Physical activity and the risk of becoming overweight or obese in middle-aged and older women

Effectiveness of an intermittent fasting diet versus regular diet on fat loss in overweight and obese middle-aged and elderly people without metabolic disease: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

As the number of adults aged over 40 with obesity increases dramatically, intermittent fasting interventions (IF) may help them to lose fat and weight. This systematic review investigated the most recent research on the effects of intermittent fasting and a regular diet on body composition and lipids in adults aged over 40 with obesity without the metabolic disease.

DATA SOURCES

Randomized controlled trials (RCTs) on IF on adults aged over 40 with obesity were retrieved from PubMed, Web of Science, EBSCO, China Knowledge Network (CNKI), VIP database, Wanfang database with the experimental group using IF and the control group using a regular diet. Revman was used for meta-analysis. Effect sizes are expressed as weighted mean differences (WMD) and 95% confidence intervals (CI).

STUDY SELECTION

A total of 9 articles of randomised controlled trials that met the requirements were screened for inclusion. Studies typically lasted 2-6 weeks. The experimental population was aged 42-66 years, with a BMI range of 25.7-35 kg/m2.

SYNTHESIS

A total of 9 RCTs were included. meta-analysis showed that body weight (MD: -2.05 kg; 95% CI (-3.84, -0.27); p = 0.02), BMI (MD: -0.73 kg/m2; 95% CI (-1.05, -0.41); p < 0.001), fat mass (MD: -2.14 kg; 95% CI (-3.81, 0.47); p = 0.01), and TG (MD = -0.32 mmol/L, 95% CI (-0.50, -0.15, p < 0.001) were significantly lower in the experimental group than in the control group. No significant reduction in lean body mass (MD: -0.31 kg; 95% CI (-0.96, 0.34); p = 0.35).

CONCLUSION

IF had a reduction in body weight, BMI, fat mass, and TG in adults aged over 40 with obesity without metabolic disease compared to RD, and IF did not cause a significant decrease in lean body mass, which suggests healthy and effective fat loss. However, more long-term and high-quality trials are needed to reach definitive conclusions.

Association of Regular Leisure-Time Physical Activity with Self-Reported Body Mass Index and Obesity Risk among Middle-Aged and Older Adults in Taiwan

Through this study, we aimed to determine the association of regular leisure-time physical activity (LTPA) with self-reported body mass index (BMI) and obesity risk among middle-aged and older adults in Taiwan. We conducted a cross-sectional study and reviewed the data derived from the Taiwan National Physical Activity Survey (TNPAS). Responses from 12,687 participants aged 45–108 years from the database were collected in this study. All the participants completed a standardized structured questionnaire that solicitated information regarding their demographic characteristics (age, gender, education, occupation, and self-reported health status), physical activity behaviors (regular/nonregular LTPA), and self-reported anthropometrics (height, weight, and BMI). Multiple linear and logistic regressions were used to examine the association between regular LTPA and BMI, and between regular LTPA and obesity status, respectively. Regular LTPA was associated with male gender, normal weight, excellent or good self-reported health status, and a lower rate of being underweight compared with nonregular LTPA. Regular LTPA was significant negatively associated with being underweight (OR = 0.71, p < 0.05), whereas it had no significant relationship with BMI and obesity (p > 0.05). Regular LTPA was associated with a reduced risk of being underweight among middle-aged and elderly adults in Taiwan. Further research on the relevant mechanism underlying this phenomenon is warranted.

Objectively Measured Physical Activity Is Associated With Body Composition and Metabolic Profiles of Pacific and New Zealand European Women With Different Metabolic Disease Risks

Objective: To assess associations between physical activity (PA), body composition, and biomarkers of metabolic health in Pacific and New Zealand European (NZE) women who are known to have different metabolic disease risks. Methods: Pacific (n = 142) or NZE (n = 162) women aged 18-45 years with a self-reported body mass index (BMI) of either 18.5-25.0 kg⋅m-2 or ≥30.0 kg⋅m-2 were recruited and subsequently stratified as either low (<35%) or high (≥35%) BF%, with approximately half of each group in either category. Seven-day accelerometery was used to assess PA levels. Fasting blood was analysed for biomarkers of metabolic health, and whole body dual-energy X-ray absorptiometry (DXA) was used to estimate body composition. Results: Mean moderate-to-vigorous physical activity (MVPA; min⋅day-1) levels differed between BF% (p < 0.05) and ethnic (p < 0.05) groups: Pacific high- 19.1 (SD 15.2) and low-BF% 26.3 (SD 15.6) and NZE high- 30.5 (SD 19.1) and low-BF% 39.1 (SD 18.4). On average Pacific women in the low-BF% group engaged in significantly less total PA when compared to NZE women in the low-BF% group (133 cpm); no ethnic difference in mean total PA (cpm) between high-BF% groups were observed: Pacific high- 607 (SD 185) and low-BF% 598 (SD 168) and NZE high- 674 (SD 210) and low-BF% 731 (SD 179). Multiple linear regression analysis controlling for age and deprivation showed a significant inverse association between increasing total PA and fasting plasma insulin among Pacific women; every 100 cpm increase in total PA was associated with a 6% lower fasting plasma insulin; no significant association was observed in NZE women. For both Pacific and NZE women, there was an 8% reduction in fasting plasma insulin for every 10-min increase in MVPA (p ≤ 0.05). Conclusion: Increases in total PA and MVPA are associated with lower fasting plasma insulin, thus indicating a reduction in metabolic disease risk. Importantly, compared to NZE, the impact of increased total PA on fasting insulin may be greater in Pacific women. Considering Pacific women are a high metabolic disease risk population, these pre-clinical responses to PA may be important in this population; indicating promotion of PA in Pacific women should remain a priority.

Physical Activity in the Prevention of Weight Gain: the Impact of Measurement and Interpretation of Associations

PURPOSE OF REVIEW

To what extent do different methods of physical activity measurement and statistical analysis influence the reported associations between physical activity and weight gain?

RECENT FINDINGS

The obesity epidemic has led to a focus on lifestyle approaches to the prevention of weight gain. Physical activity is one such approach. A number of studies have reported beneficial associations between higher levels of physical activity and weight gain at the population level. However, limitations of physical activity measurement and analytical models in some of these studies are likely to have resulted in overestimation of the strength of association. Understanding the limitations of assessment methods and analytical models used in epidemiological research should facilitate more realistic appraisal for physical activity to prevent weight gain at the population level and inform approaches to future research.

Associations of physical activity and sedentary time with body composition in Brazilian young adults

The findings of studies on the association between physical activity and adiposity are not consistent, and most are cross-sectional and used only self-reported measures. The aims of this study were to evaluate: 1) independent and combined cross-sectional associations of objectively-measured physical activity and sedentary time with body composition outcomes at 30 years, and 2) prospective associations of changes in self-reported physical activity from 23 to 30 years with the same outcomes in participants from the 1982 Pelotas (Brazil) Birth Cohort. Body mass index, waist circumference, visceral abdominal fat, fat mass index, and android/gynoid fat ratio were the outcomes. 3,206 participants were analysed. In cross-sectional analyses, higher objectively-measured moderate-to-vigorous physical activity was associated with lower body mass index (β = 0.017, 95%CI: −0.026; −0.009), waist circumference (β = −0.043, 95%CI: −0.061; −0.025), visceral abdominal fat (β = −0.006, 95%CI: −0.009; −0.003), and fat mass index (β = −0.015, 95%CI: −0.021; −0.009), independent of sedentary time. Sedentary time was independently associated only with higher fat mass index (β = 0.003, 95%CI: 0.001; 0.005). In longitudinal analyses, using self-reported measure, adiposity was lower among those who were consistently active or who became active. Adiposity was similar among the “became inactive” and “consistently inactive” subjects. Our findings suggest metabolic benefits from engagement in physical activity throughout young adulthood, with stronger associations on concurrent levels.

Which Women are Highly Active Over a 12-Year Period? A Prospective Analysis of Data from the Australian Longitudinal Study on Women's Health

INTRODUCTION

Current Australian physical activity (PA) guidelines encourage adults to accumulate 150-300 min of moderate to vigorous PA each week. Some critics assert that 300 min is unachievable.

OBJECTIVES

The aims of this study were to identify the proportion of younger and mid-aged women who met the 300-min recommendation over a 12-year period, examine how the "highly active" women achieved this level of activity (in terms of walking, moderate activity, and vigorous activity), and to identify the sociodemographic, biological, lifestyle, and work-related determinants of being "highly active".

METHODS

Younger (n = 7843) and mid-aged (n = 8043) participants in the Australian Longitudinal Study on Women's Health completed triennial surveys between 2000 and 2013, when their ages were 24.6-36.3 and 52.5-64.5 years, respectively. Self-reported PA was assessed as time spent in walking, moderate activity, and vigorous activity in the previous week; an index of MET.min/week was derived and dichotomized as <1000 MET.min/week (<300 min; not highly active) or ≥1000 MET.min/week (≥300 min; highly active). Generalized estimating equations were used to examine univariable and multivariable associations between a number of sociodemographic, lifestyle, and health variables with PA status (measured at every survey).

RESULTS

In the younger cohort, the proportion who were highly active decreased from 40% in 2000 to 31% in 2012. High levels of activity were achieved through a combination of walking (39.1-45.1% of total activity) and vigorous PA (41.8-47.7%). In the mid-age cohort, the proportion of women who were highly active increased from 32% in 2001 to 47% in 2013; this was achieved predominantly through walking (55.8-59.7%). In multi-variable models, the highest odds for being in the high PA category (odds ratios [ORs] ≥ 1.20; p < 0.001) were for younger women who were single, those who worked long full-time hours, those who drank any quantity of alcohol, and those who sat for less than 8 h/day. In the mid-age cohort, the highest odds for being in the high PA category (ORs ≥1.20; p < 0.001) were for women with post-school education, those who were retired, those who were low-risk drinkers (compared with non-drinkers), those who sat for less than 8 h/day, and those with lower levels of stress.

DISCUSSION

Our findings clearly indicate that the upper limit of the Australian PA guidelines is achievable for large numbers of women. Factors associated with being highly active were different for younger and mid-age women, but healthy weight, high education, and paid work (full-time in the younger women, part-time in mid-age) were common characteristics of highly active women in both cohorts.

Physical Activity, Television Viewing Time, and 12-Year Changes in Waist Circumference

Purpose

Both moderate-to-vigorous physical activity (MVPA) and sedentary behavior can be associated with adult adiposity. Much of the relevant evidence is from cross-sectional studies or from prospective studies with relevant exposure measures at a single time point before weight gain or incident obesity. This study examined whether changes in MVPA and television (TV) viewing time are associated with subsequent changes in waist circumference, using data from three separate observation points in a large population-based prospective study of Australian adults.

Methods

Data were obtained from the Australian Diabetes, Obesity, and Lifestyle study collected in 1999–2000 (baseline), 2004–2005 (wave 2), and 2011–2012 (wave 3). The study sample consisted of adults age 25 to 74 yr at baseline who also attended site measurement at three time points (n = 3261). Multilevel linear regression analysis examined associations of initial 5-yr changes in MVPA and TV viewing time (from baseline to wave 2) with 12-yr change in waist circumference (from baseline to wave 3), adjusting for well-known confounders.

Results

As categorical predictors, increases in MVPA significantly attenuated increases in waist circumference (P for trend < 0.001). TV viewing time change was not significantly associated with changes in waist circumference (P for trend = 0.06). Combined categories of MVPA and TV viewing time changes were predictive of waist circumference increases; compared with those who increased MVPA and reduced TV viewing time, those who reduced MVPA and increased TV viewing time had a 2-cm greater increase in waist circumference (P = 0.001).

Conclusion

Decreasing MVPA emerged as a significant predictor of increases in waist circumference. Increasing TV viewing time was also influential, but its impact was much weaker than MVPA.

Associations between domains of physical activity, sitting time, and different measures of overweight and obesity

OBJECTIVE

To describe 1) cross-sectional associations between domain-specific physical activity, sitting time and different measures of overweight/obesity and 2) longitudinal associations between patterns of change in physical activity and overweight/obesity ten years later.

METHODS

Cross-sectional and longitudinal analyses based on the first and second follow-up of the Swiss cohort study SAPALDIA (SAP) were conducted (SAP2 in 2002/03, SAP3 in 2010/11). Physical activity was assessed by self-report using the long International Physical Activity Questionnaire (IPAQ) and four short questions regarding moderate and vigorous activities. Overweight/obesity were defined based on body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and percent body fat based on bioelectric impedance analysis (BIA), all measured objectively. Multivariable logistic regression was used for analyses.

RESULTS

Cross-sectionally, leisure-time and vigorous physical activity were inversely associated with all obesity parameters. Most consistent associations were found with BIA percent body fat. There were no associations between work-related and domestic activities and overweight/obesity. Sitting time was positively associated with BIA percent body fat, but not with BMI, WHR and WHtR. Longitudinally, remaining inactive from SAP2 to SAP3 was associated with obesity and BIA percent body fat at SAP3 and with weight increase, becoming inactive with BIA percent body fat and weight increase.

CONCLUSIONS

The results support associations between physical activity and overweight/obesity cross-sectionally and longitudinally. Most consistent associations were found for BIA percent body fat. For prevention purposes, the results indicate that physical activity can have an important contribution to weight management.

Long-term Effects of Physical Activity Level on Changes in Healthy Body Mass Index Over 12 Years in Young Adult Women

OBJECTIVES

To examine the effects of overall level and timing of physical activity (PA) on changes from a healthy body mass index (BMI) category over 12 years in young adult women.

PATIENTS AND METHODS

Participants in the Australian Longitudinal Study on Women's Health (younger cohort, born 1973-1978) completed surveys between 2000 (age 22-27 years) and 2012 (age 34-39 years). Physical activity was measured in 2000, 2003, 2006, and 2009 and was categorized as very low, low, active, or very active at each survey, and a cumulative PA score for this 9-year period was created. Logistic regression was used to examine relationships between PA accumulated across all surveys (cumulative PA model) and PA at each survey (critical periods PA model), with change in BMI category (from healthy to overweight or healthy to obese) from 2000 to 2012.

RESULTS

In women with a healthy BMI in 2000, there were clear dose-response relationships between accumulated PA and transition to overweight (P=.03) and obesity (P<.01) between 2000 and 2012. The critical periods analysis indicated that very active levels of PA at the 2006 survey (when the women were 28-33 years old) and active or very active PA at the 2009 survey (age 31-36 years) were most protective against transitioning to overweight and obesity.

CONCLUSION

These findings confirm that maintenance of very high PA levels throughout young adulthood will significantly reduce the risk of becoming overweight or obese. There seems to be a critical period for maintaining high levels of activity at the life stage when many women face competing demands of caring for infants and young children.

Utilization of a free fitness center-based exercise referral program among women with chronic disease risk factors

Physical activity (PA) reduces the risk for a number of chronic diseases including heart disease, hypertension, hyperlipidemia, and diabetes mellitus type 2. However, most Americans do not meet expert recommendations for exercise, and minorities and low-income persons are the most inactive. Community-based approaches to promoting PA include primary care exercise referral programs. This study examines patient characteristics associated with utilization of a community health center-based exercise referral program. Adult female patients of a community health center with an affiliated fitness center, in Boston, MA, were included in the study if they received a referral to the fitness center from their primary care provider. Demographic and medical information was abstracted from the medical chart, and fitness records were abstracted to measure activation of a fitness center membership (creation of an account denoting at least an initial visit) and utilization over time. Overall, 503 (40%) of the 1,254 referred women in the study sample activated their membership. Black women were almost 60% more likely to activate their membership (adjusted OR 1.6, 95% CI 1.2-2.2), and women with higher co-morbidity counts were almost 45% more likely to activate (adjusted OR 1.4, 95% CI 1.0-2.0). Once activated, a minority of women participated at levels likely to improve cardiometabolic fitness. Of the 503 activations, 96 (19%) had no participation, 359 (71%) had low participation, and only 48 (10%) had high participation. No independent predictors of participation were identified. These findings suggest that program design may benefit from developing activation, initial participation, and retention strategies that address population-specific barriers.

Physical activity in relation to body size and composition in women in UK Biobank

PURPOSE

Physical activity is thought to protect against obesity, but the evidence is limited and few large studies of this topic have direct, objective measures of several different anthropometric variables. We examined the association of self-reported physical activity with measures of total and central adiposity.

METHODS

Our cross-sectional study included 38,201 premenopausal and 94,592 postmenopausal healthy women aged 40 to 70 years in UK Biobank, recruited from 2006 to 2010.

RESULTS

Means for total and vigorous physical activity were 31.3 (SD, 30.8) and 9.7 (SD, 14.8) metabolic equivalent h/wk, respectively, for premenopausal and 34.4 (SD, 33.1) and 8.9 (SD, 15.6) metabolic equivalent h/wk, respectively, for postmenopausal women. Multiple linear regression models showed that in both premenopausal and postmenopausal women, body mass index, body fat mass and percentage, trunk fat mass and percentage, waist and hip circumference, and waist-to-hip ratio were lower in women with higher physical activity (P < .0001). Within each category of total physical activity, a larger proportion of vigorous physical activity was associated with lower adiposity (P < .0001).

CONCLUSIONS

These findings support the roles of a physically active lifestyle and vigorous exercise in maintaining healthy body size and composition. Higher exercise intensity may be associated with lower adiposity, beyond the influence of exercise frequency and duration.

TV viewing and BMI by race/ethnicity and socio-economic status

Objective

To assess the association between TV viewing and obesity by race/ethnicity and socio-economic status.

Design

Cross-sectional analysis of 5,087 respondents to the Health Information National Trends Survey (HINTS), a nationally representative sample of US adults. Multivariate regression models were computed to assess the association between quartiles of TV viewing and BMI, stratified by race/ethnicity, educational attainment, employment and health insurance status.

Results

Findings indicate that increased TV viewing was associated with higher odds for being overweight/obese in the entire sample, while adjusting for physical activity and other confounders. After stratification by race/ethnicity, increased odds for overweight/obesity in the 3^rd and 4^th quartiles of TV viewing (e.g., 3^rd quartile- cumulative OR = 1.43, 95%CI 1.07–1.92) was observed in non-Hispanic whites, with statistical significance. In non-Hispanic blacks and Hispanics, the odds were similar to whites, but did not reach statistical significance. Significant relations between greater TV viewing and increased BMI were observed in college graduates and non-graduates, those with health insurance and the employed.

Conclusions

This study extends previous research by examining potential inconsistencies in this association between various racial/ethnic groups and some socio-economic variables, which primarily were not found.