Weight Loss and Physical Activity in Obese Older Adults: Impact on Skeletal Muscle and Bone

Chapter

Abstract

The prevalence of overweight and obesity continues to be a major public health concern worldwide. Obesity is a major risk factor for the development of type II diabetes, cardiovascular disease, and increased mortality. Concerns about obesity and overweight among older adults have been far more controversial. The association of overweight and obesity with increased disease burden persists in older adults, and overweight and obesity are also strongly associated with the development of physical disability in this population. However, the efficacy for treatment of obesity in older adults remains an open debate. For obese older adults, who may require weight loss to reduce the risk of cardiometabolic syndrome, weight loss may not be recommended as the associated loss of bone and muscle could leave these individuals at higher risk for frailty and fracture. Thus, optimal strategies for reducing fat mass while preserving bone and muscle mass need to be further evaluated. This chapter will first review the usual age-related changes in skeletal muscle and bone mass with advancing age, the controversy surrounding intentional weight loss in older adults, and discuss the role of diet and physical activity interventions for the successful loss of body fat with specific reference to their effects on bone and skeletal muscle.

Keywords

Obesity Weight loss Sarcopenia Physical activity Energy restriction 

Abbreviations

aLM

Appendicular lean mass

BMD

Bone mineral density

FFM

Fat-free mass

FM

Fat mass

LM

Lean mass

References

  1. 1.
    Flegal KM, et al. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Launer LJ, et al. Body mass index, weight change, and risk of mobility disability in middle-aged and older women. The epidemiologic follow-up study of NHANES I. JAMA. 1994;271(14):1093–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Goya Wannamethee S, et al. Overweight and obesity and the burden of disease and disability in elderly men. Int J Obes Relat Metab Disord. 2004;28(11):1374–82.PubMedCrossRefGoogle Scholar
  4. 4.
    Jensen LB, Quaade F, Sorensen OH. Bone loss accompanying voluntary weight loss in obese humans. J Bone Miner Res. 1994;9(4):459–63.PubMedCrossRefGoogle Scholar
  5. 5.
    Ballor DL, et al. Resistance weight training during caloric restriction enhances lean body weight maintenance. Am J Clin Nutr. 1988;47(1):19–25.PubMedGoogle Scholar
  6. 6.
    Mossey JM, et al. Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health. 1989;79(3):279–86.PubMedCrossRefGoogle Scholar
  7. 7.
    Koval KJ, et al. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res. 1995;310:150–9.PubMedGoogle Scholar
  8. 8.
    Magaziner J, et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55(9):M498–507.PubMedCrossRefGoogle Scholar
  9. 9.
    Bonar SK, et al. Factors associated with short- versus long-term skilled nursing facility placement among community-living hip fracture patients. J Am Geriatr Soc. 1990;38(10):1139–44.PubMedGoogle Scholar
  10. 10.
    Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. Am J Public Health. 1997;87(3):398–403.PubMedCrossRefGoogle Scholar
  11. 11.
    Haran PH, Rivas DA, Fielding RA. Role and potential mechanisms of anabolic resistance in sarcopenia. J Cachexia Sarcopenia Muscle. 2012;3(3):157–162.PubMedCrossRefGoogle Scholar
  12. 12.
    Davidson LE, et al. An epidemiologic study of risk factors in two teenage suicide clusters. JAMA. 1989;262(19):2687–92.PubMedCrossRefGoogle Scholar
  13. 13.
    Roubenoff R. Origins and clinical relevance of sarcopenia. Can J Appl Physiol. 2001;26(1):78–89.PubMedCrossRefGoogle Scholar
  14. 14.
    Morley JE, et al. Sarcopenia. J Lab Clin Med. 2001;137(4):231–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Fielding, R.A., et al., Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc, 2011. 12(4): p. 249–56.Google Scholar
  16. 16.
    Ensrud KE, et al. Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures. J Bone Miner Res. 1995;10(11):1778–87.PubMedCrossRefGoogle Scholar
  17. 17.
    Greenspan SL, et al. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA. 1994;271(2):128–33.PubMedCrossRefGoogle Scholar
  18. 18.
    Steiger P, et al. Age-related decrements in bone mineral density in women over 65. J Bone Miner Res. 1992;7(6):625–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Cawthon PM, et al. Loss of hip BMD in older men: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. 2009;24(10):1728–35.PubMedCrossRefGoogle Scholar
  20. 20.
    Cummings SR, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet. 1993;341(8837):72–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Edelstein SL, Barrett-Connor E. Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol. 1993;138(3):160–9.PubMedGoogle Scholar
  22. 22.
    Hannan MT, Felson DT, Anderson JJ. Bone mineral density in elderly men and women: results from the Framingham osteoporosis study. J Bone Miner Res. 1992;7(5):547–53.PubMedCrossRefGoogle Scholar
  23. 23.
    Salamone LM, et al. Body composition and bone mineral density in premenopausal and early perimenopausal women. J Bone Miner Res. 1995;10(11):1762–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Glauber HS, et al. Body weight versus body fat distribution, adiposity, and frame size as predictors of bone density. J Clin Endocrinol Metab. 1995;80(4):1118–23.PubMedCrossRefGoogle Scholar
  25. 25.
    Marottoli RA, Berkman LF, Cooney Jr LM. Decline in physical function following hip fracture. J Am Geriatr Soc. 1992;40(9):861–6.PubMedGoogle Scholar
  26. 26.
    Koval KJ, et al. Dependency after hip fracture in geriatric patients: a study of predictive factors. J Orthop Trauma. 1996;10(8):531–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Binder EF, et al. Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial. JAMA. 2004;292(7):837–46.PubMedCrossRefGoogle Scholar
  28. 28.
    Visser M, et al. Change in muscle mass and muscle strength after a hip fracture: relationship to mobility recovery. J Gerontol A Biol Sci Med Sci. 2000;55(8):M434–40.PubMedCrossRefGoogle Scholar
  29. 29.
    Fontaine KR, Barofsky I. Obesity and health-related quality of life. Obes Rev. 2001;2(3):173–82.PubMedCrossRefGoogle Scholar
  30. 30.
    Harris TB, et al. Carrying the burden of cardiovascular risk in old age: associations of weight and weight change with prevalent cardiovascular disease, risk factors, and health status in the Cardiovascular Health Study. Am J Clin Nutr. 1997;66(4):837–44.PubMedGoogle Scholar
  31. 31.
    Javed F, et al. Association of BMI and cardiovascular risk stratification in the elderly African-American females. Obesity (Silver Spring). 2011;19(6):1182–6.CrossRefGoogle Scholar
  32. 32.
    Masaki KH, et al. Association of body mass index with blood pressure in elderly Japanese American men. The Honolulu Heart Program. Hypertension. 1997;29(2):673–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Mihel S, Milanovic SM. Association of elevated body mass index and hypertension with mortality: the CroHort study. Coll Antropol. 2012;36 Suppl 1:183–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Harris MI, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care. 1998;21(4):518–24.PubMedCrossRefGoogle Scholar
  35. 35.
    King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414–31.PubMedCrossRefGoogle Scholar
  36. 36.
    Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286(10):1195–200.PubMedCrossRefGoogle Scholar
  37. 37.
    Goodpaster BH, et al. Obesity, regional body fat distribution, and the metabolic syndrome in older men and women. Arch Intern Med. 2005;165(7):777–83.PubMedCrossRefGoogle Scholar
  38. 38.
    Blaum CS, et al. The association between obesity and the frailty syndrome in older women: the Women’s Health and Aging Studies. J Am Geriatr Soc. 2005;53(6):927–34.PubMedCrossRefGoogle Scholar
  39. 39.
    Davis MA, Ettinger WH, Neuhaus JM. The role of metabolic factors and blood pressure in the association of obesity with osteoarthritis of the knee. J Rheumatol. 1988;15(12):1827–32.PubMedGoogle Scholar
  40. 40.
    Felson DT, et al. Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med. 1988;109(1):18–24.PubMedGoogle Scholar
  41. 41.
    Bagge E, et al. Factors associated with radiographic osteoarthritis: results from the population study 70-year-old people in Goteborg. J Rheumatol. 1991;18(8):1218–22.PubMedGoogle Scholar
  42. 42.
    Spector TD, Hart DJ, Doyle DV. Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. Ann Rheum Dis. 1994;53(9):565–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Cicuttini FM, Spector T, Baker J. Risk factors for osteoarthritis in the tibiofemoral and patellofemoral joints of the knee. J Rheumatol. 1997;24(6):1164–7.PubMedGoogle Scholar
  44. 44.
    Felson DT, et al. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum. 1997;40(4):728–33.PubMedCrossRefGoogle Scholar
  45. 45.
    Gunther KP, et al. Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study. Ann Rheum Dis. 1998;57(12):717–23.PubMedCrossRefGoogle Scholar
  46. 46.
    Miller GD, et al. Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. Obesity (Silver Spring). 2006;14(7):1219–30.CrossRefGoogle Scholar
  47. 47.
    Messier SP, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004;50(5):1501–10.PubMedCrossRefGoogle Scholar
  48. 48.
    Peeters A, et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138(1):24–32.PubMedGoogle Scholar
  49. 49.
    Cornoni-Huntley JC, et al. An overview of body weight of older persons, including the impact on mortality. The National Health and Nutrition Examination Survey I – Epidemiologic Follow-up Study. J Clin Epidemiol. 1991;44(8):743–53.PubMedCrossRefGoogle Scholar
  50. 50.
    Jensen GL, Friedmann JM. Obesity is associated with functional decline in community-dwelling rural older persons. J Am Geriatr Soc. 2002;50(5):918–23.PubMedCrossRefGoogle Scholar
  51. 51.
    Villareal DT, et al. Physical frailty and body composition in obese elderly men and women. Obes Res. 2004;12(6):913–20.PubMedCrossRefGoogle Scholar
  52. 52.
    Stern JS, Thomas PR. A commentary on weighing the options: criteria for evaluating weight-management programs. Obes Res. 1995;3(6):589–90.PubMedCrossRefGoogle Scholar
  53. 53.
    Ensrud KE, et al. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc. 2003;51(12):1740–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Nguyen TV, Sambrook PN, Eisman JA. Bone loss, physical activity, and weight change in elderly women: the Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res. 1998;13(9):1458–67.PubMedCrossRefGoogle Scholar
  55. 55.
    Shah K, et al. Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones. J Bone Miner Res. 2011;26(12):2851–9.PubMedCrossRefGoogle Scholar
  56. 56.
    Ensrud KE, et al. Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. Study of Osteoporotic Fractures Research Group. Ann Intern Med. 2000;132(5):345–53.PubMedGoogle Scholar
  57. 57.
    Shapses SA, Sukumar D. Bone metabolism in obesity and weight loss. Annu Rev Nutr. 2012;32:287–309.PubMedCrossRefGoogle Scholar
  58. 58.
    Chao D, et al. Effect of voluntary weight loss on bone mineral density in older overweight women. J Am Geriatr Soc. 2000;48(7):753–9.PubMedGoogle Scholar
  59. 59.
    Riedt CS, et al. Overweight postmenopausal women lose bone with moderate weight reduction and 1 g/day calcium intake. J Bone Miner Res. 2005;20(3):455–63.PubMedCrossRefGoogle Scholar
  60. 60.
    Ricci TA, et al. Moderate energy restriction increases bone resorption in obese postmenopausal women. Am J Clin Nutr. 2001;73(2):347–52.PubMedGoogle Scholar
  61. 61.
    Thorpe MP, et al. A diet high in protein, dairy, and calcium attenuates bone loss over twelve months of weight loss and maintenance relative to a conventional high-carbohydrate diet in adults. J Nutr. 2008;138(6):1096–100.PubMedGoogle Scholar
  62. 62.
    Sukumar D, et al. Areal and volumetric bone mineral density and geometry at two levels of protein intake during caloric restriction: a randomized, controlled trial. J Bone Miner Res. 2011;26(6):1339–48.PubMedCrossRefGoogle Scholar
  63. 63.
    Shapses SA, et al. Bone turnover and density in obese premenopausal women during moderate weight loss and calcium supplementation. J Bone Miner Res. 2001;16(7):1329–36.PubMedCrossRefGoogle Scholar
  64. 64.
    Dengel DR, et al. Effects of weight loss by diet alone or combined with aerobic exercise on body composition in older obese men. Metabolism. 1994;43(7):867–71.PubMedCrossRefGoogle Scholar
  65. 65.
    Gallagher D, et al. Weight loss in postmenopausal obesity: no adverse alterations in body composition and protein metabolism. Am J Physiol Endocrinol Metab. 2000;279(1):E124–31.PubMedGoogle Scholar
  66. 66.
    Houston DK, et al. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr. 2008;87(1):150–5.PubMedGoogle Scholar
  67. 67.
    Dunn MA, Houtz SK, Hartsook EW. Effects of fasting on muscle protein turnover, the composition of weight loss, and energy balance of obese and nonobese Zucker rats. J Nutr. 1982;112(10):1862–75.PubMedGoogle Scholar
  68. 68.
    Goodman MN, McElaney MA, Ruderman NB. Adaptation to prolonged starvation in the rat: curtailment of skeletal muscle proteolysis. Am J Physiol. 1981;241(4):E321–7.PubMedGoogle Scholar
  69. 69.
    Clark AS, Mitch WE. Comparison of protein synthesis and degradation in incubated and perfused muscle. Biochem J. 1983;212(3):649–53.PubMedGoogle Scholar
  70. 70.
    Villareal DT, et al. Effect of weight loss on the rate of muscle protein synthesis during fasted and fed conditions in obese older adults. Obesity (Silver Spring). 2012;20:1780–6.CrossRefGoogle Scholar
  71. 71.
    Campbell WW, et al. Resistance training preserves fat-free mass without impacting changes in protein metabolism after weight loss in older women. Obesity (Silver Spring). 2009;17(7):1332–9.Google Scholar
  72. 72.
    Hughes VA, et al. Longitudinal muscle strength changes in older adults: influence of muscle mass, physical activity, and health. J Gerontol A Biol Sci Med Sci. 2001;56(5):B209–17.PubMedCrossRefGoogle Scholar
  73. 73.
    Chan K, et al. A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. Arch Phys Med Rehabil. 2004;85(5):717–22.PubMedCrossRefGoogle Scholar
  74. 74.
    Walker M, et al. Longitudinal evaluation of supervised versus unsupervised exercise programs for the treatment of osteoporosis. Eur J Appl Physiol. 2000;83(4–5):349–55.PubMedCrossRefGoogle Scholar
  75. 75.
    White MK, et al. The effects of exercise on the bones of postmenopausal women. Int Orthop. 1984;7(4):209–14.PubMedCrossRefGoogle Scholar
  76. 76.
    Kemmler W, et al. Exercise effects on fitness and bone mineral density in early postmenopausal women: 1-year EFOPS results. Med Sci Sports Exerc. 2002;34(12):2115–23.PubMedCrossRefGoogle Scholar
  77. 77.
    Cussler EC, et al. Weight lifted in strength training predicts bone change in postmenopausal women. Med Sci Sports Exerc. 2003;35(1):10–7.PubMedCrossRefGoogle Scholar
  78. 78.
    Nelson ME, et al. A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. Am J Clin Nutr. 1991;53(5):1304–11.PubMedGoogle Scholar
  79. 79.
    Yamazaki S, et al. Effect of walking exercise on bone metabolism in postmenopausal women with ­osteopenia/osteoporosis. J Bone Miner Metab. 2004;22(5):500–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Taaffe DR, et al. Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults. J Am Geriatr Soc. 1999;47(10):1208–14.PubMedGoogle Scholar
  81. 81.
    Ettinger Jr WH, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997;277(1):25–31.PubMedCrossRefGoogle Scholar
  82. 82.
    Buchner DM, et al. The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol A Biol Sci Med Sci. 1997;52(4):M218–24.PubMedCrossRefGoogle Scholar
  83. 83.
    Schlicht J, Camaione DN, Owen SV. Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. J Gerontol A Biol Sci Med Sci. 2001;56(5):M281–6.PubMedCrossRefGoogle Scholar
  84. 84.
    Seguin R, Nelson ME. The benefits of strength training for older adults. Am J Prev Med. 2003;25(3 Suppl 2):141–9.PubMedCrossRefGoogle Scholar
  85. 85.
    Frontera WR, et al. Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol. 1988;64(3):1038–44.PubMedGoogle Scholar
  86. 86.
    Brown M, Sinacore DR, Host HH. The relationship of strength to function in the older adult. J Gerontol A Biol Sci Med Sci. 1995; 50 spec no:55–9.Google Scholar
  87. 87.
    Villareal DT, et al. Effect of weight loss and exercise on frailty in obese older adults. Arch Intern Med. 2006;166(8):860–6.PubMedCrossRefGoogle Scholar
  88. 88.
    Villareal DT, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011;364(13):1218–29.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Nutrition, Exercise Physiology, and Sarcopenia LaboratoryJean Mayer Human Nutrition Research Center on Aging at Tufts UniversityBostonUSA

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