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December 27, 1995, Vol 274, No. 24 >
ARTICLE | 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: Title and subTitle BreakA Randomized Controlled Trial FREE

Leslie I. Katzel, MD, PhD; Eugene R. Bleecker, MD; Eric G. Colman, MD; Ellen M. Rogus, PhD; John D. Sorkin, MD; Andrew P. Goldberg, MD
[+] Author Affiliations

Reprint requests to Baltimore VA Medical Center, Geriatrics Service/GRECC (18), 10 N Greene St, Baltimore, MD 21201 (Dr Katzel).


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

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)

REFERENCES

1 +
Borkan GA, Norris AH.  Fat redistribution and the changing body dimensions of the adult male. Hum Biol . 1977;;3:495-514.
2 +
Meyers D, Goldberg AP, Coon PJ, Drinkwater DT, Bleecker ER.  Relationship of obesity and physical fitness to cardiopulmonary and metabolic function in healthy older men. J Gerontol . 1991;;46:M57-M65.
3 +
Coon PJ, Bleecker ER, Drinkwater DT, Meyers DA, Goldberg AP.  Effects of body composition and exercise capacity on glucose tolerance, insulin, and lipoprotein lipids in healthy older men: a cross-sectional and longitudinal intervention study. Metabolism . 1989;:12:1201-1209.
4 +
Fraze E, Chiou M, Chen I, Reaven GM.  Age-related changes in postprandial plasma glucose, insulin, and free fatty acid concentrations in nondiabetic individuals. J Am Geriatr Soc . 1987;; 35:224-228.
5 +
National Cholesterol Education Program Expert Panel, National Heart, Lung, and Blood Institute.  Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Arch Intern Med . 1988;;148:36-69.
6 +
Hellenius ML, de Faire U, Berglund B, Hamsten A, Krakau I.  Diet and exercise are equally effective in reducing risk for cardiovascular disease: results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Atherosclerosis . 1993;;103:81-91.
7 +
Wood PD, Stefanick ML, Dreon DM, et al.  Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med . 1988;;319: 1173-1179.
8 +
Wood PD, Stefanick ML, Williams PT, Haskell WL.  The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. N Engl J Med . 1991;;325:461-466.
9 +
King AC, Haskell WL, Taylor B, Kraemer HC, De Busk RF.  Group- vs home-based exercise training in healthy older men and women: a community-based clinical trial. JAMA . 1991;;266:1535-1542.
10 +
Blumenthal JA, Emery CF, Madden DJ, et al.  Effects of exercise training on cardiorespiratory function in men and women >60 years of age. Am J Cardiol . 1991;;67:633-639.
11 +
Morey MC, Cowper PA, Feussner JR, et al.  Two-year trends in physical performance following supervised exercise among community-dwelling older veterans. J Am Geriatr Soc . 1991;;39:986-992.
12 +
Katzel LI, Coon PJ, Busby MJ, Gottlieb SO, Krauss RM, Goldberg AP.  Reduced HDL2 cholesterol subspecies and elevated postheparin lipase activity in older men with abdominal obesity and asymptomatic myocardial ischemia. Arterioscler Thromb . 1992;;12:814-823.
13 +
Dennis KE, Goldberg AP.  Differential effects of body fatness and body fat distribution on risk factors for cardiovascular disease in women. Arterioscler Thromb . 1993;;13:1487-1494.
14 +
Bruce RA, Horsten TR.  Exercise testing in the evaluation of patients with ischemic heart disease. Prog Cardiovasc Dis . 1969;;11:371-390.
15 +
American Heart Association Steering Committee for Medical and Community Programs.  Phase I diet. Circulation . 1985;;62:A449-A455.
16 +
Siri WE.  The gross composition of the body. Adv Biol Med Phys . 1956;;4:239-240.
17 +
Klimt CR, Prout TE, Bradley RF, et al.  Standardization of the oral glucose tolerance test. Diabetes . 1969;;18:299-310.
18 +
Warnick R, Benderson JM, Albers JJ.  Quantitation of high density lipoprotein subclasses after separation by dextran sulfate and Mg2++ precipitation. Clin Chem . 1982;;28:1379-1388.
19 +
Gidez LI, Miller GJ, Burstein M, Slagle S, Eder HA.  Separation and quantification of subclasses of human plasma high denstiy lipoproteins by a simple precipitation procedure. J Lipid Res . 1982;;23:1206-1223.
20 +
Friedewald WT, Levy RI, Fredrickson DS.  Estimation of the concentration of low density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem . 1972;;18: 499-502.
21 +
Tran ZV, Weltman A, Glass GV, Mood DP.  The effects of exercise on blood lipids and lipoproteins: a meta-analysis of studies. Med Sci Sports Exerc . 1983;;15:393-402.
22 +
Schwartz RS.  The independent effects of dietary weight loss and aerobic training on high density lipoproteins and apolipoprotein A-I concentrations in obese men. Metabolism . 1987;;36:165-171.
23 +
Millar JS, Lichtenstein AH, Cuchel M, et al.  Impact of age on the metabolism of VLDL, IDL, and LDL apolipoprotein B-100 in men. J Lipid Res . 1995;;36:1155-1167.
24 +
Seals DR, Hagberg JM.  The effect of exercise training on human hypertension: a review. Med Sci Sports Exerc . 1984;;16:207-215.
25 +
Fortmann SP, Haskell WL, Wood PD, and the Stanford Weight Control Project Team.  Effects of weight loss on clinic and ambulatory blood pressure in normotensive men. Am J Cardiol . 1988;;62:89-93.
26 +
Casassus P, Fontbonne A, Thibult N, et al.  Upper-body fat distribution: a hyperinsulinemia-independent predictor of coronary heart disease mortality: the Paris Prospective Study. Arterioscler Thromb . 1992;;12:1387-1392.
27 +
Bergstrom RW, Newell-Morris LL, Leonetti DL, Shuman WP, Wahl PW, Fujimoto WY.  Association of elevated fasting C-peptide level and increased intrabdominal fat distribution in the development of NIDDM in Japanese-American men. Diabetes . 1990;;39:104-111.
28 +
Kohrt WM, Kirwan JP, Staten MA, Bourey RE, King DS, Holloszy JO.  Insulin resistance in aging is related to abdominal obesity. Diabetes . 1993;;42:273-281.
29 +
Sparrow DS, Borkan GA, Gerzof SG, Wisniewski C, Silbert CK.  Relationship of fat distribution to glucose tolerance: results of computed tomography in male participants of the normative aging study. Diabetes . 1986;;35:411-415.
30 +
Ostlund RE, Staten M, Kohrt WM, Schultz J, Malley M.  The ratio of waist-to-hip circumference, plasma insulin level, and glucose intolerance as independent predictors of HDL2-cholesterol levels in older adults. N Engl J Med . 1990;;322:229-234.
31 +
Schwartz RS, Shuman WP, Larson V, et al.  The effect of intensive endurance exercise training on body fat distribution in young and older men. Metabolism . 1993;;40:545-551.
32 +
Wing RR, Jeffery RW, Burton LR, Thorson C, Kuller LI, Folson AR.  Change in waist-hip ratio with weight loss and its association with change in cardiovascular risk factors. Am J Clin Nutr . 1992;; 55:1086-1092.
33 +
Dattilo AM, Kris-Etherton PM.  Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr . 1992;;56:320-328.
34 +
Hughes VA, Fiatarone MA, Ferrara CM, McNamara JR, Charnley JM, Evans WJ.  Lipoprotein response to exercise training and a low-fat diet in older subjects with glucose intolerance. Am J Clin Nutr . 1994;;59:820-826.
35 +
Kokkinos PF, Holland JC, Narayan P, Colleran JA, Dotson CO, Papademetriou V.  Miles run per week and high density lipoprotein cholesterol levels in healthy, middle-aged men. Arch Intern Med . 1995;;155:415-420.
36 +
Wood PD, Haskell WL, Blair SN, et al.  Increased exercise level and plasma lipoprotein concentrations: a one-year, randomized, controlled study in sedentary, middle-aged men. Metabolism . 1983;; 32:31-39.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Borkan GA, Norris AH.  Fat redistribution and the changing body dimensions of the adult male. Hum Biol . 1977;;3:495-514.
2 +
Meyers D, Goldberg AP, Coon PJ, Drinkwater DT, Bleecker ER.  Relationship of obesity and physical fitness to cardiopulmonary and metabolic function in healthy older men. J Gerontol . 1991;;46:M57-M65.
3 +
Coon PJ, Bleecker ER, Drinkwater DT, Meyers DA, Goldberg AP.  Effects of body composition and exercise capacity on glucose tolerance, insulin, and lipoprotein lipids in healthy older men: a cross-sectional and longitudinal intervention study. Metabolism . 1989;:12:1201-1209.
4 +
Fraze E, Chiou M, Chen I, Reaven GM.  Age-related changes in postprandial plasma glucose, insulin, and free fatty acid concentrations in nondiabetic individuals. J Am Geriatr Soc . 1987;; 35:224-228.
5 +
National Cholesterol Education Program Expert Panel, National Heart, Lung, and Blood Institute.  Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Arch Intern Med . 1988;;148:36-69.
6 +
Hellenius ML, de Faire U, Berglund B, Hamsten A, Krakau I.  Diet and exercise are equally effective in reducing risk for cardiovascular disease: results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Atherosclerosis . 1993;;103:81-91.
7 +
Wood PD, Stefanick ML, Dreon DM, et al.  Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med . 1988;;319: 1173-1179.
8 +
Wood PD, Stefanick ML, Williams PT, Haskell WL.  The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. N Engl J Med . 1991;;325:461-466.
9 +
King AC, Haskell WL, Taylor B, Kraemer HC, De Busk RF.  Group- vs home-based exercise training in healthy older men and women: a community-based clinical trial. JAMA . 1991;;266:1535-1542.
10 +
Blumenthal JA, Emery CF, Madden DJ, et al.  Effects of exercise training on cardiorespiratory function in men and women >60 years of age. Am J Cardiol . 1991;;67:633-639.
11 +
Morey MC, Cowper PA, Feussner JR, et al.  Two-year trends in physical performance following supervised exercise among community-dwelling older veterans. J Am Geriatr Soc . 1991;;39:986-992.
12 +
Katzel LI, Coon PJ, Busby MJ, Gottlieb SO, Krauss RM, Goldberg AP.  Reduced HDL2 cholesterol subspecies and elevated postheparin lipase activity in older men with abdominal obesity and asymptomatic myocardial ischemia. Arterioscler Thromb . 1992;;12:814-823.
13 +
Dennis KE, Goldberg AP.  Differential effects of body fatness and body fat distribution on risk factors for cardiovascular disease in women. Arterioscler Thromb . 1993;;13:1487-1494.
14 +
Bruce RA, Horsten TR.  Exercise testing in the evaluation of patients with ischemic heart disease. Prog Cardiovasc Dis . 1969;;11:371-390.
15 +
American Heart Association Steering Committee for Medical and Community Programs.  Phase I diet. Circulation . 1985;;62:A449-A455.
16 +
Siri WE.  The gross composition of the body. Adv Biol Med Phys . 1956;;4:239-240.
17 +
Klimt CR, Prout TE, Bradley RF, et al.  Standardization of the oral glucose tolerance test. Diabetes . 1969;;18:299-310.
18 +
Warnick R, Benderson JM, Albers JJ.  Quantitation of high density lipoprotein subclasses after separation by dextran sulfate and Mg2++ precipitation. Clin Chem . 1982;;28:1379-1388.
19 +
Gidez LI, Miller GJ, Burstein M, Slagle S, Eder HA.  Separation and quantification of subclasses of human plasma high denstiy lipoproteins by a simple precipitation procedure. J Lipid Res . 1982;;23:1206-1223.
20 +
Friedewald WT, Levy RI, Fredrickson DS.  Estimation of the concentration of low density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem . 1972;;18: 499-502.
21 +
Tran ZV, Weltman A, Glass GV, Mood DP.  The effects of exercise on blood lipids and lipoproteins: a meta-analysis of studies. Med Sci Sports Exerc . 1983;;15:393-402.
22 +
Schwartz RS.  The independent effects of dietary weight loss and aerobic training on high density lipoproteins and apolipoprotein A-I concentrations in obese men. Metabolism . 1987;;36:165-171.
23 +
Millar JS, Lichtenstein AH, Cuchel M, et al.  Impact of age on the metabolism of VLDL, IDL, and LDL apolipoprotein B-100 in men. J Lipid Res . 1995;;36:1155-1167.
24 +
Seals DR, Hagberg JM.  The effect of exercise training on human hypertension: a review. Med Sci Sports Exerc . 1984;;16:207-215.
25 +
Fortmann SP, Haskell WL, Wood PD, and the Stanford Weight Control Project Team.  Effects of weight loss on clinic and ambulatory blood pressure in normotensive men. Am J Cardiol . 1988;;62:89-93.
26 +
Casassus P, Fontbonne A, Thibult N, et al.  Upper-body fat distribution: a hyperinsulinemia-independent predictor of coronary heart disease mortality: the Paris Prospective Study. Arterioscler Thromb . 1992;;12:1387-1392.
27 +
Bergstrom RW, Newell-Morris LL, Leonetti DL, Shuman WP, Wahl PW, Fujimoto WY.  Association of elevated fasting C-peptide level and increased intrabdominal fat distribution in the development of NIDDM in Japanese-American men. Diabetes . 1990;;39:104-111.
28 +
Kohrt WM, Kirwan JP, Staten MA, Bourey RE, King DS, Holloszy JO.  Insulin resistance in aging is related to abdominal obesity. Diabetes . 1993;;42:273-281.
29 +
Sparrow DS, Borkan GA, Gerzof SG, Wisniewski C, Silbert CK.  Relationship of fat distribution to glucose tolerance: results of computed tomography in male participants of the normative aging study. Diabetes . 1986;;35:411-415.
30 +
Ostlund RE, Staten M, Kohrt WM, Schultz J, Malley M.  The ratio of waist-to-hip circumference, plasma insulin level, and glucose intolerance as independent predictors of HDL2-cholesterol levels in older adults. N Engl J Med . 1990;;322:229-234.
31 +
Schwartz RS, Shuman WP, Larson V, et al.  The effect of intensive endurance exercise training on body fat distribution in young and older men. Metabolism . 1993;;40:545-551.
32 +
Wing RR, Jeffery RW, Burton LR, Thorson C, Kuller LI, Folson AR.  Change in waist-hip ratio with weight loss and its association with change in cardiovascular risk factors. Am J Clin Nutr . 1992;; 55:1086-1092.
33 +
Dattilo AM, Kris-Etherton PM.  Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr . 1992;;56:320-328.
34 +
Hughes VA, Fiatarone MA, Ferrara CM, McNamara JR, Charnley JM, Evans WJ.  Lipoprotein response to exercise training and a low-fat diet in older subjects with glucose intolerance. Am J Clin Nutr . 1994;;59:820-826.
35 +
Kokkinos PF, Holland JC, Narayan P, Colleran JA, Dotson CO, Papademetriou V.  Miles run per week and high density lipoprotein cholesterol levels in healthy, middle-aged men. Arch Intern Med . 1995;;155:415-420.
36 +
Wood PD, Haskell WL, Blair SN, et al.  Increased exercise level and plasma lipoprotein concentrations: a one-year, randomized, controlled study in sedentary, middle-aged men. Metabolism . 1983;; 32:31-39.

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