Even though the monetary and health costs of obesity are substantial, intentional weight loss has not been advocated for older people, because a relationship between weight loss and increased rates of hip fractures and mortality has been demonstrated. However, intentional weight loss as opposed to unintentional weight loss has actually been shown to decrease total mortality in older adults. Even small weight losses of 5 to 10% have been shown to result in increased physical function and health-related quality of life, yet standard exercise programs for older adults often do not result in any weight loss. One example of this is cardiac rehabilitation (CR), which generally results in insignificant weight loss over a 3-month time frame. However, even the highest-risk overweight patients can lose fat and overall weight, as well as achieve a more favorable cardiometabolic risk profile, when encouraged to participate in a high-calorie-expenditure (HCE) exercise program rather than a standard CR protocol.
Recent evidence suggests that higher levels of exercise (≥2,500 kcal/week) may facilitate weight loss and maintenance when included as part of a behavioral weight control program. A commonly mentioned barrier to implementing such vigorous exercise programs for older adults is the belief that only extremely motivated patients will comply with a more time-consuming program. However, a study recently published in the Journal of Aging and Physical Activity found that participants in a high-calorie-expenditure (HCE) exercise program actually grew to like exercise more than those who took part in a standard exercise program.
Participants in the HCE program were asked to exercise more frequently than those in the standard program (at least 5 days per week rather than 3) and to increase the length of each session by approximately 20 minutes (45-60 minutes vs. 25-40 minutes). Walking was the preferred exercise for those in the HCE group, and those in the standard group followed a protocol of 25 minutes of treadmill walking and 8 minutes on an ergometer. Both groups also took part in a behavioral weight-loss program. At the end of 5 months, the HCE group had lost more than twice as much weight as those in the standard group, greatly reduced their cardiometabolic risk factors, and reported improved vitality and mood. What’s more, participants saw improvements regardless of their level of physical function when they entered the program, showing that older adults of varying abilities can be successful in a rigorous exercise program.
Noticeable weight loss helped participants to enjoy exercise more, so they stuck with the program. As they exercised more, they noticed improved mood, less pain, and better general health and physical functioning. Most health care practitioners, when counseling patients, emphasize the importance of weight loss from a cardiometabolic perspective. The results of this study demonstrate that weight loss improves a patient’s perceived quality of life. An improvement in quality of life may be more of a motivating factor than improvements in specific cardiovascular risk factors. From a patient’s perspective, for example, an improvement in quality of life may be more meaningful than a reduction in triglyceride levels. Therefore, as a means of increasing compliance, health care professionals may want to counsel patients that weight loss will not only lower cardiovascular risk but also improve quality of life.
HCE exercise led not only to more weight loss than a standard CR program but also to greater improvements in self-assessments of physical, social, and emotional functioning, as well as larger increases in exercise enjoyment, for at-risk older adults. Improvements in several of these psychosocial variables were mediated by weight loss, which most likely resulted from a combination of the increased exercise of the HCE group and participation in the behavioral weight-control program. Furthermore, the study indicates that older adults in various mental and physical states can benefit from an exercise program. One of the most important conclusions of this study is that not only can older adults perform higher levels of exercise than are currently recommended, but also the higher exercise levels actually impart additional physical and mental benefits.
Find out more about the Journal of Aging and Physical Activity at www.JAPA-Journal.com.