Karen E. Dennis

Weight loss and exercise walking reduce pain and improve physical functioning in overweight postmenopausal women with knee osteoarthritis.

We conducted an uncontrolled pilot study to determine the effects of a weight loss and walking program on knee pain and physical function in overweight and obese (body mass index; BMI [kg/m2] 25–29.9 and BMI ≥ 30, respectively) postmenopausal women with knee osteoarthritis (OA). Forty-eight such women completed self-report (Western Ontario and McMaster University Osteoarthritis Index (WOMAC)) and performance-based measures of physical function (“up & go” test, 6-min walk) and enrolled in a 6-month intervention that included weekly nutrition classes and an exercise-walking program.The intervention produced an average weight loss of 5.6 ± 4.0 kg in the 30 women who completed the program. There also were significant improvements in the 6-min walk and on VO2max. Improvements in the timed up & go test and on the WOMAC pain and function scores, however, were restricted only to women who were classified as obese at baseline. These findings suggest that a 6-month weight loss and walking program improves measures of physical functioning and pain in overweight and obese postmenopausal women with knee OA. Among obese women, functional improvement correlated with weight loss, encouraging continued emphasis on weight loss for managing knee OA.

Differential effects of body fatness and body fat distribution on risk factor for cardiovascular disease in women. Impact of weight loss.

This study examines the role of obesity and body fat distribution (ie, waist-to-hip ratio [WHR]) on cardiovascular disease (CVD) risk factors in 50 nondiabetic, obese (body mass index [BMI], 31 +/- 2 kg/m2, mean +/- SD), 45 +/- 10-year-old women. The data obtained at baseline and after weight loss were analyzed after dividing subjects by WHR into upper-body (WHR > 0.80) and lower-body (WHR < or = 0.80) groups and by median-split BMI into more obese (BMI > or = 31) and less obese (BMI < 31) groups. At baseline, the upper-body obese women, when compared with lower-body obese women, had higher plasma triglycerides (TGs) (175 +/- 85 versus 111 +/- 47 mg/dL, respectively; P < .001) and lower high-density lipoprotein cholesterol (HDL-C) (44 +/- 10 versus 54 +/- 11, respectively; P < .01) but similar total and low-density lipoprotein cholesterol levels and blood pressure. There were no significant differences in these CVD risk factors at baseline by BMI split. Although weight loss (-9 +/- 5 kg) lowered blood pressure and TGs irrespective of WHR or BMI, only upper-body obese women raised HDL-C. Moreover, the magnitude of the changes was greatest in women with an upper-body fat distribution. In women with WHR > 0.80, HDL-C increased by 11%, to 49 mg/dL (P < .001), and TGs decreased by 24%, to 134 mg/dL (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary intake and changes in lipoprotein lipids in obese, postmenopausal women placed on an American Heart Association Step 1 diet

BACKGROUND Dietary intake and changes in lipoprotein lipids in obese, postmenopausal women placed on an American Heart Association Step 1 diet. OBJECTIVE The purpose of this study was to determine the specific dietary factors associated with the commonly observed decrease in HDL-C concentration in obese, postmenopausal women placed on a low-fat diet. DESIGN/SUBJECTS/INTERVENTION: Dietary intake, lipoprotein lipid concentrations, and body weight were measured before and after 10 weeks of instruction in the principles of the American Heart Association (AHA) Step 1 diet in 55 overweight and obese (body mass index=33+/-4 kg/m2), sedentary, postmenopausal women (mean age 59+/-5 years). RESULTS The percent of energy obtained from total fat, monounsaturated, polyunsaturated, saturated fat, and dietary cholesterol decreased significantly after dietary intervention, while the polyunsaturated:saturated ratio and the percent of energy obtained from total carbohydrate, complex carbohydrate, and simple carbohydrate increased. On average, the women lost a small, but significant, amount of body weight (2%+/-3%, P<.0001). Adherence to the AHA diet reduced total cholesterol (-8%+/-8%), LDL-C (-6%+/-11%), and HDL-C (-16%+/-10%). The only dietary change that predicted decreases in HDL-C concentrations was the increase in the percent of energy from simple sugar (r=-0.32, P<.05). There were no relationships between changes in HDL-C and changes in percent of energy from fat (r=0.16), saturated fat (r=0.07), polyunsaturated fat (r=0.04), or monounsaturated fat (r=0.09). APPLICATIONS/CONCLUSIONS In postmenopausal women, a dietary reduction in total fat, saturated fat, and cholesterol reduces body weight, total cholesterol, and LDL-C, but substitution of simple sugar for dietary fat may lead to a reduction in HDL-C. Further research is needed to determine which specific simple sugars are contributing to diet-induced reductions in HDL-C in older women placed on a low-fat diet.

Applicability of Maximal Oxygen Consumption Criteria in Obese, Postmenopausal Women

This study examines the applicability of using three standard criteria (age-predicted maximal heart rate [HRmax], respiratory exchange ratio [RER>1.10], and plateau in oxygen uptake [Vo(2)] for the measurement of maximal oxygen consumption (Vo(2)max) in postmenopausal women. One hundred eight postmenopausal (60 +/- 6 years), overweight and obese (body mass index [BMI] = 33 +/- 4 kg/m(2)), sedentary (Vo(2)max = 19 +/- 3 ml/kg/min) women underwent one exercise test (Bruce protocol), and 71 of these women underwent a second test (modified Balke protocol). On test 1, 69 (64%) women achieved age-predicted HRmax, 61 (57%) reached an RER>1.10, and 16 (15%) achieved a plateau in Vo(2) (<2 ml/kg/min change). Women who reached age-predicted HRmax and reached an RER of at least 1.10 had a higher peak Vo(2) (p <0.01) than women who did not meet these criteria. There was no difference in the highest V02 obtained between women who did and did not achieve a plateau in Vo(2) during test 1 (p = 0.55). Resting HR, HRmax, and RER were similar between the two tests. On average, peak Vo(2) was higher on the second test (p <0.01). However, Vo(2)max was not different between exercise tests in women who achieved at least two of the three criteria on both tests (n = 24; test 1, 19.4 +/- 3.4; test 2: 19.8 +/- 3.7 ml/kg/min; p = NS). In addition, Vo(2)max was similar between the two exercise tests in 14 women who reached a plateau on the second test but did not reach a plateau on the first test (19.2 +/- 3.3 vs. 19.6 +/- 4.2 ml/kg/min; p = NS). We conclude that achievement of a plateau in Vo(2) is not a necessary criterion for a valid measurement of Vo(2)max in overweight and obese, sedentary, postmenopausal women.