Multimodel Exercise and Weight Loss in Older Obese Veterans With Dysmobility

Not Applicable

Completed

Interventions: Behavioral: Multi Modal Balance Training
Behavioral: Weight Loss

Brief Summary: Obesity is a major risk factor for mobility problems in older adults and many older adults use a walking aid to help with their mobility. The use of a walking aid changes normal walking patterns and makes walking harder, leading people to have more functional problems. The purpose of this study is to test the effects of 12 months of a multi-modal balance intervention (MMBI) with supervised weight loss compared to MMBI only on fitness, functional performance, balance, and economy of gait. Participants will be one of 120 participants in the VA Maryland Health Care System (VAMHCS). Participation in this study is voluntary. The research will be conducted at the VAMHCS. The entire study will take approximately 4 years to complete. Subjects' participation in the study will last 24 months.

Detailed Description: Note: Study has been completed, enrollment and study interventions were severely impacted by coronavirus disease 2019 (COVID)

Older obese adults suffer disproportionately from walking mobility limitations. Sedentary, obese older adults are at an increased risk for having or developing difficulties with mobility. These individuals are often excluded from studies due to their advanced mobility limitations. A number of studies have compared the effects of weight loss alone, exercise alone, or weight loss in combination with exercise on functional performance in older adults, but none of the studies have specifically targeted subjects who use walking assistive devices. The purpose of this study is to test the effects of a 12 month multi-modal exercise rehabilitation intervention with a nutrition program versus a nutrition program only on fitness, functional performance, mobility, and muscle mass. The results of this study will lead to new and more effective interventions that could reduce disability, fall risk, injury-related hospitalization and death in older Veterans.

Recruitment & Eligibility

Inclusion Criteria

Age >= 60
Body Mass Index (BMI) >= 30 kg/m2
Dysmobility as define by 1 or more of the following: Use of or prescribed an assistive walking device, measured gait speed < 1.0 m/s, Four Square Step Test >/= 12 secs OR inability to complete the Four Square Step Test, and/or self-reported difficulty walking 1 km.
Community dwelling

Exclusion Criteria

Unable to walk >0.2 mph on a treadmill for 2 minutes
Poorly controlled hypertension >180 systolic or >100 diastolic
Episodes of acute coronary syndrome, coronary revascularization, or major cardiac/vascular procedures within the prior 6 months
New York Heart Association Class 3 or 4 heart failure
Symptomatic angina at rest or during exercise
Syncope within the past 12 months without known cause or resolution
Chronic lung disease required oxygen dependency
Severe spinal stenosis limiting ambulation
Known dementia
Mini Mental State Exam score <24
Transtibial or above the knee amputation
Currently enrolled and active in a supervised exercise program or Weight Management Program for Veterans (MOVE)
Poorly controlled diabetes as defined by HbA1C >10% or frequent hypoglycemic episodes
Currently undergoing chemotherapy and/or radiation therapy for cancer treatment

Arm && Interventions

Group	Intervention	Description
Multi Modal Balance Training & Weight Loss	Weight Loss	Supervised exercise 3 times per week for about 1 hour. The classes will consist of a group balance class (about 30 minutes), a supervised obstacle course (about 10 minutes), and lower body and core body strength exercises (about 20 minutes). Weekly nutrition sessions for individual dietary recommendations designed to produce about a 10% weight loss over the first six months of the study.
Multi Modal Balance Training & Weight Loss	Multi Modal Balance Training	Supervised exercise 3 times per week for about 1 hour. The classes will consist of a group balance class (about 30 minutes), a supervised obstacle course (about 10 minutes), and lower body and core body strength exercises (about 20 minutes). Weekly nutrition sessions for individual dietary recommendations designed to produce about a 10% weight loss over the first six months of the study.
Multi Modal Balance Training Only	Multi Modal Balance Training	Supervised exercise 3 times per week for about 1 hour. The classes will consist of a group balance class (about 30 minutes), a supervised obstacle course (about 10 minutes), and lower body and core body strength exercises (about 20 minutes).

Primary Outcome Measures

Name	Time	Method
Change in 6 Minute Walk Distance	6 months	Distance walked during the 6 minute walking test

Secondary Outcome Measures

Name	Time	Method
Change in Short Physical Performance Battery	baseline, 3 months	overall short physical performance battery score. Scale range 0 - 12 with higher scores indicating better possible function.
Change in 6 Minute Walk With Oxygen Uptake (VO2) Measurement	6 months	6 minute walk with submaximal assessment of oxygen uptake as a measure of fitness.
Change in Gait Biomechanics	6 months	Gait biomechanics as assessed by walking mechanics on the gait rite mat. Scale range 0 - 24 with higher scores indicating better outcome.
Change in Lean Mass as Assessed by Dual Energy X Ray Absorptiometry (DXA) Scan	baseline, 6 months	The DXA scan provides information about the body composition including total body fat, and lean muscle mass
Change in Four Square Step Test	baseline, 3 months	Dynamic test of balance involving change in stepping direction.
Change in 8 Foot up and go	baseline, 3 months	Time to get up from a chair and walk around a cone 8 feet away and sit back down, representing agility.