BACKGROUND: Obesity impairs cognition and health-related quality of life (HRQOL) in older adults; however, the appropriate treatment of obese older adults remains controversial. OBJECTIVE: The objective was to determine the independent and combined effects of weight loss and exercise on cognition, mood, and HRQOL in obese older adults. DESIGN: One hundred seven frail, obese older adults were randomly assigned to a control, weight-management (diet), exercise, or weight-management-plus-exercise (diet-exercise) group for 1 y. In this secondary analysis, main outcomes were Modified Mini-Mental State Examination (3MS) and total Impact of Weight on Quality of Life-Lite (IWQOL) scores. Other outcomes included Word Fluency Test, Trail Making Test Parts A and B, and Geriatric Depression Scale (GDS) scores. RESULTS: Scores on the 3MS improved more in the diet (mean +/- SE 1.7 +/- 0.4), exercise (2.8 +/- 0.4), and diet-exercise (2.9 +/- 0.4) groups than in the control group (0.1 +/- 0.4) (between-group p = 0.0001 to 0.04); scores in the diet-exercise group improved more than in the diet group but not more than in the exercise group. Scores on the Word Fluency Test improved more in the exercise (4.1 +/- 0.8) and diet-exercise (4.2 +/- 0.7) groups than in the control group (20.8 +/- 0.8; both p = 0.001). For the Trail Making Test Part A, scores in the diet-exercise group (-11.8 +/- 1.9) improved more than in the control group (-0.8 +/- 1.9) (p = 0.001); a similar finding was observed for the Trail Making Test Part B. Scores on the IWQOL improved more in the diet (7.6 +/- 1.6), exercise (10.1 +/- 1.6), and diet-exercise (14.0 +/- 1.4) groups than in the control group (0.3 +/- 1.6) (p = 0.0001 to 0.03); scores in the diet-exercise group improved more than in the diet group but not more than in the exercise group. In the diet-exercise group, peak oxygen consumption and strength changes were independent predictors of 3MS changes; weight and strength changes were independent predictors of IWQOL changes. GDS scores did not change. CONCLUSIONS: Weight loss and exercise each improve cognition and HRQOL, but their combination may provide benefits similar to exercise alone. These findings could inform practice guidelines with regard to optimal treatment strategies for obese older adults. This trial was registered at ClinicalTrials.gov as NCT00146107.
Copyright by the American Society for Clinical Nutrition.

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