The one-two punch of diet and exercise may be the best for obese seniors who want to be stronger and more fit, finds a study released Wednesday in the New England Journal of Medicine.

Researchers placed 107 men and women who were obese and age 65 and older into one of four groups for a year: one that dieted; one that did cardio, resistance, flexibility and balance exercises three times a week; one that did both; and a control group that neither dieted nor exercised.

Almost across the board, the seniors in the diet and exercise group fared better than the diet group, exercise group or control group alone. Physical performance improved by 21% in the combination group, by 15% in the exercise group and by 12% in the weight loss group. The study subjects were tested on tasks such as walking, putting on and removing a coat, standing up from a chair and climbing a flight of stairs.

Participants also had their peak oxygen consumption (a measure of a person’s physical fitness) calculated during a treadmill walk. Those in the diet and exercise group improved 17% from the start of the study, while the diet group improved 10% and the exercise group improved 8%.

Quality of life scores also improved most in the combination group–15%, compared with 14% in the diet group and 10% in the exercise group. The diet and exercise group also showed the most progress in strength, gait and balance.

Body weight decreased 10% in the diet group, 9% in the diet and exercise group, but did not decline in the exercise or control groups.

There was a slight down side to the interventions–researchers noted that most participants showed small decreases in lean body mass and bone mineral density. Bone mineral density measured at the hip decreased by 1.1% in the diet and exercise group and 2.6% in the diet-only group, but increased 1.5% in the exercise group. However, no substantial differences were seen in the participants in bone mineral density in the entire body or at the lumbar spine. The combination group lost 3% of its lean body mass, and the diet group lost 5%.

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