American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults

The Effect of Eight Weeks of Aerobic Exercise and Spirulina Supplementation on Some Liver Enzymes, Body Composition, and Cardiorespiratory Fitness in Overweight and Obese Adult Women

Objective: This study aimed to evaluate the effects of eight weeks of aerobic exercise and spirulina supplementation on liver enzymes, body composition, and cardiorespiratory fitness in overweight and obese women. Methods: A randomized, double-blind, placebo-controlled trial was conducted involving 36 overweight and obese adult women (body mass index [BMI] ≥ 25 kg/m2, aged 25-40 years) randomly assigned to four groups: placebo with aerobic exercise, spirulina with aerobic exercise, spirulina-only, and placebo-only. Interventions included aerobic training three times per week (40-50 minutes/session) and a twice-daily dose (each 500 mg) of Spirulina or placebo for eight weeks. Outcomes were assessed at baseline and post-intervention, including liver enzyme levels (alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), body composition (BMI, body fat percentage, waist-to-hip ratio (WHR)), and VO2max using validated protocols. Results: Significant within-group improvements in ALT, AST, body weight, BMI, WHR, and VO2max were observed in the aerobic training and spirulina groups, either alone or combined (p < .001). The aerobic training + placebo group demonstrated the greatest reduction in body weight and BMI, while spirulina-alone showed significant ALT and AST reductions. VO2max improved in all intervention groups, but post hoc analysis revealed no significant between-group differences. Conclusion: Aerobic exercise and spirulina supplementation independently and synergistically improve liver function, body composition, and cardiorespiratory fitness in overweight and obese women. Combining these interventions may offer a holistic approach to managing obesity-related health risks. Further research is essential to elucidate the underlying mechanisms and optimize intervention strategies for diverse populations.

The Effect of 6 Weeks of Dynamic Neuromuscular Stabilization Exercises on Motor Control, Cardiovascular Fitness, and Respiratory Performance in Overweight and Obese Women

Background: Obesity is linked to impairments in motor control, cardiovascular fitness, and respiratory function. Dynamic Neuromuscular Stabilization (DNS) aims to enhance core stability, diaphragmatic breathing, and neuromuscular coordination. This study investigated the effects of a 6-week DNS program on these functional outcomes in overweight and obese women. Methods: Thirty-six participants (aged 35-50 years, BMI: 25-34 kg/m2) were randomly assigned to either an experimental group (n = 18), which underwent DNS training, or a control group (n = 18), which received no intervention. The DNS program consisted of six weekly sessions (three supervised, three home-based), emphasizing core stabilization, diaphragmatic breathing, and neuromuscular coordination. Motor control (lumbar movement control tests), cardiovascular fitness (two-minute step test), and respiratory performance (breath-hold time, respiratory rate, and respiratory muscle strength) were assessed before and after the intervention. Results: The DNS group demonstrated significant improvements compared to the control group, with notable increases in motor control scores (p < .001) and cardiovascular fitness (p < .001). Additionally, inspiratory and expiratory breath-hold times (p < .001 for both), respiratory rate (p < .001), and maximum inspiratory and expiratory pressures (p < .001) showed substantial enhancements. No significant changes were observed in the control group. Conclusion: A 6-week DNS exercise program significantly improved motor control, cardiovascular fitness, and respiratory performance in overweight and obese women. These findings support DNS training as an effective intervention for enhancing core stability, breathing efficiency, and neuromuscular coordination, with potential applications in rehabilitation and health promotion.

The effects and post-exercise energy metabolism characteristics of different high-intensity interval training in obese adults

This study aimed to compare the effects of two high-intensity interval training modalities on body composition and muscular fitness in obese young adults and examined the characteristics of energy expenditure (EE) after training. Thirty-six obese young adults (eleven female, age: 22.1 ± 2.3 years, BMI: 25.1 ± 1.2 kg/m2) were to Whole-body high-intensity interval training group (WB-HIIT) (n = 12), jump rope high-intensity interval training group (JR-HIIT) (n = 12), or non-training control group (CG) (n = 12). WB-HIIT and JR-HIIT groups performed an 8-week HIIT protocol. WB-HIIT, according to the program of unarmed resistance training, JR-HIIT use rope-holding continuous jump training, each execution of 4 sets of 4 × 30 s training, interval 30 s, inter-set interval 1min, and the control group maintained their regular habits without additional exercise training. Body composition and muscular strength were assessed before and after 8 weeks. Repeated measures analysis of variance and clinical effect analysis using Cohen's effect size were used, with a significance level of p < 0.05. In comparison with the CG group in both experimental groups, Body Mass and BMI significantly reduced (p < 0.05), and Muscular strength significantly improved (p < 0.05).WB-HIIT versus JR-HIIT: Fat Mass (- 1.5 ± 1.6; p = 0.02 vs - 2.3 ± 1.2; p < 0.01) and % Body Fat (- 1.3 ± 1.7; p = 0.05 vs - 1.9 ± 1.9; p < 0.01) the effect is more pronounced in the JR-HIIT group; Muscle Mass (1.5 ± 0.7; p < 0.01 vs - 0.8 ± 1.1; p = 0.07) the effect is more pronounced in the WB-HIIT group. Estimated daily energy intake (122 ± 459 vs 157 ± 313; p > 0.05). Compared to the CG, body composition was significantly improved in both intervention groups. All three groups had no significant changes in visceral adipose tissue (p > 0.05). Significant differences in Lipid and Carbohydrate oxidation and energy output were observed between the two groups, as well as substantial differences in WB-HIIT and JR-HIIT VO2, ventilation, and energy consumption minute during the 0-5 min post-exercise period (p > 0.05). WB-HIIT and JR-HIIT interventions effectively improve the body composition of young adults with obesity, while WB-HIIT additionally improves muscular fitness. After exercise, WB-HIIT produces higher excess post-exercise oxygen consumption and associated lipid and carbohydrate metabolism than JR-HIIT.

HIIT versus MICT in MASLD: mechanisms mediated by gut-liver axis crosstalk, mitochondrial dynamics remodeling, and adipokine signaling attenuation

OBJECTIVE

Compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on metabolic dysfunction-associated steatotic liver disease (MASLD), focusing on the mechanisms by which these two exercise modalities influence gut microbiota structure, bile acid metabolism, and intestinal barrier function, as well as their regulatory roles in hepatic lipid synthesis and oxidative dynamics. Explore the synergistic effects of exercise-mediated mitochondrial fusion remodeling and leptin signaling, elucidate the causal relationship between gut-derived factors and hepatic metabolic reprogramming, and reveal the potential multi-scale and cross-organ dominant mechanisms of exercise, providing a theoretical basis for systematically comparing the effects of different exercise modalities.

METHODS

Thirty-two male rats were randomly divided into NFD (n = 8) and HFD (n = 24) groups and fed normal chow and high-fat chow, respectively. After eight weeks, the HFD group was randomly divided into three groups: (1) MICT-8; (2) HIIT-8; and (3) HFD-8. At the end of the experiment, blood, liver, ileum, and skeletal muscle samples were collected for analysis of the rats' baseline conditions, mitochondrial function, hepatic lipid metabolism, bile acid pathway and gut microbiota, and synthesis of analyses.

RESULTS

Both modes of exercise ameliorated metabolic dysregulation and attenuated pathological progression, insulin resistance, and liver fat accumulation in rats with MASLD. Furthermore, both interventions counteracted HFD-induced intestinal barrier dysfunction and restored gut-liver axis homeostasis. HIIT and MICT also upregulated bile acid-related gene expression modulated butyrate-producing bacterial taxa, and adjusted the abundance of butyrate-generating bacteria.

CONCLUSION

Both HIIT and MICT improved lipid metabolism in MASLD rats and the difference between the HIIT and MICT groups was not statistically significant. It is noteworthy that HIIT was more effective in improving mitochondrial function in MASLD than MICT (P < 0.001).

The association of motivational factors with weight loss and treatment time in a publicly funded weight management clinic

The objective of the study is to explore differences in weight loss (WL) and treatment time with having health, mobility, and/or aesthetics motivations for attempting WL. Data from 7540 adults with overweight or obesity who participated in a publicly funded weight management programme at the Wharton Medical Clinic were analysed. Patients' WL motivations were categorised into six groups: Health only; Health and Aesthetics; Health and Mobility; Health, Mobility and Aesthetics; No Health; and None. Women with Health, Mobility and Aesthetics or No Health motivations had marginally higher WL goals compared to other groups, with no differences in men. Men with Health and Aesthetics or Health and Mobility motivations showed marginally higher 6-month attendance rates. Men who discontinued after one visit were 40% less likely to have a Health and Aesthetics motivation as opposed to Health only, compared to those who continued. No differences were observed in WL between motivation groups in either sex. No correlation was found between WL goals and WL attained. Only weak correlations between treatment time and WL were observed across most motivation groups. Despite small differences in treatment time and WL goals, motivations for attempting WL were not significantly associated with differences in the WL achieved.

Efficacy of an online exercise program to improve weight management outcomes in individuals with obesity; A randomised trial

AIMS

To compare the efficacy of an online exercise programme with that of standard physical activity recommendations for weight management.

METHODS

We conducted an unblinded randomised controlled trial involving individuals with obesity. The study group received dietary advice and participated in an online exercise programme, while the control group received dietary advice and exercise guidance via printed documents.

RESULTS

Fifty-four participants completed the trial, with 27 in each group. The mean ages of the study and control groups were 34.11 ± 8.77 and 35.89 ± 10.61 years, respectively. The baseline body mass index, waist circumference, fat mass, and fat-free mass were not significantly different between the groups. After 12 weeks of intervention, the study group showed a significant reduction in body weight and fat mass from 106.54 ± 21.81 to 104.59 ± 21.24 kg (P = 0.004) and 47.92 ± 14.14 to 46.32 ± 13.91 kg (P = 0.005), respectively. The control group also showed a significant reduction in body weight, fat mass, and waist circumference from 103.31 ± 22.2 to 101.3 ± 22.36 kg (P = 0.015), 46.03 ± 16.31 to 41.76 ± 13.57 kg (P = 0.04), and 113.42 ± 17.00 to 111.63 ± 17.29 cm (P = 0.033), respectively. However, no significant differences were observed in any of the parameters between the groups after 12 weeks of the intervention. The study group showed a higher rate of physical activity than the control group.

CONCLUSION

Online exercise programmes can promote weight reduction and engagement in physical activity among individuals with obesity.

Weight-Inclusive Physical Activity: A Systematic Evaluation of Virtual Resources

BACKGROUND

Higher-weight individuals report lower rates of physical activity behavior and poorer physical activity experiences compared with their normative-weight counterparts, likely owing to the pervasiveness of weight stigma in physical activity contexts. Employing weight-inclusive strategies may improve physical activity outcomes, though little is known about the practical application of weight-inclusive principles in physical activity contexts. Furthermore, given the prominence of virtual methods of information dissemination, exploring online weight-inclusive resources is valuable.

METHODS

Using Google, Instagram, and snowball searches, a virtual environmental scan was conducted to collect publicly available weight-inclusive physical activity resources. Two independent coders applied an a priori codebook to all eligible resources to evaluate the application of weight-inclusive principles.

RESULTS

N = 80 weight-inclusive physical activity resources were identified, offering a range of educational materials (40%) and/or provision of physical activity services (76.3%). Virtual resources generally adhered to weight-inclusive principles by showcasing diversity in body size, using weight-inclusive language, and centering physical activity that honors the body's signals and cues; however, some also included weight-normative content. Provisional physical activity resources primarily targeted diverse-bodied end users, offered a range of physical activity types (eg, yoga, weight training, and dance), were membership-based, and offered asynchronous access.

CONCLUSIONS

This study utilizes a systematic approach to collect and evaluate virtual, publicly available, and weight-inclusive physical activity resources. Virtual physical activity resources that adhere to weight-inclusive principles may be important for increasing accessible physical activity opportunities for higher-weight individuals.

The Effect of 4:3 Intermittent Fasting on Weight Loss at 12 Months : A Randomized Clinical Trial

BACKGROUND

Long-term (≥12 months) randomized trials evaluating the efficacy of intermittent fasting (IMF) as a dietary weight loss strategy are limited. Furthermore, no studies have compared IMF versus daily caloric restriction (DCR) when both interventions are provided in the context of a guidelines-based behavioral weight loss program.

OBJECTIVE

To compare the effects of 4:3 IMF versus DCR on changes in weight at 12 months, with comprehensive behavioral support provided to both groups.

DESIGN

Randomized clinical trial. (ClinicalTrials.gov: NCT03411356).

SETTING

Denver, Colorado, and surrounding metropolitan area.

PARTICIPANTS

Adults aged 18 to 60 years with body mass index (BMI) of 27 to 46 kg/m2.

INTERVENTION

The IMF group was instructed to restrict energy intake by 80% on 3 nonconsecutive days per week, with ad libitum intake (no restriction) the other 4 days (4:3 IMF). The DCR group was instructed to reduce daily energy intake by 34% to match the weekly energy deficit of 4:3 IMF. Both groups received a high-intensity comprehensive behavioral weight loss program that included group-based behavioral support and a recommendation to increase moderate-intensity physical activity to 300 minutes per week.

MEASUREMENTS

The primary outcome was change in body weight (in kilograms) at 12 months.

RESULTS

Of the 165 (4:3 IMF, n = 84; DCR, n = 81) randomly assigned participants (mean age, 42 years [SD, 9]; mean BMI, 34.1 kg/m2 [SD, 4.4]; 73.9% female), 125 completed the trial. In an intention-to-treat analysis, 4:3 IMF showed greater reductions in weight than DCR at 12 months (mean difference, 2.89 kg [95% CI, 5.65 to 0.14 kg]; P = 0.040).

LIMITATION

Limited generalizability.

CONCLUSION

Compared with DCR, 4:3 IMF resulted in modestly greater weight loss among adults with overweight or obesity enrolled in a 12-month, high-intensity, comprehensive behavioral weight loss program.

PRIMARY FUNDING SOURCE

National Institute of Diabetes and Digestive and Kidney Diseases.

Theory-Driven Behavioral Obesity Treatment and Carry-Over of Exercise-Related, to Eating-Related, Self-Regulation: Effects on Short- and Long-Term Weight/Waist Circumference Reductions

The predominant method for treating obesity has been suggesting and providing information on a controlled diet and, to a lesser extent, increased exercise. That approach has largely failed beyond the short term for many decades as obesity rates continue to rise. Therefore, leveraging improvements in psychosocial correlates of weight-loss behaviors has sometimes been suggested instead. The aim of this study was evaluation of targeted improvements in self-regulation and self-efficacy within a theoretically derived weight-loss program. Women with obesity (N = 103) participated in a year-long community-based program emphasizing self-regulatory skills development to counter lifestyle barriers/challenges to first exercise, then controlled eating. Within a structured treatment protocol administered by community facility employees-and based on tenets of social cognitive theory, self-regulation theory, self-efficacy theory, and coaction theory-self-regulatory skills were initially developed to foster adherence to exercise. Those skills were then adapted to promote eating-behavior changes, emphasizing fruit and vegetable intake. Improvements in measures of exercise self-regulation, eating self-regulation, and self-efficacy for controlling eating, their corresponding behaviors, and weight and waist circumference were significant. Greater within-participant carry-over of changes in exercise self-regulation to eating self-regulation was significantly associated with more weight and waist circumference reductions over both 6 and 12 months. Change in eating-related self-efficacy significantly mediated those relationships. The mean weight reduction of approximately 6% indicated positive effects on obesity-related health risks. The community-based setting indicated potentials for large-scale dissemination of theory- and evidence-driven behavioral obesity treatments focused primarily on self-regulatory skills development.

Time reallocation to moderate-to-vigorous physical activity and its association with chronic kidney disease prevalence in Chinese adults with type 2 diabetes

AIMS

To examine the isotemporal substitution association of replacing moderate-to-vigorous physical activity (MVPA) with other behaviors on the prevalence of chronic kidney disease (CKD) among Chinese adults with type 2 diabetes mellitus (T2DM).

METHODS

This study included 5421 adults with T2DM from the National Metabolic Management Centre Ningbo Branch. Data on physical activity, sedentary behavior, and sleep were collected using a standardized questionnaire through face-to-face interviews. Isotemporal substitution models were employed to evaluate the associations of reallocating time from other behaviors to MVPA with the risk of CKD.

RESULTS

Substitution of 30 min per day of sleeping or sitting with MVPA was associated with a lower CKD prevalence (OR: 0.87 for sleep substitution; 0.90 for sitting substitution). Among individuals with inadequate MVPA levels (less than 150 min per week), the association of replacing 30 min of sleeping, sitting, or low-intensity physical activity with MVPA was particularly strong, cutting the risk of CKD by more than 60%. Stratified analysis among participants with inadequate MVPA revealed that the association of reallocating time to MVPA with lower CKD prevalence were predominantly observed among men, individuals with prolonged sleep duration (sleep duration more than 7.5 h per day), and those with better glycemic control (HbA1c levels below 7%).

CONCLUSIONS

This study revealed that replacing sleep or sedentary time with MVPA was associated with a lower prevalence of CKD among Chinese adults with T2DM, especially those with low MVPA. Incorporating MVPA into daily routines is potentially beneficial for improving renal health in people with T2DM.

Diet Quality Changes in a 12-Week Web-Based Physical Activity Intervention without Explicit Dietary Guidance

Lifestyle habits seem interconnected and extant studies suggest that a lifestyle-related modification can impact other related behaviors. For instance, interventions targeting physical activity (PA) could potentially impact dietary patterns and quality. Therefore, we hypothesized that a web-based intervention to increase PA would lead to changes in diet quality without explicit dietary guidance. Our aim was to evaluate changes in diet quality, measured by the Healthy Eating Index 2020 (HEI-2020), following a 12-week web-based PA intervention in adults with obesity. The study consisted of secondary analysis of a 12-week pilot randomized controlled trial, wherein participants (N = 82) were randomized to the Physical Activity for The Heart (PATH) intervention group, which included workout videos and virtual coaching, or a wait-list control group. Diet quality was assessed at baseline and post-intervention using the HEI-2020 based on recalls collected through the Automated Self-Administered 24-h recall (ASA-24) system. Baseline characteristics were similar across groups. Both groups showed small improvements in HEI-2020 total scores after 12 wk (PATH: 65.11 vs. Control: 62.24). Stratification by moderate to vigorous physical activities increase (<60 min. vs. ≥60 min.) revealed greater improvements in specific HEI-2020 components in the ≥60 min group, though overall changes remained modest. The PA intervention led to small improvements in certain diet quality components, suggesting potential interconnectedness between PA and dietary habits. However, overall changes in HEI-2020 scores were modest. Future research with larger samples should explore the effects of PA intervention alone vs. combined with dietary guidance on diet quality in adults with obesity.

The Effect of a Physical Activity Program on Subjective Well-Being, Happiness and Problem-Solving Skills in Patients with Schizophrenia: A Randomized Controlled Trial

The aim of this randomized controlled trial was to examine the effect of Physical Activity Program applied to patients with schizophrenia on subjective well-being, happiness and problem-solving skills levels. This study was conducted with a total of 86 individuals diagnosed with schizophrenia (43 intervention and 43 control) registered in a family health center. Subjective Well-Being Scale, the Short Form of the Oxford Happiness Questionnaire and Problem-Solving Inventory were used to collect the data at baseline and, post-intervention. Significant increases in subjective well-being, happiness, and problem-solving skills were found in the intervention group after the total of 12 weeks of the Physical Activity Program, which included walking and exercises, compared to the control group. Accordingly, it can be said that the Physical Activity Program is an effective method that increases subjective well-being, happiness and problem-solving skills. ClinicalTrials.gov Identifier number is NCT15976921 and date of registration is 21/11/2023, retrospectively registered.

The Effects of Concurrent Training Versus Aerobic or Resistance Training Alone on Body Composition in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Introduction and Aim: The beneficial effects of aerobic training (AT) on preventing excess fat mass, and of resistance training (RT) on skeletal muscle adaptation, are well established. However, the effects of concurrent training (CT) compared to AT or RT alone on body composition in middle-aged and older adults are less understood, and therefore, the focus of this meta-analysis. Methods: Three databases, including PubMed, Web of Science, and Scopus, were searched from inception to March 2024. Randomized trials were included if they compared CT versus either AT or RT, and included body composition measures such as fat mass, body fat percentage, waist circumference, visceral fat mass, lean body mass (LBM), muscle mass/volume, or muscle or muscle fiber cross-sectional area (CSA), in middle-aged (50 to <65 years) and older adults (≥65 years). Weighted mean differences (WMD) or standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. Results: A total of 53 studies involving 2873 participants were included. Overall, CT increased body weight and LBM significantly more, trending toward significantly larger increases in muscle mass and CSA, compared with AT alone. However, there were no significant differences between CT and RT alone, for body weight, BMI, body fat percentage, fat mass, waist circumference, or visceral fat mass. Conclusions: CT is as effective as AT for decreasing body fat measures and as effective as RT for increasing muscle mass in middle-aged and older adults, and it should be recommended accordingly.

The Impact of Physical Activity on Weight Loss in Relation to the Pillars of Lifestyle Medicine-A Narrative Review

Currently, overweight and obesity are key problems globally. Several modifiable factors influence weight management. The number of obese and overweight people has significantly increased over the past few decades. Therefore, it is crucial to find effective and tailored strategies for weight management in public health and medicine. It has become necessary to take a comprehensive look at the problem of obesity and the process of weight loss, taking into account various aspects of lifestyle. To date, the effectiveness of dietary interventions, training interventions, or a combination of both has been repeatedly studied, with varying results, but a combination of properly selected diet and physical activity is considered the most effective therapy. Physical activity is one of the main tools in the treatment of obesity, in part due to its direct effect on body weight by increasing energy expenditure, especially when paired with other elements of lifestyle. The effect of physical activity is broad, and to properly implement it in obesity therapy, it is necessary to understand its impact on aspects such as body composition, food intake, sleep, alcohol use, and mental state. The primary aim of this review is to present the influence of physical activity on weight loss in combination with the influence of physical activity on other pillars of lifestyle medicine in adults. The secondary aim is to present various dietary, exercise, and combined interventions on weight loss with their efficacies.

Diabetes, obesity, and cardiovascular disease-what is the impact of lifestyle modification?

Diabetes, obesity, and cardiovascular disease (CVD) represent an escalating global health challenge, contributing significantly to morbidity, mortality, and healthcare costs. Evidence from large cohort studies and clinical trials underscores the impact of diabetes and obesity as major risk factors for CVD, causing systemic inflammation, insulin resistance, and neurohormonal activation. Frequently, a sedentary lifestyle and unbalanced dietary habits are associated with these risk factors. Physical activity and exercise training interventions, a Mediterranean and plant-based diet, smoking cessation, and reduction of alcohol have shown promise in mitigating these risks. The implementation of lifestyle and pharmacotherapy have emerged as new pillars of preventive medicine. This review discusses the evidence of lifestyle interventions to reduce the burden of diabetes, obesity, and CVD. It is highlighted that only a multifaceted, sustained approach integrating lifestyle interventions and pharmacological strategies can reduce the burden of disease and improve long-term outcomes.

JCL Roundtable: Prediabetes

Prediabetes affects more than 1 in 3 adults in the United States and is associated with increased risks of type 2 diabetes, cardiovascular diseases, chronic kidney disease, and dementia. Excess adiposity is the strongest risk factor for prediabetes, and can contribute to several other cardiometabolic risk factors, such as dyslipidemia and insulin resistance. This Journal of Clinical Lipidology Roundtable presents a conversation between Drs. Jaime P. Almandoz, Carol F. Kirkpatrick, and Kevin C. Maki, who discussed lifestyle and pharmacologic interventions for the management of prediabetes and the prevention of associated health risks. The discussion highlights the importance of interventions for addressing excess adiposity in those with prediabetes, including lifestyle, pharmacotherapy, and metabolic surgery, along with involving patients in shared decision-making conversations to identify, implement, and maintain an effective treatment plan.

Effect of water-based aerobic training on anthropometric, biochemical, cardiovascular, and explosive strength parameters in young overweight and obese women: a randomized controlled trial

Background

Obesity is a major health concern that raises the risk of chronic illnesses such as heart disease, diabetes, and metabolic disorders. Traditional workouts such as running or walking can be difficult for overweight individuals due to the heavy impact on joints, which causes discomfort and the possibility of injury. Water-based exercises offer a low-impact alternative that overweight people may find more tolerable. There is minimal research on the specific effects of structured water aerobic exercise on health markers in young overweight and obese women, despite the acknowledged benefits of physical activity for weight control and overall health. This study aimed to assess the effects of 10-week water-based aerobic training (thrice a week) on anthropometric, biochemical, cardiovascular parameters, and explosive strength in young overweight and obese women.

Methods

In a randomized controlled trial with a pre-to-post testing design, twenty-seven young overweight and obese women (age: 27 ± 1 years; body mass index (BMI) = 30.0 ± 3.1) were randomly assigned into experimental (EG: performing a water-based aerobic training, n = 16) or control (CG: maintaining their usual activities during the intervention, n = 11) groups. The pre- and post-intervention participants were assessed for their anthropometrics (body height, body weight, body mass index (BMI), body fat and circumferences), biochemical (fasting glycemia, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG)), cardiovascular parameters (resting blood pressure and resting heart rate (RHR)), and explosive strength of upper and lower limbs.

Results

EG showed reductions in body weight, BMI, %BF, fasting glycemia, and TG, along with improvements in HDL-C, LDL-C, RHR, and explosive strength (all p < 0.05; effect size (ES) = 0.180-1.512, trivial to large). In contrast, CG exhibited increases in body weight, BMI, fasting glycemia, LDL-C, and RHR (all p < 0.05; ES = 0.127-0.993, trivial to large), with no significant changes observed in other measured variables. EG showed superior post-test results in fasting glycemia (p < 0.0001; ES = 2.559, large), LDL-C (p < 0.0001; ES = 0.971, large), and explosive strength measures (0.003 ≤ p < 0.0001; ES = 1.145-1.311, large) compared to the CG.

Conclusions

Our findings indicate that water-based aerobic training could be a useful program to enhance anthropometric, biochemical, cardiovascular, and explosive strength parameters in young overweight and obese women compared to inactive persons.

Substituting Carbohydrate at Lunch for Added Protein Increases Fat Oxidation During Subsequent Exercise in Healthy Males

CONTEXT

How pre-exercise meal composition influences metabolic and health responses to exercise later in the day is currently unclear.

OBJECTIVE

Examine the effects of substituting carbohydrate for protein at lunch on subsequent exercise metabolism, appetite, and energy intake.

METHODS

Twelve healthy males completed 3 trials in randomized, counterbalanced order. Following a standardized breakfast (779 ± 66 kcal; ∼08:15), participants consumed a lunch (1186 ± 140 kcal; ∼13:15) containing either 0.2 g·kg-1 carbohydrate and ∼2 g·kg-1 protein (LO-CARB), or 2 g·kg-1 carbohydrate and ∼0.4 g·kg-1 protein (HI-CARB), or they fasted (FAST). Participants later cycled at ∼60% V̇O2peak for 1 hour (∼16:15) and post-exercise ad libitum energy intake was measured (∼18:30). Substrate oxidation, subjective appetite, and plasma concentrations of glucose, insulin, nonesterified fatty acids (NEFA), peptide YY (PYY), glucagon-like peptide 1 (GLP-1), and acylated ghrelin were measured for 5 hours post-lunch.

RESULTS

Fat oxidation was greater during FAST (+11.66 ± 6.63 g) and LO-CARB (+8.00 ± 3.83 g) than HI-CARB (P < .001), with FAST greater than LO-CARB (+3.67 ± 5.07 g; P < .05). NEFA were lowest in HI-CARB and highest in FAST, with insulin demonstrating the inverse response (all P < .01). PYY and GLP-1 demonstrated a stepwise pattern, with LO-CARB greatest and FAST lowest (all P < .01). Acylated ghrelin was lower during HI-CARB and LO-CARB vs FAST (P < .01). Energy intake in LO-CARB was lower than FAST (-383 ± 233 kcal; P < .001) and HI-CARB (-313 ± 284 kcal; P < .001).

CONCLUSION

Substituting carbohydrate for protein in a pre-exercise lunch increased fat oxidation, suppressed subjective and hormonal appetite, and reduced post-exercise energy intake.

The past, present, and future of behavioral obesity treatment

Over the last century, hundreds of evaluations have been conducted to examine weight-management interventions related to diet, physical activity, and behavior therapy. These investigations have contributed to a growing body of knowledge that has consistently advanced the field of obesity treatment, while also revealing some persistent challenges. This narrative review summarizes key findings from randomized controlled trials conducted in adults that have combined diet, physical activity, and behavior therapy, an approach variously referred to as behavioral treatment, comprehensive lifestyle modification, or intensive lifestyle intervention. The review shows that current behavioral approaches induce average reductions in baseline body weight of 5 to 10% at 6 to 12 months. Such losses have proven effective in reducing the risk of type 2 diabetes in persons with impaired glucose tolerance and in improving other obesity-related complications. These benefits have also been associated with reductions in healthcare costs. Despite these advances, behavioral treatment is challenged by the need for larger losses to achieve optimal improvements in health, by difficulties associated with maintaining weight loss, and by barriers limiting access to treatment. New anti-obesity medications, when combined with behavioral obesity treatment, hold promise of addressing the first two issues.

Effect of different intensity aerobic exercise on remodeling immune microenvironment of adipose tissue in obesity mouse

Obesity can change the immune microenvironment of adipose tissue and induce inflammation. This study is dedicated to exploring the internal mechanism by which different intensities of exercise reprogram the immune microenvironment of epididymal adipose tissue in nutritionally obese mice. C57BL/6J male obese mouse models were constructed by high-fat diet, which were respectively obese control group (OC), moderate-intensity continuous exercise group (HF-M), high-intensity continuous exercise group (HF-H), and high-intensity intermittent exercise group (HF-T). The exercise group was subjected to aerobic exercise intervention for 8 wk, and samples of mice were collected at the fourth and eighth week, respectively. Mice blood, liver, and adipose tissue of the epididymis were collected for index detection and adipose tissue ordinary transcriptome sequencing. After exercise intervention, when compared with the OC group, the morphology and blood indexes of the exercise groups were significantly improved. The liver lipid content was decreased, adipose tissue inflammation was reduced, and the mRNA and protein expression levels of IL-1β, F4/80, and CD64 in adipose tissue were significantly decreased (P < 0.01). Among the three exercise groups, the effect of the HF-T group was more significant. When compared with the OC group, fibroblast-specific marker genes, neutrophil marker genes, macrophage marker genes, and immune-related signaling pathways were significantly downregulated in the HF-T group. Exercise can reshape the immune microenvironment of adipose tissue, and high-intensity intermittent aerobic exercise is the most effective.NEW & NOTEWORTHY The present study has revealed that obesity is capable of altering the immune microenvironment within adipose tissue, thereby giving rise to inflammation. It has been demonstrated that exercise holds the potential to reverse the onset of inflammatory responses, with high-intensity intermittent aerobic exercise emerging as the most efficacious approach.

Differences in appetite, food intake, and gastric emptying responses to protein intake by older adults varying in level of physical activity: A randomised controlled trial

Older adults are encouraged to increase their protein intake and engage in more physical activity to preserve muscle mass. However, since protein is considered the most satiating macronutrient, this advice might lead to a decrease in overall energy consumption. Physical activity is also recommended to older adults to enhance appetite, as it has been shown to help regulate appetite in younger adults, yet there is limited evidence to support this in older populations. The objective of this study was to investigate the impact of physical activity and protein on food intake, perceived appetite, and gastric emptying in older adults. Nineteen active and 19 less active older adults completed a single-blind, randomised, crossover trial involving two test days at home. Participants received a standard breakfast, followed by an isovolumetric (250 ml) and isocaloric (∼300 kcal) high- or low-protein preload milkshake (57% versus 17% energy as protein) matched for sensory properties. Three hours after the preload, participants were offered an ad libitum meal. Food intake was weighed, perceived appetite was measured by 100 mm visual analogue scales, and gastric emptying via the 13C-octanoic acid breath test. Higher protein intake did not affect subsequent energy intake or appetite ratings in both active and less active groups. Gastric emptying half time was longer following the high-protein milkshake compared to the low-protein milkshake. The active group had a lower perceived appetite, but faster gastric emptying time compared to the less active group. In conclusion, while higher protein intake slows gastric emptying, it did not reduce appetite or subsequent food intake in older adults, regardless of physical activity level. Additionally, being physically active suppresses perceived appetite and accelerates gastric emptying without affecting food intake.

Assessing the evidence for health benefits of low-level weight loss: a systematic review

Individuals with excess weight are at a higher risk for various physical and mental health conditions. Interventions targeting weight loss can improve health, with modest weight loss of five to ten percent of body weight often considered clinically meaningful for enhancing health outcomes. However, the benefits of achieving low-level weight loss ( < 5% body weight) are poorly understood. We aimed to systematically review relevant literature and synthesise the evidence that assessed the potential health benefits of losing less than five percent body weight. We searched seven academic databases and included studies in any language, from any country, with no time constraints. We included any intervention studies that assessed the impact of less than five percent weight loss on any measured physical or mental health markers or indices. 70 studies from 68 articles were included, with study participants ranging from 14 to 10,742. In total, 137 health markers were assessed, categorised into metabolic markers (n = 42), cardiovascular markers (n = 32), anthropometric measures (n = 19), quality of life indices (n = 10), inflammatory biomarkers (n = 10), renal and hepatic markers (n = 9), psychosocial and behavioural measures (n = 8), pulmonary function (n = 3), total mortality (n = 2), ovulatory function (n = 1), and muscle strength (n = 1). Overall, 60% of studies reported improvements, 37% found no change or mixed results, and 3% observed a worsening of health markers or indices. Based on the available data, 87% of participants (n = 15,839) in the studies reported improvements in health markers or indices as a result of low-level weight loss. Our findings suggest that low-level weight loss can lead to various health benefits and challenges the conventional threshold for effective weight loss.Preregistration The review protocol was pre-registered with PROSPERO (CRD42023406342).

Association of 'weekend warrior' and other leisure time physical activity patterns with obesity and adiposity: A cross-sectional study

AIM

To investigate the effect of different physical activity patterns on obesity.

MATERIALS AND METHODS

Data from adults aged 17-79 years were extracted from the Hong Kong Territory-Wide Physical Fitness Survey conducted in 2011-2012 and 2021-2022. Moderate to vigorous physical activity (MVPA) patterns were collected through questionnaires and categorized as inactive (no MVPA ≥10 min), insufficiently active (<150 min MVPA/week), weekend warriors (≥150 min MVPA/week from 1 to 2 days) and regularly active (≥150 min MVPA/week from ≥3 days). The association between these activity patterns with obesity risk and body fat percentage was analysed.

RESULTS

This study included 9863 obesity data (including valid waist circumference and body mass index) and 7496 body fat data. Compared with the inactive group, the weekend warriors and regularly active individuals had lower risks of general and abdominal obesity, as well as reduced body fat. Furthermore, individuals who were insufficiently active but engaged in ≥3 days of MVPA showed significantly lower body fat and obesity risk than their inactive counterparts.

CONCLUSION

Engaging in physical activity even once or twice a week can positively impact weight control.

Physical Activity before and After Bariatric Surgery

Lifestyle changes including reduced calorie intake and increased physical activity (PA) improve the prognosis associated with bariatric surgery (BS) and metabolic indices. Early implementation of exercise leads to improved physical performance, better glycemic control and lipid profile, reduces the risks associated with anesthesia, and accelerates recovery from surgery. Undertaking systematic exercise after BS is associated with a better quality of life, improves insulin sensitivity, results in additional weight loss, reduces adverse effects on bone mass, and results in better body composition. The aim of this review was to summarize recommendations for physical activity in patients undergoing BS and to highlight the key role of physical activity in this patient group.

Synergistic Effects of Probiotics and Lifestyle Interventions on Intestinal Microbiota Composition and Clinical Outcomes in Obese Adults

BACKGROUND AND OBJECTIVE

Obesity is a growing global epidemic. The composition of the intestinal microbiota can be influenced by several factors. Studies highlight the role of intestinal bacteria in the pathophysiology of obesity. So, the objective of this study was to investigate whether the use of probiotics, together with healthy lifestyle habits, contributes to weight reduction in obese individuals by analyzing the intestinal microbiota profile.

METHODS

A prospective study was carried out with 45 adults with obesity. Participants underwent guidance on healthy lifestyle habits, received a probiotic component containing different microbiological strains and were followed for 60 days. Clinical parameters, body composition, biochemical analysis, and intestinal microbiota assessment were performed before and after treatment. After 60 days, it was observed that the bacterial strains present in the probiotic were present in the patients' intestinal microbiota. Participants also showed improvements in physical activity, sleep quality, and anxiety management, as well as changes in some eating habits, such as a reduction in the consumption of processed foods and a significant increase in water intake.

RESULTS

A reduction in BMI, fasting glucose, insulin, HOMA-IR, LDL cholesterol, and triglycerides was observed, in addition to an increase in HDL cholesterol, improvement in bowel movement frequency, and stool consistency. Analysis of the intestinal microbiota revealed an increase in microbial diversity and a better balance between the bacterial phyla Firmicutes and Bacteroidetes.

CONCLUSIONS

The changes related to improving the composition of the intestinal microbiota, dietary habits, increased physical activity, reduced anxiety, and better sleep quality have significantly contributed to weight loss and improvements in physiological parameters in obese individuals.

When Should the Treatment of Obesity in Thyroid Disease Begin?

Obesity often coexists with thyroid diseases, and the prevalence of these disorders has been on the rise for years. While hypothyroidism can contribute to excess fat tissue, the relationship between Body Mass Index (BMI) and thyroid function hormones is bidirectional. Research confirms that fat tissue reduction can positively impact thyroid function. Thus, delaying the initiation of therapies beyond substitution treatment to achieve optimal weight reduction in individuals with thyroid dysfunction seems unwarranted. The authors summarize current knowledge on this topic in the article.

Fall risk screening in older adults using the "CARE" frailty scale: The NuAge cohort results

BACKGROUND

"CARE" is an electronic health (e-health) application (app) which assesses frailty with its frailty module and risk of falls with its mobility module. This study examines and compares the risk of incident falls (i.e., ≥1, ≥2 and severe falls) among older people in Quebec classified as "frail" and those classified as being at a high risk of falls by the CARE app.

METHODS

A subset of men and women (n = 1151; 74.2 ± 4.2 years; 52.8 % female) who participated in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge) were selected for this study. Pre-frail and frail states using the CARE frailty scale as well as high risk of falls estimated by CARE mobility module were determined at baseline. Pre-frail and frail states were merged in a single "frail state" group. Incident falls (i.e., ≥1, ≥2 and severe falls) were annually recorded over a 3-year follow-up.

RESULTS

Both CARE frail state (Odd ratio (OR) ≥1.89 with P ≥ 0.040) and high risk of falls estimated by the CARE mobility module (OR) ≥3.32 with P ≥ 0.023) were significantly associated with incident falls (i.e., at least one fall) and recurrent falls (i.e., at least two falls). A greater association with these fall outcomes was observed with the high risk of falls than with the frail state. No significant association between the high risk of falls and severe falls was found (OR = 1.71 with P = 0.227), whereas that was the case with frail state (OR = 3.08 with P = 0.003).

CONCLUSIONS

Frail state determined by the CARE frailty module and high risk of falls determined by the CARE mobility module were both significantly associated with fall outcomes, a greater association being shown with the CARE high risk of falls and with CARE frail state for severe falls. These results suggest that the CARE app may be useful for screening older people for the risk of falls.

Differences of Sedentary Behavior, Physical Activity, and Metabolic Syndrome Severity Among Metabolic Syndrome Clusters

Background: Sedentary behavior (SB), physical activity (PA), and metabolic syndrome (MetS) are risk indicators for cardiometabolic diseases. Novel methods for researching MetS by the 16 unique clusters (i.e., WC+FBG+BP) and as a continuous severity z-score (MetS-Z) have emerged. This study examined how SB, PA, and MetS-Z differed among MetS clusters and SB and PA differences by MetS-Z tertiles. Methods: Using 2015-2016 National Health and Nutritional Examination Survey (NHANES) data, participants with MetS (N = 792) were identified. Subsequently, sex-, race-, and ethnicity-specific MetS-Z were calculated. SB and PA differences were compared between MetS clusters and MetS-Z tertiles. Additionally, MetS-Z was compared between MetS clusters. Results: The WC+FBG+BP MetS cluster was prevalent among 23.80% of participants (95% CIs, 18.41-30.18) and the overall mean MetS-Z was 1.16 (1.08-1.24). Participants reported over 6 daily hours of SB (393.41 minutes⋅day-1 [370.07-416.75]). The TRI+FBG+BP+HDL MetS cluster had less SB than the WC+TRI+FBG+HDL, WC+TRI+HDL, and WC+FBG+BP MetS clusters. PA did not differ between MetS clusters and no differences in SB or PA between MetS-Z tertiles. Conclusions: Limited differences in SB and PA were observed. Participants with 4 or more MetS criteria had worse MetS-Z. Efforts should support replacing SB with PA to improve cardiometabolic health.

The quality of information on anxiety-related websites: A systematic search about the most online item searched after Covid-19 pandemics

BACKGROUND

The acquisition of health information via the internet has emerged as a prevalent approach within the general population and is likely to exert an influence on health decision-making processes. This study aims to evaluate the comprehensive quality of online information about anxiety treatment and management comparing websites in English, which is widely used for international scientific communication, and Italian, a popular local language. It was used a multidimensional methodology that assesses scientific quality of information; readability of the website; the technological quality of the website and the website's popularity ranking.

METHODS

We conducted a systematic search on four widely used online search engines. Duplicated, unrelated websites, and scientific papers were excluded. The assessment included the use of several criteria and tools: the DISCERN scale, the JAMA benchmark criteria, adherence to the Health on the Net Code; the Nibbler tool; PageRank; and the Flesch Reading Ease test/the Gulpease readability index.

RESULTS

78 websites in Italian and 60 in English were evaluated. Quality of information of the English websites was higher than that of the Italian ones, but only a small percentage of them reported high level information about all treatment types and shared decision-making process. Technological quality was higher in English websites. In general, all websites were difficult to read, requiring reading skills at the high school level or higher.

CONCLUSIONS

These results can promote future guidelines to improve online health information. Users should be able to find information about all treatment types (pharmacological and psychosocial) in line with the current guidelines for the treatment and the management of anxiety disorders. This would help internet users to achieve a higher level of quality information.

Impacts of early psychological changes on correlates of weight-loss maintenance: Seeking increased precision for sustained behavioural obesity treatment effects

ISSUE ADDRESSED

Obesity is an increasing worldwide health issue. In affluent English-speaking countries, obesity ranges from ~28% (Australia) to ~42% (United States) of the adult population. Enabling weight loss beyond an initial 6 months is an unresolved challenge.

METHODS

Women with obesity participated in community-based obesity treatments incorporating either cognitive-behavioural methods emphasizing self-regulatory skills development (n = 106) or typical information/education processes (n = 47). Psychosocial, behavioural, and weight changes were measured.

RESULTS

Significant overall improvements in exercise-related self-regulation and self-efficacy, mood, physical activity/exercise (PA/exercise), diet, and weight were found from baseline-month 6 (weight-loss phase) and baseline-month 12, but not from months 6-12 (weight-loss maintenance phase). Significantly greater improvements were found in the cognitive-behavioural group. Within the weight-loss phase, changes in both PA/exercise and diet significantly contributed to the explained variance in weight loss, whereas within the weight-loss maintenance phase, only change in PA/exercise was a significant predictor. There was no significant relationship of weight loss across phases. Months 6-12 change in PA/exercise significantly mediated relationships of changes in self-regulation→weight, mood→weight, and self-efficacy→weight. Earlier scores and score changes in mood and self-efficacy significantly impacted the subsequent parallel relationships.

CONCLUSIONS

Cognitive-behavioural methods affect psychosocial changes leading to initial changes in diet, PA/exercise, and weight. Those changes then impact subsequent changes in PA/exercise-a primary malleable correlate of maintained weight loss. SO WHAT?: This research extended previous findings to better-inform behavioural obesity-treatment foci to address the pervasive public health problem of attaining and sustaining weight loss. Findings related to PA/exercise will help impact health-promotion outcomes.

The association of SLC16A1 (MCT1) gene polymorphism with body composition changes during weight loss interventions: A randomized trial with sex-dependent analysis

Monocarboxylates, transported by monocarboxylate transporters (MCTs), have been proposed to influence energy homeostasis and exhibit altered metabolism during exercise. This study investigated the association between the Asp490Glu (T1470A) (rs1049434) polymorphism of the SLC16A1 (MCT1) gene and changes in body composition in males and females with overweight or obesity. The 173 participants (56.6% females) completed a 6-month randomized controlled trial, being assigned to the Supervised Exercise group (strength, endurance, or strength plus endurance training) or the Physical Activity (PA) Recommendations group. Participants were genotypically categorized as Asp/Asp (TT), Asp/Glu (TA), or Glu/Glu (AA). ANCOVA analysis showed main effects for genotype and interaction genotype × group (p < 0.05) for several variables, especially in females. Asp/Asp (TT) females showed greater reductions in total fat mass (-29.30 ± 8.75% change), percentage of body fat (-17.50 ± 8.06% change), and body weight (-13.90 ± 2.62% change) compared with Glu/Glu (AA) (p ≤ 0.020; d ≥ 0.18) and Asp/Glu (TA) (p ≤ 0.050; d ≥ 0.16) females, but only within the PA Recommendations group. Data indicated higher decreases in lean body mass of the Asp/Asp (TT) compared to Glu/Glu (AA) in females (p = 0.067, η2 p = 0.067) and to Asp/Glu (TA) in males (p = 0.026; η2 p = 0.101). Our investigation suggests an association of the single-nucleotide polymorphism with body composition changes especially in females following exercise recommendations, highlighting the importance of supervised training to offset genetic predisposition for different weight loss. Differences in males only appeared for lean body mass, suggesting sex differences for this genetic association. The study underscores the potential influence of MCT1 functionality on human adaptations to weight loss interventions. ClinicalTrials.gov information: registry name, Nutrition and Physical Activity for Obesity (PRONAF); registration number, NCT01116856.

8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Aerobic Exercise and Weight Loss in Adults: A Systematic Review and Dose-Response Meta-Analysis

Importance

Current guidance on the duration of aerobic exercise recommended in existing guidelines comes primarily from individual trials. Meta-analyses are lacking to examine the dose-response association of aerobic exercise with adiposity measures.

Objective

To clarify the dose-response association of aerobic exercise with adiposity measures.

Data Sources

PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and gray literature sources (ProQuest and ClinicalTrials.gov) from inception to April 30, 2024.

Study Selection

Randomized clinical trials with intervention durations of at least 8 weeks evaluating the effects of supervised aerobic training on adults with overweight or obesity.

Data Extraction and Synthesis

The PRISMA guidelines were followed to report the results of the meta-analysis. Data extraction was conducted by 2 teams of 2 reviewers each, working independently and in duplicate. Random-effects meta-analyses were performed to estimate mean differences and 95% CIs for each 30-minute per week aerobic exercise and to clarify the shape of the curvilinear associations.

Main Outcomes and Measures

Measures of body weight, waist circumference, body fat, adverse events, medication use reduction, and health-related quality of life score. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool, with a range from very low to high certainty.

Results

In total, 116 randomized clinical trials involving 6880 participants (4199 [61%] female; mean [SD] age, 46 [13] years) with overweight or obesity were included. Each 30 minutes per week of aerobic exercise was associated with reduced body weight by 0.52 kg (95% CI, -0.61 to -0.44 kg; n = 109 trials, GRADE = moderate), waist circumference by 0.56 cm (95% CI, -0.67 to -0.45 cm; n = 62 trials, GRADE = high), body fat percentage by 0.37% (95% CI, -0.43% to -0.31%; n = 65 trials, GRADE = moderate), as well as the areas of visceral (mean difference, -1.60 cm2 [95% CI, -2.12 to -1.07 cm2]; n = 26 trials, GRADE = high) and subcutaneous (mean difference, -1.37 cm2 [95% CI, -1.82 to -0.92 cm2]; n = 27 trials, GRADE = moderate) adipose tissues. Aerobic exercise was associated with modestly increased physical (standardized mean difference, 1.69 SD [95% CI, 1.18-2.20 SD]) and mental (standardized mean difference, 0.74 SD [95% CI, 0.29-1.19 SD]) aspects of quality of life (1 trial with 80 participants, GRADE = low). It was associated with modestly increased mild to moderate adverse events, which were mostly musculoskeletal symptoms (risk difference, 2 more events per 100 participants [95% CI, 1 to 2 more]; GRADE = low). Dose-response meta-analyses indicated that body weight, waist circumference, and body fat measures decreased linearly or monotonically in association with increasing duration of aerobic exercise to 300 minutes per week, with aerobic exercise lasting 150 minutes per week at moderate to vigorous intensities resulting in clinically important reductions in waist circumference and body fat.

Conclusions and Relevance

In this meta-analysis of randomized clinical trials, engaging in 30 minutes of aerobic exercise per week was associated with modest reductions in body weight, waist circumference, and body fat measures among adults with overweight or obesity. However, aerobic training exceeding 150 minutes per week at moderate intensity or greater may be needed to achieve clinically important reductions.

The Energy Expenditure Associated With Body-Weight Resistance Exercises of Various Movement Patterns Performed at Different Durations

Poulios, A, Fotiou, C, Draganidis, D, Avloniti, A, Rosvoglou, A, Batrakoulis, A, Tsimeas, P, Papanikolaou, K, Deli, CK, Stampoulis, T, Douroudos, II, Chatzinikolaou, A, Jamurtas, AZ, and Fatouros, IG. The energy expenditure associated with body-weight resistance exercises of various movement patterns performed at different durations. J Strength Cond Res 38(12): 2034-2046, 2024-Although body-weight resistance exercises (BWRE) are popular and effective for body mass reduction and neuromuscular performance, limited information exists regarding their total energy expenditure (TEE). This study determined the energy cost associated with seven BWRE of different movement patterns plank, push-ups, squat, single-leg squat [SLS], forward lunge [FL], burpees, and jumping jacks [JJ] using 2 different durations (T30: 30-second; T45: 45-second) in 10 healthy young adults using a randomized, 2-trial, crossover, repeated-measures design. The level of significance was set at p ≤ 0.05. The burpees were associated with the highest and the plank with the lowest intensity (rates of perceived exertion [RPE] and mean heart rate [MHR]) and metabolic load (blood lactate [BL] accumulation, metabolic equivalents of task [METs], and excess post-exercise oxygen consumption [EPOC]) in both trials. In T30 and T45, TEE (kcals per minute) was 11.3/12.6 in plank, 18.6/22.0 in FL, 19.8/21.2 in SLS, 19.9/23.2 in squat, 22.0/24.9 in push-ups, 23.1/22.8 in JJ, and 32.2/40.7 in burpees. Although RPE, MHR, BL, and EPOC were comparable among T30 and T45, METs and TEE were greater in T45. These results suggest that TEE of BWRE ranges from ∼11 to 40 kcals·min -1 , depending on the movement pattern and the duration of exercise. This information may be valuable for those using BWRE for body-weight management and improvement of strength performance.

Advances in body composition and gender differences in susceptibility to frailty syndrome: Role of osteosarcopenic obesity

There is general consensus that an improper diet negatively impacts health and that nutrition is a primary tool for the prevention of non-communicable diseases. Unfortunately, the importance of studying body composition, which can reveal early predictors of gender-related diseases, is still not well understood in this context. Currently, individuals are still classified as obese based solely on their body mass index, without considering the amount of fat, its distribution, and the quantity of muscle and bone mass. In this regard, the body composition phenotype defined as "osteosarcopenic obesity" affects approximately 6-41 % of postmenopausal women, with prevalence increasing with age due to the hormonal and metabolic changes that occur during this period. This particular phenotype arises from the strong relationship between visceral fat, muscle, bone, and gut microbiota and predispose postmenopausal women to frailty. Frailty is a complex clinical phenomenon with significant care and economic implications for our society. Recent studies suggest that women have a higher prevalence of frailty syndrome and its individual components, such as osteoporosis, fractures and sarcopenia, compared to men. Here, we provide a comprehensive overview of recent advances regarding the impact of gender on body composition and frailty. Furthermore, we reflect on the crucial importance of personalized nutritional interventions, with a focus on reducing visceral fat, increasing protein intake and optimizing vitamin D levels. A review of the scientific literature on this topic highlights the importance of studying body composition for a personalized and gender-specific approach to nutrition and dietetics, in order to identify frailty syndrome early and establish personalized treatments. This new method of researching disease predictors could likely help clarify the controversial results of studies on vitamin D, calcium and proteins, translate into practical wellness promotion across diverse elderly populations.

The relationship between physical activity and psychological sub-health among high altitude region Tibetan college students

Background

The reduction in moderate to vigorous physical activity (MVPA) and the increased prominence of psychological sub-health (PSH) have had a serious negative impact on the health of Tibetan college students. Few studies have been conducted on college student populations at high altitude region in China. Therefore, the study investigated MVPA and PSH in 8721 Tibetan college students to analyze the relationship that exists between them.

Methods

In this study, subjects were selected by cluster sampling method, and 8,721 high altitude region Tibetan college students were questioned about MVPA, PSH, family situation, BMI, and lifestyle. One-way ANOVA, chi-square test, and stepwise logistic regression analysis were used to analyze the relationship between MVPA and PSH.

Results

The proportion of Chinese Tibetan college students at high altitude region with MVPA duration ≤30 Mins/Day, 31-60 Mins/Day, and ≥ 61 Mins/Day were 76.7, 18.7, and 4.7%, respectively. The proportion of Tibetan college students in China experiencing PSH was 16.41%. The percentage of emotional symptoms, behavioral symptoms, and social adaptation difficulties were 17.61, 18.04, and 14.59%, respectively. Logistic regression analysis showed that after adjusting for relevant covariates, Tibetan college students with MVPA ≤30 Mins/Day had a higher odds ratio of PSH compared to college male students with MVPA ≥61 Mins/Day (OR = 2.95, 95% CI: 1.79,4.84). In contrast, there was no significant relationship between MVPA and PSH in college females. Overall, Tibetan college students with MVPA ≤30 Mins/Day had a higher odds ratio of PSH compared to Tibetan college students with MVPA ≥61 Mins/Day (OR = 2.99, 95% CI: 2.00,4.47).

Conclusion

Chinese Tibetan college students from high altitude region areas had lower levels of MVPA and higher rates of PSH. There is an relationship between MVPA time and PSH among high altitude region Tibetan college students, and the incidence of PSH is higher among high altitude region Tibetan college students with shorter MVPA time.

The effect of clinically significant weight loss prior to open ventral hernia repair

PURPOSE

The study aim was to assess the impact of clinically significant weight loss (CSWL; ≥5% weight reduction) on postoperative complications following abdominal wall reconstruction with the component separation technique (CST).

METHODS

A retrospective review of patients who underwent open ventral hernia repair (VHR) with CST from November 2008 to January 2022 was performed. Cohorts were stratified by presence of CSWL from baseline weight at preoperative consultation.

RESULTS

Of 180 total patients, 40 (22.2%) achieved CSWL prior to VHR. Mean age was 59.6 ± 11.2 years. Patients in the CSWL cohort represented a higher average body mass index (BMI) (33.6 vs. 31.7 kg/m2, p = 0.076), and were obese more frequently (80.0% vs. 56.4%, p = 0.007). The CSWL cohort had a higher proportion of patients in Ventral Hernia Working Group (VHWG) classification II (82.5% vs. 63.6%) while the non-CSWL cohort had more VHWG classification III/IV (20.0% vs. 10.0%, p = 0.078). Mean follow-up duration was 6.1 ± 13.4 months. Complications, including 30- and 90-day surgical site occurrence (SSO), return to operating room, readmission, and hernia recurrence (CSWL: 5.0% vs. non-CWL 1.4%, p = 0.179), were comparable between cohorts. BMI was an independent predictor of any complication (OR 1.07, p = 0.044) and 90-day SSO (OR 1.10, p = 0.043).

CONCLUSION

Achievement of CSWL prior to open VHR utilizing CST results in similar post-reconstruction outcomes to patients who maintained a comparable BMI at baseline. Higher day-of-surgery BMI was more consequential to postoperative complications than percent weight loss.

Physical activity, leisure-time management, perceived barriers to physical activity and mental well-being among Turkish university students

This study examined the relationship between physical activity (PA) level, free time management, mental well-being, and perceptions of barriers to PA among university students. A cross-sectional survey was conducted with 723 Turkish university students, which included four questionnaires to assess participants' PA levels, conditions of mental well-being, free time management, and perceived barriers to PA. Multivariate linear regression was performed to identify factors associated with the participants' PA level. The study found that 216 (29.9%) of participants were inactive, 325 (45%) were minimally active, and 182 (25.1%) were health-enhancing active. While 25.23% of males were inactive, 42.02% were minimally active, and 31.45% were health-enhancing active, these rates were 31.4, 45.98, and 22.62% for females, respectively. These findings highlight that 3/4 of university students have inadequate PA levels. Changes in barriers to PA (p < 0.001), free time management (p = 0.040), and mental well-being (p < 0.001) were associated with PA levels. According to the regression analysis, only increased barriers to PA was a significant predictor of PA (p < 0.001). Given the role of health science students in public health, this study could help policymakers develop new strategies to promote healthy living and address barriers to PA, such as students' free time and mental health.

Baseline predictors associated with successful weight loss among breast cancer survivors in the Lifestyle, Exercise, and Nutrition (LEAN) study

PURPOSE

To investigate participant characteristics associated with clinically meaningful weight loss (≥ 5% weight loss) among breast cancer survivors participating in the Lifestyle, Exercise, and Nutrition (LEAN) study.

METHODS

Female breast cancer survivors with a body mass index ≥ 25 kg/m2 were enrolled in a 6-month weight loss intervention. Univariate and multivariable logistic regression were used to determine baseline predictors of clinically meaningful weight loss (< vs. ≥ 5%) among those in the intervention arm. The area under the receiver operator characteristic curve (ROC-AUC) C-statistic evaluated the final model's ability to classify weight loss success.

RESULTS

Baseline data were available for 77 participants. Having a history of weight gain during breast cancer treatment was associated with lower odds of achieving ≥ 5% weight loss (OR = 0.36, 95% CI 0.13 - 0.99) compared to women with no history of weight gain during cancer treatment.

CONCLUSION

Breast cancer survivors with overweight or obesity who gained weight during their cancer treatment were less likely to achieve clinically meaningful weight loss during a post-treatment weight loss intervention.

IMPLICATION FOR CANCER SURVIVORS

Breast cancer survivors are encouraged to achieve and maintain a healthy body weight to minimize the risk for cancer recurrence and comorbidity. Our results indicate that programs aimed at prevention of weight gain during treatment could aid in this goal. Understanding characteristics that increase or decrease the likelihood of achieving clinically meaningful weight loss will inform the design of programs that better support breast cancer survivors' weight loss success.

Walking economy and exercise efficiency in successful weight loss maintainers

PURPOSE

Following short-term weight loss, the energetic cost of transport decreases and exercise efficiency increases. Whether changes persist during long-term weight maintenance is unknown.

METHODS

We compared walking economy and exercise efficiency in weight loss maintainers (WLM, maintaining ≥13.6 kg weight loss for ≥1 year), controls without obesity (NC, BMI similar to current BMI of WLM), and controls with overweight/obesity (OC, BMI similar to pre-weight loss BMI of WLM). Energy expenditure (EE) and respiratory quotient were measured using indirect calorimetry at rest, while standing, and during treadmill walking. Gross and net energetic cost of transport (J/kg/m) was measured during level treadmill walking at 0.75, 1.12, and 1.52 m/s. Gross, net, and delta efficiency (%) were measured during inclined treadmill walking (2 %, 4 %, and 6 % grade) and a constant speed (1.12 m/s).

RESULTS

WLM (n = 32, BMI: 23.8 ± 2.3 kg/m2) and NC (n = 28, BMI: 22.7 ± 1.6 kg/m2) had significantly lower EE (kJ/min) compared to OC (n = 26, BMI: 33.0 ± 4.5 kg/m2) during rest, standing, and walking (p < 0.01). Net energetic cost of transport was significantly lower in WLM compared to OC at 1.12 and 1.52 m/s (p < 0.05). Net efficiency was significantly greater in WLM compared to OC while walking (p ≤ 0.05). There were no significant differences between WLM and NC for any measures of economy or efficiency.

CONCLUSION

WLM had lower walking economy and greater walking efficiency compared to OC, but there were no differences between WLM and NC. Thus, individuals maintaining significant weight loss may be successful with long-term weight loss, in part, due to resistance against adaptive reductions in walking energetics.

Sculpting Success: The Importance of Diet and Physical Activity to Support Skeletal Muscle Health during Weight Loss with New Generation Anti-Obesity Medications

Obesity is a public health crisis, with prevalence rates tripling over the past 60 y. Although lifestyle modifications, such as diet and physical activity, remain the first-line treatments, recent anti-obesity medications (AOMs) have been shown to achieve greater reductions in body weight and fat mass. However, AOMs also reduce fat-free mass, including skeletal muscle, which has been demonstrated to account for 20% to 50% of total weight loss. This can equate to ∼6 kg or 10% of total lean mass after 12-18 mo, a loss comparable to a decade of human aging. Despite questions surrounding the clinical relevance of weight loss-induced muscle loss, the importance of adopting lifestyle behaviors such as eating a protein-rich diet and incorporating regular resistance training to support skeletal muscle health, long-term weight loss maintenance, and overall well-being among AOM users should be encouraged. Herein, we provide a rationale for the clinical significance of minimizing weight-loss-induced lean mass loss and emphasize the integration of diet and physical activity into AOM clinical care. Owing to a lack of published findings on diet and physical activity supporting skeletal muscle health with AOMs, specifically, we lean on findings from large-scale clinical weight loss and diet and exercise trials to draw evidence-based recommendations for strategies to protect skeletal muscle. We conclude by identifying gaps in the literature and emphasizing the need for future experimental research to optimize skeletal muscle and whole-body health through a balance of pharmacotherapy and healthy habits.

Morning physical activity may be more beneficial for blood lipids than afternoon physical activity in older adults: a cross-sectional study

BACKGROUND

The effect of differences in daily physical activity patterns on blood lipids has not been determined. This study examines the effects of the differences in free-living daily physical activity patterns (amount and intensity) on blood lipid levels in older adults.

METHODS

This cross-sectional study included 51 older participants (71.8 ± 0.6 years, men = 8, women = 43). A triaxial accelerometer was used to assess physical activity patterns. The time from awakening to bedtime for each participant was used for group classification based on the amount (number of steps) and intensity (moderate-to-vigorous physical activity, MVPA) of physical activity. The morning step group (M Step) was defined as those who took more steps in the morning, and the afternoon step group (A Step) was defined as those who took more steps in the afternoon. The same method was used for MVPA (morning MVPA: M MVPA; afternoon MVPA: A MVPA). Blood samples were collected at the start of the study to determine blood lipid levels.

RESULTS

Number of steps taken showed a trend toward lower low-density lipoprotein cholesterol (LDL-C) levels in the M Step group compared with the A Step group. The LDL/high-density lipoprotein (HDL) ratio was significantly lower in the M Step group than the A Step group (p < 0.05). The M MVPA group also had higher HDL-C levels and significantly lower LDL/HDL ratios than the A MVPA group (p < 0.05).

CONCLUSIONS

These results suggest that compared with afternoon physical activity, daily morning physical activity (amount and intensity) is more effective in improving blood lipid levels.

Effects of Weight Loss and Weight Maintenance on Lipoprotein Insulin Resistance Scores in Adults with Overweight and Obesity

Background: An elevated lipoprotein insulin resistance (LP-IR) score corresponds to insulin resistance in adults with overweight and obesity, yet data are lacking regarding the impact of exercise interventions on LP-IR. The purpose of this secondary analysis was to evaluate the effects of a weight loss and weight maintenance intervention on LP-IR score in adults with overweight and obesity. Methods: Thirty sedentary adults with overweight and obesity completed a 10-week OPTIFAST® weight loss program with supervised aerobic exercise to achieve clinical weight loss (CWL) (≥7% from baseline). Aerobic exercise volume increased weekly until 700 MET min/week was reached. Participants who reached CWL were randomized to groups at volumes at either physical activity (PA-REC) or weight maintenance (WM-REC) recommendations (weeks 11-28). Plasma blood samples were analyzed via nuclear magnetic resonance spectroscopy at baseline, after weight loss (week 10), and following weight maintenance (week 28). Results: Following the weight loss phase, on average, participants significantly (p < 0.001) reduced LP-IR score (-12.1 ± 13.5), body weight (-8.9 ± 2.7%), and waist circumference (-7.7 ± 4.1 cm). During the weight maintenance phase, there were no changes in LP-IR score between exercise groups (PA-REC: 4.1 ± 13.6; WM-REC: -2.0 ± 11.2; P = 0.7). The PA-REC group had improvements in LP-IR score from baseline (49.8 ± 24.6 to 36.6 ± 27.6, P < 0.001), yet there were no within-group changes during the weight maintenance phase (P > 0.05). Conclusion: LP-IR score improved during weight loss in adults with overweight and obesity and were sustained during the weight maintenance phase in the PA-REC group. Aerobic exercise at least at minimum guidelines following CWL can preserve LP-IR score improvements and may indicate a reduced T2DM risk in adults with overweight and obesity.

Unveiling the neural mechanisms of acute aerobic exercise on inhibitory control among young adults with obesity: Insights from an ERP study

Obesity has become a prominent public health concern worldwide and is associated with adverse cognitive function. Exercise, particularly aerobic exercise, is known to benefit for weight loss and cognitive function. However, whether acute aerobic exercise could yield benefits to obese individuals and the precise brain mechanisms of action remain poorly understood. The study aimed to investigate whether acute aerobic exercise could improve inhibitory control among obese individuals and what neuroelectric mechanisms are implicated. A 3 (session: control, low-intensity exercise, moderate-intensity exercise) × 2 (congruency: congruent, incongruent) within-subject design was conducted. 18 obese young male adults underwent three sessions of 30-min interventions in a counterbalanced order seperated by five days: moderate-intensity aerobic exercise (MIE), low-intensity aerobic exercise (LIE) and a control session (a sedentary period of seated rest). The Flanker task and EEG recordings (N2 and P3 amplitude) were investigated following exercise and the control treatment. Results showed that the N2 amplitude following MIE was larger than the control session, whereas a larger N2 and reduced congruent P3 amplitude was observed following MIE than LIE. However, no main effect of the session was found for reaction time and accuracy, but a significant main effect of congruency was observed. These findings suggest acute moderate-intensity aerobic exercise may modulate brain activity through enhanced recruitment of attentional resources for cognitive control and conflict monitoring in adults with obesity.

Race, Ethnicity, and Geography as Determinants of Excessive Weight and Low Physical Activity in Pediatric Population: Protocol for Systematic Review and Meta-Analysis

The rationale for the current study is the sparsity of data on the combined effect of the environmental and individual risks of obesity and sedentary lifestyle in children of different races/ethnicities from different regions. An effective weight management strategy is hard to design due to insufficient evidence. This work was initiated to study race, ethnicity, and geography as determinants of excessive weight and low physical activity in the pediatric population. To achieve this aim, we systematically review publications on daily length of physical activity of light, moderate, and vigorous intensity, as well as sedentary time and BMI and its dynamics in children of different races/ethnicities and geographies. The extracted data are stratified into six major geographic regions and six races/ethnicities. Then, a random-effects meta-analysis is used to calculate the pooled mean of each outcome measure. A ridge regression is constructed to explore age-related change in BMI. A Kruskal-Wallis H test is applied to compare the pooled duration of physical activity and sedentary time in the subgroups. Finally, we calculate paired correlation coefficients between BMI and physical activity/inactivity for each group. The findings can be further used in public health surveillance to clarify the epidemiology of obesity, to guide priority setting and planning, and to develop and evaluate public health policy and strategy.

Potential Impact of Physical Activity on Measures of Well-Being and Quality of Life in People with Rare Diseases: A Nationwide Cross-Sectional Study in Italy

BACKGROUND

Rare diseases constitute a heterogeneous group of approximately 7000-8000 conditions, distinguished by their low prevalence. Collectively, they present a significant global health challenge, affecting millions of people worldwide. It is estimated that rare diseases affect approximately 10% of the global population, which places a significant burden on individuals, families, and society. It is, therefore, important to consider strategies to improve the overall well-being and quality of life of individuals with rare diseases. One potential avenue for exploration is the incorporation of physical activity (PA). The scope of this study was to ascertain whether PA has a positive impact on measures of well-being and to determine its potential to enhance the quality of life of these individuals.

METHODS

The data were collected via an online survey. The one-way ANOVA test for multiple groups and multivariate Poisson models were employed to identify the significant predictors of the outcomes of interest.

RESULTS

The protective effects of PA become evident with a minimum of six hours of activity per week. Our data confirm that the weekly hours devoted to PA can serve as a significant protective factor for QoL. The study also provided some insights into the motivations behind patients' engagement in PA. These included improving QoL and physical well-being, as well as the desire to interact socially, with the goal of meeting friends or making new acquaintances. Finally, for adults and older adults, engaging in PA can also be a way to control weight.

CONCLUSIONS

It is becoming increasingly clear that individuals with rare diseases stand to benefit greatly from PA, so it is only sensible to educate them on the advantages of an active lifestyle.

Temporal Aspects of Psychosocial Mediators of the Exercise-Weight Loss Maintenance Relationship Within Scalable Behavior-Change Treatments

STUDY BACKGROUND

Limited knowledge of psychological correlates of weight loss is associated with continuing failures of behavioral obesity treatments beyond the short term.

PURPOSE

This study aimed to inform health professionals' obesity interventions via an increased knowledge of mediators of the exercise-weight loss maintenance relationship.

METHODS

Women participated in 6-month obesity treatments within community settings emphasizing moderate exercise and self-regulation skills development via primarily in-person (n = 54) or primarily written (n = 54) means. Changes in mood, self-regulating eating, and weight over 6, 12, and 24 months were assessed. A moderated mediation model was tested using the PROCESS macro instruction.

RESULTS

Improvements in mood, self-regulating eating, and weight were significantly greater in the in-person group. The relationship between a dichotomous measure of completing at least 3 sessions of exercise per week (or not) and change in weight over 6 months was no longer significant when the mediators of changes in negative mood and self-regulation of eating were sequentially entered. Paths of exercise→negative mood reduction→eating self-regulation increase→weight loss over 6, 12 and 24 months were significant. Exercise self-regulation at Month 3 significantly moderated the mood change→eating self-regulation change relationship.

CONCLUSIONS

Based on the identified paths, scalable obesity-treatment content and emphases were informed. This could help guide health professionals' actions concerning the management of obesity.

Carry-Over of Exercise-Related Self-Regulation to Eating-Related Self-Regulation in Women Participating in Behavioral Obesity Treatments

Purpose: Because obesity has not responded well to instructing affected adults in healthier eating behaviors and increased physical activity/exercise, enhanced research on psychosocial determinants of those behavioral changes is needed. Intervention foci on self-regulation have been suggested, but targeted research is required. Method: Women with obesity participated in community-based treatments that were either self-regulation-focused (self-regulation emphasis group; n = 52) or typical instruction-based (education [treatment-as-usual] group; n = 54). Results: There were overall significant increases in exercise-related self-regulation, physical activity/exercise, exercise-related self-efficacy, and eating-related self-regulation that were each significantly more pronounced in the self-regulation emphasis group. Increase in exercise-related self-regulation over 3 months predicted eating-related self-regulation over 6 months; however, sequential entry of changes in physical activity and exercise-related self-efficacy significantly mediated that relationship. However, only the path from changes in exercise-related self-regulation to exercise self-efficacy to eating-related self-regulation was significant. In a revised model where change in exercise self-efficacy was the sole mediator, treatment group did not significantly moderate the exercise self-regulation to eating self-regulation change relationship, but full mediation of that relationship occurred. Conclusion: Findings indicated salience for perceived ability/self-efficacy for physical activity, over actual physical activity progress, and its role in the transfer of self-regulatory skills from an exercise to eating context. Increased eating self-regulation significantly predicted weight loss over 6, 12, and 24 months. In the self-regulation emphasis group that translated to meaningful weight loss/weight-loss maintenance of greater than 5% of initial weight. Findings contributed to an increased understanding of psychosocial-change processes within obesity treatment research.