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A study explores the short- and long-term efficacy of two distinct weight maintenance approaches versus no continued treatment control following standard family-based behavioral weight loss treatment for childhood overweight, and examines children's social functioning as a moderator of outcome. Results indicate that the addition of maintenance-targeted treatment improves short-term efficacy of weight loss treatment for children relative to no maintenance treatment.

Background. Caloric restriction (CR) increases maximal life span in short-lived organisms, and its effects are being explored in nonhuman primates. The objectives of this study were to determine the feasibility of prolonged CR in nonobese adults and to compare the effects of CR- and exercise-induced weight loss on body composition and abdominal adiposity. Methods. A randomized, controlled trial was conducted with 48 healthy, nonobese women and men, aged 57 [+ or -] 1 (mean [+ or -] standard error [SE]) years, with body mass index 27.3 [+ or -] 0.3 kg/[m.sup.2]. Participants were randomly assigned to a 20% calorically-restricted diet (CR, n = 19), exercise designed to produce a similar energy deficit (EX, n = 19), or a healthy lifestyle control group (HL, n = 10) for 1 year. Assessments included weight, body composition by dual-energy x-ray absorptiometry, abdominal adipose tissue by magnetic resonance imaging, and energy intake by doubly labeled water. Results. The average level of CR achieved by the CR group was 11.5 [+ or -] 2.1%, and the EX group completed 59 [+ or -] 6.7% of their prescribed exercise. Weight changes were greater (p < .0005) in the CR (-8.0 [+ or -] 0.9 kg) and EX (-45.4 [+ or -] 0.9) groups as compared to the HL group (-1.3 [+ or -] 0.9 kg), corresponding to reductions of 10.7%, 8.4%, and 1.7% of baseline weights, respectively. Whole-body fat mass and visceral and subcutaneous abdominal adipose tissue decreased significantly (p < .005) and comparably in the CR and EX groups, but did not change in the HL group. Conclusions. CR for 1 year was feasible, but the level of CR achieved was less than prescribed. CR and exercise were equally effective in reducing weight and adiposity.

Background. Progressive resistance exercise training (PRT) has been shown to increase muscle strength and fat-free mass (FFM) in elderly persons. Limited information is available regarding the effects of PRT on lean and fat mass in frail elderly persons. Methods. Ninety-one community-dwelling sedentary men and women, 78 years and older with physical frailty (defined using standardized objective criteria) were enrolled in a 9-month trial of exercise training (ET). Physical frailty was defined as having 2 of the 3 following criteria: modified Physical Performance Test score between 18 and 32, peak aerobic power between 10 and 18 ml/kg/min, or self-report of difficulty or assistance with two instrumental activities of daily living or one basic activity of daily living. Participants were randomly assigned to either a control (CTL) group that performed a low intensity home exercise program or a supervised ET group that performed 3 months of low intensity exercise and 3 months of PRT. Results. After completion of PRT, ET participants had greater improvements than did CTL participants in maximal voluntary force production for knee extension (mean [DELTA] +5.3 [+ or -] 13 ft/lb vs +1.1 [+ or -] 11 ft/lb, p = .05), measured using isokinetic dynamometry. Total body FFM (measured using dual energy x-ray absorptiometry) increased in the ET group, but not in the CTL group (mean [DELTA] +0.84 [+ or -] 1.4 kg vs +0.01 [+ or -] 1.5 kg, p = .005). Total, trunk, intra-abdominal, and subcutaneous fat mass (measured using dual energy x-ray absorptiometry and [sup.1]H-magnetic resonance imaging) did not change in response to PRT. Conclusions. Three months of supervised PRT induced improvements in maximal voluntary thigh muscle strength and whole body FFM in frail, community-dwelling elderly women and men. This supervised exercise program may not be sufficient to reduce whole-body or intra-abdominal fat area in this population.

A study to determine whether the extended outpatient rehabilitation, which includes progressive resistance training, improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture is presented. The results indicate that six months of extended outpatient rehabilitation can improve physical function and quality of life, and reduce disability compared with low intensity home exercise.

Soto, Pablo F., Pilar Herrero, Andrew M. Kates, Carmen S. Dence, Ali A. Ehsani, Victor Davila-Roman, Kenneth B. Schechtman, and Robert J. Gropler. Impact of aging on myocardial metabolic response to dobutamine. Am J Physiol Heart Circ Physiol 285: H2158-H2164, 2003. First published July 24, 2003; 10.1152/ajpheart.00086. 2003.-In humans, under resting conditions there is an age-related decrease in myocardial fatty acid utilization (MFAU) and oxidation (MFAO) and a relative increase in myocardial glucose utilization (MGU). The impact of age on an individual's myocardial metabolic response to catecholamines is not well defined. Sixteen younger (mean age, 26 [+ or -] 5 yr) and 14 older (mean age, 69 [+ or -] 4 yr) volunteers underwent positron emission tomography to measure myocardial blood flow, myocardial oxygen consumption (MV[O.sub.2]), MFAU, MFAO, and MGU both under resting conditions and during dobutamine infusion. In response to dobutamine administration, the rate-pressure product, myocardial blood flow, and MV[O.sub.2] measurements increased by similar amounts in both groups. No age-related differences, were noted in the responses of plasma insulin, glucose, fatty acid, or lactate levels to dobutamine. With dobutamine infusion, MFAU and MFAO increased by a similar extent in both younger and older volunteers (age/ dobutamine interactions, P=0.62 and 0.75 respectively). In contrast, MGU increased with dobutamine adminidtration in the younger (from 149 [+ or -] 71 to 209 [+ or -] 78 [nmol * g.sup.-1] * [min.sup.-1]; P=0.04) but not in the older (from 235 [+ or -] 147 to 176 [+ or -] 84 [nmol * g.sup.-1] * [min.sup.-1]; P=0.23; age/dobutamine interaction, P= 0.03) group. With dobutamine infusion, hearts in both younger and older volunteers responded by increasing their MFAU and MFAO values. Whereas younger hearts also responded with an increase in MGU, older hearts did not. Although the clinical significance of these findings awaits further study, these results may partially explain the impaired contractile reserve and the increased incidence of cardiovascular disease in older individuals. fatty acids; glucose; oxidation; heart; cathecholamine

We studied the effects of age and gender on cardiovascular responses to beta-adrenergic stimulation with the use of two-dimensional echocardiography in 16 young (aged 20-31) and 20 older (aged 60-75) healthy individuals. Following administration of atropine, each subject was given an infusion of isoproterenol at incremental doses from 0.010 to 0.030 mug kg(super-1) min(super-1). The slopes of the fractional shortening-end systolic wall stress (FSsigma(sub es) relationships were steeper in the young men(-0.87 +/- 0.28, n=8) compared to the older men (-0.41 +/- 0.13, n=10), and the young women (-0.55 +/- 0.14, n=8) compared to the older women (-0.38 +/- 0.13, n=10). Furthermore, the magnitude of the age-associated differences in these slopes was larger in the men (old vs young) than in the women (old vs young) which, in the absence of changes in preload, suggests a greater decline in the contractile response to isoproterenol with advancing age in men compared to women. Furthermore, the men exhibited a greater attenuation of chronotropic response to isoproterenol than did the women. These observations suggest that gender plays a significant role in the age-associated decline in inotropic and chronotropic responses to beta-adrenergic stimulation, with men exhibiting a greater decline with aging than women.

The present study was designed to determine if gender affects the adaptive response to endurance exercise training of left ventricular filling dynamics in older individuals. Recently, it was shown that gender influences the cardiovascular responses to endurance exercise training in older subjects. Older men improve left ventricular systolic performance and increase maximal cardiac output in response to endurance exercise training, whereas older women do not. Twelve men (65 [+ or -] 1 years old; mean [+ or -] SE) and 10 women (64 [+ or -] 1) were studied before and after 9 months of endurance exercise training. Maximal [O.sub.2] uptake was determined during treadmill exercise. Left ventricular filling dynamics and ejection fraction (EF) at rest and during supine exercise were assessed by Tc-99m radionuclide ventriculography. When expressed relative to body weight, maximal [O.sub.2] uptake [Vo.sub.2] max) was increased by 24% (27.3 [+ or -] 1.5 to 34.0 [+ or -] 1.5 ml/kg/min; p < .01) in men and 27% (21.9 [+ or -] 1.0 to 27.8 [+ or -] 1.0 ml/kg/min; p < .01) in women in response to endurance exercise training. In men, the time-to-peak filling rate (TPFR) decreased (-19.8 [+ or -] 6.7 ms; p < .05) during exercise at a comparable heart rate in response to training. In contrast, the change in TPFR in women ( [+ or -] 2.7 [+ or -] 6.0 ms) was small and insignificant. Peak filling rate (PFR) at rest and during exercise was similar before and after training in men and women. The change in left ventricular systolic reserve at a comparable heart rate from pre- to posttraining improved in men ([delta]EF 4 [+ or -] 3%; p < :05), but not in women (-2 [+ or -] 3%). The results indicate that the adaptive response of left ventricular filling dynamics to endurance exercise training is influenced by gender in older subjects. Older men show improvement in left ventricular filling dynamics, whereas older women do not.

Myocardial injury appears to occur frequently in critically ill patients, but often is not detected. This injury to the heart tissue may be identified by measuring levels of cardiac troponin I, a protein found only in heart tissue. Of 209 hospital patients studied during an eight-week period, 32 (15%) had high blood levels of cardiac troponin I, indicating that their heart muscle was damaged. Mortality was considerably greater in ill patients with myocardial injury: 40.6% compared to 14.7%. Patients with myocardial injury were more likely to develop abnormally low blood pressure. Myocardial injury can occur in critically ill patients because of stresses caused by insufficient oxygen supply, reduced oxygenation of the blood, anemia, coronary artery disease, and hypotension., Objective. - To determine the incidence and effect of unrecognized cardiac injury in critically ill patients. Design. - Prospective, blinded, single-center study. Setting. - The medical and respiratory intensive care unit of an academic health center. Patients. - Two hundred nine patients (224 admissions). Main Outcome Measures. - Daily measurement of levels of cardiac troponin I, a sensitive, highly specific, and long-lived marker of myocardial injury. Concurrently, signs and symptoms potentially related to myocardial ischemia were tabulated by blinded investigators. All clinical evaluation and management decisions were made by the physicians responsible for the care of the patient. Results. - Thirty-two (15%) of the 209 patients had evidence of myocardial damage based on elevated levels of cardiac troponin I. Only 12 (37%) of these 32 patients were diagnosed as having acute myocardial infarction by the intensive care unit staff. Cardiac damage was unrecognized in the other 20 (63%). Unrecognized cardiac injury was more common in young patients and in blacks. Mortality in patients with myocardial injury that was recognized (42%) or unrecognized (40%) was higher than in those without myocardial injury (15%) (P

The Multicenter Trials of Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) is a project supported under a cooperative agreement for 1990 through 1993 by the National Institute on […]