Existing community resources such as the cooperative extension programs available in most U.S. counties can help obese, physically impaired elderly people with cardiovascular disease improve and preserve their physical functioning, according to a report published online Jan. 24 in the Archives of Internal Medicine.
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Overweight and obese seniors who participated in a physical activity and weight loss intervention had significantly improved mobility and lost more weight after six months compared with seniors who only participated in a physical activity.
Such linkage between the health care system and cooperative extension programs in North Carolina boosted obese elderly patients’ levels of physical activity and weight loss, which in turn improved their mobility "substantially," said W. Jack Rejeski, Ph.D., of the department of health and exercise science and geriatric medicine, Wake Forest University, Winston-Salem, N.C., and his associates.
"The intervention was successfully translated into a community setting with results ... comparable with those observed in the best randomized controlled trials conducted in academic health centers," the investigators noted.
They enrolled 288 overweight or obese adults (body mass index greater than 28 kg/m2) aged 60-79 years who had limited mobility in a randomized, controlled trial to evaluate the intervention. The study subjects either had known cardiovascular disease or were at high risk from cardiometabolic dysfunction.
The subjects were randomly assigned to a physical activity intervention alone, a physical activity plus weight-loss intervention, or a control group, and were followed for 18 months. The interventions were delivered at existing Cooperative Extension Centers by Cooperative Extension agents (also known as family and consumer sciences educators) who were field faculty from North Carolina State University, Raleigh, with degrees in home economics and/or nutrition education.
"Cooperative Extension Centers are located ... in most counties nationwide. Cooperative extension specialists provide unbiased, research-based information to the public in such areas as agriculture, human nutrition, diet and health, food safety, gerontology, and human development," Dr. Rejeski and his colleagues noted.
The physical activity intervention involved three 90-minute group activity and counseling sessions and one 30-minute individual counseling session per month aimed at getting patients to gradually increase and maintain more than 30 minutes of moderately intense activity most days of the week, for a total of 150 minutes per week.
The combined activity plus weight-loss intervention added to this a program to reduce caloric intake, with a goal of losing 7%-10% of baseline weight and maintaining that loss. This intervention included cooking demonstrations and food tastings illustrating the preparation of palatable but low-fat, low-calorie foods, as well as counseling to guide subjects to self-regulate their eating behaviors.
Within 6 months, physical activity alone resulted in a 1% weight loss and improved the subjects’ performance on the 400-meter walking test, which reflects overall mobility and physical functioning. However, that benefit had largely disappeared by 18 months.
In contrast, the combined intervention produced a substantial 8.5% weight loss within 6 months, which was maintained throughout follow-up, along with a significant improvement on the 400-meter walking test that also persisted until the conclusion of the trial.
"We surmise that the benefit of [the combined intervention] was due either to increased motivation to be physically active when one has lost weight, and/or that being physically active is perceptually or objectively less demanding once one has lost weight," the investigators said (Arch. Intern. Med. 2011 [doi:10.1001/archinternmed.2010.522]).
In comparison, the control group lost only 1% of their baseline weight and showed progressive impairment of mobility on the 400-meter walking test over time.
With the combined intervention, the study subjects who had the worst performance on the walking test at baseline were the ones who showed the greatest improvement.
These results show that community-based combined intervention "can have a favorable effect on preserving the mobility of older, obese adults who are at risk for or have CVD. The magnitude of change that we observed ... was comparable with data from highly successful, medical center-based intervention research," Dr. Rejeski and his associates said.
Adverse events were more frequent with the combined intervention than in the other two groups, but these mostly involved transient musculoskeletal complaints that quickly resolved. "Only 2 of the [39] serious adverse events were definitely related to treatment," the researchers added.
This study was supported by the National Heart, Lung, and Blood Institute, the National Institute for Aging, and the General Clinical Research Centers. No financial disclosures were reported.