Source: UNIVERSITY OF RHODE ISLAND submitted to
HEALTHY LIVING FOR OLDER ADULTS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
TERMINATED
Funding Source
Reporting Frequency
Annual
Accession No.
0216415
Grant No.
(N/A)
Project No.
RI00HI-89
Proposal No.
(N/A)
Multistate No.
(N/A)
Program Code
(N/A)
Project Start Date
Oct 1, 2008
Project End Date
Sep 30, 2010
Grant Year
(N/A)
Project Director
Lofgren, I. E.
Recipient Organization
UNIVERSITY OF RHODE ISLAND
19 WOODWARD HALL 9 EAST ALUMNI AVENUE
KINGSTON,RI 02881
Performing Department
NUTRITION & FOOD SCIENCE
Non Technical Summary
Obesity-related disability and heart disease in older adults is an urgent public health problem. Additionally, aging is associated with a decline in muscle mass that is associated with losses of muscle power, which has been shown to play a strong role in an individual's physical functioning. Resistance training has been shown to be an ideal intervention strategy for improving physical functioning in at-risk older adults, but its effectiveness in improving function and heart disease risk factors has not been tested in a weight loss setting. The primary aims of this interdisciplinary study are to 1) evaluate the impact of a novel, muscle power-focused, resistance exercise training (PT) program when combined with a well-validated weight loss intervention (Dietary Approaches to Stop Hypertension - DASH-WL) in a group of overweight and obese men and women versus a DASH-WL only group(Phase 1) and 2) implement a community based outreach intervention in four RI senior centers targeting overweight and obese older adults who are also at risk of disability and CHD (Phase 2). The PT exercise program for both phases will focus on resistance exercise training that employs more rapid exercise movements with lighter resistances, which has been shown to have similar benefits on muscle function in older adults compared to traditional resistance exercise training. Participants of Phase 1 will be community-dwelling older adults who are overweight or obese (body mass index (BMI) between 25.0-39.9 kg/m2) and in need of weight loss based on national guidelines. In order to evaluate the impact of the PT training with weight loss on physical functioning and heart disease risk factors, participants in both groups in Phase 1 will be tested baseline and after the intervention to evaluate changes in physical function, muscle power, body composition, and blood lipid (e.g. cholesterol and triglyceride) profile. Results from this innovative study will be both submitted for publication and used as pilot data for more thoroughly developed NIH and USDA grant proposals. The results from phase 1 will also be utilized to formulate a community-based intervention (Phase 2). The power training with weight loss based on the DASH diet that was implemented in Phase 1 will be modified in order to be implemented in four Rhode Island senior centers targeting overweight and obese older adults who are also at risk of disability and coronary heart disease. As with Phase 1, the community outreach program (Phase 2) will examine whether a PT/DASH-WL intervention designed for at-risk older adults will increase participants' physical function while decreasing certain markers of CHD risk. One-hundred overweight and obese (BMI 25.0-39.9 kg/m2) older adults, aged 60 to 75 years of age will be recruited to take part in a 10-week intervention program. The results from both phases will be used to design a more comprehensive study that will combine other intervention strategies in order to make recommendations for optimizing body composition for improving physical function and reducing CHD risk for the growing community of overweight and obese older adults in the U.S.
Animal Health Component
60%
Research Effort Categories
Basic
(N/A)
Applied
60%
Developmental
40%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7035010101050%
7246010302050%
Goals / Objectives
Obesity-related disability and coronary heart disease (CHD) in older adults are urgent public health problems. Also, aging is associated with declining muscle mass that is associated with muscle power loss, which plays a role in physical functioning. Resistance training is ideal for improving physical functioning in at-risk older adults, but its effectiveness in improving function and CHD risk factors has not been fully tested. The primary aims of this interdisciplinary study are to 1) evaluate the impact of a novel, muscle power-focused, resistance exercise (PT) program combined with a well-validated weight loss intervention (Dietary Approaches to Stop Hypertension - DASH-WL) in a group of overweight/obese men and women (Phase 1) and 2) implement a community based outreach program in 4 RI senior centers targeting overweight/obese older adults (Phase 2). Primary Aim 1: Assess changes in physical function in response to PT/DASH-WL compared to DASH-WL (reference group). Hypothesis (H) 1. PT/DASH-WL will improve physical function and this will be significantly greater than observed in the reference group. Primary Aim 2: Compare changes in biochemical and clinical measures of CHD in response to PT/DASH-WL and the reference group. H1. PT/DASH-WL will have significantly larger decreases in total cholesterol, low density lipoprotein cholesterol, and triglycerides compared with the reference group. H2. PT/DASH-WL will result higher concentrations of high density lipoprotein cholesterol compared with the reference group. H3. PT/DASH-WL will result in a significant decrease in blood pressure compared with the reference group. Primary Aim 3: To examine the effect of PT/DASH-WL on physical function and CHD risk profile in older adults at senior centers. H1: PT/DASH-WL will result in significant improvements in physical function measures compared to baseline. Hypothesis 2: PT/DASH-WL will result in significant improvements in blood pressure and lipids compared to baseline. Secondary Aim 1: To determine effect of PT/DASH-WL on improving muscle power and attenuating loss of lean mass compared to the reference group. H1. PT/DASH-WL will result in increases in leg extensor muscle power that will be significantly greater than the reference group. H2. PT/DASH-WL will have an attenuated loss of skeletal muscle mass compared to the reference group. H3. PT/DASH-WL will have a significant increase in leg extensor muscle power quality compared to the reference group. Primary aims 1 and 2 and secondary aim 1 will help form the community based outreach intervention in which a modified PT/DASH program will be done with older adults attending senior centers. It is expected that PT will improve physical function and muscle power, decrease CHD risk, and attenuate the loss of lean mass with weight loss. These improvements are necessary as many older adults in RI and nationally are at risk for functional limitations and disability and CHD remains the number one cause of death. The lack of integrative diet and exercise programs in the community make this an essential program that will strengthen the breadth of current intervention strategies offered for older adults.
Project Methods
This randomized clinical trial will examine the hypothesis that compared to a diet only intervention; power muscle training combined with dietary intervention will significantly improve muscle power, physical function, and decrease CHD risk in overweight and obese older adults. 30 overweight, obese adults, aged 60-75 years will be randomized to 1 of 2 groups; 1) PT/DASH-WL or 2) DASH-WL. The following will be completed by all participants at baseline and post-intervention (Phase I). The short physical performance battery and 400 meter walk test will be completed. Blood lipids will be determined from fasted blood samples collected on two non-consecutive morning visits in one week. Blood pressure and anthropometrics will be measured according to standardized protocols. Participants will complete a medical history, a survey on personal satisfaction, and a food frequency questionnaire. Leg extensors of both legs will be tested and the first leg will be selected randomly. Leg extensor power and one repetition maximum (1-RM) will be measured using a customized pneumatic resistance machine. Full body composition and CT imaging of the thighs will be performed. Randomization will occur after all baseline testing. Each group will meet with study dietary staff 1x/ week for 10 weeks in 30 minute sessions. The weight loss goal for all participants will be 5%-10%. PT will be done by subjects in the PT/DASH-WL group 3x/week on non-consecutive days for 10 weeks. To formulate an effective interdisciplinary community-based outreach intervention for Phase II, study staff will work with gerontology consultants. SNAP will facilitate entrance into the senior centers, scheduling of orientations and presentations, recruitment, and retention. The primary modifications will be combining dietary information and PT exercises into ten weekly 30-minute sessions. Phase II will examine whether a PT/DASH-WL intervention designed for at-risk older adults will increase participants' physical function while decreasing their CHD risk. One-hundred overweight and obese, sedentary older adults, aged 60 to 75 years will be recruited to take part in the 10-week intervention program. A total of 100 seniors, 25 from 4 different RI senior centers will be recruited primarily via personal contact with study staff such as health presentations at the senior centers or displays at local retail stores. Once in the study, nutrition and exercise goals will be reviewed concurrently and study staff will demonstrate to participants how to do the PT exercises. The PT portion will be completed with equipment such as exercise bands and hand and ankle weights. The research staff conducting the sessions will supervise the participants and be sure that there is no undue stress during the exercise for the participants. These measures will be completed at baseline and at the end of the 10-week intervention of Phase II in a private area at the senior center that participants attend. Physical function and blood pressure testing will be performed. The Cholestech LDX system will be utilized to obtain blood lipid values. A 4-month follow-up will be completed.

Progress 10/01/08 to 09/30/10

Outputs
OUTPUTS: The overall purpose of the study was to improve physical functioning, power, body composition and biomarkers for coronary heart disease in overweight and obese older adults. Phase one was a randomized clinical trial testing moderate intensity resistance training with weight loss versus weight loss alone. Twenty-seven participants completed the entire study. Individual and group results from the study were shared with the subjects at a group meeting in January 2009. In addition, the study is part of a multi-state project, NE1023, and the results from "Healthy Living for Older Adults" were shared at the NE1023 annual meeting (June 2009). Three graduate and ten undergraduate students were mentored and trained by the two PIs. A formative evaluation of the clinical research was performed to develop the community-based intervention that was completed in the second year. Phase two was a quasi-experimental community outreach research study in which phase one protocol was modified to complete at Rhode Island senior centers. Ninety-five older adults attending one of four Rhode Island Senior centers participated in an 8-week resistance training and dietary education intervention. There were significant improvements in weight, body composition, strength, and dietary quality after the eight weeks. Participants received their data and an explanation of the results at the end of the study. The results have been shared at six conferences; 1) University of Rhode Island's Kinesiology Graduate Student Research Night (April 2009 and 2010), 2) American College of Sports Medicine (May/June 2009 and 2010), and 3) Experimental Biology (April 2009 and 2010). Phase three was completed in the spring of 2010. It was a pilot study in which 10 obese women completed a 12-week Tai Chi and diet education intervention. These participants received videos of the full Tai Chi set of motions so they could continue to do the Tai Chi once the study was over. The participants of phase three also received their results at the end of the intervention. The total sample size available for analysis was too small to find significant changes in body weight and body mass index but there was a significant increase in flexibility. A total of eight graduate students and thirty undergraduate students were trained on current nutrition and exercise science research methodology for older adult populations. PARTICIPANTS: Matthew Delmonico and Ingrid Lofgren - PIs - Drs Delmonico and Lofgren were responsible for conceiving the project including writing of the proposal. They were responsible for training of the graduate and undergraduate students, implementation and oversight of the data collection and intervention. Josh Avila, Julie Guiterries, Chad Straight, and Leah Dorfman were the Kinesiology graduate student study coordinators and Meg Sheehy and Kathryn Cottell were the Nutrition graduate student study coordinators. They had direct oversight of the undergraduates and were the liaisons between the study subjects and the PIs. They were the coordinators for recruitment, data collection, planning, developing, and teaching the nutrition and physical activity education sessions, data management, and dissemination. All graduate students received extensive training in all the assessment methods, with the most intensive training in biochemical and dietary assessment. Three other graduate students were trained (but did not receive any funding from this study) on anthropometric, biochemical, clinical, and dietary assessment measures. Twenty undergraduates received training on nutrition and exercise physiology research methods and helped with recruiting, data collection, data review, data management, peer review of dissemination materials, and scientific writing. The PIs and graduate students completed professional development by attending conferences in which study results were disseminated. TARGET AUDIENCES: Phase one of the project targeted overweight and obese older community members to take part in a randomized trial examining the impact of diet education and high-velocity resistance training on physical and muscle function, body composition, and coronary heart disease risk. Phase two targeted overweight and obese older adults who frequented Rhode Island senior centers to examine the impact of resistance training and diet education in a community setting on physical functioning, body composition, diet quality, and heart disease risk. Phase three targeted obese sedentary women to take part in a pilot study of the impact of Tai Chi and diet education on similar outcomes as phase one. A second target group for all phases of the study was the group of undergraduate and graduate students who were trained on the study. PROJECT MODIFICATIONS: Phase III was added at the end of the first year to be completed during the second half of the second year. Eleven obese older women were recruited to complete a combined intervention of Tai Chi exercise and the DASH diet. This group had similar measures and dietary education as compared to phase one of the study in order for a three group comparison.

Impacts
Change in Knowledge. The PIs developed a high velocity resistance training and diet education program that decreased fat mass, sustained lean mass, and improved selected lipid measures. The trainees received extensive knowledge on all components of research methodology including study design, recruitment, screening, testing, intervention delivery, and dissemination of results to subjects and the scientific community. Twenty-nine community members completed the study. The PIs and trainees formulated phase II of the study which was a modified version of the clinical trial that took place in the community. The trainees received experiential learning in the community working with the ninety-five participants from four different Rhode Island senior centers that completed the study. The PIs also developed an 12-week Tai Chi and dietary education intervention that was pilot tested by 11 women. Change in Actions. The trainees also continued to learn additional techniques and methodologies necessary for graduation. One of the graduate students was accepted to a PhD program after he graduated in May of 2009. Two of the undergraduate trainees decided to enter the Masters program after they graduated in May 2009 to work on phase II of the study. All subjects (n=29) implemented aspects of the DASH diet and 16 of the subjects completed a resistance training program. The subjects in phase II improved their strength and dietary quality which suggests change in behaviors. The subjects in phase III with the Tai Chi intervention improved their flexibility. Change in Condition. There was a significant reduction in percent body fat and increase in muscle function in 16 subjects in phase I. In addition, subjects in phase one in both groups increased their physical functioning. We now have a better basic knowledge of how moderate intensity resistance training with dietary changes appears to improve body and muscle composition, physical functioning, and select lipids. This was an efficacious way to intervene with overweight and obese older adults. The improvements seen in weight, body composition, and dietary quality by the phase II subjects translates to improved physical functioning and decreased risk for coronary heart disease.

Publications

  • Avila JJ, Gutierres JA, Sheehy ME, Lofgren IE, Delmonico MJ. 2010. Effect of Moderate Intensity Resistance Training during Weight Loss on Body Composition and Physical Performance in Overweight Older Adults. European Journal of Applied Physiology. 109(3):517-525.
  • Cottell KE, Dorfman LR, Straight CR, Delmonico MJ, Lofgren IE. 2010. The Effects of Diet Education Plus Light Resistance Training on Coronary Heart Disease Risk Factors in Community-Dwelling Older Adults. Journal of Nutrition, Health, and Aging. Accepted.
  • Cottell KE, Dorfman LR, Straight CR, Delmonico MJ, Lofgren IE. 2010. Assessment of Overweight and Obese Older Adults using a Dietary Questionnaire and Biochemical Values. FASEB J. 24:738.1. (Abstract)
  • Straight C, Dorfman L, Cottell K, Lofgren IE, Delmonico MJ. 2010. Can Isometric Knee Extensor Torque from Hand-held Dynamometry Predict Physical Function in Overweight Older Adults Medicine & Science in Sports & Exercise. 42;5. (Abstract)
  • Dorfman LR, Straight CR, Cottell KE, Riebe DA, Lofgren IE, Delmonico MJ. 2010. Body Composition Indices and their Association with Physical Functioning in Community-Dwelling Older Adults. Medicine & Science in Sports & Exercise. 42;5. (Abstract)
  • Krol, J. 2010. Effects of Tai Chi and Diet on Physical Function in Obese Older Women. University of Rhode Island, Kingston RI. (MS thesis)


Progress 10/01/08 to 09/30/09

Outputs
OUTPUTS: The overall purpose of the study is to improve physical functioning, power, body composition and biomarkers for coronary heart disease in overweight and obese older adults. The first phase was a randomized clinical trial testing moderate intensity resistance training with weight loss versus weight loss alone. Twenty-seven participants completed the entire study. Individual and group results from the study were shared with the subjects at a group meeting in January 2009. The results have been shared at three conferences; 1)University of Rhode Island's Kinesiology Graduate Student Research Night (April 2009), 2) American College of Sports Medicine (May/June 2009), and 3) Experimental Biology (April 2009). In addition, the study is part of a multi-state project, NE1023, and the results from "Healthy Living for Older Adults" were shared at the NE1023 meeting (June 2009). Three graduate and ten undergraduate students were mentored and trained by the two PIs. These same three graduate students completed the requirements for their Masters between May and August of 2009 using data from "Healthy Living for Older Adults". A formative evaluation of the clinical research was performed to develop the community-based intervention to be completed in the second year. PARTICIPANTS: Matthew Delmonico and Ingrid Lofgren - PIs - Drs Delmonico and Lofgren were responsible for conceiving the project including writing of the proposal. They were responsible for training of the graduate and undergraduate students, implementation and oversite of the data collection and intervention. Josh Avila, Julie Gutierres,and Megan Sheey - graduate students - The three graduate students were responsible for carrying out the screening and intervention. They also had direct oversite of the undergraduates and were the liaisons between the study subjects and the PIs. PIs and graduate students completed professional development by attending conferences in which study results were disseminated. TARGET AUDIENCES: The project targeted overweight and obese older community members to take part in a randomized trial examining the impact of diet education and high velocity resistance training on physical and muscle function, body composition, and coronary heart disease risk. PROJECT MODIFICATIONS: Phase III has been added to the current project and will be completed during the spring of 2010. Fifteen obese older women will be recruited to complete a combined intervention of Tai Chi exercise and the DASH diet. This group will have similar measures and dietary education as compared to phase I of the study in order for a three group comparison.

Impacts
Change in Knowledge The PIs developed a high velocity resistance training and diet education program that decreased fat mass, sustained lean mass, and improved selected lipid measures. The trainees received extensive knowledge on all components of research methodology including study design, recruitment, screening, testing, intervention delivery, and dissemination of results to subjects and the scientific community. Twenty-nine community members completed the study. Change in Actions The PIs and trainees formulated phase II of the study which was a modified version of the clinical trial that took place in the community. The trainees also continued to learn additional techniques and methodologies necessary for graduation. Two of the undergraduate trainees decided to enter the Masters program after they graduated in May 2009 to work on phase II. All subjects (29) implemented aspects of the DASH diet and 16 of the subjects completed a resistance training program. Change in Condition There was a significant reduction in %body fat and increase in muscle function in 16 subjects. Subjects in both groups increased their physical functioning. We now have a better basic knowledge of how moderate intensity resistance training with dietary changes appears to improve body and muscle composition, physical functioning, and select lipids. This seems to be an efficacious way to intervene with overweight and obese older adults. A larger study should be done to test effectiveness in order to add this type of intervention to other options to improve outcomes stated above.

Publications

  • Sheehy ME, Avila JJ, Gutierres JA, Delmonico MJ, Lofgren IE. 2009. Association of dietary intake with sarcopenia prevalence. FASEB J. 23:548.4.
  • Avila J, Sheehy M, Gutierres J, Manfredi T, Lofgren I, Delmonico M. 2009. Determinants of peak leg extensor muscle power in overweight and obese older adults. Medicine and Science in Sports and Exercise. 41(5):528-529.
  • Avila JJ. 2009. Effect of muscle power training and weight loss on physical performance in community dwelling overweight and obese older adults. MS Thesis. University of Rhode Island, Kingston RI.
  • Gutierres JA. 2009. Effect of power training and weight loss on muscle composition and blood glucose in overweight and obese older adults. MS Thesis. University of Rhode Island, Kingston RI.
  • Sheehy, ME. 2009. Effects of diet education plus power training on heart disease risk factors of overweight and obese older adults. MS Thesis. University of Rhode Island, Kingston RI.