Results:

A total of 93 participants (87%) completed the study (enrolled 107 participants). The median attendance at diet-therapy sessions was 83% among participants in the diet group and 82% among those in the diet/exercise group. The median attendance at exercise sessions was 88% among participants in the exercise group and 83% among those in the diet/exercise group. Larger improvements in Physical Performance Test scores were observed among those randomized to the diet/exercise group compared to the diet alone group or the exercise alone group (increases from baseline of 21% vs. 12% and 15%, respectively). Scores in all three intervention groups improved to a greater degree than the scores of the control group. 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). Scores for the Functional Status Questionnaire also increased to a greater degree in the diet/exercise group compared to the diet alone group (10% vs. 4%, p < 0.01). Body weight decreased by 10% in the diet alone 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 alone group; p < 0.05 for both comparisons). Strength, balance, and gait improved consistently in the diet/exercise group (p < 0.05 for all comparisons).