***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older adults ; however , the appropriate treatment for obese older adults is controversial . METHODS In this 1-year , r and omized , controlled trial , we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese . Participants were r and omly assigned to a control group , a weight-management ( diet ) group , an exercise group , or a weight-management-plus-exercise ( diet-exercise ) group . The primary outcome was the change in score on the modified Physical Performance Test . Secondary outcomes included other measures of frailty , body composition , bone mineral density , specific physical functions , and quality of life . RESULTS A total of 93 participants ( 87 % ) completed the study . In the intention-to-treat analysis , the score on the Physical Performance Test , in which higher scores indicate better physical status , increased more in the diet-exercise group than in the diet group or the exercise group ( increases from baseline of 21 % vs. 12 % and 15 % , respectively ) ; the scores in all three of those groups increased more than the scores in the control group ( in which the score increased by 1 % ) ( P<0.001 for the between-group differences ) . Moreover , the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group ( increases of 17 % vs. 10 % and 8 % , respectively ; P<0.001 ) ; the score on the Functional Status Question naire , in which higher scores indicate better physical function , increased more in the diet-exercise group than in the diet group ( increase of 10 % vs. 4 % , P<0.001 ) . Body weight decreased by 10 % in the diet group and by 9 % in the diet-exercise group , but did not decrease in the exercise group or the control group ( P<0.001 ) . Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group ( reductions of 3 % and 1 % , respectively , in the diet-exercise group vs. reductions of 5 % and 3 % , respectively , in the diet group ; P<0.05 for both comparisons ) . Strength , balance , and gait improved consistently in the diet-exercise group ( P<0.05 for all comparisons ) . Adverse events included a small number of exercise-associated musculoskeletal injuries . CONCLUSIONS These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone . ( Funded by the National Institutes of Health ; Clinical Trials.gov number , NCT00146107 . ) Bone loss accompanies a diet-induced weight loss and could be prevented with a combination of exercises . This study was conducted to examine the effects of additional resistance training during diet-induced weight loss on whole-body and selected regional bone mineral density ( BMD ) . The participants of a 14-week weight-loss study were 42 overweight premenopausal Japanese women who were r and omly placed in either a  diet-only group  ( D ; n = 21 ) or a diet plus resistance training group  ( DR ; n = 21 ) . Whole-body BMD and body composition , lumbar spine BMD , and 1/3 radial BMD were measured by dual-energy X-ray absorptiometry before and after the intervention . Bone formation and resorption markers were also measured . Thirty-five participants ( 83 % ) completed the study . Individuals in groups D ( n = 17 ) and DR ( n = 18 ) lost 6.2 ± 3.5 kg and 8.6 ± 3.6 kg body weight , respectively . Reductions in percentage fat mass and fat mass in group DR were significantly greater than in group D ; lean mass decreased significantly in both groups . The effect of time on whole-body BMD was significant ( −0.3 % ) ; however , whole-body bone mineral content , lumbar spine BMD , and 1/3 radial BMD remained unchanged . There were no significant timeby-group interactions in the whole-body and regional BMD and bone markers . These results suggest that additional resistance training during weight loss has no effect on BMD in overweight premenopausal Japanese women . Further long-term studies with large numbers of subjects are needed Purpose This study aim ed to evaluate the hypothesis that exercise attenuates the reductions in lean mass , muscle strength , bone mineral density , and V˙O2max that accompany modest weight loss induced by calorie restriction ( CR ) . Methods Overweight , sedentary women and men ( n = 52 , 45–65 yr ) were r and omized to 6%–8 % weight loss by using CR , endurance exercise training ( EX ) , or both ( CREX ) . The CR and the CREX groups underwent counseling to reduce energy intake by 20 % and 10 % , respectively . The EX and the CREX groups exercised 7.4 ± 0.5 and 4.4 ± 0.5 h·wk−1 , respectively . Before and after 16.8 ± 1.1 wk of weight loss , lean mass and bone mineral density were measured with dual-energy x-ray absorptiometry , strength was measured with dynamometry , and aerobic capacity ( V˙O2max ) was measured with indirect calorimetry during maximal-intensity treadmill exercise . Results Weight loss was ~7 % in all groups . Decreases in whole-body ( ~2 % , P = 0.003 ) and lower extremity ( ~4 % , P < 0.0001 ) lean mass occurred in the CR group ( both P < 0.05 ) . Despite similar weight loss , these reductions were attenuated in the CREX group ( ~1 % , P = 0.44 and ~2 % , P = 0.05 , respectively ) and absent in the EX group . Absolute aerobic capacity decreased ~6 % in the CR group ( P = 0.04 ) , was unchanged in the CREX group ( P = 0.28 ) , and increased ~15 % in the EX group ( P < 0.0001 ) . No changes in muscle strength or bone were observed . Conclusions Modest weight loss ( ~7 % ) induced by 20  % CR in overweight women and men  decreases lean mass and reduces absolute V˙O2max . Exercise protects against these effects . Although the CR-induced changes might be considered physiologically appropriate for a reduced body weight , exercise preserves and /or improves these parameters during weight loss , which likely improves physical function . These findings support the notion of using exercise as an important component of weight loss programs Background To examine the effect of exercise modality during weight loss on hip and spine bone mineral density ( BMD ) in overweight and obese , older adults . Methods This analysis compared data from two 5-month , r and omized controlled trials of caloric restriction ( CR ; inducing 5 - 10 % weight loss ) with either resistance training ( RT ) or aerobic training ( AT ) in overweight and obese , older adults . Participants in the RT + CR study underwent 3 days/week of 8 upper/lower body exercises ( 3 sets , 10 repetitions at 70 % 1 RM ) and participants in the AT+CR study underwent 4 days/week of treadmill walking ( 30 min at 65 - 70 % heart rate reserve ) . BMD at the total hip , femoral neck , and lumbar spine was assessed via dual-energy X-ray absorptiometry at baseline and 5 months . Results A total of 123 adults ( 69.4 ± 3.5 years , 67 % female , 81 % Caucasian ) participated in the RT+CR ( n = 60 ) and AT+CR ( n = 63 ) interventions . Average weight loss was 5.7 % ( 95 % CI : 4.6 - 6.7 % ) and 8.2 % ( 95 % CI : 7.2 - 9.3 % ) in RT+CR and AT+CR groups , respectively . After adjustment for age , gender , race , baseline BMI and BMD , and weight change , differential treatment effects were observed for total hip and femoral neck ( both p < .05 ) , but not lumbar spine . Total hip ( 1.83 [ -3.90 , 7.55 ] mg/cm2 ) and femoral neck ( 9.14 [ -0.70 , 18.98 ] mg/cm2 ) BMD was unchanged in RT+CR participants , and modestly decreased in AT+CR participants ( total hip : -7.01 [ -12.73 , -1.29 ] mg/cm2 ; femoral neck : -5.36 [ -14.92 , 4.20 ] mg/cm2 ) . Conclusions Results suggest performing resistance , rather than aerobic , training during CR may attenuate loss of hip and femoral neck BMD in overweight and obese older adults . Findings warrant replication from a long-term , adequately powered , RCT BACKGROUND Calorie restriction ( CR ) is promoted to increase longevity , yet this regimen could lead to bone loss and fracture and therefore affect quality of life . METHODS Forty-six individuals were r and omized to 4 groups for 6 months : ( 1 ) healthy diet ( control group ) ; ( 2 ) 25 % CR from baseline energy requirements ( CR group ) ; ( 3 ) 25 % energy deficit by a combination of CR and increased aerobic exercise ( CR + EX group ) ; and ( 4 ) low-calorie diet ( 890 kcal/d ; goal , 15 % weight loss ) followed by weight maintenance ( LCD group ) . Bone mineral density ( total body and hip by dual-energy x-ray absorptiometry ) and serum bone markers ( bone-specific alkaline phosphatase , osteocalcin , cross-linked C-telopeptide of type I collagen , and cross-linked N-telopeptide of type I collagen ) were measured at baseline and after 6 months . RESULTS Mean + /- SE body weight was reduced by -1.0 % + /- 1.1 % ( control ) , -10.4 % + /- 0.9 % ( CR ) , -10.0 % + /- 0.8 % ( CR + EX ) , and -13.9 % + /- 0.7 % ( LCD ) . Compared with the control group , none of the groups showed any change in bone mineral density for total body or hip . Bone resorption by serum cross-linked C-telopeptide of type I collagen was increased in all 3 intervention groups , with the largest change observed in the LCD group ( CR , 23 % + /- 10 % ; CR + EX , 22 % + /- 9 % ; and LCD , 74 % + /- 16 % vs control , 4 % + /- 10 % ) . Serum levels of cross-linked N-telopeptide of type I collagen were also increased in the LCD group . With regard to bone formation , bone alkaline phosphatase levels were decreased in the CR group ( -23 % + /- 10 % ) but were unchanged in the CR + EX , LCD , and control groups . CONCLUSIONS Moderate CR , with or without exercise , that preserves calcium intake for 6 months leads to large changes in body composition without significant bone loss in young adults . Longer studies with assessment s of bone architecture are needed to confirm that CR nutrient-dense diets have no deleterious effect on bone health . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00099151 This study examines the effects of weight loss by caloric restriction ( WL ) and aerobic exercise plus weight loss ( AEx+WL ) on total and regional bone mineral density ( BMD ) in older women . Healthy , postmenopausal women [ age 63 + /- 1 ( SE ) yr ] not on hormone-replacement therapy underwent 6 mo of WL ( n = 15 ) consisting of dietary counseling one time per week with a caloric deficit ( 250 - 350 kcal/day ) or AEx+WL ( n = 15 ) consisting of treadmill exercise three times per week in addition to the weight loss . Maximal aerobic capacity increased only in the AEx+WL group ( P < 0 . 001 ) . Body weight , percent fat , and fat mass decreased similarly in both groups ( P < 0.005 ) , with no changes in fat-free mass . Total body BMD ( by dual-energy X-ray absorptiometry ) decreased in both groups ( P < 0.05 ) . Femoral neck , Ward 's triangle , and greater trochanter BMD decreased in the WL group ( P < /= 0.05 ) but were not significantly different after AEx+WL .  L2-L4 BMD did not significantly change in either group . Thus WL and AEx+WL both result in losses of total body BMD ; however , AEx+WL appears to prevent the loss in regional BMD seen with WL alone in healthy , older women . This suggests that the addition of exercise to weight-loss programs may reduce the risk for bone loss Objective The aim of this study was to assess the impact of caloric restriction diet versus caloric restriction diet combined with aerobic exercises on bone mineral density ( BMD ) in obese premenopausal women . Subjects and methods Forty premenopausal obese women were classified r and omly into two groups equal in number . The first group ( group A ) received caloric restriction diet , while the second ( group B ) received caloric restriction diet combined with a program of aerobic exercises , over 3 months . The variables measured in this study included age , weight , height , body mass index , fat weight , lean mass , fat percent , basal metabolic 
    Output:
    
Conclusion : This study suggests that physical training can preserve and even significantly increase the bone mass of the hip and femoral neck during weight reduction .
Of note , various exercise modalities affected BMD at different sites .
Similar results were not found for lumbar spine and total body BMD