What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta-analysis

Effects and dose-response relationships of exercise intervention on weight loss in overweight and obese children: a meta-regression and system review

The aim of this study was to determine the effect of different exercise doses on weight loss in obese/overweight children. PubMed, Embase, SPORTDiscus, and the Cochrane library were searched from inception to November 2020 for randomized controlled trials. Fourty six trials involving 2,599 obese/overweight children were finally included. Different exercise dose interventions had different impacts. Exercise intervention reduce body weight (BW) by 1.46 kg (95% CI, -2.35 to -0.56, p=0.001), body fat percentage (BF%) by 2.24 (95% CI, -2.63 to -1.84, p<0.001) and body mass index (BMI) by 1.09 kg/m² (95% CI, -1.45 to -0.73, p<0.001). Each MET-h/week was association with 0.147 kg (95% CI, -0.287 to -0.007, p=0.039) decrease in BW, 0.060 (95% CI, -0.118 to -0.002, p=0.042) decrease in BF%, and 0.069 kg/m² (95% CI, -0.125 to -0.014, p=0.015) decrease in BMI. The findings suggest that there is a positive liner between exercise dose and weight loss, each MET-h/week associated with 0.147 kg, 0.060 and 0.069 kg/m² decrease in body weight, BF%, BMI, respectively.

Which Type of Exercise During Radiation Therapy Is Optimal to Improve Fatigue and Quality of Life in Men with Prostate Cancer? A Bayesian Network Analysis

Context

Physical exercise in men with prostate cancer (CaP) has shown benefits in improving cancer-related fatigue (CRF) and quality of life (QoL) during radiation therapy. However, types of exercises that are more effective are not well understood.

Evidence acquisition

We searched PubMed, Web of Science, and ClinicalTrials.gov up to November 2021 to identify potentially relevant studies. Randomized controlled trials (RCTs) testing the effects of exercise training on CRF, QoL, and treatment-related toxicities in patients with CaP undergoing radiation therapy were included. The quality of individual studies was evaluated using the Tool for the assEssment of Study qualiTy and reporting in Exercise (TESTEX) scale. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. A meta-regression analysis was conducted to test the study-level covariates. A random-effect network meta-analysis was conducted based on a Bayesian model.

Evidence synthesis

Eight RCTs with 466 participants were included. Exercise achieved significant improvements in CRF (standardized mean difference [SMD] = 1.24, 95% confidence interval or CI [0.43, 2.06], I2 = 93%) and QoL (SMD = 1.40, 95% CI [0.05, 2.75], I2 = 95%). Based on the meta-regression and Bayesian model, combined moderate-intensity continuous training aerobic exercise and resistance exercise (MICT/RES) showed the highest probability of ranking first in terms of CRF and QoL improvement, but the results of QoL were unstable. Exercise training also had a positive effect on urinary toxicities (SMD = -0.53, 95% CI [-0.79, -0.27], I2 = 0%). A subgroup analysis indicated that MICT/RES might be the most promising exercise modality for reducing intestinal toxicities (SMD = -1.76, 95% CI [-2.32, -1.20]).

Conclusions

MICT/RES might be superior to any other types of exercise at reducing CRF. MICT/RES was more effective on significantly mitigating urinary and intestinal toxicities.

Patient summary

In prostate cancer (CaP) survivors during radiation therapy, exercise training is an effective and safe intervention to reduce cancer-related fatigue (CRF) and improve quality of life (QoL), and should be prescribed as a rehabilitation option for clinical management. As for the types of exercises, moderate-intensity continuous training aerobic exercise and resistance exercise seem to be the most effective interventions to reduce CRF, improve QoL, and mitigate treatment-related symptoms.

Effects of Supervised Physical Exercise as Prehabilitation on Body Composition, Functional Capacity and Quality of Life in Bariatric Surgery Candidates: A Systematic Review and Meta-Analysis

Background: Prehabilitation is a strategy used aiming to reduce the risk factors and complications of surgery procedures, but there is no consensus on the effectiveness of supervised physical exercise and its optimal prescription during this phase. Objectives: To determine the effects of exercise prehabilitation on body composition, functional capacity and quality of life in candidates for bariatric surgery. Search methods: A search was conducted in PubMed, Web of Science, SciELO, Scopus, MEDLINE and CINAHL. Selection criteria: Only randomized clinical trials that examined the effectiveness of supervised physical exercise were included. The main outcomes were body composition, functional capacity, quality of life and surgical outcomes. Data collection and analysis: Two researchers independently selected the literature, extracted the data and evaluated the risk of bias. A third researcher was consulted when a consensus was not reached. The risk of bias was assessed by the tool recommended by the Cochrane Collaboration, the quality of the evidence by GRADE, and to analyze the effects of prehabilitation on the primary objectives, RevMan software, version 5.3 was used. Main results: The search resulted in 4550 articles, of which 22 met the eligibility criteria, leaving 5 articles selected for this review. One article was assessed as a high bias risk and four as an uncertain risk, which included 139 candidates for bariatric surgery. Most of the studies evaluated the body composition, functional capacity and quality of life; none reported surgical outcomes. Conclusions: Supervised physical exercise has positive effects on the body composition, functional capacity and quality of life; there was no evidence for surgical outcomes, which opens up a field of study for future research of this population.

Proof of Concept of a 6-Month Person-Oriented Exercise Intervention 'MultiPill-Exercise' among Patients at Risk of or with Multiple Chronic Diseases: Results of a One-Group Pilot Trial

Physical exercise has been shown to be effective in the treatment of non-communicable chronic diseases. However, patients with multiple chronic diseases (multimorbidity) have received little attention in health policy. This pilot trial served as a proof of concept of a 6-months person-oriented exercise intervention for people at risk of or with diagnosed cardiovascular diseases, diabetes mellitus type 2, overweight and/or hip/knee osteoarthritis, regarding effects on health outcomes as well as adherence and safety. The intervention (‘MultiPill-Exercise’) was designed to promote physical exercise participation, considering an individual perspective by addressing personal and environmental factors. Outcomes were assessed at baseline (t0) and after three- (t3) and six-months (t6). The primary outcome was self-reported physical exercise participation in minutes/week comparing t3 and t6 vs. t0. Secondary outcomes included cardio-respiratory fitness (maximum oxygen uptake VO2peak during incremental cycling ergometry), isometric peak torque of knee extensors and flexors, health-related quality of life (Veterans Rand 12 with its subscales of perceived general health (GH), mental health (MCS), and physical health (PCS)) and blood levels. Adherence to exercise (% of attended sessions during the first 12-weeks of the intervention) and adverse events were monitored as well. Data were analyzed using a non-parametric procedure for longitudinal data, estimating rank means (MRank) and relative treatment effects (RTE) as well as linear-mixed effect models for parametric data. The primary endpoint of physical exercise participation was significantly higher at t3 and t6 compared to baseline (t3 vs. t0: MRank = 77.1, p < 0.001, RTE: 0.66; t6 vs. t0: MRank = 70.6, p < 0.001, RTE = 0.60). Improvements at both follow-up time points compared to t0 were also found for relative VO2peak (t3 vs. t0 = 2.6 mL/kg/min, p < 0.001; t6 vs. t0 = 2.0 mL/kg/min, p = 0.001), strength of knee extensors (t3 vs. t0 = 11.7 Nm, p = 0.007; t6 vs. t0= 18.1 Nm, p < 0.001) and GH (t3 vs. t0 = 16.2, p = 0.003; t6 vs. t0 = 13.4, p = 0.008). No changes were found for MCS, PCS and for blood levels. Overall exercise adherence was 77%. No serious adverse events were recorded. Results of this pilot trial represent a first proof of concept for the intervention ‘MultiPill-Exercise’ that will now be implemented and evaluated in a real-world health care setting.

Effect of aerobic exercise on waist circumference in adults with overweight or obesity: A systematic review and meta-analysis

Excess visceral adiposity contributes to elevated cardiometabolic risk, and waist circumference is commonly used as a surrogate measure of visceral adipose tissue. Although regular aerobic exercise is known to improve abdominal obesity, its effect on waist circumference is unclear. A systematic review and meta-analysis was performed to determine (1) the effect of aerobic exercise on waist circumference in adults with overweight or obesity; (2) the association between any change in waist circumference and change in visceral adipose tissue and/or bodyweight with aerobic exercise interventions; and (3) if reductions in waist circumference with exercise are moderated by clinical characteristics or components of aerobic exercise prescription. Twenty-five randomized controlled trials (1686 participants) were included. Regular aerobic exercise significantly reduced waist circumference by 3.2 cm (95% confidence interval [CI] -3.86, -2.51, p ≤ 0.001) versus control. Change in waist circumference was associated with change in visceral adipose tissue (β = 4.02; 95% CI 1.37, 6.66, p = 0.004), and vigorous intensity produced superior reduction (-4.2 cm, 95% CI -4.99, -3.42, p < 0.0001) in waist circumference compared with moderate intensity (-2.50 cm, 95% CI -3.22, -1.79, p = 0.058). These findings suggest regular aerobic exercise results in modest reductions in waist circumference and associated visceral adipose tissue and that higher intensity exercise may offer superior benefit to moderate intensity.

COVID-19 and Cardiometabolic Health: Lessons Gleaned from the Pandemic and Insights for the Next Wave

PURPOSE OF REVIEW

To review the current evidence regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiometabolic health, with a focus on strategies to help mitigate adverse effects on population health.

RECENT FINDINGS

Individuals with cardiometabolic disease are particularly vulnerable to worse outcomes with COVID-19 infection. In addition, the pandemic itself has had significant deleterious impact on the cardiometabolic health of the population, including declines in physical activity, increases in smoking and alcohol use, worsening blood pressure and glycemic control, and detrimental effects on mental health. Targeted interventions at the patient and community level will be needed to mitigate the long-term consequences of the COVID-19 pandemic on population cardiometabolic health. The COVID-19 pandemic has worsened cardiometabolic health, but there are several opportunities and enhanced tools available to counteract these changes.

Effect of fixed 7.5 minutes' moderate intensity exercise bouts on body composition and blood pressure among sedentary adults with prehypertension in Western-Kenya

Prehypertension is a modifiable risk factor for cardiovascular disease observed to affect an estimated 25-59% of global population and closely associated with body composition. Without appropriate interventions, one-third of individuals with prehypertension would develop full-blown hypertension within 4 years. The existing exercise recommendations need substitutes that appeal more yet accord similar or better outcomes in desire to halt this progression. This study evaluated the effect of Fixed 7.5-minute Moderate Intensity Exercise (F-7.5m-MIE) bouts on Body Composition and Blood Pressure (BP) among sedentary adults with prehypertension in Western-Kenya in a Randomized Control Trial (RCT) performed throughout the day compared to the single-continuous 30-60-minute bouts performed 3 to 5 times weekly. This RCT, with three arms of Experimental Group1 (EG1) performing the F-7.5m-MIE bouts, Experimental Group 2 (EG2) performing current World Health Organization (WHO) recommendation of ≥30-min bouts, and, control group (CG), was conducted among 665 consenting pre-hypertensive sedentary adults enrolled from western Kenya. EG1 and EG2 performed similar weekly cumulative minutes of moderate intensity exercises. Adherence was determined using activity monitors and exercise logs. Data regarding demographic characteristics, heart rate, BP, and anthropometric measures were collected at baseline and 12th week follow-up. Data regarding univariate, bivariate and multivariate (repeated measurements between and within groups) analysis were conducted using STATA version 13 at 5% level of significance. The study revealed that males (92.1% in EG1, 92% in EG2 and 96.3% in CG) and females (94.6% in EG1, 89.3% in EG2 and 95% in CG) in the three arms completed the exercise at follow-up respectively. At 12th week follow-up from all exercise groups, males' and females' measurements for waist-hip-ratio, waist-height-ratio, systolic BP (SBP), heart rate and pulse pressure showed significant drops from baseline, while diastolic BP (DBP) and body mass index (BMI) reported mixed results for males and females from the various treatments. Both treatments demonstrated favourable outcomes. However, differences in the change between baseline and endpoint yielded mixed outcomes (SBP; p<0.05 for both males and females, DBP; p<0.05 for males and females, waist-height-ratio; p = 0.01 and <0.05 for males and females respectively, waist-hip-ratio; P = 0.01 and >0.05 for males and females respectively, BMI; p>0.05 for both males and females, heart rate; p<0.05 for males and females and pulse pressure; p = 0.01 and >0.05 for males and females respectively). The study design however could not test for superiority. The study demonstrated that the F-7.5m- MIE treatment programme and the WHO recommended 3-5 times weekly bouts of 30-60 minutes regime produced comparably similar favourable outcomes in adherence and BP reductions with improved body composition. Trial registration: Trial registered with Pan African Clinical Trial Registry (www.pactr.org): no. PACTR202107584701552. (S3 Text).

Effect of Exercise Training on Body Composition and Inflammatory Cytokine Levels in Overweight and Obese Individuals: A Systematic Review and Network Meta-Analysis

Objective

This study aimed to compare and rank the effectiveness of aerobic exercise (AE), resistance training (RT), combined aerobic and resistance training (CT), and high-intensity interval training (HIIT) on body composition and inflammatory cytokine levels in overweight and obese individuals by using network meta-analysis (NMA).

Methods

We searched the PubMed, Cochrane, Embase, Web of Science, and EBSCO databases to identify randomized controlled trials investigating the effects of exercise training on inflammatory cytokines in overweight and obese patients. The retrieval period was from inception to November 2021. Two reviewers independently screened the retrieved articles, extracted the pertinent data, and assessed the risk of bias of the included studies; then, they used Stata 16.0 and Review Manager 5.3 to perform an NMA.

Results

A total of 38 studies involving 1317 patients were included in this study. The results of the NMA indicated that AE had the greatest effect on weight loss (SUCRA=78.3; SMD=−0.51, 95% CI: −0.70, −0.33); CT had the greatest effect on reducing body mass index (SUCRA=70.7; SMD=−0.46, 95% CI: −0.81, −0.10), waist circumference (SUCRA=93.4; SMD=−1.86, 95% CI: −2.80, −0.93), percentage body fat (SUCRA=79.6; SMD=−1.38, 95% CI: −2.29, −0.48), interleukin-6 level (SUCRA=86.4; SMD=−1.98, 95% CI: −3.87, −0.09), and tumor necrosis factor-α level (SUCRA=79.4; SMD=−2.08, 95% CI: −3.75, −0.42); AE (SMD=0.51, 95% CI: −1.68, 2.69), RT (SMD=0.15, 95% CI: −3.01, 3.32), CT (SMD=1.78, 95% CI: −1.35, 4.92), and HIIT (SMD=2.29, 95% CI: −1.27, 5.86) did not significantly increase the adiponectin level.

Conclusion

The current results suggest that CT is the best exercise modality for improving body composition and inflammatory status in overweight and obese individuals. More rigorous randomized control trials are needed for further validation.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022303165.

Associations between Objectively Determined Physical Activity and Cardiometabolic Health in Adult Women: A Systematic Review and Meta-Analysis

The purpose of this systematic review and meta-analysis was to qualitatively synthesize and quantitatively assess the evidence of the relationship between objectively determined volumes of physical activity (PA) and cardiometabolic health in women. Four databases (PubMed, Web of Science, Scopus, and the Cochrane library) were searched and, finally, 24 eligible studies were included, with a total of 2105 women from eight countries. A correlational meta-analysis shows that moderate-to-vigorous intensity physical activity (MVPA) was favorably associated with high-density lipoprotein (r = 0.16; 95% CI: 0.06, 0.25; p = 0.002); however, there was limited evidence for the effects of most of the other cardiometabolic biomarkers recorded from steps, total physical activity, light- and moderate-intensity physical activity and MVPA. It is most compelling and consistent that being more physically active is beneficial to the metabolic syndrome. Overall, PA levels are low in adult women, suggesting that increasing the total volume of PA is more important than emphasizing the intensity and duration of PA. The findings also indicate that, according to the confounding effects of body composition and cardiorespiratory fitness, meeting the minimal level of 150 min of moderate-intensity physical activity recommended is not enough to obtain a significant improvement in cardiometabolic indicators. Nonetheless, the high heterogeneity between studies inhibits robust conclusions.

Comparative Efficacy of 5 Exercise Types on Cardiometabolic Health in Overweight and Obese Adults: A Systematic Review and Network Meta-Analysis of 81 Randomized Controlled Trials

BACKGROUND

Although regular exercise is recommended for preventing and treating overweight/obesity, the most effective exercise type for improving cardiometabolic health in individuals with overweight/obesity remains largely undecided. This network meta-analysis aimed to evaluate and rank the comparative efficacy of 5 exercise modalities on cardiometabolic health measures in individuals with overweight/obesity.

METHODS

A database search was conducted in MEDLINE, Embase, Scopus, and Web of Science from inception up to September 2020. The review focused on randomized controlled trials involving exercise interventions consisting of continuous endurance training, interval training, resistance training, combined aerobic and resistance training (combined training), and hybrid-type training. Exercise interventions aimed to improve somatometric variables, body composition, lipid metabolism, glucose control, blood pressure, cardiorespiratory fitness, and muscular strength. The Cochrane risk of bias tool was used to evaluate eligible studies. A random-effects network meta-analysis was performed within a frequentist framework. The intervention ranking was carried out using a Bayesian model where mean and SD were equal to the respective frequentist estimates.

RESULTS

A total of 4331 participants (59% female; mean age: 38.7±12.3 years) from 81 studies were included. Combined training was the most effective modality and hybrid-type training the second most effective in improving cardiometabolic health-related outcomes in these populations suggesting a higher efficacy for multicomponent exercise interventions compared to single-component modalities, that is, continuous endurance training, interval training, and resistance training. A subgroup analysis revealed that the effects from different exercise types were mediated by gender.

CONCLUSIONS

These findings corroborate the latest guidelines on exercise for individuals with overweight/obesity highlighting the importance of a multicomponent exercise approach to improve cardiometabolic health. Physicians and healthcare professionals should consider prescribing multicomponent exercise interventions to adults with overweight/obesity to maximize clinical outcomes.

REGISTRATION

URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020202647.

Resistance Exercise Training Improves Metabolic and Inflammatory Control in Adipose and Muscle Tissues in Mice Fed a High-Fat Diet

This study investigates whether ladder climbing (LC), as a model of resistance exercise, can reverse whole-body and skeletal muscle deleterious metabolic and inflammatory effects of high-fat (HF) diet-induced obesity in mice. To accomplish this, Swiss mice were fed for 17 weeks either standard chow (SC) or an HF diet and then randomly assigned to remain sedentary or to undergo 8 weeks of LC training with progressive increases in resistance weight. Prior to beginning the exercise intervention, HF-fed animals displayed a 47% increase in body weight (BW) and impaired ability to clear blood glucose during an insulin tolerance test (ITT) when compared to SC animals. However, 8 weeks of LC significantly reduced BW, adipocyte size, as well as glycemia under fasting and during the ITT in HF-fed rats. LC also increased the phosphorylation of Akt_Ser473 and AMPK_Thr172 and reduced tumor necrosis factor-alpha (TNF-α) and interleukin 1 beta (IL1-β) contents in the quadriceps muscles of HF-fed mice. Additionally, LC reduced the gene expression of inflammatory markers and attenuated HF-diet-induced NADPH oxidase subunit gp91phox in skeletal muscles. LC training was effective in reducing adiposity and the content of inflammatory mediators in skeletal muscle and improved whole-body glycemic control in mice fed an HF diet.

Concurrent Training Promotes Greater Gains on Body Composition and Components of Physical Fitness Than Single-Mode Training (Endurance or Resistance) in Youth With Obesity

The prevalence of obesity in the pediatric population has become a major public health issue. Indeed, the dramatic increase of this epidemic causes multiple and harmful consequences, Physical activity, particularly physical exercise, remains to be the cornerstone of interventions against childhood obesity. Given the conflicting findings with reference to the relevant literature addressing the effects of exercise on adiposity and physical fitness outcomes in obese children and adolescents, the effect of duration-matched concurrent training (CT) [50% resistance (RT) and 50% high-intensity-interval-training (HIIT)] on body composition and physical fitness in obese youth remains to be elucidated. Thus, the purpose of this study was to examine the effects of 9-weeks of CT compared to RT or HIIT alone, on body composition and selected physical fitness components in healthy sedentary obese youth. Out of 73 participants, only 37; [14 males and 23 females; age 13.4 ± 0.9 years; body-mass-index (BMI): 31.2 ± 4.8 kg·m-2] were eligible and randomized into three groups: HIIT (n = 12): 3-4 sets×12 runs at 80-110% peak velocity, with 10-s passive recovery between bouts; RT (n = 12): 6 exercises; 3-4 sets × 10 repetition maximum (RM) and CT (n = 13): 50% serial completion of RT and HIIT. CT promoted significant greater gains compared to HIIT and RT on body composition (p < 0.01, d = large), 6-min-walking test distance (6 MWT-distance) and on 6 MWT-VO2max (p < 0.03, d = large). In addition, CT showed substantially greater improvements than HIIT in the medicine ball throw test (20.2 vs. 13.6%, p < 0.04, d = large). On the other hand, RT exhibited significantly greater gains in relative hand grip strength (p < 0.03, d = large) and CMJ (p < 0.01, d = large) than HIIT and CT. CT promoted greater benefits for fat, body mass loss and cardiorespiratory fitness than HIIT or RT modalities. This study provides important information for practitioners and therapists on the application of effective exercise regimes with obese youth to induce significant and beneficial body composition changes. The applied CT program and the respective programming parameters in terms of exercise intensity and volume can be used by practitioners as an effective exercise treatment to fight the pandemic overweight and obesity in youth.

Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta-analysis

To systematically review and analyze the effects of resistance-based exercise programs on body composition, regional adiposity, and body weight in individuals with overweight/obesity across the lifespan. Using PRISMA guidelines, randomized controlled trials were searched in nine electronic databases up to December 2020. Meta-analyses were performed using random-effects model. One-hundred sixteen articles describing 114 trials (n = 4184 participants) were included. Interventions involving resistance training and caloric restriction were the most effective for reducing body fat percentage (ES = -3.8%, 95% CI: -4.7 to -2.9%, p < 0.001) and whole-body fat mass (ES = -5.3 kg, 95% CI: -7.2 to -3.5 kg, p < 0.001) compared with groups without intervention. Significant results were also observed following combined resistance and aerobic exercise (ES = -2.3% and -1.4 kg, p < 0.001) and resistance training alone (ES = -1.6% and -1.0 kg, p < 0.001) compared with no training controls. Resistance training alone was the most effective for increasing lean mass compared with no training controls (ES = 0.8 kg, 95% CI: 0.6 to 1.0 kg, p < 0.001), whereas lean mass was maintained following interventions involving resistance training and caloric restriction (ES = ~ - 0.3 kg, p = 0.550-0.727). Results were consistently observed across age and sex groups (p = 0.001-0.011). Reductions in regional adiposity and body weight measures were also observed following combined resistance and aerobic exercise and programs including caloric restriction (p < 0.001). In conclusion, this study provides evidence that resistance-based exercise programs are effective and should be considered within any multicomponent therapy program when caloric restriction is utilized in individuals with overweight or obesity.

Exercise dose-response relationship with heart rate variability in individuals with overweight and obesity: protocol for a systematic review and meta-analysis of randomised controlled trials

INTRODUCTION

Obesity is a chronic relapsing disease process and serious public health concern that can lead to chronic diseases, medical complications and a higher risk of disability. Another significant feature of obesity is dysfunction in cardiac autonomic function, which leads to changes in parasympathetic and sympathetic regulation, which can be measured using heart rate variability (HRV). The objective of this review is to estimate the extent to which exercise doses impacts on HRV among individuals living with overweight and obesity class I and II.

METHODS AND ANALYSIS

A systematic literature search will be performed using PubMed/Medline, Scopus, EMBASE, ProQuest, CINAHL, Web of Science and the Cochrane Library for articles dating from 1965 to December 2021. Inclusion criteria include studies designed as parallel-arm randomised trials, enrolling adolescent and adult individuals with overweight (body mass index, BMI≥25 to ≤29.9) and obesity (class I BMI: 30-34.9 and class II BMI: 35-39.9) undergoing aerobic or resistance training or concurrent exercise training. For data synthesis, sensitivity analysis, subgroup analysis and risk of bias assessment, Stata V.13.0 software will be used.

ETHICS AND DISSEMINATION

Formal ethical approval is not required. This systematic review will be submitted to a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42019104154.

Dietary Intake of Adults Who Participate in CrossFit® Exercise Regimens

Background: The combination of high-intensity aerobic and high-load resistance training, as in CrossFit®, exerts similar or superior benefits to other exercise modalities. This study aimed to assess dietary habits and characterize the nutritional goals, exercise habits, and clinical health outcomes of individuals who participate in CrossFit®. Methods: Adults who are 19 y or older, with >6 mo of CrossFit® participation, completed an electronic survey and the dietary health questionnaire III. In separate models, multiple stepwise linear regressions were performed to detect the associations between (i) dietary intake, (ii) exercise habits, (iii) clinical measures, and a priori selected predictors (sex, weight status, age, and exercise frequency) in each case. Odds ratios were detected between nutritional and fitness goals, clinical outcomes, and predictors. Results: In total, 449 respondents completed both questionnaires. Of these, 443 respondents were used for relative macronutrients assessment due to not reporting body weight. Dietary intake was associated with sex, weight status, age, exercise frequency, and nutritional goals. Nutritional and fitness goals and clinical outcomes were associated with sex, weight status, age, and exercise frequency. Conclusion: Nutritional goals are underlying factors that affect eating behaviors in non-competitive CrossFit® participants. It is imperative to consider the sex, age, exercise habits, and nutritional goals of CrossFit® participants when investigating and prescribing dietary outcomes.

Comparison of time-matched aerobic, resistance or combined exercise training in women living with obesity: a protocol for a pilot randomised controlled trial-the EXOFFIT (Exercise for Obesity in Females to increase Fitness) study

INTRODUCTION

Obesity in women has more than doubled in the past thirty years. Increasing research suggests that increased cardiorespiratory fitness (CRF) can largely attenuate the negative health risks associated with obesity. Though previous literature suggests that combined training may be the most effective for improving CRF in adults with obesity, there is minimal research investigating the efficacy of combined and resistance programmes in women with obesity. This article outlines a protocol for a parallel pilot study which aims to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for increasing CRF and strength and improving body composition and other health outcomes (i.e. quality of life).

METHODS AND ANALYSIS

Sixty women (aged 18-50) with obesity (body mass index [BMI] ≥ 30 and/or waist circumference ≥ 88 cm) who are physically inactive, have no unstable health conditions and are safe to exercise will be recruited from September 2021 to December 2022. The main outcome will be feasibility and acceptability of the intervention and procedures. Trial feasibility outcomes will be evaluated to determine if a definitive trial should be undertaken. Trial acceptability will be explored through follow-up qualitative interviews with participants. Secondary outcomes will include CRF (predicted VO2 max), anthropometrics (i.e. BMI), strength (5RM bench press, leg dynamometry, grip strength) and other health outcomes (i.e., pain). Participants will be block randomised into one of four trial arms (aerobic exercise, resistance training and combined training groups, non-active control group) and measurements will be completed pre- and post-intervention. The exercise groups will receive an individualised supervised exercise programme for 3× sessions/week for 12 weeks. The change in mean values before and after intervention will be calculated for primary and secondary outcomes. ANOVA and t-tests will be applied to evaluate within-group and between-group differences. If sufficient participants are recruited, the data will be analysed using ANCOVA with the age and BMI as covariates.

DISCUSSION

This pilot will provide data on the feasibility and acceptability of trial procedures and of the programmes' three progressive time-matched exercise interventions (aerobic, resistance and combined) for women living with obesity, which will help inform future research and the potential development of a full-scale randomised clinical trial.

TRIAL REGISTRATION

ISRCTN, ISRCTN13517067 . Registered 16 November 2021-retrospectively registered.

Changes in Fat Oxidation and Body Composition after Combined Exercise Intervention in Sedentary Obese Chinese Adults

(1) Background: Evidence suggests that aerobic exercise and high-intensity interval training (HIIT) might increase fat oxidation and reduce fat. However, limited research has examined the effects of combining progressive aerobic exercise and HIIT interventions in sedentary adults with overweight and obesity, and differences in its effects between men and women remain unclear. The purpose of this study was to investigate the effects of combined progressive aerobic exercise and HIIT (CAEH) on fat oxidation and fat reduction in sedentary Chinese adults and compare sex differences in sedentary adults after seven weeks. (2) Methods: Eighty-four sedentary obese adults were enrolled and allocated to two groups in baseline (experimental (EXP) group:42; control (CON) group:42), and fifty-six subjects (EXP:31; CON:25) completed the experiments and were included in the final analysis. Subjects in the EXP group performed CAEH three times per week for seven weeks. Subjects in the CON group were advised to continue with their normal daily activities. Anthropometric, lipid profile, cardiorespiratory fitness, and fat oxidation outcomes were assessed before and after the intervention. (3) Results: After seven weeks of the CAEH intervention, compared with the CON group, the EXP group showed significant increases in fat oxidation at rest (FO_rest) (+0.03 g/min, p < 0.01), maximal fat oxidation (MFO) (+0.05 g/min, p < 0.01), and maximal oxygen intake (VO₂max) (+3.2 mL/kg/min, p < 0.01). The changes in the percentages of the FO_rest (+57%) and the VO₂max (+16%) were significantly greater (+20%, +6%) in males than in females (p < 0.05, p < 0.05). The body mass index (BMI) (−1.2 kg/m², p < 0.01), body fat percentage (−3.2%, p < 0.001), visceral fat area (−12.8 cm², p < 0.001), and total cholesterol (TC) levels (−0.4 mmol/L, p < 0.05) were significantly decreased in the EXP group. (4) Conclusions: Seven weeks of the CAEH intervention effectively improved FO_rest, MFO, and VO₂max in sedentary obese adults, and the improvements in FO_rest and VO₂max were more pronounced in males than in females. CAEH also improved body composition and TC levels in sedentary obese adults.

Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle-Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise

A sedentary lifestyle is associated with overweight/obesity, which involves excessive fat body accumulation, triggering structural and functional changes in tissues, organs, and body systems. Research shows that this fat accumulation is responsible for several comorbidities, including cardiovascular, gastrointestinal, and metabolic dysfunctions, as well as pathological pain behaviors. These health concerns are related to the crosstalk between adipose tissue and body systems, leading to pathophysiological changes to the latter. To deal with these health issues, it has been suggested that physical exercise may reverse part of these obesity-related pathologies by modulating the cross talk between the adipose tissue and body systems. In this context, this review was carried out to provide knowledge about (i) the structural and functional changes in tissues, organs, and body systems from accumulation of fat in obesity, emphasizing the crosstalk between fat and body tissues; (ii) the crosstalk between fat and body tissues triggering pain; and (iii) the effects of physical exercise on body tissues and organs in obese and non-obese subjects, and their impact on pathological pain. This information may help one to better understand this crosstalk and the factors involved, and it could be useful in designing more specific training interventions (according to the nature of the comorbidity).

Responses of different functional tests in candidates for bariatric surgery and the association with body composition, metabolic and lipid profile

Individuals with obesity can have metabolic disorders and may develop impairments that affect the ability to exercise. The maximal incremental cardiopulmonary exercise test is widely used to assess functional capacity. However, submaximal tests such as the two-minute step test (2MST) and the six-minute walk test (6MWT) also allow this assessment. We propose to analyze whether body composition, metabolic and lipid profile influence the maximal and submaximal performance, and investigate these variables in response to different functional tests. Forty-four individuals with obesity, aged 18–50 years, underwent analysis of body composition, metabolic and lipid profile, incremental treadmill test (ITMT), 6MWT, and 2MST. One-way ANOVA, Pearson or Spearman correlation, and Stepwise multiple linear regression analysis were performed. ITMT induced a greater metabolic, ventilatory, cardiovascular, and perceived exertion demand when compared to the 6MWT and 2MST (p < 0.05). In addition, 2MST elicited a higher chronotropic (HR) and metabolic (V̇O₂) demand when compared to the 6MWT (p < 0.05). Significant correlations were found between tests and body composition, metabolic and lipid profile. Fat mass and low-density lipoprotein can explain 30% of the V̇O₂ variance in the ITMT; and fat mass, glucose, and performance in the 2MST can explain 42% of the variance of the distance walked in the ITMT. Obesity and its metabolic impairments are capable of influencing responses to exercise. ITMT generated greater demand due to the high stress imposed, however, 2MST demanded greater metabolic and chronotropic demand when compared to the 6MWT.

Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: An overview of 12 systematic reviews and 149 studies

This overview of reviews aimed to summarize the effects of exercise training programs on weight loss, changes in body composition, and weight maintenance in adults with overweight or obesity. A systematic search of systematic reviews and meta-analyses (SR-MAs) published between 2010 and December 2019 was performed. Only SR-MAs of controlled trials were included. The mean difference (MD) or standardized MD (SMD) were extracted from SR-MAs. Twelve SR-MAs (149 studies) were included. Exercise led to a significant weight loss (4 SR-MAs, MDs ranging from -1.5 to -3.5 kg), fat loss (4 SR-MAs, MDs ranging from -1.3 to -2.6 kg) and visceral fat loss (3 SR-MAs, SMDs ranging from -0.33 to -0.56). No difference in weight, fat, and visceral loss was found between aerobic and high-intensity interval training as long as energy expenditure was equal. Resistance training reduced lean mass loss during weight loss (1 SR-MA, MD: 0.8 [95%CI: 0.4-1.3] kg). No significant effect of exercise was found on weight maintenance (1 SR-MA). These findings show favorable effects of exercise training on weight loss and body composition changes in adults with overweight or obesity. Visceral fat loss may lead to benefits for cardiometabolic health. More research is needed to identify training modalities that promote weight maintenance.

Effect of Combined Interval and Continuous Exercise Training on Gastric Emptying, Appetite, and Adaptive Responses in Men With Overweight and Obesity

Background/Objectives: Characterizing compensatory and adaptive responses to exercise assists in understanding changes in energy balance and health outcomes with exercise interventions. This study investigated the effects of a short-term exercise intervention (combining high intensity interval (HII) and continuous exercise) on (1) gastric emptying, appetite and energy intake; and (2) other adaptive responses including cardiorespiratory fitness, in inactive men with overweight/obesity. Methods: Fifteen men (BMI: 29.7 ± 3.3 kg/m-2) completed a 4-wk supervised exercise intervention, consisting of 5 exercise sessions per week alternating between HII (30 s at 100% VO2max followed by 30 s recovery) and continuous (at 50% VO2max) training on a cycle ergometer, progressing from 30 to 45 min session duration. Gastric emptying (13C-octanoic acid breath test), appetite (visual analog scale), energy intake (ad libitum lunch meal), body composition (air displacement plethysmography), non-exercise activity (accelerometery) VO2max, blood pressure, and fasting concentrations of glucose, insulin, and ghrelin were measured before and after (≥48 h) the intervention. Results: Gastric emptying, glucose, insulin and ghrelin were unchanged, but energy intake at the ad libitum lunch test meal significantly increased at post-intervention (+171 ± 116 kcal, p < 0.01). Body weight (-0.9 ± 1.1 kg), waist circumference (-2.3 ± 3.5 cm) and percent body fat (-0.9 ± 1.1%) were modestly reduced (P < 0.05). VO2max increased (+4.4 ± 2.1 ml.kg.min-1) by 13% and systolic (-6.2 ± 8.4 mmHg) and diastolic (-5.8 ± 2.2 mmHg) blood pressure were significantly reduced (P ≤ 0.01 for all). Conclusions: Four weeks of exercise training did not alter gastric emptying, indicating gastric emptying may only adapt to a higher volume/longer duration of exercise or changes in other characteristics associated with regular exercise. The combination of HII and continuous exercise training had beneficial effects on body composition, cardiorespiratory fitness, and blood pressure and warrants further investigation in larger randomized controlled trials.

What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta-analysis

Current international guidelines recommend people living with obesity should be prescribed a minimum of 300 min of moderately intense activity per week for weight loss. However, the most efficacious exercise prescription to improve anthropometry, cardiorespiratory fitness (CRF) and metabolic health in this population remains unknown. Thus, this network meta-analysis was conducted to assess and rank comparative efficacy of different exercise interventions on anthropometry, CRF and other metabolic risk factors. Five electronic databases were searched for randomized controlled trials (RCTs) that compared different exercise modalities to improve anthropometry, CRF and/or metabolic health in adults living with obesity. RCTs were evaluated using the Cochrane risk of bias tool. A random effects network meta-analysis was performed within a frequentist framework. Of the 6663 articles retrieved, 45 studies with a total 3566 participants were included. Results reveal that while any type of exercise intervention is more effective than control, weight loss induced is modest. Interventions that combine high-intensity aerobic and high-load resistance training exert beneficial effects that are superior to any other exercise modality at decreasing abdominal adiposity, improving lean body mass and increasing CRF. Clinicians should consider this evidence when prescribing exercise for adults living with obesity, to ensure optimal effectiveness.

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.