Journal of Behavioral Medicine

, Volume 41, Issue 3, pp 299–308 | Cite as

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?

  • Jason Fanning
  • Michael P. Walkup
  • Walter T. Ambrosius
  • Lawrence R. Brawley
  • Edward H. Ip
  • Anthony P. Marsh
  • W. Jack Rejeski


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.


Aging 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.


  1. Aguilar, M., Bhuket, T., Torres, S., Liu, B., & Rj, W. (2015). Prevalence of the metabolic syndrome in the United States, 2003–2012. JAMA, 313, 1973–1974. CrossRefPubMedGoogle Scholar
  2. Bandura, A. (1986). Social foundations of thought and action. Englewood Clifs, NJ: Prentice Hall.Google Scholar
  3. Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W. H. Freeman and Company.Google Scholar
  4. Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31, 143–164. CrossRefGoogle Scholar
  5. 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.
  6. 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. CrossRefGoogle Scholar
  7. Blalock, S., Vellis, B., & DeVellis, R. (1988). Self-evaluation processes and adjustment to rheumatoid arthritis. Arthritis and Rheumatism, 31, 1245–1251.CrossRefPubMedGoogle Scholar
  8. Borg, G. A. (1973). Perceived exertion: A note on “history” and methods. Medicine and Science in Sports, 5, 90–93.PubMedGoogle Scholar
  9. 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
  10. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  11. Brawley, L. R., Rejeski, W. J., & King, A. C. (2003). Promoting physical activity for older adults: The challenges for changing behavior. American Journal of Preventive Medicine, 25, 172–183. CrossRefPubMedGoogle Scholar
  12. Buman, M. P., Hekler, E. B., Haskell, W. L., Pruitt, L., Conway, T. L., Cain, K. L., et al. (2010). Objective light-intensity physical activity associations with rated health in older adults. American Journal of Epidemiology, 172, 1155–1165.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Caroll, A. (2015). To lose weight, eating less is far more important than exercising more—the New York Times. The New York Times. Accessed April 30, 2017.
  14. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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. CrossRefPubMedGoogle Scholar
  16. Felix, H. C., & West, D. S. (2013). Effectiveness of weight loss interventions for obese older adults. American Journal of Health Promotion, 27, 191–199. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 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
  18. 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. CrossRefPubMedGoogle Scholar
  19. Fontaine, K. R., & Barofsky, I. (2001). Obesity and health-related quality of life. Obesity Reviews, 2, 173–182. CrossRefPubMedGoogle Scholar
  20. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  22. Huang, P. L. (2009). A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms, 2, 231–237. CrossRefGoogle Scholar
  23. Katula, J. A., Rejeski, W. J., Wickley, K. L., & Berry, M. J. (2004). Perceived difficulty, importance, and satisfaction with physical function in COPD patients. Health and Quality of Life Outcomes, 2, 18. CrossRefPubMedPubMedCentralGoogle Scholar
  24. Katz, P. P., & Neugebauer, A. (2001). Does satisfaction with abilities mediate the relationship between the impact of rheumatoid arthritis on valued activities and depressive symptoms? Arthritis and Rheumatism, 45, 263–269.CrossRefPubMedGoogle Scholar
  25. 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. CrossRefPubMedGoogle Scholar
  26. Liaw, F. Y., Kao, T. W., Wu, L. W., Wang, C. C., Yang, H. F., Peng, T. C., et al. (2016). Components of metabolic syndrome and the risk of disability among the elderly population. Scientific Reports, 6, 22750. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 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. CrossRefPubMedGoogle Scholar
  28. Martin Ginis, K. A., Latimer, A. E., Brawley, L. R., Jung, M. E., & Hicks, A. L. (2006). Weight training to activities of daily living: Helping older adults make a connection. Medicine and Science in Sports and Exercise, 38, 116–121.CrossRefPubMedGoogle Scholar
  29. McAuley, E., & Blissmer, B. (2000). Self-efficacy determinants and consequences of physical activity. Exercise and Sport Sciences Reviews, 28, 85–88.PubMedGoogle Scholar
  30. McAuley, E., Doerksen, S. E., Morris, K. S., Motl, R. W., Hu, L., Wójcicki, T. R., et al. (2008). Pathways from physical activity to quality of life in older women. Annals of Behavioral Medicine, 36, 13–20. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 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
  32. 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. CrossRefGoogle Scholar
  33. 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. CrossRefPubMedGoogle Scholar
  34. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  35. Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., et al. (2016). Heart disease and stroke statistics—2016 update. Circulation, 133, e38–e360. CrossRefPubMedGoogle Scholar
  36. 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
  37. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  38. Ray, K. M., Hector, L. L., Lynes, L. K., Stewart, A. L., Painter, P. L., & Dibble, S. L. (1996). Assessment of satisfaction with physical fitness in kidney transplant recipients 38. Medicine and Science in Sports and Exercise, 28, 7.CrossRefGoogle Scholar
  39. 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. CrossRefGoogle Scholar
  40. 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. Google Scholar
  41. 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. CrossRefPubMedGoogle Scholar
  42. Rejeski, J. W., Ettinger, W., Schumaker, S., James, P., Burns, R., & Elam, J. (1995). Assessing performance-related disability in patients with knee osteoarthritis. Osteoarthritis Cartilage, 3, 157–167.CrossRefPubMedGoogle Scholar
  43. Rejeski, W. J., & Focht, B. C. (2002). Aging and physical disability: On integrating group and individual counseling with the promotion of physical activity. Exercise and Sport Sciences Reviews, 30, 166–170. CrossRefPubMedGoogle Scholar
  44. Rejeski, W. J., Focht, B. C., Messier, S. P., Morgan, T. M., Pahor, M., & Penninx, B. W. J. H. (2002). Obese, older adults with knee osteoarthritis: Weight loss, exercise, and quality of life. Health Psychology, 21, 419–426. CrossRefPubMedGoogle Scholar
  45. 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
  46. Rejeski, W. J., Marsh, A. P., Chmelo, E., & Rejeski, J. J. (2010). Obesity, intentional weight loss and physical disability in older adults. Obesity Reviews, 11, 671–685. CrossRefPubMedPubMedCentralGoogle Scholar
  47. Rejeski, W. J., & Mihalko, S. L. (2001). Physical activity and quality of life in older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56, 23–35. CrossRefGoogle Scholar
  48. 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. CrossRefPubMedGoogle Scholar
  49. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  50. Rose, D. J., & Hernandez, D. (2010). The role of exercise in fall prevention for older adults. Clinics in Geriatric Medicine, 26, 607–631. CrossRefPubMedGoogle Scholar
  51. Stewart, A. L., Greenfield, S., Hays, R. D., Wells, K., Rogers, W. H., Berry, S. D., et al. (1989). Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA, 262, 907–913.CrossRefPubMedGoogle Scholar
  52. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  53. Villareal, D. T., Waters, D. L., & Qualls, C. (2017). Exercise type in dieting obese older adults. New England Journal of Medicine, 377, 598–600. CrossRefGoogle Scholar
  54. Ware, J., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233. CrossRefPubMedGoogle Scholar
  55. 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. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Health and Exercise ScienceWake Forest UniversityWinston-SalemUSA
  2. 2.Section on Geriatric Medicine, Department of Internal MedicineWake Forest School of MedicineWinston-SalemUSA
  3. 3.Department of Biostatistical SciencesWake Forest School of MedicineWinston-SalemUSA
  4. 4.College of KinesiologyUniversity of SaskatchewanSaskatoonCanada

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