Health promotion with targeted exercise intervention for decreasing fall risk and inactivity in aging Veterans with obesity and signs of sarcopenia

Significance to VA: Older Veterans with obesity and sarcopenia (1.2 million Veterans) are three times more likely to fall and six times more likely to become frail than older Veterans without these conditions. Current guidelines recommend weight loss for all Veterans with obesity. However, declines in muscle mass and bone density accompanying weight loss can lead to poorer muscle quality, loss of strength, and increased risk of fall- related fractures. There is an urgent need to identify a feasible and efficacious intervention addressing functional limitations and fall risk in aging Veterans with sarcopenic obesity that does not further compromise their health. Obesity and sarcopenia are intrinsically linked to poor muscle quality, highlighting the importance of a physical activity-centered intervention aimed at preserving and enhancing muscle mass, function, and overall mobility. Still, Veterans demonstrate low levels of physical activity engagement and report a lack of understanding of how to exercise, indicating a need for health promotion education. However, adults with sarcopenic obesity are at greater risk of experiencing geriatric vulnerabilities which may pose barriers to participation in and response to a health promotion intervention. Therefore, we expect a more targeted approach is needed. Innovation and Impact: Addressing disability and sarcopenia in at risk Veterans with obesity departs from the status quo focusing on caloric restriction and, instead, prioritizes Veteran’s functional health and fall risk. Interventions will be delivered with a live virtual group-based format to remove barriers to accessing and benefiting from the interventions expected to disproportionately affect Veterans with greater mobility limitations, pain, and/or socioeconomic barriers. The group format also promotes a sense of community and peer-accountability. Further, health promotion education supports sustainable behavior change after the intervention period. This project leverages wearable sensors to quantify biomechanical changes to real-world mobility, as well as muscle imaging to quantify physiological changes, to understand mechanisms of change from the proposed interventions. Specific Aims: Compare effects of a targeted exercise-based fall prevention intervention plus health promotion education (EX+EDU) vs. health promotion education alone (EDU) on 1) fall risk and dysmobility, 2) physical activity and gait performance, and 3) lower extremity muscle quality. We hypothesize EX+EDU will show 1) greater reductions in fall risk [Four Square Step Test] and dysmobility [Timed Up and Go] compared to EDU, 2) greater improvements in community mobility abilities [Actigraphy-derived activity fragmentation and gait quality] compared to EDU, and 3) improvements in muscle quality [muscle specific force and fatty infiltration on CT imaging] not observed for EDU. Methodology: Fifty older (≥ 65 years) Veterans with obesity (BMI: 30-40 kg/m2) and signs of sarcopenia (SARC-F≥4, OR gait speed<0.8 m/s, OR grip strength<27 kg [Males]/16 kg [Females]) will be randomized to a 12-week EX+EDU or EDU. Changes in fall risk, physical activity engagement, and muscle quality will be assessed and compared between groups at 12 weeks, and again at 24 weeks to evaluate effect retention. Falls and changes in gait quality, muscle strength, balance confidence, and weekly physical activity (from Fitbit worn throughout the study) will also be assessed. Path to Translation: The research activities in this CDA-2 are expected to lead to a larger, multi-site randomized controlled exercise and health promotion trial for Veterans with sarcopenic obesity. Skills gained during this mentored research study, including how to design and run a clinical trial, deliver health promotion education for aging adults, and quantify changes to muscle physiology, will enhance Dr. Rekant’s transition to an independent VA research career. Information gained from this study will lead to approp Project Number: 1IK2RD000462-01A1 | Fiscal Year: 2026 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Julie Rekant | Institution: BALTIMORE VA MEDICAL CENTER, BALTIMORE, MD | Activity Code: IK2 | Study Section: Career Development Program - Panel I[RRD8] View on NIH RePORTER: https://reporter.nih.gov/project-details/11240962