Aging may be accompanied by changes in body composition, muscle strength, metabolic health, and well-being. In older adults with overweight or obesity, strategies that combine physical exercise, behavioral changes, and nutritional guidance may contribute to better health and the maintenance of healthier habits.
This study aims to investigate the effects of a 16-week intervention combining resistance training, group cognitive behavioral therapy, and nutritional guidance for a higher-protein diet. Changes in body composition, muscle strength and function, vascular and metabolic health, cognitive function, psychological outcomes, quality of life, autonomy, self-care, and motivation for exercise and changes in eating habits will be assessed.
The study will include adults aged 60 years or older who have low levels of physical activity and excess body fat. Participants will be randomly assigned to one of three groups. The first group will receive resistance training only; the second group will receive resistance training plus group cognitive behavioral therapy; and the third group will receive resistance training, group cognitive behavioral therapy, and nutritional guidance for a higher-protein diet. This comparison will help determine the effects of each additional component of the intervention.
Resistance training will be performed three times per week. Group cognitive behavioral therapy sessions will be held weekly and will address strategies to support sustainable behavioral changes, including self-awareness, goal setting, the relationship between thoughts, emotions, and behaviors, problem-solving, and maintenance of behavioral changes. Nutritional guidance will also be provided in weekly group sessions, focusing on the sustainable adoption of a higher-protein diet using commonly consumed foods while considering participants' individual circumstances and autonomy.
Assessments will be conducted before and after the 16-week intervention to evaluate potential changes associated with the interventions. Comparing the three groups will help determine whether adding psychological and nutritional strategies to resistance training provides additional benefits for the physical, metabolic, cognitive, and psychological health of older adults with overweight or obesity.
Age ≥ 60 years;
Presence of excess adiposity/overweight or obesity, according to protocol criteria;
Medical clearance to perform supervised physical exercises and the tests;
No regular participation in structured resistance training over the past 5 months.
Contraindication to resistance training or physical testing;
Unstable or uncontrolled cardiovascular disease;
Recent (< 6 months) coronary or cerebrovascular event;
Uncontrolled arterial hypertension;
Parallel
Nutritional guidance focused on adopting a high-protein diet.
BehavioralThe nutritional guidance will be delivered in a group setting by nutritionist(s), with 16 weekly sessions lasting 25-30 minutes over 16 weeks. The intervention will focus on the sustainable adoption of a high-protein diet based on commonly consumed foods, without providing protein supplements and considering participants' socioeconomic and cultural contexts. The protein target will be 1.2-1.6 g/kg/day, calculated using adjusted body weight and distributed evenly across main meals. Accessible, high-quality protein sources will be prioritized, supported by practical nutrition education strategies such as meal planning, portion guides, and food substitution lists. Adherence will be monitored using 3-day food diaries completed every three weeks. The program will be organized into four progressive modules, ranging from nutrition fundamentals in aging to the consolidation and maintenance of dietary changes.
Group Cognitive Behavioral Therapy Intervention
BehavioralThe Cognitive Behavioral Therapy (CBT) intervention will be delivered weekly in 25-30-minute group sessions, conducted by a trained psychologist for the GBI and GINT groups. The program will focus on promoting sustainable changes in thoughts, emotions, and behaviors related to excess weight. It will be structured into four progressive modules: Foundations and Self-Awareness; Cognitive and Behavioral Skills; Biopsychosocial Integration; and Consolidation and Maintenance. Strategies will include psychoeducation, self-monitoring, goal setting, stimulus control, cognitive restructuring, problem-solving, and relapse prevention. The intervention will specifically address emotional eating, eating disinhibition, and self-efficacy and will be integrated with nutritional guidance and resistance training. Homework assignments and adherence monitoring will be used throughout the intervention.
Resistance Training Program
BehavioralThe resistance training (RT) program will be conducted over 16 weeks, with three sessions per week on non-consecutive days, each lasting approximately 40 minutes and supervised by qualified Physical Education and Physiotherapy professionals. The protocol will include exercises targeting the upper limbs, lower limbs, and trunk, performed in two 1-minute sets, with 45-second rest intervals. Training intensity will be monitored using the OMNI Rating of Perceived Exertion Scale (OMNI-RPE) and progressively adjusted across six phases, starting from very light to light effort, progressing to hard to very hard effort, and ending with a recovery week. Before the intervention, participants will complete familiarization sessions covering the exercises, proper technique, and the perceived exertion scale to ensure safety and reliable monitoring of training intensity.
Change in Fat-Free Mass
Change in fat-free mass following the 16-week intervention. Fat-free mass is assessed using multifrequency bioelectrical impedance analysis (InBody 570, InBody Co. Ltd., South Korea) under standardized pre-assessment conditions, including an overnight fast, avoidance of alcohol and caffeine, and abstention from vigorous exercise before testing. Fat-free mass is expressed in kilograms (kg). The primary outcome is the change in fat-free mass from baseline to post-intervention, compared across the three intervention arms.
Change in Body Mass
Change in body mass from baseline to post-intervention. Body mass is assessed using multifrequency bioelectrical impedance analysis (InBody 570) and reported in kilograms (kg). The outcome is calculated as the post-intervention value minus the baseline value.
Change in lean mass
Change in lean mass from baseline to post-intervention. Lean mass is assessed using multifrequency bioelectrical impedance analysis (InBody 570) and reported in kilograms (kg). The outcome is calculated as the post-intervention value minus the baseline value.
Change in Appendicular Lean Mass
Change in appendicular lean mass from baseline to post-intervention. Appendicular lean mass is assessed using multifrequency bioelectrical impedance analysis (InBody 570) and reported in kilograms (kg). The outcome is calculated as the post-intervention value minus the baseline value.
Change in Fat Mass
Change in fat mass from baseline to post-intervention. Fat mass is assessed using multifrequency bioelectrical impedance analysis (InBody 570) and reported in kilograms (kg). The outcome is calculated as the post-intervention value minus the baseline value.
Participant-reported experience and acceptability of the intervention (qualitative)
Qualitative exploration of participants' experience and acceptability of the interdisciplinary intervention. At the end of the intervention, completers from all three arms are invited to an individual semi-structured interview (audio-recorded, \~20-25 min), conducted by a trained interviewer not involved in delivering the sessions. Interviews are transcribed verbatim and analysed using reflexive thematic analysis (Braun \& Clarke), with a primarily deductive orientation around four predefined domains: (1) satisfaction with the program, (2) eating pleasure, (3) self-efficacy to maintain behavioural changes, and (4) empowerment for health-related decision-making, while remaining open to additional themes. As a qualitative outcome, results are reported as constructed themes rather than a numeric metric. Conduct and reporting follow the COREQ guidelines.
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