ONE, 11, e0150025. https://doi.org/10.1371/journal.pone.0150025 CrossRefPubMedPubMedCentralGoogle Scholar
- Kuo, H. K., Snih, S. Al, Kuo, Y.-F., & Raji, M. A. (2012). Chronic inflammation, albuminuria, and functional disability in older adults with cardiovascular disease: The National Health and Nutrition Examination Survey, 1999–2008. Atherosclerosis, 222, 502–508. https://doi.org/10.1016/j.atherosclerosis.2012.03.004 CrossRefPubMedGoogle Scholar
- Marsh, A. P., Janssen, J. A., Ambrosius, W. T., Burdette, J. H., Gaukstern, J. E., Morgan, A. R., et al. (2013). The cooperative lifestyle intervention program-II (clip-II): Design and methods. Contemporary Clinical Trials, 36, 382–393. https://doi.org/10.1016/j.cct.2013.08.006 CrossRefPubMedGoogle Scholar
- Mcauley, E., Katula, J., Mihalko, S. L., Blissmer, B., Duncan, T. E., Pena, M., et al. (1999). Mode of physical activity and self-efficacy in older adults: A latent growth curve analysis. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 54, 283–292.CrossRefGoogle Scholar
- McAuley, E., Konopack, J. F., Morris, K. S., Motl, R. W., Hu, L., Doerksen, S. E., et al. (2006). Physical activity and functional limitations in older women: Influence of self-efficacy. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 61, P270–P277. https://doi.org/10.1093/geronb/61.5.P270 CrossRefGoogle Scholar
- Messier, S. P., Loeser, R. F., Miller, G. D., Morgan, T. M., Rejeski, W. J., Sevick, M. A., et al. (2004). Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The arthritis, diet, and activity promotion trial. Arthritis and Rheumatism, 50, 1501–1510. https://doi.org/10.1002/art.20256 CrossRefPubMedGoogle Scholar
- Messier, S. P., Mihalko, S. L., Legault, C., Miller, G. D., Nicklas, B. J., DeVita, P., et al. (2013). Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: The IDEA randomized clinical trial. JAMA, 310, 1263–1273. https://doi.org/10.1001/jama.2013.277669 CrossRefPubMedPubMedCentralGoogle Scholar
- Pahor, M., Blair, S. N., Espeland, M., Fielding, R., Guralnik, J. M., Hadley, E. C., et al. (2006). Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for elders pilot (LIFE-P) study. The Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 61, 1157–1165.CrossRefGoogle Scholar
- Pellegrini, C. A., Ledford, G., Hoffman, S. A., Chang, R. W., & Cameron, K. A. (2017). Preferences and motivation for weight loss among knee replacement patients: Implications for a patient-centered weight loss intervention. BMC Musculoskeletal Disorders, 18, 327. https://doi.org/10.1186/s12891-017-1687-x CrossRefPubMedPubMedCentralGoogle Scholar
- Reboussin, B. A., Rejeski, W. J., Martin, K. A., Callahan, K., Dunn, A. L., King, A. C., et al. (2000). Correlates of satisfaction with body function and body appearance in middle- and older aged adults: The activity counseling trial (ACT). Psychology & Health, 15, 239–254. https://doi.org/10.1080/08870440008400304 CrossRefGoogle Scholar
- Rejeski, W. J., Ambrosius, W. T., Burdette, J. H., Walkup, M. P., & Marsh, A. P. (2017). Community weight loss to combat obesity and disability in at-risk older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 72, 1547–1553. https://doi.org/10.1093/gerona/glw252 Google Scholar
- Rejeski, W. J., Brawley, L. R., Ambrosius, W. T., Brubaker, P. H., Focht, B. C., Foy, C. G., et al. (2003). Older adults with chronic disease: Benefits of group-mediated counseling in the promotion of physically active lifestyles. Health Psychology, 22, 414–423. https://doi.org/10.1037/0278-6220.127.116.114 CrossRefPubMedGoogle Scholar
- Rejeski, W. J., King, A. C., Katula, J. A., Kritchevsky, S., Miller, M. E., Walkup, M. P., et al. (2008). Physical activity in prefrail older adults: Confidence and satisfaction related to physical function. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 63, P19–P26.CrossRefPubMedPubMedCentralGoogle Scholar
- Rejeski, W. J., Shelton, B., Miller, M., Dunn, A. L., King, A. C., Sallis, J. F., et al. (2001). Mediators of increased physical activity and change in subjective well-being: Results from the activity counseling trial (ACT). Journal of Health Psychology, 6, 159–168. https://doi.org/10.1177/135910530100600206 CrossRefPubMedGoogle Scholar
- Rejeski, W. J., Spring, B., Domanchuk, K., Tao, H., Tian, L., Zhao, L., et al. (2014). A group-mediated, home-based physical activity intervention for patients with peripheral artery disease: Effects on social and psychological function. Journal of Translational Medicine, 12, 29. https://doi.org/10.1186/1479-5876-12-29 CrossRefPubMedPubMedCentralGoogle Scholar
- Villareal, D. T., Chode, S., Parimi, N., Sinacore, D. R., Hilton, T., Armamento-Villareal, R., et al. (2011). Weight loss, exercise, or both and physical function in obese older adults. New England Journal of Medicine, 364, 1218–1229. https://doi.org/10.1056/NEJMoa1008234 CrossRefPubMedPubMedCentralGoogle Scholar
- Wyrwich, K. W., Tierney, W. M., Babu, A. N., Kroenke, K., & Wolinsky, F. D. (2005). A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease. Health Services Research, 40, 577–591. https://doi.org/10.1111/j.1475-6773.2005.00373.x CrossRefPubMedPubMedCentralGoogle Scholar