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Therefore, it is recommended that weight loss therapy of older adults with obesity should include an intervention such as regular exercise to reduce the concomitant bone loss. However, the most appropriate exercise types to combine with weight loss therapy in this older population is unknown. In a randomized controlled trial, we performed a head-to-head comparison of aerobic or resistance exercise, or both, during matched ~10% weight loss in 160 older adults with obesity. We measured changes in BMD (total hip, femoral neck, trochanter, intertrochanter, one-third radius, lumbar spine) and bone markers. Changes between groups were analyzed using mixed-model repeated measures analyses of variance. After 6\u2009months of intensive lifestyle interventions, BMD decreased less in the resistance group (\u22120.006\u2009g\/cm2 [\u22120.7%]) and combination group (\u22120.012\u2009g\/cm2 [\u22121.1%]) than in the aerobic group (\u22120.027\u2009g\/cm2 [\u22122.6%]) (p = 0.001 for between-group comparisons). Serum C-telopeptide, procollagen type 1\u2009N-propeptide, and osteocalcin concentrations increased more in the aerobic group (33%, 16%, and 16%, respectively) than in the resistance group (7%, 2%, and 0%, respectively) and combination group (11%, 2%, and 5%, respectively) (p = 0.004 to 0.048 for between-group comparisons). Multiple regression analyses revealed that the decline in whole body mass and serum leptin were the independent predictors of the decline in hip BMD (multiple R = 0.45 [p\u2009&amp;lt;\u2009.001]). These findings indicate that compared with aerobic exercise, resistance and combined aerobic and resistance exercise are associated with less weight loss\u2013induced decrease in hip BMD and less weight loss\u2013induced increase in bone turnover. Therefore, both resistance and combined aerobic and resistance exercise can be recommended to protect against bone loss during weight loss therapy of older adults with obesity. (LITOE ClinicalTrials.gov number NCT01065636.) \u00a9 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.<\/jats:p>","DOI":"10.1002\/jbmr.3905","type":"journal-article","created":{"date-parts":[[2019,12,4]],"date-time":"2019-12-04T08:02:24Z","timestamp":1575446544000},"page":"430-439","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":94,"title":["Effect of Aerobic or Resistance Exercise, or Both, on Bone Mineral Density and Bone Metabolism in Obese Older Adults While Dieting: A Randomized Controlled Trial"],"prefix":"10.1093","volume":"35","author":[{"given":"Reina","family":"Armamento-Villareal","sequence":"first","affiliation":[{"name":"Center for Translational Research on Inflammatory Diseases (CTRID) Michael E DeBakey VA Medical Center Houston TX, USA"},{"name":"Division of Endocrinology, Diabetes, and Metabolism Baylor College of Medicine Houston TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Aguirre","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of New Mexico School of Medicine Albuquerque NM, USA"},{"name":"Medicine Care Line New Mexico VA Health Care System Albuquerque NM, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra L","family":"Waters","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Physiotherapy University of Otago Dunedin New Zealand"},{"name":"Department of Internal Medicine University of New Mexico School of Medicine Albuquerque NM, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3091-8205","authenticated-orcid":false,"given":"Nicola","family":"Napoli","sequence":"additional","affiliation":[{"name":"Division of Bone and Mineral Diseases Washington University School of Medicine St. Louis MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Qualls","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Statistics University of New Mexico School of Medicine Albuquerque NM, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1365-7960","authenticated-orcid":false,"given":"Dennis T","family":"Villareal","sequence":"additional","affiliation":[{"name":"Center for Translational Research on Inflammatory Diseases (CTRID) Michael E DeBakey VA Medical Center Houston TX, USA"},{"name":"Division of Endocrinology, Diabetes, and Metabolism Baylor College of Medicine Houston TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,12,4]]},"reference":[{"issue":"21","key":"2024031503440897300_jbmr3905-bib-0001","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1001\/jama.2016.6458","article-title":"Trends in 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