Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults

O. G. Geirsdottir; M. Chang; P.V. Jonsson; I. Thorsdottir; A. Ramel

doi:10.1155/2019/5340328

Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults

Geirsdottir, O. G.;Chang, M.;Jonsson, P.V.;Thorsdottir, I.;Ramel, A. 2019-02-18 00:00:00 Hindawi Journal of Aging Research Volume 2019, Article ID 5340328, 10 pages https://doi.org/10.1155/2019/5340328 Clinical Study Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults 1,2 1,3 1,4 5,6 1,2 O. G. Geirsdottir, M. Chang, P.V. Jonsson, I. Thorsdottir, and A. Ramel e Icelandic Gerontological Research Institute, Reykjavik, Iceland Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland School of Education, University of Iceland, Reykjavik, Iceland Department of Geriatrics, National University Hospital of Iceland, Reykjavik, Iceland School of Health Sciences, University of Iceland, Reykjavik, Iceland Unit for Nutrition Research, University of Iceland, Reykjavik, Iceland Correspondence should be addressed to A. Ramel; alfonsra@hi.is Received 24 October 2018; Revised 28 December 2018; Accepted 4 February 2019; Published 18 February 2019 Academic Editor: Rainer Beurskens Copyright © 2019 O. G. Geirsdottir et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Obesity-related physiological changes can limit improvements of obese subjects after training. *e aim was to in- vestigate obesity, muscular strength, and physical function in community-dwelling nonsarcopenic old adults. Methods. Non- sarcopenic subjects (N � 229, 73.7± 5.7 years; 21% normal weight, 42% overweight, and 37% obese based on body mass index (BMI)) participated in a 12-week resistance exercise program. Leisure time physical activity (LTPA), body composition (dual- energy X-ray absorptiometry), quadriceps strength (maximum voluntary isometric contraction; absolute and relative to body weight), and physical function in terms of 6-minutes-walk-for-distance (6MWD) and timed up and go (TUG) were measured baseline and endpoint. Results. At baseline, normal weight participants had lower absolute quadriceps strength (−43± 22 N, P � 0.015) than obese, but better quadriceps strength relative to body weight (1.4± 0.7 N/kg, P< 0.001), 6MWD (53± 27 m, P< 0.001), and TUG (−1.4± 0.7 sec, P≤ 0.001). LTPA was positively associated with 6MWD and TUG (both P< 0.05), but based on general linear models, diﬀerences in LTPA between BMI categories did not explain diﬀerences in 6MWD and TUG between BMI categories. During the program, dropout (11.9%) and attendance (85%) were similar between BMI groups. After the intervention, body composition and physical function signiﬁcantly improved in all three BMI categories; however, normal weight participants lost more body fat (−1.53± 0.78%, P � 0.014), gained more lean mass (0.70± 0.36 kg, P< 0.001) and relative quadriceps strength (0.31± 0.16 N/kg, P � 0.017), and improved more on the 6MWD (24± 12 m, P< 0.001) but gained less grip strength (−2.4± 1.3 N/kg, P � 0.020) compared to obese. *ere were no diﬀerences in TUG or absolute quadriceps strength changes between the BMI strata. Physical function at baseline as well as training success of overweight participants was located between the normal weight and obesity groups. Conclusion. Nonsarcopenic obese community-dwelling old adults have lower physical function than their normal weight counterparts. *is diﬀerence is not explained by lower LTPA. A 12-week resistance exercise program improves body composition and physical function in normal weight, overweight, and obese old adults; however, obese participants experience less favorable changes in body composition and physical function than normal weight individuals. *is trial is registered with NCT01074879. changed physiologic milieu, e.g., alterations in insulin 1. Introduction sensitivity, sex hormones, and inﬂammatory cytokines [2, 3], Obesity has been increasing for several decades in Western and consequently, higher BMI has been regarded as risk countries, and an increased prevalence has also been ob- factor for diseases such as cardiovascular diseases, diabetes, served in old adults [1]. Obesity is characterized by a musculoskeletal disorders, and some cancers [4–6]. 2 Journal of Aging Research Unfavorable changes in body composition can be seen deﬁnition and diagnosis [18] were excluded. All measure- during ageing, i.e., body fat increases bit by bit while muscle ments were conducted at baseline (within one week before mass decreases [7, 8]. In particular, visceral and in- the intervention started) and endpoint of the study (within tramuscular fat usually increase, thus resulting into low one week after the intervention ended). muscle quality, while subcutaneous fat often actually de- clines with age. As maintenance of muscular strength and 2.2. Intervention. *e resistance exercise program has been physical function is a cornerstone of successful ageing, described in previous publications [12, 19]. In short, it was exercise has been widely recommended to ﬁght the decrease designed to increase strength and mass of major muscle in muscle mass in old adults and it possibly also prevents groups, and the participants exercised 3 days/week for twelve obesity [9]. Several studies have indicated that various weeks in groups supervised by study staﬀ. A training session training programs, either alone or in combination with included warmup (10–15 minutes), weight lifting (10 dif- dietary interventions, are eﬀective to improve body com- ferent exercises, 3 sets, each exercise was repeated 6–8 times position and physical function in old people [10–12]. at 75–80% of the 1-repetition maximum; 45–60 minutes), However, there are obesity-related physiological changes and cool down including stretching (10–15 minutes). [13–16], which can potentially limit improvements of obese subjects after training when compared to normal weight 2.3. Assessments subjects. In obese subjects, endocrinological disturbances after strength exercise have been reported, e.g., a blunted 2.3.1. Muscular Strength growth hormone response or a greater cortisol release. It has been suspected that these hormonal disturbances can lead to (1) Quadriceps Strength. Quadriceps strength (maximum a reduced lipolytic response and a decreased skeletal muscle voluntary isometric contraction (MVIC) in N) was tested protein synthesis [13]. Accordingly, experimental studies using an isokinetic dynamometer (Kin-Com 500H, conﬁrmed reduced stimulation of myoﬁbrillar protein Chattanooga). synthesis after feeding and resistance exercise in people with obesity when compared with their lean participants [14–16]. (2) Grip Strength. Hand grip strength (lb) was measured Whether reduced muscle protein synthesis measured in using a hydraulic hand dynamometer (Baseline Baseline short-term experiments actually translates into reduced Evaluations Corporation). success after a resistance exercise program of several weeks is currently unknown. In order to gain knowledge on obesity and its associa- 2.3.2. Physical Function tions with muscular strength and physical function in community-dwelling nonsarcopenic old adults, we con- (1) Six-Minutes-Walk-for-Distance (6MWD). *e 6MWD ducted this secondary data analysis based on results from a (in minutes) was conducted according to the guidelines from previously published randomized, controlled trial, originally the American *oracic Society [20]. designed to examine the eﬀect of postexercise protein in- gestion on the eﬃcacy of strength training [12]. (2) Timed Up and Go Test (TUG). *is test (shown as *e aim of the present study was to investigate whether seconds) was conducted as outlined in the publication from (1) nonsarcopenic obese old adults have poorer muscular Podsiadlo and Richardson [21]. strength and physical function than their normal and For more details, see [12] and [19]. overweight counterparts; (2) this relationship is confounded by leisure time physical activity; and (3) obese old adults 2.3.3. Body Composition. Body weight was measured in light show less training success when participating in a 12-week underwear on a calibrated scale (model no. 708; Seca, resistance exercise program. Hamburg, Germany), and height was measured with a calibrated stadiometer (model no. 206; Seca, Hamburg, 2. Methods Germany). BMI was calculated from height and weight (kg/ ). Participants were categorized according to their BMI 2.1. Subjects. Subjects (N � 236) at least 65 years old (range into normal weight (18.5–24.9 kg/m ), overweight (BMI 65–92 years) were invited for participation by advertise- 2 2 25.0–29.9 kg/m ), and obese (BMI≥ 30 kg/m ) [22]. Detailed ments distributed in the capital area of Iceland. *e fol- body composition (body fat (% and kg), lean mass (kg), and lowing exclusion criteria were used: low cognitive function appendicular skeletal muscle (kg)) was assessed by dual- (Mini-Mental State Examination (MMSE) ≤19 points) [17], energy X-ray absorptiometer (DXA) with Hologic QDR- major orthopedic disease, treatment with exogenous tes- 2000 plus , Hologic Inc., Waltham, MA, USA. tosterone or other medication aﬀecting lean mass, muscu- loskeletal disorders, or other disorders that could aﬀect their muscle mass. *e Icelandic National Bioethics Committee 2.3.4. Leisure Time Physical Activity (LTPA). Information approved the study protocol (VSNb2008060007/03-15). All on LTPA (shown as min/week) during the last 12 months subjects gave their written, informed consent for study was collected using a questionnaire [23] based on the participation. For the present analysis, participants with Compendium of Physical Activities [24] and Paﬀenberger’s sarcopenia as deﬁned by the revised European consensus on questionnaire [25]. Journal of Aging Research 3 2.3.5. Demographic Variables. Background variables (age was diﬀerent between BMI strata with a higher proportion of (years), current smoking (yes vs. no), and alcohol use (yes vs. males in the obesity category. Mean time of LTPA was no)) were assessed using questionnaires. 342± 341 minutes/week, and the two most frequent activities reported were walking and gardening. Both normal weight and overweight participants exercised more than obese 2.4. Statistical Analysis. Statistical analysis was conducted participants. *ere were obvious diﬀerences in body com- using SPSS for Windows version 24.0 (SPSS, Chicago, IL, position between strata. Normal weight participants had USA), and the level of signiﬁcance was P< 0.05. Data were lower quadriceps and grip strength when compared to obese, checked for normal distribution using the Kolmogorov– but better quadriceps strength relative to body weight, TUG, Smirnov test and are shown as mean± standard deviation and 6MWD. (SD). When further comparing physical strength and function between the three diﬀerent BMI strata using linear models controlling for various confounders (Table 2), we found that 2.4.1. Baseline Data. Crude comparisons between the three groups were done using 1-way ANOVA including LSD post when correcting for age and gender, diﬀerences in grip strength was no longer signiﬁcant between the groups. hoc test. In order to eliminate the potential confounding However, the diﬀerences in the other strength and function eﬀects of, e.g., age, uneven gender distribution and diﬀerent variables previously observed in the crude analyses remained levels of LTPA between the BMI categories, we used linear signiﬁcant. LTPA was positively associated with most of the models (general linear model–univariate in SPSS) correcting functional variables, but inclusion of LTPA in the models for these variables to further investigate baseline diﬀerences did only marginally change the diﬀerences in function be- in physical function and muscular strength between the tween BMI strata. groups: model 1 (intercept, BMI categories, age, and gender) Figure 1 shows actual physical function of participants and model 2 (additionally LTPA). stratiﬁed by BMI and LTPA (6 groups). *e ﬁgure indicates *e general linear model–univariate procedure in SPSS that BMI and LTPA are both independently associated with provides regression analysis and analysis of variance for one physical function. dependent variable by one or more factors (which divide the Quadriceps strength relative to body weight was stronger population into groups) and/or variables (continuous related to physical function than absolute quadriceps covariates). Both balanced and unbalanced models can be strength. We found that relative quadriceps strength tested, and this method is robust to departures from normal explained 23% and 29% of the variance observed in TUG and distribution [26]. 6MWD, respectively. Accordingly, absolute quadriceps Linear models (general linear model–univariate) were strength explained only 13% and 17% of the variance, also used to ﬁnd out how much variation either absolute or respectively. relative quadriceps strength explains of TUG and 6MWD (dependent variables). One-way ANOVA including LSD post hoc test was used 3.2. Training Eﬀects. During the 12-week resistance exer- to investigate whether there was a diﬀerence between par- cise program, dropout rate and attendance were similar ticipants when categorized into six groups according to their between the three BMI groups (Table 1). *e program BMI status (normal weight, overweight, and obese) and improved body composition (Figure 2) and physical LTPA (active and inactive). function of the participants (quadriceps strength: 53.5± 52.6 N; relative quadriceps strength: 0.65± 0.64 N/ 2.4.2. Intervention Eﬀects. In order to investigate changes kg body weight; grip strength: 3.1± 5.6 lb; 6MWD: after training in the three BMI categories, we used linear 33± 35 m; TUG: −0.64± 1.12 sec; all P< 0.001); however, models (general linear model–univariate) correcting for there were signiﬁcant diﬀerences between groups. potential confounders (anthropometric variables: corrected Figure 2 shows the estimated means of anthropometric for age and gender; muscular strength and physical function changes for each of the three categories (corrected for age changes: corrected for age, gender, and the corresponding and gender). Table 3 shows the diﬀerences in changes in baseline value). muscular strength and physical function changes between the three groups (corrected for age, gender, and the cor- 3. Results responding baseline value). Figure 3 shows the estimated improvements in muscular strength and physical function Only two of 236 participants were sarcopenic, and they were after the resistance exercise program in normal weight, excluded from the present analysis. All together, complete overweight, and obese participants based on calculations data from 229 participants were available. *e participants from Table 3. appeared to be healthy, but several had hypertension, hy- Normal weight participants lost more body fat and perlipidemia, or type 2 diabetes [19, 27]. gained more muscle mass and relative quadriceps strength when compared to obese. Further, normal weight partici- pants improved more on the 6MWD but gained less grip 3.1. Baseline Function. Baseline characteristics of the par- strength. *ere were no diﬀerences in improvements in ticipants stratiﬁed by BMI are shown in Table 1. Of the participants, 41.5% were male; however, gender distribution 4 Journal of Aging Research Table 1: Characteristics of the participants. ∗ ∗ ∗ All subjects Normal weight Overweight Obese Descriptives (N � 229) (N � 48) (N � 96) (N � 85) Mean± SD Mean± SD Mean± SD Mean± SD P value Age (years) 73.5± 5.7 74.1± 5.8 73.2± 6.2 73.3± 4.8 n.s. Male (%) 41.5 27.5 38.5 52.9 0.011 Smokers (yes in %) 6.0 5.9 4.2 8.3 n.s. Alcohol (yes in %) 81.5 80.4 85.1 78.8 n.s. 1,3 LTPA (min/week) 342± 342 445± 392 377± 351 252± 277 0.003 Dropout (%) 11.9 5.9 13.5 9.4 n.s. Attendance (%) 85.8± 20.2 87.1± 17.7 83.0± 23.5 88.1± 17.1 n.s. 1,2,3 Body weight (kg) 82.6± 17.5 64.9± 7.1 78.2± 10.9 98.1± 14.9 <0.001 1,2,3 Waist circumference (cm) 99.8± 14.5 84.4± 8.4 96.7± 8.7 112.9± 11.0 <0.001 2 1,2,3 BMI (kg/m ) 28.8± 4.8 23.0± 1.5 27.3± 1.5 33.9± <0.001 1,2,3 Body fat (%) 38.2± 7.3 33.5± 8.3 37.4± 6.0 42.1± 5.8 <0.001 1,2,3 Body fat (kg) 31.7± 9.9 21.7± 5.2 29.0± 4.7 41.2± 8.4 <0.001 1,2,3 Lean mass (kg) 47.9± 10 42.0± 7.0 46.3± 9.2 53.3± 9.8 <0.001 1,2,3 Appendicular skeletal muscle (kg) 24.4± 5.4 20.8± 3.2 23.7± 5.1 27.5± 5.1 <0.001 1,2 Quadriceps strength (N) 465± 124 417± 97 464± 119 496± 135 0.002 1,2,3 Relative quadriceps strength (N/kg BW) 5.7± 1.4 6.4± 1.2 5.9± 1.3 5.1± 1.4 <0.001 1,2 Grip strength (lb) 62.5± 19.1 56.3± 15.4 63.0± 20.1 65.9± 19.4 0.020 1,3 6MWD (m) 454± 79 479± 73 465± 81 426± 74 <0.001 1,2 TUG (sec) 7.9± 2.2 7.1± 1.3 8.0± 2.6 8.4± 2.0 0.003 1 2 3 One-way ANOVA including LSD post hoc test; normal weight vs. overweight signiﬁcant diﬀerence; normal weight vs. obese signiﬁcant diﬀerence; obese vs. overweight signiﬁcant diﬀerence. Table 2: Comparison in baseline function between normal weight, overweight, and obese participants using linear models . Model 1 Model 2 Parameter estimates dependent variable Parameter B 95% CI P value B 95% CI P value Intercept 1050.87 885.163 1216.58 <0.001 1007.37 838.628 1176.11 <0.001 Normal weight −34.949 −69.025 −0.874 0.044 −43.145 −77.696 −8.594 0.015 Overweight −10.293 −39.264 18.679 0.484 −14.575 −43.537 14.387 0.322 Obese Ref. Ref. Quadriceps strength (N) Age (years) −8.629 −10.901 −6.358 <0.001 −8.186 −10.472 −5.901 <0.001 Male 143.809 117.445 170.173 <0.001 143.484 117.358 169.610 <0.001 LTPA (min/week) 0.042 0.004 0.080 0.028 2 2 R � 43.4% R � 46.1% Intercept 9.713 7.518 11.908 <0.001 9.125 6.891 11.359 <0.001 Normal weight 1.511 1.060 1.963 <0.001 1.401 0.943 1.858 <0.001 Overweight 0.921 0.537 1.305 <0.001 0.863 0.480 1.247 <0.001 Obese Ref. Ref. Rel. quadriceps str. (N/kg BW) Age (years) −0.068 −0.098 −0.038 <0.001 −0.062 −0.092 −0.032 <0.001 Male 0.716 0.367 1.065 <0.001 0.711 0.366 1.057 <0.001 LTPA (min/week) 0.001 <0.001 0.001 0.025 2 2 R � 22.8% R � 26.1% Intercept 108.052 88.780 127.324 <0.001 105.186 85.406 124.966 <0.001 Normal weight −0.888 −4.851 3.075 0.659 −1.428 −5.478 2.622 0.488 Overweight 0.691 −2.678 4.061 0.686 0.409 −2.986 3.804 0.812 Obese Ref. Ref. Grip strength (lb) Age (years) −0.809 −1.073 −0.545 <0.001 −0.780 −1.048 −0.512 <0.001 Male 32.322 29.255 35.388 <0.001 32.300 29.238 35.363 <0.001 LTPA (min/week) 0.003 −0.002 0.007 0.216 2 2 R � 68.1% R � 69.1% Intercept 968.333 860.340 1076.33 <0.001 912.846 806.580 1019.11 <0.001 Normal weight 62.965 40.758 85.173 <0.001 52.512 30.753 74.271 <0.001 Overweight 45.106 26.226 63.987 <0.001 39.644 21.405 57.883 <0.001 Obese Ref. Ref. 6MWD (m) Age (years) −7.573 −9.053 −6.093 <0.001 −7.008 −8.447 −5.569 <0.001 Male 30.925 13.744 48.107 <0.001 30.511 14.058 46.964 <0.001 LTPA (min/week) 0.054 0.030 0.077 <0.001 2 2 R � 36.5% R � 44.0% Journal of Aging Research 5 Table 2: Continued. Model 1 Model 2 Parameter estimates dependent variable Parameter B 95% CI P value B 95% CI P value Intercept −6.690 −9.501 −3.879 <0.001 −5.655 −8.485 −2.825 <0.001 Normal weight −1.533 −2.111 −0.955 <0.001 −1.338 −1.917 −0.758 <0.001 Overweight −0.529 −1.021 −0.038 0.035 −0.427 −0.913 0.058 0.084 Obese Ref. Ref. TUG (sec) Age (years) 0.208 0.170 0.247 <0.001 0.198 0.159 0.236 <0.001 Male −0.483 −0.930 −0.036 0.034 −0.475 −0.913 −0.037 0.034 LTPA (min/week) −0.001 −0.002 <0.001 0.002 2 2 R � 32.2% R � 41.5% Linear models (general linear model–univariate in SPSS) to investigate baseline diﬀerences in physical function and muscular strength between the groups. 1 2 Model 1: intercept, BMI categories, age, and gender; model 2: additionally LTPA. as compared to female; LTPA, leisure time physical activity. Ref. Ref. Active Inactive Active Inactive 6MWD TUG Figure 1: Physical function (6MWD and TUG) according to six categories of BMI (normal weight, overweight, and obese) and LTPA (active and inactive). Values are expressed as % of the reference which is the normal weight-active category. Higher 6MWD and lower TUG indicate better physical function. Signiﬁcantly diﬀerent from the normal weight-active category according to 1-way ANOVA including LSD post hoc test. indicate normal weight, overweight, and obese, respectively. TUG or quadriceps strength between the BMI strata their average exercise time per day was close to the rec- (Table 3). ommended amount of at least 30 minutes [28]. Apparently, our participants were not representative for this age group, although physical function of our subjects was in accordance 4. Discussion with age; i.e., TUG time tended to be at the faster end of the reference spectrum [29] and 6MWD at the corresponding *e present study investigated the associations between slower end [30]. obesity, muscular strength, and physical function in non- At baseline, obese participants showed more absolute sarcopenic community-dwelling old adults in Iceland using strength, but part of this was explained by the uneven gender a cross-sectional as well as a longitudinal approach. At distribution between BMI categories. Relative to body baseline of our study, obese participants had higher absolute weight, though, normal weight participants were stronger. In quadriceps strength but lower physical function when our calculations, relative strength was a better predictor of compared to normal weight participants. After the resistance physical function than absolute strength, which is also re- exercise training program, both normal weight and obese ﬂected in the better TUG time and further 6MWD in the participants improved; however, more favorable changes in normal weight group. LTPA was higher in normal weight body composition and 6MWD were seen in the normal participants than in their obese peers, and it was positively weight group. Both baseline function and training success of related to physical function and strength, but interestingly, overweight participants were located between the normal the diﬀerence in LTPA between the BMI strata did not weight and obesity groups. explain their functional diﬀerences. 4.1. Baseline Characteristics and Function. Our participants were subjects who volunteered to take part in a 12-week 4.2. Resistance Exercise and Training Success. Our resistance resistance exercise program. *ey were physically active, and exercise program was successful with a low dropout rate, 6 Journal of Aging Research 1.5 0.5 –0.5 –1 –1.5 ∗∗ –2 –2.5 Body weight (kg) Waist (cm) Body fat (%) Body fat (kg) Lean mass (kg) ASM (kg) Normal weight Overweight Obese Figure 2: Estimated anthropometric changes after the resistance exercise program in normal weight, overweight, and obese participants. Estimates based on linear models (general linear model–univariate in SPSS) corrected for age and gender. Signiﬁcant diﬀerences between ∗∗ normal weight and obese participants. Borderline signiﬁcant diﬀerences (P � 0.08) between normal weight and obese participants. ASM, appendicular skeletal muscle. Table 3: Changes in strength and physical function after a resistance exercise training program in normal weight, overweight, and obese participants. Parameter estimates dependent variable Parameter B 95% CI P value Intercept 273.363 148.539 398.187 <0.001 Male 19.712 1.181 38.243 0.037 Normal weight −10.576 −29.920 8.769 0.282 Quadriceps strength (N) Overweight −6.924 −23.160 9.312 0.401 Obese Ref. Age (years) −2.384 −3.856 −0.912 0.002 Baseline quad. strength −0.104 −0.181 −0.027 0.008 Intercept 2.735 1.405 4.066 <0.001 Male 0.013 −0.172 0.199 0.888 Normal weight 0.307 0.054 0.560 0.017 Rel. quadriceps str. (N/kg BW) Overweight 0.159 −0.046 0.365 0.127 Obese Ref. Age (years) −0.022 −0.038 −0.005 0.010 Baseline rel. quad. strength −0.107 −0.177 −0.038 0.003 Intercept 28.282 15.938 40.625 <0.001 Male 3.499 0.756 6.242 0.013 Normal weight −2.420 −4.456 −0.384 0.020 Grip strength (lb) Overweight −1.542 −3.265 0.181 0.079 Obese Ref. Age (years) −0.259 −0.405 −0.114 0.001 Baseline grip strength (lb) −0.105 −0.176 −0.034 0.004 Intercept 214.698 119.155 310.240 <0.001 Male 4.029 −5.921 13.979 0.426 Normal weight 24.124 10.737 37.511 <0.001 6MWD (m) Overweight 14.586 3.349 25.823 0.011 Obese Ref. Age (years) −1.549 −2.564 −0.534 0.003 Baseline 6MWD (m) −0.175 −0.255 −0.096 <0.001 Journal of Aging Research 7 Table 3: Continued. Parameter estimates dependent variable Parameter B 95% CI P value Intercept −1.609 0.419 −3.637 0.119 Male 0.058 0.369 −0.252 0.711 Normal weight −0.303 0.124 −0.729 0.163 TUG (sec) Overweight −0.249 0.094 −0.592 0.154 Obese Ref. Age (years) 0.047 0.081 0.014 0.006 Baseline TUG (sec) −0.306 −0.196 −0.415 <0.001 Based on linear models (general linear model–univariate in SPSS) correcting for age, gender, and the corresponding baseline value. 4.1 0.79 0.78 0.72 0.64 56.2 2.5 49.2 0.48 0.47 45.6 ∗ 45.3 35.8 1.6 21.3 Absolute quadriceps Relative quadriceps Grip strength (lb) 6MWD (m) TUG (sec) strength (N) strength (N/kg BW) Normal weight Overweight Obese Figure 3: Estimated improvements in muscular strength and physical function after the resistance exercise program in normal weight, overweight, and obese participants. Estimates based on linear models (corrected for age, gender, and the corresponding baseline value) from Table 3. Signiﬁcant diﬀerences between categories. high attendance, and anthropometric as well as functional signiﬁcant diﬀerences for TUG; however, obese individuals improvements observed in all three BMI groups. *ese gained more grip strength during the intervention. Con- changes were in agreement with previous published studies sidering that attendance was similar, we can only speculate on the reasons for these observed diﬀerences, but they may [31–33]. In our study, dropout of 11.9% was low compared to be related to insulin resistance, intramuscular fat inﬁltration, earlier reported studies [34–36] and not signiﬁcantly dif- and/or inﬂammation which are disturbed metabolic features ferent BMI categories. *ere are several potential reasons frequently related to obesity [37, 38]. why dropout was low but we think in particular that our Insulin can stimulate skeletal muscle growth, and studies study population consisted of rather healthy volunteers who have shown that the hormone reduces muscle protein did neither represent the general population at this age nor a breakdown [39], as well as increases muscle protein syn- clinical sample of patients. It can be assumed that volunteers thesis [40], and thus, poor insulin sensitivity can have a show higher motivation and compliance towards physical negative eﬀect on muscle protein homeostasis. Further, it is training independently from the BMI category. thought that intramuscular adipose tissue is not only a After the 12 weeks, body composition improved more in consequence of increased body fatness or of loss of muscle normal weight than in obese participants as did relative quality during ageing or physical inactivity [37, 41, 42] but it quadriceps strength and gait speed. We did not observe any may also play an active role in aﬀecting muscular function by 8 Journal of Aging Research releasing inﬂammatory cytokines which results into lower and the Helga Jonsdottir and Sigurlidi Kristjansson Geriatric protein synthesis [43] and lower muscle quality [44], factors Research Fund. that all contribute to poorer muscle function and immobility in older adults [45]. 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Publisher: Hindawi Publishing Corporation
Copyright: Copyright © 2019 O. G. Geirsdottir et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN: 2090-2204
eISSN: 2090-2212
DOI: 10.1155/2019/5340328
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Abstract

Hindawi Journal of Aging Research Volume 2019, Article ID 5340328, 10 pages https://doi.org/10.1155/2019/5340328 Clinical Study Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults 1,2 1,3 1,4 5,6 1,2 O. G. Geirsdottir, M. Chang, P.V. Jonsson, I. Thorsdottir, and A. Ramel e Icelandic Gerontological Research Institute, Reykjavik, Iceland Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland School of Education, University of Iceland, Reykjavik, Iceland Department of Geriatrics, National University Hospital of Iceland, Reykjavik, Iceland School of Health Sciences, University of Iceland, Reykjavik, Iceland Unit for Nutrition Research, University of Iceland, Reykjavik, Iceland Correspondence should be addressed to A. Ramel; alfonsra@hi.is Received 24 October 2018; Revised 28 December 2018; Accepted 4 February 2019; Published 18 February 2019 Academic Editor: Rainer Beurskens Copyright © 2019 O. G. Geirsdottir et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Obesity-related physiological changes can limit improvements of obese subjects after training. *e aim was to in- vestigate obesity, muscular strength, and physical function in community-dwelling nonsarcopenic old adults. Methods. Non- sarcopenic subjects (N � 229, 73.7± 5.7 years; 21% normal weight, 42% overweight, and 37% obese based on body mass index (BMI)) participated in a 12-week resistance exercise program. Leisure time physical activity (LTPA), body composition (dual- energy X-ray absorptiometry), quadriceps strength (maximum voluntary isometric contraction; absolute and relative to body weight), and physical function in terms of 6-minutes-walk-for-distance (6MWD) and timed up and go (TUG) were measured baseline and endpoint. Results. At baseline, normal weight participants had lower absolute quadriceps strength (−43± 22 N, P � 0.015) than obese, but better quadriceps strength relative to body weight (1.4± 0.7 N/kg, P< 0.001), 6MWD (53± 27 m, P< 0.001), and TUG (−1.4± 0.7 sec, P≤ 0.001). LTPA was positively associated with 6MWD and TUG (both P< 0.05), but based on general linear models, diﬀerences in LTPA between BMI categories did not explain diﬀerences in 6MWD and TUG between BMI categories. During the program, dropout (11.9%) and attendance (85%) were similar between BMI groups. After the intervention, body composition and physical function signiﬁcantly improved in all three BMI categories; however, normal weight participants lost more body fat (−1.53± 0.78%, P � 0.014), gained more lean mass (0.70± 0.36 kg, P< 0.001) and relative quadriceps strength (0.31± 0.16 N/kg, P � 0.017), and improved more on the 6MWD (24± 12 m, P< 0.001) but gained less grip strength (−2.4± 1.3 N/kg, P � 0.020) compared to obese. *ere were no diﬀerences in TUG or absolute quadriceps strength changes between the BMI strata. Physical function at baseline as well as training success of overweight participants was located between the normal weight and obesity groups. Conclusion. Nonsarcopenic obese community-dwelling old adults have lower physical function than their normal weight counterparts. *is diﬀerence is not explained by lower LTPA. A 12-week resistance exercise program improves body composition and physical function in normal weight, overweight, and obese old adults; however, obese participants experience less favorable changes in body composition and physical function than normal weight individuals. *is trial is registered with NCT01074879. changed physiologic milieu, e.g., alterations in insulin 1. Introduction sensitivity, sex hormones, and inﬂammatory cytokines [2, 3], Obesity has been increasing for several decades in Western and consequently, higher BMI has been regarded as risk countries, and an increased prevalence has also been ob- factor for diseases such as cardiovascular diseases, diabetes, served in old adults [1]. Obesity is characterized by a musculoskeletal disorders, and some cancers [4–6]. 2 Journal of Aging Research Unfavorable changes in body composition can be seen deﬁnition and diagnosis [18] were excluded. All measure- during ageing, i.e., body fat increases bit by bit while muscle ments were conducted at baseline (within one week before mass decreases [7, 8]. In particular, visceral and in- the intervention started) and endpoint of the study (within tramuscular fat usually increase, thus resulting into low one week after the intervention ended). muscle quality, while subcutaneous fat often actually de- clines with age. As maintenance of muscular strength and 2.2. Intervention. *e resistance exercise program has been physical function is a cornerstone of successful ageing, described in previous publications [12, 19]. In short, it was exercise has been widely recommended to ﬁght the decrease designed to increase strength and mass of major muscle in muscle mass in old adults and it possibly also prevents groups, and the participants exercised 3 days/week for twelve obesity [9]. Several studies have indicated that various weeks in groups supervised by study staﬀ. A training session training programs, either alone or in combination with included warmup (10–15 minutes), weight lifting (10 dif- dietary interventions, are eﬀective to improve body com- ferent exercises, 3 sets, each exercise was repeated 6–8 times position and physical function in old people [10–12]. at 75–80% of the 1-repetition maximum; 45–60 minutes), However, there are obesity-related physiological changes and cool down including stretching (10–15 minutes). [13–16], which can potentially limit improvements of obese subjects after training when compared to normal weight 2.3. Assessments subjects. In obese subjects, endocrinological disturbances after strength exercise have been reported, e.g., a blunted 2.3.1. Muscular Strength growth hormone response or a greater cortisol release. It has been suspected that these hormonal disturbances can lead to (1) Quadriceps Strength. Quadriceps strength (maximum a reduced lipolytic response and a decreased skeletal muscle voluntary isometric contraction (MVIC) in N) was tested protein synthesis [13]. Accordingly, experimental studies using an isokinetic dynamometer (Kin-Com 500H, conﬁrmed reduced stimulation of myoﬁbrillar protein Chattanooga). synthesis after feeding and resistance exercise in people with obesity when compared with their lean participants [14–16]. (2) Grip Strength. Hand grip strength (lb) was measured Whether reduced muscle protein synthesis measured in using a hydraulic hand dynamometer (Baseline Baseline short-term experiments actually translates into reduced Evaluations Corporation). success after a resistance exercise program of several weeks is currently unknown. In order to gain knowledge on obesity and its associa- 2.3.2. Physical Function tions with muscular strength and physical function in community-dwelling nonsarcopenic old adults, we con- (1) Six-Minutes-Walk-for-Distance (6MWD). *e 6MWD ducted this secondary data analysis based on results from a (in minutes) was conducted according to the guidelines from previously published randomized, controlled trial, originally the American *oracic Society [20]. designed to examine the eﬀect of postexercise protein in- gestion on the eﬃcacy of strength training [12]. (2) Timed Up and Go Test (TUG). *is test (shown as *e aim of the present study was to investigate whether seconds) was conducted as outlined in the publication from (1) nonsarcopenic obese old adults have poorer muscular Podsiadlo and Richardson [21]. strength and physical function than their normal and For more details, see [12] and [19]. overweight counterparts; (2) this relationship is confounded by leisure time physical activity; and (3) obese old adults 2.3.3. Body Composition. Body weight was measured in light show less training success when participating in a 12-week underwear on a calibrated scale (model no. 708; Seca, resistance exercise program. Hamburg, Germany), and height was measured with a calibrated stadiometer (model no. 206; Seca, Hamburg, 2. Methods Germany). BMI was calculated from height and weight (kg/ ). Participants were categorized according to their BMI 2.1. Subjects. Subjects (N � 236) at least 65 years old (range into normal weight (18.5–24.9 kg/m ), overweight (BMI 65–92 years) were invited for participation by advertise- 2 2 25.0–29.9 kg/m ), and obese (BMI≥ 30 kg/m ) [22]. Detailed ments distributed in the capital area of Iceland. *e fol- body composition (body fat (% and kg), lean mass (kg), and lowing exclusion criteria were used: low cognitive function appendicular skeletal muscle (kg)) was assessed by dual- (Mini-Mental State Examination (MMSE) ≤19 points) [17], energy X-ray absorptiometer (DXA) with Hologic QDR- major orthopedic disease, treatment with exogenous tes- 2000 plus , Hologic Inc., Waltham, MA, USA. tosterone or other medication aﬀecting lean mass, muscu- loskeletal disorders, or other disorders that could aﬀect their muscle mass. *e Icelandic National Bioethics Committee 2.3.4. Leisure Time Physical Activity (LTPA). Information approved the study protocol (VSNb2008060007/03-15). All on LTPA (shown as min/week) during the last 12 months subjects gave their written, informed consent for study was collected using a questionnaire [23] based on the participation. For the present analysis, participants with Compendium of Physical Activities [24] and Paﬀenberger’s sarcopenia as deﬁned by the revised European consensus on questionnaire [25]. Journal of Aging Research 3 2.3.5. Demographic Variables. Background variables (age was diﬀerent between BMI strata with a higher proportion of (years), current smoking (yes vs. no), and alcohol use (yes vs. males in the obesity category. Mean time of LTPA was no)) were assessed using questionnaires. 342± 341 minutes/week, and the two most frequent activities reported were walking and gardening. Both normal weight and overweight participants exercised more than obese 2.4. Statistical Analysis. Statistical analysis was conducted participants. *ere were obvious diﬀerences in body com- using SPSS for Windows version 24.0 (SPSS, Chicago, IL, position between strata. Normal weight participants had USA), and the level of signiﬁcance was P< 0.05. Data were lower quadriceps and grip strength when compared to obese, checked for normal distribution using the Kolmogorov– but better quadriceps strength relative to body weight, TUG, Smirnov test and are shown as mean± standard deviation and 6MWD. (SD). When further comparing physical strength and function between the three diﬀerent BMI strata using linear models controlling for various confounders (Table 2), we found that 2.4.1. Baseline Data. Crude comparisons between the three groups were done using 1-way ANOVA including LSD post when correcting for age and gender, diﬀerences in grip strength was no longer signiﬁcant between the groups. hoc test. In order to eliminate the potential confounding However, the diﬀerences in the other strength and function eﬀects of, e.g., age, uneven gender distribution and diﬀerent variables previously observed in the crude analyses remained levels of LTPA between the BMI categories, we used linear signiﬁcant. LTPA was positively associated with most of the models (general linear model–univariate in SPSS) correcting functional variables, but inclusion of LTPA in the models for these variables to further investigate baseline diﬀerences did only marginally change the diﬀerences in function be- in physical function and muscular strength between the tween BMI strata. groups: model 1 (intercept, BMI categories, age, and gender) Figure 1 shows actual physical function of participants and model 2 (additionally LTPA). stratiﬁed by BMI and LTPA (6 groups). *e ﬁgure indicates *e general linear model–univariate procedure in SPSS that BMI and LTPA are both independently associated with provides regression analysis and analysis of variance for one physical function. dependent variable by one or more factors (which divide the Quadriceps strength relative to body weight was stronger population into groups) and/or variables (continuous related to physical function than absolute quadriceps covariates). Both balanced and unbalanced models can be strength. We found that relative quadriceps strength tested, and this method is robust to departures from normal explained 23% and 29% of the variance observed in TUG and distribution [26]. 6MWD, respectively. Accordingly, absolute quadriceps Linear models (general linear model–univariate) were strength explained only 13% and 17% of the variance, also used to ﬁnd out how much variation either absolute or respectively. relative quadriceps strength explains of TUG and 6MWD (dependent variables). One-way ANOVA including LSD post hoc test was used 3.2. Training Eﬀects. During the 12-week resistance exer- to investigate whether there was a diﬀerence between par- cise program, dropout rate and attendance were similar ticipants when categorized into six groups according to their between the three BMI groups (Table 1). *e program BMI status (normal weight, overweight, and obese) and improved body composition (Figure 2) and physical LTPA (active and inactive). function of the participants (quadriceps strength: 53.5± 52.6 N; relative quadriceps strength: 0.65± 0.64 N/ 2.4.2. Intervention Eﬀects. In order to investigate changes kg body weight; grip strength: 3.1± 5.6 lb; 6MWD: after training in the three BMI categories, we used linear 33± 35 m; TUG: −0.64± 1.12 sec; all P< 0.001); however, models (general linear model–univariate) correcting for there were signiﬁcant diﬀerences between groups. potential confounders (anthropometric variables: corrected Figure 2 shows the estimated means of anthropometric for age and gender; muscular strength and physical function changes for each of the three categories (corrected for age changes: corrected for age, gender, and the corresponding and gender). Table 3 shows the diﬀerences in changes in baseline value). muscular strength and physical function changes between the three groups (corrected for age, gender, and the cor- 3. Results responding baseline value). Figure 3 shows the estimated improvements in muscular strength and physical function Only two of 236 participants were sarcopenic, and they were after the resistance exercise program in normal weight, excluded from the present analysis. All together, complete overweight, and obese participants based on calculations data from 229 participants were available. *e participants from Table 3. appeared to be healthy, but several had hypertension, hy- Normal weight participants lost more body fat and perlipidemia, or type 2 diabetes [19, 27]. gained more muscle mass and relative quadriceps strength when compared to obese. Further, normal weight partici- pants improved more on the 6MWD but gained less grip 3.1. Baseline Function. Baseline characteristics of the par- strength. *ere were no diﬀerences in improvements in ticipants stratiﬁed by BMI are shown in Table 1. Of the participants, 41.5% were male; however, gender distribution 4 Journal of Aging Research Table 1: Characteristics of the participants. ∗ ∗ ∗ All subjects Normal weight Overweight Obese Descriptives (N � 229) (N � 48) (N � 96) (N � 85) Mean± SD Mean± SD Mean± SD Mean± SD P value Age (years) 73.5± 5.7 74.1± 5.8 73.2± 6.2 73.3± 4.8 n.s. Male (%) 41.5 27.5 38.5 52.9 0.011 Smokers (yes in %) 6.0 5.9 4.2 8.3 n.s. Alcohol (yes in %) 81.5 80.4 85.1 78.8 n.s. 1,3 LTPA (min/week) 342± 342 445± 392 377± 351 252± 277 0.003 Dropout (%) 11.9 5.9 13.5 9.4 n.s. Attendance (%) 85.8± 20.2 87.1± 17.7 83.0± 23.5 88.1± 17.1 n.s. 1,2,3 Body weight (kg) 82.6± 17.5 64.9± 7.1 78.2± 10.9 98.1± 14.9 <0.001 1,2,3 Waist circumference (cm) 99.8± 14.5 84.4± 8.4 96.7± 8.7 112.9± 11.0 <0.001 2 1,2,3 BMI (kg/m ) 28.8± 4.8 23.0± 1.5 27.3± 1.5 33.9± <0.001 1,2,3 Body fat (%) 38.2± 7.3 33.5± 8.3 37.4± 6.0 42.1± 5.8 <0.001 1,2,3 Body fat (kg) 31.7± 9.9 21.7± 5.2 29.0± 4.7 41.2± 8.4 <0.001 1,2,3 Lean mass (kg) 47.9± 10 42.0± 7.0 46.3± 9.2 53.3± 9.8 <0.001 1,2,3 Appendicular skeletal muscle (kg) 24.4± 5.4 20.8± 3.2 23.7± 5.1 27.5± 5.1 <0.001 1,2 Quadriceps strength (N) 465± 124 417± 97 464± 119 496± 135 0.002 1,2,3 Relative quadriceps strength (N/kg BW) 5.7± 1.4 6.4± 1.2 5.9± 1.3 5.1± 1.4 <0.001 1,2 Grip strength (lb) 62.5± 19.1 56.3± 15.4 63.0± 20.1 65.9± 19.4 0.020 1,3 6MWD (m) 454± 79 479± 73 465± 81 426± 74 <0.001 1,2 TUG (sec) 7.9± 2.2 7.1± 1.3 8.0± 2.6 8.4± 2.0 0.003 1 2 3 One-way ANOVA including LSD post hoc test; normal weight vs. overweight signiﬁcant diﬀerence; normal weight vs. obese signiﬁcant diﬀerence; obese vs. overweight signiﬁcant diﬀerence. Table 2: Comparison in baseline function between normal weight, overweight, and obese participants using linear models . Model 1 Model 2 Parameter estimates dependent variable Parameter B 95% CI P value B 95% CI P value Intercept 1050.87 885.163 1216.58 <0.001 1007.37 838.628 1176.11 <0.001 Normal weight −34.949 −69.025 −0.874 0.044 −43.145 −77.696 −8.594 0.015 Overweight −10.293 −39.264 18.679 0.484 −14.575 −43.537 14.387 0.322 Obese Ref. Ref. Quadriceps strength (N) Age (years) −8.629 −10.901 −6.358 <0.001 −8.186 −10.472 −5.901 <0.001 Male 143.809 117.445 170.173 <0.001 143.484 117.358 169.610 <0.001 LTPA (min/week) 0.042 0.004 0.080 0.028 2 2 R � 43.4% R � 46.1% Intercept 9.713 7.518 11.908 <0.001 9.125 6.891 11.359 <0.001 Normal weight 1.511 1.060 1.963 <0.001 1.401 0.943 1.858 <0.001 Overweight 0.921 0.537 1.305 <0.001 0.863 0.480 1.247 <0.001 Obese Ref. Ref. Rel. quadriceps str. (N/kg BW) Age (years) −0.068 −0.098 −0.038 <0.001 −0.062 −0.092 −0.032 <0.001 Male 0.716 0.367 1.065 <0.001 0.711 0.366 1.057 <0.001 LTPA (min/week) 0.001 <0.001 0.001 0.025 2 2 R � 22.8% R � 26.1% Intercept 108.052 88.780 127.324 <0.001 105.186 85.406 124.966 <0.001 Normal weight −0.888 −4.851 3.075 0.659 −1.428 −5.478 2.622 0.488 Overweight 0.691 −2.678 4.061 0.686 0.409 −2.986 3.804 0.812 Obese Ref. Ref. Grip strength (lb) Age (years) −0.809 −1.073 −0.545 <0.001 −0.780 −1.048 −0.512 <0.001 Male 32.322 29.255 35.388 <0.001 32.300 29.238 35.363 <0.001 LTPA (min/week) 0.003 −0.002 0.007 0.216 2 2 R � 68.1% R � 69.1% Intercept 968.333 860.340 1076.33 <0.001 912.846 806.580 1019.11 <0.001 Normal weight 62.965 40.758 85.173 <0.001 52.512 30.753 74.271 <0.001 Overweight 45.106 26.226 63.987 <0.001 39.644 21.405 57.883 <0.001 Obese Ref. Ref. 6MWD (m) Age (years) −7.573 −9.053 −6.093 <0.001 −7.008 −8.447 −5.569 <0.001 Male 30.925 13.744 48.107 <0.001 30.511 14.058 46.964 <0.001 LTPA (min/week) 0.054 0.030 0.077 <0.001 2 2 R � 36.5% R � 44.0% Journal of Aging Research 5 Table 2: Continued. Model 1 Model 2 Parameter estimates dependent variable Parameter B 95% CI P value B 95% CI P value Intercept −6.690 −9.501 −3.879 <0.001 −5.655 −8.485 −2.825 <0.001 Normal weight −1.533 −2.111 −0.955 <0.001 −1.338 −1.917 −0.758 <0.001 Overweight −0.529 −1.021 −0.038 0.035 −0.427 −0.913 0.058 0.084 Obese Ref. Ref. TUG (sec) Age (years) 0.208 0.170 0.247 <0.001 0.198 0.159 0.236 <0.001 Male −0.483 −0.930 −0.036 0.034 −0.475 −0.913 −0.037 0.034 LTPA (min/week) −0.001 −0.002 <0.001 0.002 2 2 R � 32.2% R � 41.5% Linear models (general linear model–univariate in SPSS) to investigate baseline diﬀerences in physical function and muscular strength between the groups. 1 2 Model 1: intercept, BMI categories, age, and gender; model 2: additionally LTPA. as compared to female; LTPA, leisure time physical activity. Ref. Ref. Active Inactive Active Inactive 6MWD TUG Figure 1: Physical function (6MWD and TUG) according to six categories of BMI (normal weight, overweight, and obese) and LTPA (active and inactive). Values are expressed as % of the reference which is the normal weight-active category. Higher 6MWD and lower TUG indicate better physical function. Signiﬁcantly diﬀerent from the normal weight-active category according to 1-way ANOVA including LSD post hoc test. indicate normal weight, overweight, and obese, respectively. TUG or quadriceps strength between the BMI strata their average exercise time per day was close to the rec- (Table 3). ommended amount of at least 30 minutes [28]. Apparently, our participants were not representative for this age group, although physical function of our subjects was in accordance 4. Discussion with age; i.e., TUG time tended to be at the faster end of the reference spectrum [29] and 6MWD at the corresponding *e present study investigated the associations between slower end [30]. obesity, muscular strength, and physical function in non- At baseline, obese participants showed more absolute sarcopenic community-dwelling old adults in Iceland using strength, but part of this was explained by the uneven gender a cross-sectional as well as a longitudinal approach. At distribution between BMI categories. Relative to body baseline of our study, obese participants had higher absolute weight, though, normal weight participants were stronger. In quadriceps strength but lower physical function when our calculations, relative strength was a better predictor of compared to normal weight participants. After the resistance physical function than absolute strength, which is also re- exercise training program, both normal weight and obese ﬂected in the better TUG time and further 6MWD in the participants improved; however, more favorable changes in normal weight group. LTPA was higher in normal weight body composition and 6MWD were seen in the normal participants than in their obese peers, and it was positively weight group. Both baseline function and training success of related to physical function and strength, but interestingly, overweight participants were located between the normal the diﬀerence in LTPA between the BMI strata did not weight and obesity groups. explain their functional diﬀerences. 4.1. Baseline Characteristics and Function. Our participants were subjects who volunteered to take part in a 12-week 4.2. Resistance Exercise and Training Success. Our resistance resistance exercise program. *ey were physically active, and exercise program was successful with a low dropout rate, 6 Journal of Aging Research 1.5 0.5 –0.5 –1 –1.5 ∗∗ –2 –2.5 Body weight (kg) Waist (cm) Body fat (%) Body fat (kg) Lean mass (kg) ASM (kg) Normal weight Overweight Obese Figure 2: Estimated anthropometric changes after the resistance exercise program in normal weight, overweight, and obese participants. Estimates based on linear models (general linear model–univariate in SPSS) corrected for age and gender. Signiﬁcant diﬀerences between ∗∗ normal weight and obese participants. Borderline signiﬁcant diﬀerences (P � 0.08) between normal weight and obese participants. ASM, appendicular skeletal muscle. Table 3: Changes in strength and physical function after a resistance exercise training program in normal weight, overweight, and obese participants. Parameter estimates dependent variable Parameter B 95% CI P value Intercept 273.363 148.539 398.187 <0.001 Male 19.712 1.181 38.243 0.037 Normal weight −10.576 −29.920 8.769 0.282 Quadriceps strength (N) Overweight −6.924 −23.160 9.312 0.401 Obese Ref. Age (years) −2.384 −3.856 −0.912 0.002 Baseline quad. strength −0.104 −0.181 −0.027 0.008 Intercept 2.735 1.405 4.066 <0.001 Male 0.013 −0.172 0.199 0.888 Normal weight 0.307 0.054 0.560 0.017 Rel. quadriceps str. (N/kg BW) Overweight 0.159 −0.046 0.365 0.127 Obese Ref. Age (years) −0.022 −0.038 −0.005 0.010 Baseline rel. quad. strength −0.107 −0.177 −0.038 0.003 Intercept 28.282 15.938 40.625 <0.001 Male 3.499 0.756 6.242 0.013 Normal weight −2.420 −4.456 −0.384 0.020 Grip strength (lb) Overweight −1.542 −3.265 0.181 0.079 Obese Ref. Age (years) −0.259 −0.405 −0.114 0.001 Baseline grip strength (lb) −0.105 −0.176 −0.034 0.004 Intercept 214.698 119.155 310.240 <0.001 Male 4.029 −5.921 13.979 0.426 Normal weight 24.124 10.737 37.511 <0.001 6MWD (m) Overweight 14.586 3.349 25.823 0.011 Obese Ref. Age (years) −1.549 −2.564 −0.534 0.003 Baseline 6MWD (m) −0.175 −0.255 −0.096 <0.001 Journal of Aging Research 7 Table 3: Continued. Parameter estimates dependent variable Parameter B 95% CI P value Intercept −1.609 0.419 −3.637 0.119 Male 0.058 0.369 −0.252 0.711 Normal weight −0.303 0.124 −0.729 0.163 TUG (sec) Overweight −0.249 0.094 −0.592 0.154 Obese Ref. Age (years) 0.047 0.081 0.014 0.006 Baseline TUG (sec) −0.306 −0.196 −0.415 <0.001 Based on linear models (general linear model–univariate in SPSS) correcting for age, gender, and the corresponding baseline value. 4.1 0.79 0.78 0.72 0.64 56.2 2.5 49.2 0.48 0.47 45.6 ∗ 45.3 35.8 1.6 21.3 Absolute quadriceps Relative quadriceps Grip strength (lb) 6MWD (m) TUG (sec) strength (N) strength (N/kg BW) Normal weight Overweight Obese Figure 3: Estimated improvements in muscular strength and physical function after the resistance exercise program in normal weight, overweight, and obese participants. Estimates based on linear models (corrected for age, gender, and the corresponding baseline value) from Table 3. Signiﬁcant diﬀerences between categories. high attendance, and anthropometric as well as functional signiﬁcant diﬀerences for TUG; however, obese individuals improvements observed in all three BMI groups. *ese gained more grip strength during the intervention. Con- changes were in agreement with previous published studies sidering that attendance was similar, we can only speculate on the reasons for these observed diﬀerences, but they may [31–33]. In our study, dropout of 11.9% was low compared to be related to insulin resistance, intramuscular fat inﬁltration, earlier reported studies [34–36] and not signiﬁcantly dif- and/or inﬂammation which are disturbed metabolic features ferent BMI categories. *ere are several potential reasons frequently related to obesity [37, 38]. why dropout was low but we think in particular that our Insulin can stimulate skeletal muscle growth, and studies study population consisted of rather healthy volunteers who have shown that the hormone reduces muscle protein did neither represent the general population at this age nor a breakdown [39], as well as increases muscle protein syn- clinical sample of patients. It can be assumed that volunteers thesis [40], and thus, poor insulin sensitivity can have a show higher motivation and compliance towards physical negative eﬀect on muscle protein homeostasis. Further, it is training independently from the BMI category. thought that intramuscular adipose tissue is not only a After the 12 weeks, body composition improved more in consequence of increased body fatness or of loss of muscle normal weight than in obese participants as did relative quality during ageing or physical inactivity [37, 41, 42] but it quadriceps strength and gait speed. We did not observe any may also play an active role in aﬀecting muscular function by 8 Journal of Aging Research releasing inﬂammatory cytokines which results into lower and the Helga Jonsdottir and Sigurlidi Kristjansson Geriatric protein synthesis [43] and lower muscle quality [44], factors Research Fund. that all contribute to poorer muscle function and immobility in older adults [45]. 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Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults

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Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults

Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults

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