Weighted Vest Use or Resistance Exercise to Offset Weight Loss-Associated Bone Loss in Older Adults: A Randomized Clinical Trial.
Level 2 - randomized trial
Individual randomized clinical trial
PubMed 40540267 · doi:10.1001/jamanetworkopen.2025.16772
What was done
In a single-blind, 12-month randomized clinical trial at an academic medical center, 150 older adults with obesity (mean age 66.4 years, 74.7% women, mean BMI 33.6) were randomized equally to weight loss alone (WL; caloric restriction targeting 10% weight loss with protein, calcium, and vitamin D), weight loss plus weighted vest (WL+VEST; 8 h/d, replacing up to 10% lost weight), or weight loss plus supervised progressive resistance training (WL+RT; 3 sessions weekly). Primary outcomes were 12-month changes in computed tomography-measured trabecular volumetric bone mineral density and dual-energy X-ray absorptiometry-measured areal bone mineral density at the total hip.
What was found
A total of 133 participants (88.7%) completed the trial. All groups achieved significant weight loss ranging from 9.0% to 11.2%. Self-reported vest wear averaged 7.1 h/d (replacing 78.0% of lost weight), and resistance training attendance averaged 71.4%. Total hip trabecular volumetric bone mineral density significantly decreased across all groups (-1.2% to -1.9%), with no significant difference between WL+VEST and WL alone (estimated treatment difference +0.91 mg/cm3; 97.5% CI, -0.27 to 2.09 mg/cm3; P = .13) and noninferiority of WL+VEST compared with WL+RT (estimated treatment difference +0.29 mg/cm3; 98.75% lower bound, -1.05 mg/cm3). Similar results were observed for total hip areal bone mineral density.
Why it matters
Neither weighted vest use nor progressive resistance exercise counteracts hip bone loss induced by dietary weight reduction in older adults with obesity. Clinicians cannot assume mechanical loading or exercise alone is sufficient to protect bone during intentional weight loss in this population.
Limits
Conducted at a single academic medical center with a predominantly female sample (74.7%). Vest adherence relied on self-report, and resistance training attendance was modest (71.4%). Clinical fractures and long-term bone quality were not evaluated.
Cited by
- supports Walking with a weighted vest does not provide an adequate stimulus to improve muscle mass or bone density.