Multilevel Approach of a 1-Year Program of Dietary and Exercise Interventions on Bone Mineral Content and Density in Metabolic Syndrome--the RESOLVE Randomized Controlled Trial

Daniel Courteix, João Valente-dos-Santos, Béatrice Ferry, Gérard Lac, Bruno Lesourd, Robert Chapier, Geraldine Naughton, Geoffroy Marceau, Manuel João Coelho-e-Silva, Agnès Vinet, Guillaume Walther, Philippe Obert, Frédéric Dutheil, Daniel Courteix, João Valente-dos-Santos, Béatrice Ferry, Gérard Lac, Bruno Lesourd, Robert Chapier, Geraldine Naughton, Geoffroy Marceau, Manuel João Coelho-e-Silva, Agnès Vinet, Guillaume Walther, Philippe Obert, Frédéric Dutheil

Abstract

Background: Weight loss is a public health concern in obesity-related diseases such as metabolic syndrome (MetS). However, restrictive diets might induce bone loss. The nature of exercise and whether exercise with weight loss programs can protect against potential bone mass deficits remains unclear. Moreover, compliance is essential in intervention programs. Thus, we aimed to investigate the effects that modality and exercise compliance have on bone mineral content (BMC) and density (BMD).

Methods: We investigated 90 individuals with MetS who were recruited for the 1-year RESOLVE trial. Community-dwelling seniors with MetS were randomly assigned into three different modalities of exercise (intensive resistance, intensive endurance, moderate mixed) combined with a restrictive diet. They were compared to 44 healthy controls who did not undergo the intervention.

Results: This intensive lifestyle intervention (15-20 hours of training/week + restrictive diet) resulted in weight loss, body composition changes and health improvements. Baseline BMC and BMD for total body, lumbar spine and femoral neck did not differ between MetS groups and between MetS and controls. Despite changes over time, BMC or BMD did not differ between the three modalities of exercise and when compared with the controls. However, independent of exercise modality, compliant participants increased their BMC and BMD compared with their less compliant peers. Decreases in total body lean mass and negative energy balance significantly and independently contributed to decreases in lumbar spine BMC.

Conclusion: After the one year intervention, differences relating to exercise modalities were not evident. However, compliance with an intensive exercise program resulted in a significantly higher bone mass during energy restriction than non-compliance. Exercise is therefore beneficial to bone in the context of a weight loss program.

Trial registration: ClinicalTrials.gov NCT00917917.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of participants.
Fig 1. Flow chart of participants.
re: moderate-resistance-moderate-endurance; Re: high-Resistance-moderate-endurance; rE: moderate-resistance-high-Endurance.
Fig 2. Changes (360 days) on total…
Fig 2. Changes (360 days) on total body bone mineral content (BMC) and density (BMD), lumbar spine BMC and BMD and femoral neck BMC and BMD for re, Re and rE groups.
re: moderate-resistance-moderate-endurance; Re: high-Resistance-moderate-endurance; rE: moderate-resistance-high-Endurance. There were no significant differences in BMD and BMC parameters between re, Re and rE participants across the intervention. Participants in the intervention did not have significantly greater or lower bone mass or density development than controls.
Fig 3. Compliance effect (360 days) on…
Fig 3. Compliance effect (360 days) on total body bone mineral content (BMC), lumbar spine BMC and femoral neck BMC for re, Re and rE groups.
re: moderate-resistance-moderate-endurance; Re: high-Resistance-moderate-endurance; rE: moderate-resistance-high-Endurance. * Compliant participants significantly different from non-compliants (p<0.05). ‡ Non-compliant participants significantly different from controls.
Fig 4. Compliance effect (360 days) on…
Fig 4. Compliance effect (360 days) on total body bone mineral density (BMD), lumbar spine BMD and femoral neck BMD for re, Re and rE groups.
re: moderate-resistance-moderate-endurance; Re: high-Resistance-moderate-endurance; rE: moderate-resistance-high-Endurance. *Compliant participants significantly different from non-compliants (p<0.05).

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