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December 27, 1995

Effects of Weight Loss vs Aerobic Exercise Training on Risk Factors for Coronary Disease in Healthy, Obese, Middle-aged and Older Men: A Randomized Controlled Trial

Author Affiliations

From the Department of Medicine, Divisions of Gerontology (Drs Katzel, Colman, Rogus, and Goldberg) and Pulmonary Medicine (Dr Bleecker), University of Maryland School of Medicine, Baltimore, and Baltimore Veteran Affairs Medical Center Geriatrics Research, Education, and Clinical Center (Drs Katzel, Rogus, Goldberg, and Bleeker); and Laboratory of Clinical Physiology, Metabolism Section, Gerontology Research Center, National Institute on Aging, National Institutes of Health, Baltimore (Dr Sorkin).

JAMA. 1995;274(24):1915-1921. doi:10.1001/jama.1995.03530240025035

Objective.  —To compare the effects of weight loss vs aerobic exercise training on coronary artery disease risk factors in healthy sedentary, obese, middle-aged and older men.

Design.  —Randomized controlled trial.

Subjects.  —A total of 170 obese (body mass index, 30±1 kg/m2 [mean±SEM]), middle-aged and older (61 ±1 years) men.

Interventions.  —A 9-month diet-induced weight loss intervention, 9-month aerobic exercise training program, and a weight-maintenance control group.

Main Outcome Measures.  —Change in body composition, maximal aerobic capacity (Vo2max), blood pressure, lipoprotein concentrations, and glucose tolerance.

Results.  —Forty-four of 73 men randomized to weight loss completed the intervention and had a 10% mean reduction in weight (-9.5±0.7 kg; P<.001), with no change in Vo2max. Forty-nine of 71 men randomized to aerobic exercise completed the intervention, increased their Vo2max by a mean of 17% (P<.001), and did not change their weight, whereas the 18 men who completed in the control group had no significant changes in body composition or Vo2max. Weight loss decreased fasting glucose concentrations by 2%, insulin by 18%, and glucose and insulin areas during the oral glucose tolerance test (OGTT) by 8% and 26%, respectively (P<.01). By contrast, aerobic exercise did not improve fasting glucose or insulin concentrations or glucose responses during the OGTT but decreased insulin areas by 17% (P<.001). In analysis of variance, the decrement in fasting glucose and insulin levels and glucose areas with intervention differed between weight loss and aerobic exercise when compared with the control group (P<.05). Similarly, weight loss but not aerobic exercise increased high-density lipoprotein cholesterol levels (+13%) and decreased blood pressure compared with the control group. In multiple regression analyses, the improvement in lipoproteins and glucose metabolism was related primarily to the reduction in obesity.

Conclusions.  —These results suggest that weight loss is the preferred treatment to improve coronary artery disease risk factors in overweight, middle-aged and older men.(JAMA. 1995;274:1915-1921)

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