EMPOWER-PULM (PULMonary Outcomes in Older Adults Empowered With Movement to Prevent Obesity and Weight Regain)

This is a randomized clinical trial of the effects of structured aerobic exercise and a
sedentary behavior intervention during weight loss on respiratory function. Site will enroll
150 older (65-85 years), obese (BMI=30-45 kg/m2), sedentary men and women from EMPOWER.
EMPOWER is a 3-group design where participants will undergo a 9-month weight loss (WL)
intervention (6-mo intensive phase and 3-mo reduced contact phase), followed by a 9-month
self-managed follow-up phase with minimal contact. The diet element of the interventions is
identical across groups, but groups differ by activity intervention: 1) moderate-intensity
aerobic exercise (WL+EX); 2) intervening on SB (WL+SitLess); or 3) (WL+EX+SitLess)

Inclusion Criteria:

- 65 -85 years of age

- BMI = 30-45 kg/m2

- Weight stable - no loss or gain (±5%) in past 6 months

- Sedentary

- No contraindication for safe and optimal participation in exercise training

- Approved for participation by Medical Director

Exclusion Criteria:

- Dependent on cane or walker

- Reported unintentional or intentional weight loss or gain of >5% in past 6 months

- Participation in regular resistance training and/or > 20 mins/day of aerobic exercise
in past 6 months

- Osteroporosis (t-score <2.3 on hip or spine scan); Severe arthritis, or other
musculoskeletal disorder; Joint replacement or other orthopedic surgery in past 6 mos;
joint replacement or other orthopedic surgery planned in next 2 years

- Uncontrolled resting hypertension (>160/90 mmHg);

- Current or recent past (within 1 year) severe symptomatic heart disease, uncontrolled
angina, stroke, chronic respiratory disease other than asthma or COPD, any disease
requiring oxygen use, neurological or hematological disease,; cancer requiring
treatment in past year, except non-melanoma skin cancers

- Serious conduction disorder, new Q waves or ST-segment depression (>3mm), or
uncontrolled arrhythmia

- Room air SpO2 (oxygen saturation) at rest or with exercise qualifying for
supplementary oxygen (SpO2≤88%)

- Abnormal kidney or liver function (2x upper limit of normal);

- eFGR < mL/min/1.73m2

- Anemia (Hb<14 g/dl in men/<12.3 g/dL in women);

- Uncontrolled diabetes (fasting blood glucose > 140 mg/dl);

- Deficient levels of vitamin D (25 hydroxyvitamin D level <20mg/mL) in those not taking
a vitamin D supplement

- Smoker (No nicotine in past yr)

- No heavy alcohol use (>14 drinks/week)

- Unstable severe depression

- Regular use of: growth hormones, oral steroids, weight loss medications* or
prescription osteoporosis medications*

- Current participation in other research study