Weighted vests and resistance training confer similar outcomes for bone density in the elderly

1. In this 12-month randomized clinical trial, weight loss (WL)-associated bone loss occurred in older adults with obesity, regardless of whether they used a weighted vest or resistance training (RT).  

Evidence Rating Level: 1 (Excellent)

Obesity is rising in older adults and poses detrimental health risks, however, recommending weight loss (WL) has been controversial due to associated bone mineral density (BMD) loss and the increased risk of fractures. While resistance training (RT) can reduce bone loss, it does not fully prevent it, and has associated barriers such as cost, access, and adherence. One potential alternative is using weighted vests to mimic the mechanical loading lost during WL. The Incorporating Nutrition, Vests, Education, and Strength Training (INVEST) in Bone Health randomized clinical trial (RCT) was designed to test whether adding weighted vests to WL can protect bone health as effectively as WL combined with RT. Participants were recruited through advertising and included if they were between the ages of 60 to 85, had a body mass index (BMI) of 30-40 or 27 to less than 30 with one obesity risk factor, and a stable body weight. The main outcome was the change in total hip trabecular volumetric bone mineral density (vBMD), measured by quantitative computed tomography (CT), over one year. Of 150 individuals recruited, 50 were randomized into each group (WL, WL+VESTm and WL+RT), and a total of 133 (88.7%) individuals completed the study. The mean (SD) age was 66.4 (4.6) years, with women accounting for the majority of participants (74.7%). Between all three groups, significant WL was achieved, ranging from 9.0% to 11.2%. In the WL+VEST group, participants wore the weighted vest for an average (SD) of 7.1 (1.5) hours per day over the year, with the vest containing a mean (SD) of 78.0% (29.9%) of the weight they had lost. Participants in the WL+RT group completed a mean (SD) of 71.4% (19.1%) of sessions. At 12 months, all treatment groups showed a significant decrease in total hip trabecular vBMD (-1.2% to -1.9%). There was no significant difference between the WL+VEST and WL groups (estimated treatment difference, +0.91 mg/cm3; 97.5% CI, -0.27 to 2.09 mg/cm3; P=.13), and the WL+VEST approach was found to be noninferior to WL+RT for total hip trabecular vBMD (estimated treatment difference, +0.29 mg/cm3; 98.75% lower bound, -1.05 mg/cm3) and total hip areal BMD (aBMD) (estimated treatment difference, +0.83 mg/cm3; 98.75% lower bound only, -10.08 mg/cm3). Overall, neither a weighted vest nor resistance training was able to mitigate the effects of WL-associated hip bone loss in older adults with obesity. 

Click to read the study in JAMA Network Open 

Image: PD

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