Weight loss therapy of older adults with obesity is limited by weight loss–induced decrease in bone mineral density (BMD), which could exacerbate ongoing age‐related bone loss and increase the risk for fractures. Therefore, it is recommended that weight loss therapy of older adults with obesity should include an intervention such as regular exercise to reduce the concomitant bone loss. However, the most appropriate exercise types to combine with weight loss therapy in this older population is unknown. In a randomized controlled trial, we performed a head‐to‐head comparison of aerobic or resistance exercise, or both, during matched ~10% weight loss in 160 older adults with obesity. We measured changes in BMD (total hip, femoral neck, trochanter, intertrochanter, one‐third radius, lumbar spine) and bone markers. Changes between groups were analyzed using mixed‐model repeated measures analyses of variance. After 6 months of intensive lifestyle interventions, BMD decreased less in the resistance group (−0.006 g/cm² [−0.7%]) and combination group (−0.012 g/cm² [−1.1%]) than in the aerobic group (−0.027 g/cm² [−2.6%]) (p = 0.001 for between‐group comparisons). Serum C‐telopeptide, procollagen type 1 N‐propeptide, and osteocalcin concentrations increased more in the aerobic group (33%, 16%, and 16%, respectively) than in the resistance group (7%, 2%, and 0%, respectively) and combination group (11%, 2%, and 5%, respectively) (p = 0.004 to 0.048 for between‐group comparisons). Multiple regression analyses revealed that the decline in whole body mass and serum leptin were the independent predictors of the decline in hip BMD (multiple R = 0.45 [p < .001]). These findings indicate that compared with aerobic exercise, resistance and combined aerobic and resistance exercise are associated with less weight loss–induced decrease in hip BMD and less weight loss–induced increase in bone turnover. Therefore, both resistance and combined aerobic and resistance exercise can be recommended to protect against bone loss during weight loss therapy of older adults with obesity. (LITOE ClinicalTrials.gov number NCT01065636.) © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

中文翻译：

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有氧运动或阻力运动对肥胖的老年人节食时骨矿物质密度和骨代谢的影响：一项随机对照试验。

体重减轻引起的骨矿物质密度（BMD）降低，限制了肥胖症老年人的减肥治疗，这可能加剧与年龄有关的持续骨质流失并增加骨折的风险。因此，建议老年肥胖者的减肥治疗应包括定期运动等干预措施，以减少随之而来的骨质流失。然而，在这个老年人群中，最合适的运动方式与减肥疗法相结合尚不明确。在一项随机对照试验中，我们对160名肥胖的成年人进行了有氧运动或抗阻力运动，或两者同时进行的〜10％的体重减轻，进行了头对头的比较。我们测量了BMD（总髋部，股骨颈，转子，转子间，三分之一radius骨，腰椎）和骨标记物的变化。使用混合模型重复测量方差分析来分析组之间的变化。经过6个月的强化生活方式干预后，抵抗组的BMD下降较少（-0.006 g / cm² [-0.7％]）和组合组（-0.012 g / cm ² [-1.1％]）比有氧组（-0.027 g / cm ² [-2.6％]）（组间比较p = 0.001 ）。有氧组（分别为33％，16％和16％）的血清C-端肽，1型前胶原N-前肽和骨钙素浓度的增加比抗药性组（7％，2％和0％）高，分别）和组合组（分别为11％，2％和5％）（组间比较p = 0.004至0.048）。多元回归分析显示，全身质量和血清瘦素的下降是髋部BMD下降的独立预测因子（多个R = 0.45 [ p <.001]）。这些发现表明，与有氧运动相比，抵抗力以及有氧运动和阻力运动的组合与体重减轻（引起的髋部BMD减少）和体重减轻（引起的骨代谢增加）较少相关。因此，在肥胖的老年人进行减肥治疗期间，建议同时进行抗阻力运动和有氧运动与抗阻力运动的组合，以防止骨质流失。（LITOE ClinicalTrials.gov编号NCT01065636。）©2019美国骨矿物质研究学会。出版于2019年。本文是美国政府的工作，在美国属于公共领域。