Exercise in a behavioural weight control programme for obese patients with Type 2 (non-insulin-dependent) diabetes. Men gain additional psychological benefits by adding exercise to a weight-loss program. Plasma leptin in moderately obese men: independent effects of weight loss and aerobic exercise. The influence of a 1-year programme of brisk walking on endurance fitness and body composition in previously sedentary men aged 42-59 years. Effects of an ad libitum low-fat, high-carbohydrate diet on body weight, body composition, and fat distribution in older men and women: a randomized controlled trial. The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomized controlled trial. Improved carbohydrate metabolism after physical training and dietary intervention in individuals with the "atherothrombogenic syndrome'. Oslo Diet and Exercise Study (ODES). A randomized trial. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. Training-induced changes in serum lipids, fat tolerance, and adipose tissue metabolism in patients with hypertriglyceridemia. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. Effects of exercise training on gallbladder function in an obese female population. Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. Effects of an energy-restrictive diet with or without exercise on abdominal fat, intermuscular fat, and metabolic risk factors in obese women. The independent effects of dietary weight loss and aerobic training on high density lipoproteins and apolipoprotein A-I concentrations in obese men. Effect of exercise training at different intensities on fat metabolism of obese men. Independent and additive effects of energy restriction and exercise on glucose and insulin concentrations in sedentary overweight men. Immune response to exercise training and/or energy restriction in obese women. A worksite program for overweight middle-aged men achieves lesser weight loss with exercise than with dietary change. Lifestyle intervention in overweight individuals with a family history of diabetes. Effects of cross-training on markers of insulin resistance/hyperinsulinemia. Physical activity within a community-based weight control program: program evaluation and predictors of success. Exercise and weight control in sedentary overweight men: effects on clinic and ambulatory blood pressure. The effect of weight loss with or without exercise training on large artery compliance in healthy obese men. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. Moderate exercise improves glucose metabolism in uncontrolled elderly patients with non-insulin-dependent diabetes mellitus. Use of personal trainers and financial incentives to increase exercise in a behavioral weight-loss program. Influence of diet and exercise on skeletal muscle and visceral adipose tissue in men. Effect of an energy-restrictive diet, with or without exercise, on lean tissue mass, resting metabolic rate, cardiovascular risk factors, and bone in overweight postmenopausal women. The effect of intensity controlled aerobic dance exercise on aerobic capacity of middle-aged, overweight women. Comparison of single versus multiple lifestyle interventions: are the antihypertensive effects of exercise training and diet-induced weight loss additive? Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Effects of a resistive training program on lipoprotein--lipid levels in obese women. Short-term effects of weight loss with or without low-intensity exercise training on fat metabolism in obese men. Exercise training and severe caloric restriction: effect on lean body mass in the obese. Exercise in the treatment of obesity: effects of four interventions on body composition, resting energy expenditure, appetite, and mood. The effect of low-intensity exercise training on fat metabolism of obese women. Does the amount of endurance exercise in combination with weight training and a very-low-energy diet affect resting metabolic rate and body composition? Physical activity and weight loss: does prescribing higher physical activity goals improve outcome?
Two studies were conducted to determine whether adding exercise to a diet programme promotes weight loss or glycaemic control in Type 2 (non-insulin-dependent) diabetic subjects. In Study 1, 25 subjects were randomly assigned to diet plus moderate exercise or diet plus placebo exercise. All subjects exercised twice a week as a group and once a week on their own; the diet plus moderate exercise group walked a 3-mile route at each session while the diet plus placebo exercise group did very low intensity exercises such as stretching and light calisthenics. All subjects followed a calorie-counting diet and were taught behaviour modification strategies. Weight losses and improvements in glycaemic control did not differ significantly between the two treatment groups at the end of the 10-week treatment or at 1-year follow-up. In Study 2, more extreme conditions were compared: a diet only group and a diet plus exercise group. The diet plus exercise group walked a 3-mile route with the group 3 times/week and once a week on their own, while the diet only group was instructed to maintain their current low level of activity. Both groups received comparable diet and behaviour modification instruction and therapist contacts. The diet plus exercise group had significantly (p less than 0.01) better weight losses than the diet only condition at the end of the 10 week programme (-9.3 kg vs -5.6 kg) and at 1 year follow-up (-7.9 kg vs -3.8 kg).(ABSTRACT TRUNCATED AT 250 WORDS) Adding exercise to a comprehensive weight-loss program might not only attenuate any psychological distress associated with weight-loss attempts but also may provide psychological benefits. This study examined whether a diet-plus-exercise weight-loss program improved psychological outcomes more than a diet-only weight-loss program or an assessment-only control group.
                This study was part of a larger 1-year randomized weight-loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year.
                Men and women in either weight-loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet-plus-exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet-only program. Women in the diet-plus-exercise program did not experience additional psychological benefits specific to weight control than those in the diet-only program, despite increases in aerobic capacity.
                The pattern seen for overweight men in the diet-plus-exercise program at 1 year-greater restraint, less disinhibition, and less hunger-is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women. The independent effects of weight loss and exercise on plasma leptin and total (AT), subcutaneous (SAT), and visceral (VAT) adipose tissue were investigated in 52 obese men. Subjects were randomly assigned to four 12-wk protocols: 1) control (C, n = 8), 2) diet-induced weight loss (DWL, n = 14), 3) exercise-induced weight loss (EWL, n = 14), and 4) exercise with weight maintenance (EWS, n = 16). Plasma leptin was unchanged in C (from 7.8 +/- 1.3 to 7.7 +/- 1.0 ng/ml). Equivalent weight loss (7.5 kg) decreased leptin significantly but similarly (DWL, from 8.5 +/- 1.0 to 4.8 +/- 0.6 ng/ml; EWL, from 10.1 +/- 1.0 to 5.0 +/- 0.6 ng/ml). Exercise in the absence of weight loss did not alter leptin levels (from 10.1 +/- 1. 3 to 9.2 +/- 1.2 ng/ml). Changes in leptin correlated with changes in AT and SAT (both P < 0.05) but not in VAT. We conclude that reduction in adipose tissue after weight loss results in a collateral decrease in circulating leptin, and exercise, independent of its effects on weight loss, has no profound influence on leptin secretion. This study examined the influence of a 1-year brisk walking programme on endurance fitness and the amount and distribution of body fat in a group of formerly sedentary men. Seventy-two males, aged 42-59 years, body mass index 25.2 (0.3) kg.m-2 [mean (SEM)], were randomly allocated to either a walking group (n = 48) or control group (n = 24). Brisk walking speed was evaluated using a 1.6-km track walk. Changes in endurance fitness were assessed by measuring blood lactate concentration and heart rate during submaximal treadmill walking. Body composition was determined by hydrostatic weighing and anthropometry; energy intake was assessed from 7-day weighed food inventories. Differences in the response of walkers and controls were examined using two-way analyses of variance. Forty-two walkers (87.5%) completed the study and averaged 27.9 (1.4%) min.day-1 of brisk walking (range 11-46). Brisk walking speed averaged 1.95 (0.03) m.s-1 and elicited approximately 68 (1) % of maximum heart rate. Heart rate and blood lactate concentration during submaximal treadmill walking were significantly reduced in the walkers after 3, 6 and 12 months and the oxygen uptake at a reference blood lactate concentration of 2 mmol.l-1 was increased by 3.2 ml.kg-1.min-1 (14.9%) in the walkers at 6 months (P < 0.01). Although skinfold thicknesses at anterior thigh and medial calf sites decreased significantly for the walkers, the response of the two groups did not differ significantly for other body composition variables or for energy intake. The efficacy of ad libitum low-fat diets in reducing body weight and fat in overweight and obese adults remains controversial.
                We examined the effect of a 12-week low-fat, high-complex carbohydrate diet alone (HI-CHO) and in combination with aerobic exercise training (HI-CHO + EX) on body weight and composition in 34 individuals with impaired glucose tolerance (20 women and 14 men; mean +/- SEM age, 66 +/- 1 years). Participants were randomly assigned to a control diet (41% fat, 14% protein, 45% carbohydrates, and 7 g of fiber per 1000 kcal), a HI-CHO diet (18% fat, 19% protein, 63% carbohydrates, and 26 g of fiber per 1000 kcal), or a HI-CHO diet plus endurance exercise 4 d/wk, 45 min/d, at 80% peak oxygen consumption (HI-CHO + EX). Participants were provided 150% of estimated energy needs and were instructed to consume food ad libitum. Total food intake, body composition, resting metabolic rate, and substrate oxidation were measured.
                There was no significant difference in total food intake among the 3 groups and no change in energy intake over time. The HI-CHO + EX and HI-CHO groups lost more body weight (-4.8 +/- 0.9 kg [P=.003] and -3.2 +/- 1.2 kg [P=.02]) and a higher percentage of body fat (-3.5% +/- 0.7% [P=.01] and -2.2% +/- 1.2% [P=.049]) than controls (-0.1 +/- 0.6 kg and 0.2% +/- 0.6%). In addition, thigh fat area decreased in the HI-CHO (P=.003) and HI-CHO + EX (P<.001) groups compared with controls. High carbohydrate intake and weight loss did not result in a decreased resting metabolic rate or reduced fat oxidation.
                A high-carbohydrate diet consumed ad libitum, with no attempt at energy restriction or change in energy intake, results in losses of body weight and body fat in older men and women. The National Cholesterol Education Program (NCEP) recommends a low-saturated-fat, low-cholesterol diet, with weight loss if indicated, to correct elevated plasma cholesterol levels. Weight loss accomplished by simple caloric restriction or increased exercise typically increases the level of high-density lipoprotein (HDL) cholesterol. Little is known about the effects on plasma lipoproteins of a hypocaloric NCEP diet with or without exercise in overweight people.
                We tested the hypothesis that exercise (walking or jogging) will increase HDL cholesterol levels in moderately overweight, sedentary people who adopt a hypocaloric NCEP diet. We randomly assigned 132 men and 132 women 25 to 49 years old to one of three groups: control, hypocaloric NCEP diet, or hypocaloric NCEP diet with exercise. One hundred nineteen of the men and 112 of the women returned for testing after one year.
                After one year, the subjects in both intervention groups had reached or closely approached NCEP Step 1 dietary goals and reduced their mean body fat significantly (range of reduction in mean fat weight, 4.0 to 7.8 kg). Weight loss on the NCEP diet alone did not significantly change HDL cholesterol levels in either the men or the women as compared with the subjects in the control group. Plasma levels of HDL cholesterol increased significantly more in the men who exercised and dieted (mean [+/- SE] change, +13 +/- 3 percent) than in the men who only dieted (+2 +/- 3 percent, P less than 0.01) or the men who acted as controls (-4 +/- 2 percent, P less than 0.001). HDL cholesterol levels remained about the same in the women who exercised and dieted (+1 +/- 2 percent); they were higher than in the women who only dieted (-10 +/- 3 percent, P less than 0.01), but not higher than in the controls (-3 +/- 3 percent).
                Regular exercise in overweight men and women enhances the improvement in plasma lipoprotein levels that results from the adoption of a low-saturated-fat, low-cholesterol diet. The increasing prevalence of obesity is a major public health concern. Physical activity may promote weight and body fat loss.
                To examine the effects of exercise on total and intra-abdominal body fat overall and by level of exercise.
                Randomized controlled trial conducted from 1997 to 2001.
                A total of 173 sedentary, overweight (body mass index > or =24.0 and >33% body fat), postmenopausal women aged 50 to 75 years who were living in the Seattle, Wash, area.
                Participants were randomly assigned to an intervention consisting of exercise facility and home-based moderate-intensity exercise (n = 87) or a stretching control group (n = 86).
                Changes in body weight and waist and hip circumferences at 3 and 12 months; total body, intra-abdominal, and subcutaneous abdominal fat at 12 months.
                Twelve-month data were available for 168 women. Women in the exercise group participated in moderate-intensity sports/recreational activity for a mean (SD) of 3.5 (1.2) d/wk for 176 (91) min/wk. Walking was the most frequently reported activity. Exercisers showed statistically significant differences from controls in baseline to 12-month changes in body weight (-1.4 kg; 95% confidence interval [CI], -2.5 to -0.3 kg), total body fat (-1.0%; 95% CI, -1.6% to -0.4%), intra-abdominal fat (-8.6 g/cm2; 95% CI, -17.8 to 0.9 g/cm2), and subcutaneous abdominal fat (-28.8 g/cm2); 95% CI, -47.5 to -10.0 g/cm2). A significant dose response for greater body fat loss was observed with increasing duration of exercise.
                Regular exercise such as brisk walking results in reduced body weight and body fat among overweight and obese postmenopausal women. To compare the single and joint effect of 1-year diet and exercise intervention on carbohydrate metabolism and associated coronary risk variables.
                Unmasked, randomized, 2 x 2 factorial intervention trial with 1-year duration for each participant.
                The participants were recruited from a screening examination of 40-year-old persons in Oslo, Norway.
                Two hundred and nineteen sedentary men and women, with diastolic blood pressure 86-99 mmHg, HDL cholesterol < 1.20 mmol L-1, triglycerides > 1.4 mmol L-1, total cholesterol 5.20-7.74 mmol L-1 and BMI > 24. Participants were randomly allocated to control (n = 43), diet (n = 55), exercise (n = 54) and diet+exercise (n = 67).
                Exercise: supervised endurance exercise three times a week. Diet: reduce weight, increase the intake of fish and reduce total fat intake.
                One-year changes in insulin and glucose before and after a standardized glucose load.
                As compared with controls fasting insulin in pmol L-1 decreased significantly in the combined diet and exercise group (3.9 +/- 6.2 versus -22.6 +/- 4.7 respectively, P = 0.003). Insulin in pmol L-1 after glucose load decreased significantly in all intervention groups compared to controls (diet: -82.2 +/- 49.9 P = 0.02; exercise: -92.4 +/- 60.1 P = 0.03; diet + exercise: -179.6 +/- 46.1 P = 0.0004). Fasting glucose in mmol L-1 decreased significantly in the diet alone group (0.21 +/- 0.07 P = 0.006) and in the diet+exercise group (-0.26 +/- 0.08 P = 0.005). In a subgroup analysis of the good responders, the observed changes with respect to total cholesterol (-0.76 mmol L-1), HDL cholesterol (0.16 mmol L-1), triglycerides (-0.72 mmol L-1), systolic and diastolic blood pressure (-8.5/ -6.8 mmHg) were all statistically significant compared to the control with P < 0.001).
                Exercise and diet intervention and in particular the combination of the two, were effective in improving carbohydrate metabolism. Associated risk factors were also affected in a beneficial direction. Guidelines established by the National Cholesterol Education Program (NCEP) promote exercise and weight loss for the treatment of abnormal lipoprotein levels. Little is known, however, about the effects of exercise or the NCEP diet, which is moderately low in fat and cholesterol, in persons with lipoprotein levels that place them at high risk for coronary heart disease.
                We studied plasma lipoprotein levels in 180 postmenopausal women, 45 through 64 years of age, and 197 men, 30 through 64 years of age, who had low high-density lipoprotein (HDL) cholesterol levels (< or =59 mg per deciliter in women and < or =44 mg per deciliter in men) and moderately elevated levels of low-density lipoprotein (LDL) cholesterol (>125 mg per deciliter but <210 mg per deciliter in women and >125 mg per deciliter but <190 mg per deciliter in men). The subjects were randomly assigned to aerobic exercise, the NCEP Step 2 diet, or diet plus exercise, or to a control group, which received no intervention.
                Dietary intake of fat and cholesterol decreased during the one-year study (P<0.001), as did body weight, in women and men in either the diet group or the diet-plus-exercise group, as compared with the controls (P<0.001) and the exercise group (P<0.05), in which dietary intake and body weight were unchanged. Changes in HDL cholesterol and triglyceride levels and the ratio of total to HDL cholesterol did not differ significantly among the treatment groups, for subjects of either sex. The serum level of LDL cholesterol was significantly reduced among women (a decrease of 14.5+/-22.2 mg per deciliter) and men (a decrease of 20.0+/-17.3 mg per deciliter) in the diet-plus-exercise group, as compared with the control group (women had a decrease of 2.5+/-16.6 mg per deciliter, P<0.05; men had a decrease of 4.6+/-21.1 mg per deciliter, P<0.001). The reduction in LDL cholesterol in men in the diet-plus-exercise group was also significant as compared with that among the men in the exercise group (3.6+/-18.8 mg per deciliter, P<0.001). In contrast, changes in LDL cholesterol levels were not significant among the women (a decrease of 7.3+/-18.9 mg per deciliter) or the men (10.8+/-18.8 mg per deciliter) in the diet group, as compared with the controls.
                The NCEP Step 2 diet failed to lower LDL cholesterol levels in men or women with high-risk lipoprotein levels who did not engage in aerobic exercise. This finding highlights the importance of physical activity in the treatment of elevated LDL cholesterol levels. Ten males (mean age 44 years) with primary hypertriglyceridemia were trained for 4 months 3 times/week for 1-h sessions. Eleven patients with similar physical characteristics and hypertriglyceridemia served as controls. Serum was assayed for TG and cholesterol (CH) and the various lipoprotein fractions, apoprotein A-I, glucose, insulin, and C-peptide. The removal of TG from the circulation was estimated by the Intralipid test. An open fat biopsy was taken and the incorporation and esterification of [14C]palmitate and glycerol release were measured in vitro. Following endurance physical training, serum TG and VLDL-TG decreased by 25 and 27%, respectively. No changes were observed in total CH and CH in the lipoprotein fractions or in apoprotein A-I. Fat tolerance increased slightly (+8%) whereas the incorporation of labelled palmitate into adipose tissue was reduced by 16%. The diminished incorporation was concomitant with a reduction in the esterification of fatty acids to TG (-29%). Enhanced removal of TG may contribute to the lowering of serum TG. The skeletal muscle is probably responsible for this adaptation, whereas the uptake of TG into adipose tissue is diminished. Physical inactivity contributes to weight gain, but only 22% of Americans are regularly active.
                To examine short- and long-term changes in weight, body composition, and cardiovascular risk profiles produced by diet combined with either structured aerobic exercise or moderate-intensity lifestyle activity.
                Sixteen-week randomized controlled trial with 1-year follow-up, conducted from August 1995 to December 1996.
                Forty obese women (mean body mass index [weight in kilograms divided by the square of height in meters], 32.9 kg/m2; mean weight, 89.2 kg) with a mean age of 42.9 years (range, 21-60 years) seen in a university-based weight management program.
                Structured aerobic exercise or moderate lifestyle activity; low-fat diet of about 1200 kcal/d.
                Changes in body weight, body composition, cardiovascular risk profiles, and physical fitness at 16 weeks and at 1 year.
                Mean (SD) weight losses during the 16-week treatment program were 8.3 (3.8) kg for the aerobic group and 7.9 (4.2) kg for the lifestyle group (within groups, P<.001; between groups, P = .08). The aerobic group lost significantly less fat-free mass (0.5 [1.3] kg) than the lifestyle group (1.4 [1.3] kg; P = .03). During the 1-year follow-up, the aerobic group regained 1.6 [5.5] kg, while the lifestyle group regained 0.08 (4.6) kg. At week 16, serum triglyceride levels and total cholesterol levels were reduced significantly (P<.001) from baseline (16.3% and 10.1% reductions, respectively) but did not differ significantly between groups and were not different from baseline or between groups at week 68.
                A program of diet plus lifestyle activity may offer similar health benefits and be a suitable alternative to diet plus structured aerobic activity for obese women. A higher duration and intensity of exercise may improve long-term weight loss.
                To compare the effects of different durations and intensities of exercise on 12-month weight loss and cardiorespiratory fitness.
                Randomized trial conducted from January 2000 through December 2001 involving 201 sedentary women (mean [SD] age, 37.0 [5.7] years; mean [SD] body mass index, 32.6 [4.2]) in a university-based weight control program.
                Participants were randomly assigned to 1 of 4 exercise groups (vigorous intensity/high duration; moderate intensity/high duration; moderate intensity/moderate duration; or vigorous intensity/moderate duration) based on estimated energy expenditure (1000 kcal/wk vs 2000 kcal/wk) and exercise intensity (moderate vs vigorous). All women were instructed to reduce intake of energy to between 1200 and 1500 kcal/d and dietary fat to between 20% and 30% of total energy intake.
                Body weight, cardiorespiratory fitness, and exercise participation.
                After exclusions, 184 of 196 randomized participants completed 12 months of treatment (94%). In intention-to-treat analysis, mean (SD) weight loss following 12 months of treatment was statistically significant (P <.001) in all exercise groups (vigorous intensity/high duration = 8.9 [7.3] kg; moderate intensity/high duration = 8.2 [7.6] kg; moderate intensity/moderate duration = 6.3 [5.6] kg; vigorous intensity/moderate duration = 7.0 [6.4] kg), with no significant difference between groups. Mean (SD) cardiorespiratory fitness levels also increased significantly (P =.04) in all groups (vigorous intensity/high duration = 22.0% [19.9%]; moderate intensity/high duration = 14.9% [18.6%]; moderate intensity/moderate duration = 13.5% [16.9%]; vigorous intensity/moderate duration = 18.9% [16.9%]), with no difference between groups. Post hoc analysis revealed that percentage weight loss at 12 months was associated with the level of physical activity performed at 6 and 12 months. Women reporting less than 150 min/wk had a mean (SD) weight loss of 4.7% [6.0%]; inconsistent (other) pattern of physical activity, 7.0% [6.9%]; 150 min/wk or more, 9.5% [7.9%]; and 200 min/wk or more of exercise, 13.6% [7.8%].
                Significant weight loss and improved cardiorespiratory fitness were achieved through the combination of exercise and diet during 12 months, although no differences were found based on different exercise durations and intensities in this group of sedentary, overweight women. Aerobic exercise may influence gallstone disease pathogenesis through its effect on gallbladder motility. The purpose of this investigation was to examine the effects of exercise training on gallbladder emptying in obese women.
                Twenty-seven obese subjects were randomized into one of two groups: exercise (E) (five 45-min brisk walking sessions per week at 75.2 +/- 0.5% of maximum heart rate) and controls (C). Gallbladder function via cholescintigraphy, cardiorespiratory fitness, and body composition were measured in all subjects before and after a 12-wk intervention period. In each cholescintigraphy trial subjects ingested an 8-oz liquid meal 45 min after injection of 99mTc disofenin to promote gallbladder emptying. Gallbladder areas were then scanned for 60 s and then every 5 min for 60 min.
                VO2max increased significantly by 9% for E when compared with that for C (P < 0.001). Within E postprandial gallbladder ejection fraction (EF) increased significantly after training (39.5 +/- 4.9% to 54.7 +/- 6.5%, P < 0.05); however, this 15.2% increase in EF was not significantly greater than the change reported in the controls.
                Results indicate that 12 wk of moderate exercise training does improve cardiorespiratory fitness but does not significantly effect gallbladder emptying in obese women. We studied separately the influence of two methods for losing fat weight on the levels of plasma lipids and lipoproteins in overweight sedentary men--decreasing energy intake without increasing exercise (diet), and increasing energy expenditure without altering energy intake (exercise, primarily running)--in a one-year randomized controlled trial. As compared with controls (n = 42), dieters (n = 42) had significant loss of total body weight (-7.8 +/- 0.9 kg [mean +/- SE]), fat weight (-5.6 +/- 0.8 kg), and lean (non-fat) weight (-2.1 +/- 0.5 kg) (P less than 0.001 for each variable), and exercisers (n = 47) had significant loss of total body weight (-4.6 +/- 0.8 kg) and fat weight (-3.8 +/- 0.7 kg) (P less than 0.001 for both variables) but not lean weight (-0.7 +/- 0.4 kg). Fat-weight loss did not differ significantly between dieters and exercisers. All subjects were discouraged from altering their diet composition; however, dieters and exercisers had slight reductions in the percentage of kilojoules derived from fat. As compared with the control group, both weight-loss groups had significant increases (P less than 0.01) in plasma concentrations of high-density lipoprotein (HDL) cholesterol (diet vs. exercise, 0.13 +/- 0.03 vs. 0.12 +/- 0.03 mmol per liter), HDL2 cholesterol (0.07 +/- 0.02 vs. 0.07 +/- 0.02 mmol per liter), and HDL3 cholesterol (0.07 +/- 0.02 vs. 0.06 +/- 0.02 mmol per liter) and significant decreases (P less than 0.05) in triglyceride levels (diet vs. exercise, -0.35 +/- 0.14 vs. -0.24 +/- 0.12 mmol per liter). Levels of total and low-density lipoprotein cholesterol were not significantly changed, relative to values in controls. None of these changes were significantly different between dieters and exercisers. Thus, we conclude that fat loss through dieting or exercising produces comparable and favorable changes in plasma lipoprotein concentrations. The primary objective was to examine whether the combination of diet and aerobic exercise (DA) or diet and resistance exercise (DR) is associated with greater improvements in metabolic risk factors by comparison to diet only (DO) in obese women. A second objective considered whether reductions in metabolic risk factors are related to concurrent changes in abdominal and/or intermuscular fat distribution.
                A total of 38 premenopausal obese women were randomly assigned to one of three 16-week treatments: DO (n=13), DA (n=11), or DR (n=14). Plasma glucose, insulin, and lipid levels were measured in a fasting state and after a 75-g oral glucose challenge (oral glucose tolerance test [OGTT]). Total, abdominal subcutaneous, visceral, and intermuscular fat were measured by magnetic resonance imaging.
                Significant reductions (P < 0.02) in body weight (approximately 10 kg or 10%) and in total, abdominal subcutaneous, visceral, and intermuscular fat were observed within each group. Fasting and OGTT insulin, total cholesterol, LDL cholesterol, and apolipoprotein B also decreased within each group (P < or = 0.02). The changes in the body fat and metabolic variables were not different across treatment (P > 0.05). Visceral fat alone was related to the metabolic risk factors both before and after the treatment.
                Weight loss was associated with reductions in metabolic risk factors in obese women. The improvement in the metabolic profile was not enhanced by the addition of aerobic or resistance exercise. The findings reinforce the importance of diminished visceral fat in the treatment of insulin resistance. Several studies have demonstrated that high density lipoprotein cholesterol (HDL-C) is increased after either dietary weight loss or aerobic exercise training, but it is unclear whether the effects of these two interventions are separate and independent, or just related to the amount of weight or fat lost. The effect of dietary weight loss or aerobic training on apolipoprotein A1 (Apo-A-I) has not been extensively studied. In the present study we evaluated the effects of either dietary weight loss or aerobic exercise training on lipoproteins and Apo A-I, and assessed whether they are related to changes in body composition. Twenty-six obese, otherwise healthy, untrained, nonsmoking, male subjects were weight stabilized for ten days, during which maximal aerobic capacity, body composition, and fat cell size were measured. At the end of this ten-day period lipoproteins and Apo A-I were measured. Subjects were then randomized into either a dietary weight loss (n = 12) or aerobic exercise group (n = 14). At the end of three months the groups were restabilized and restudied. Although both groups lost weight, the weight loss was greater in the diet group (-13.1 v -2.8 kg, P less than 0.001). Important differences in body composition were also detected after the two interventions with 25% of the total weight loss in the diet group coming from fat free mass. Significant decrements in triglyceride (-54 +/- 67 mg/dL, P less than 0.05), total cholesterol (-29 +/- 27 mg/dL, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) The present study investigated the effect of exercise training at different intensities on fat oxidation in obese men. Twenty-four healthy male obese subjects were randomly divided in either a low- [40% maximal oxygen consumption (VO(2 max))] or high-intensity exercise training program (70% VO(2 max)) for 12 wk, or a non-exercising control group. Before and after the intervention, measurements of fat metabolism at rest and during exercise were performed by using indirect calorimetry, [U-(13)C]palmitate, and [1,2-(13)C]acetate. Furthermore, body composition and maximal aerobic capacity were measured. Total fat oxidation did not change at rest in any group. During exercise, after low-intensity exercise training, fat oxidation was increased by 40% (P < 0.05) because of an increased non-plasma fatty acid oxidation (P < 0.05). High-intensity exercise training did not affect total fat oxidation during exercise. Changes in fat oxidation were not significantly different among groups. It was concluded that low-intensity exercise training in obese subjects seemed to increase fat oxidation during exercise but not at rest. No effect of high-intensity exercise training on fat oxidation could be shown. Overweight and inactivity are associated with impaired glucose tolerance, reduced insulin sensitivity, and diabetes. Few controlled trials have assessed the independent and combined effects of energy restriction and exercise on the prevention of these conditions.
                The objective was to evaluate the independent and additive effects of 16 wk of energy restriction and exercise on glucose and insulin concentrations.
                Sixty nonsmoking, overweight, sedentary men aged 20-50 y were randomly assigned to either maintain or restrict their energy intake (4186-6279 kJ/d). Within each of these arms, the subjects were further randomly assigned to either a light-intensity (control) or a vigorous-intensity exercise program for 30 min 3 times/wk.
                Fifty-one subjects completed the study. Maximal oxygen uptake increased ( approximately 24%; P < 0.001) with vigorous but not with light exercise. Significant weight loss was observed with energy restriction (x: 10.12 kg; 95% CI: 8.02, 12.22 kg; P < 0.001) but not with exercise. Vigorous exercise reduced fasting glucose and glucose and insulin areas under the curve (AUCs) by 13% (P = 0.01) and 20% (P = 0.02), respectively. Exercise effects were independent of weight change. Energy restriction resulted in a 40% reduction in the insulin AUC (P = 0.01). Vigorous exercise and energy restriction were additive in reducing the insulin AUC.
                Energy restriction and vigorous exercise independently and additively reduce glucose and insulin concentrations in response to an oral-glucose-tolerance test. Both of these lifestyle interventions provide a potent strategy that should be an integral part of any program to reduce the risk of impaired glucose tolerance, insulin resistance, and diabetes in overweight and sedentary persons. The effect of exercise training (five 45-min walking sessions/wk at 60-75% maximum heart rate) and/or moderate energy restriction (4.19-5.44 MJ or 1,200-1,300 kcal x d(-1)) on innate and adaptive immunity (including mitogen-stimulated lymphocyte proliferation (MSLP), natural killer cell activity (NKCA), and monocyte and granulocyte phagocytosis and oxidative burst (MGPOB) was studied in obese women (N = 91, age 45.6 +/- 1.1 yr, body mass index 33.1 +/- 0.6 kg x m(-2)) randomized to one of four groups: control (C), exercise (E), diet (D), exercise, and diet (ED).
                Aerobic power, body composition, and immune function were measured in all subjects before and after a 12-wk diet intervention period, with data analyzed using a 4 x 2 repeated measures design. All subjects self-reported symptoms of sickness in health logs using a precoded checklist. Statistical significance was set at P < or = 0.05.
                Data from this study indicate that although exercise training was unrelated to any significant changes in resting immune function, the number of days with symptoms of upper respiratory tract infection (URTI) was reduced relative to subjects in the nonexercise groups (5.6 +/- 0.9 and 9.4 +/- 1.1 sickness days, respectively, P < 0.05). Energy restriction and weight loss (7.9 +/- 0.7 kg) was associated with a significant decrease in MSLP, but no change in NKCA, MGPOB, or URTI.
                The data are consistent the viewpoint that weight loss, even at a moderate rate, is associated with a decrease in mitogen-stimulated lymphocyte proliferation without a change in various measures of innate immunity of the blood compartment. To compare changes in total and regional body composition using dual energy X-ray absorptiometry (DEXA) after subjects lost weight through change in diet or exercise.
                A 12-month, randomized, controlled study of two weight-loss interventions-low-fat diet ad libitum or moderate, unsupervised exercise-in free-living, middle-aged men. Compliance was determined at monthly measurement sessions through food records and activity logs; DEXA scans were performed every 3 months.
                Fifty-eight overweight men (mean body mass index = 29.0 +/- 2.6; mean age = 43.4 +/- 5.7 years) recruited from a national corporation were assigned randomly to diet, exercise, or control groups.
                One group reduced dietary fat to 26.4% of energy intake but kept activity unchanged; another group self-selected aerobic exercise (three sessions per week at 65% to 75% maximum heart rate) but kept diet unchanged. A control group maintained weight.
                At 12 months, measurements of weight, total and regional fat mass and lean mass, energy intake, and percentage dietary fat; physical activity indexes.
                Results were analyzed using paired t tests and analysis of variance.
                Mean weight loss was 6.4 +/- 3.3 kg in dieters and 2.6 +/- 3.0 kg in exercisers; control subjects maintained weight. DEXA scans revealed that 40% of dieters' weight loss was lean tissue; more than 80% of weight lost by exercisers was fat. Exercisers maintained limb lean tissue and lost fat mass.
                Greater total weight and lean tissue loss occurred when subjects lost weight through a low-fat diet consumed ad libitum than when subjects participated in unsupervised aerobic exercise. Use of DEXA enabled identification of progressive total and regional changes in fat and lean tissue. To assess the effect of lifestyle intervention over 2 years on changes in weight, coronary heart disease (CHD) risk factors, and incidence of diabetes in overweight individuals with a parental history of diabetes.
                Participants (n = 154), who were 30-100% over ideal body weight, had one or both parents with diabetes, and were currently nondiabetic, were randomly assigned to 2-year treatments focused on diet (decreasing calories and fat intake), exercise (goal of 1,500 kcal/week of moderate activity), or the combination of diet plus exercise or to a no-treatment control group. Subjects were reassessed at 6 months, 1 year, and 2 years.
                At 6 months, the groups differed significantly on measures of eating, exercise, and fitness; weight losses in the diet and diet-plus-exercise groups were significantly greater than in the exercise and control conditions. Weight losses were associated with positive changes in CHD risk factors. After 6 months, there was gradual deterioration of behavioral and physiological changes, so that at 2 years, almost no between-group differences were maintained. Differences between groups in risk of developing diabetes were of borderline significance (P = 0.08). Strongest predictors were impaired glucose tolerance at baseline, which was positively related to risk of developing diabetes, and weight loss from baseline to 2 years, which was negatively related; in all treatment groups, a modest weight loss of 4.5 kg reduced the risk of type 2 diabetes by approximately 30% compared with no weight loss.
                Although initially successful, the interventions studied here were not effective in producing long-term changes in behavior, weight, or physiological parameters. However, weight loss from 0 to 2 years reduced the risk of developing type 2 diabetes. Since modest weight loss significantly reduced risk of type 2 diabetes, further research is needed to determine how best to increase the percentage of subjects achieving at least a modest weight loss. This study examined, through a randomized controlled trial, the effects of cross-training (combined resistance and endurance exercise) on markers of insulin resistance, (e.g., dyslipidemia, intra-abdominal obesity, hyperinsulinemia, and hypertension), body composition, and performance in hyperinsulinemic individuals. Sedentary adult males characterized as hyperinsulinemic (fasting insulin > 2 OuU.mL-1), randomly assigned to two groups (N = 8 each), completed 14 wk of training at 3 d.wk-1. An endurance-only (E) group performed both continuous cycle exercise and walking (30 min each at 60-70% heart rate reserve). A cross-training (C) group performed both endurance and resistance exercise (8 exercises, 4 sets/exercise, 8-12 repetitions/set) in a single session. Both E and C groups demonstrated similar increases in VO2max (25% and 27%) while only C demonstrated an increase in 1 RM bench press (19%) and leg press (25%). The changes induced by C training were significantly greater than those from E training alone in percent fat (6.9 +/- 1.3 vs 1.4 +/- 1.4), insulin concentration (8.5 +/- 2.7 vs 3.0 +/- 1.3 uU.mL-1), glucose levels (11.1 +/- 2.9 vs 5.9 +/- 2.6 mg.dL-1), HDL-C levels (5.1 +/- 1.3 vs 2.9 +/- 1.6 mg.dL-1), triglyceride concentration (43.8 +/- 13.6 mg.dL-1), and systolic blood pressure (14.6 +/- 5.5 vs 8.3 +/- 6.8 mm Hg). Results indicate that the addition of resistance training to an endurance training program will induce significantly greater differences in markers of insulin resistance and body composition in individuals with hyperinsulinemia than endurance training alone. To assess the feasibility and effectiveness of adding physical activity sessions to a weight control program in a community health center and to identify individuals suitable for outpatient group treatment with and without physical activity.
                The study population included 42 overweight women who were randomly divided into treatment groups. Both treatment groups received guidance in nutrition and behavior modification and the exercise group also participated in physical activity sessions. Both treatments included 20 sessions and participants were followed up for eight months.
                In both treatments, significant improvements were seen in physical fitness, anthropometric measurements, nutritional knowledge, food consumption, and eating behaviors. Weight loss following three months of weekly sessions did not differ by treatment group. At follow-up there was a trend towards increased maintenance of weight loss in the exercise group, however differences were not statistically significant. Attrition rates were low in both treatments and participant satisfaction was high. Lower baseline BMI predicted larger weight losses, in particular in the exercise group. Other predictors of weight loss included poorer baseline eating behaviors and employment outside of the home. Perceived spouse support predicted continual participation. To examine whether restriction of caloric intake and exercise of vigorous intensity can independently and additively influence clinic and ambulatory blood pressures in sedentary overweight men.
                Sixty subjects aged 20-50 years were randomly allocated either to continue their normal caloric intake or to restrict it by 4186-6279 kl/day, with 15% provided by protein, 30% by fat and 55% by carbohydrate, for 16 weeks. Within each of these groups subjects were further randomly allocated either to a control light intensity programme of exercise or to a vigorous intensity programme of exercise for 30 min three times a week. The light exercise group performed stationary cycling against no resistance, flexibility exercises and slow walking. The vigorous intensity group cycled on an ergometer at 60-70% of maximum their workload.
                Fifty-one subjects completed the study. Their maximal oxygen uptake was increased by approximately 24% with vigorous exercise but did not change with light exercise. Caloric intake restriction led to a significant loss of body mass of 9.5 kg (95% confidence interval 7.6-11.3), whereas vigorous exercise had no effect. Restriction of caloric intake reduced supine clinic systolic and diastolic blood pressures significantly by 5.6 (2.3-8.9) and 2.4 mmHg (0.4-4.2), respectively. Relative to the control light exercise group, exercise of vigorous intensity exercise had no significant effect on clinic blood pressure. In contrast, time series analysis revealed that both caloric intake restriction and vigorous exercise were associated with lower daytime ambulatory systolic blood pressure, the reduction in systolic blood pressure being sustained throughout the 24 h period when vigorous exercise and caloric intake restriction were combined.
                Compared with the effects of caloric intake restriction, the effects of a vigorous exercise programme on blood pressure are inconsistent, there being no influence on clinic blood pressure but a reduction in daytime ambulatory blood pressure. However, when combined with caloric intake restriction, regular vigorous exercise exhibits a synergistic effect in reducing ambulatory blood pressure throughout a 24 h period. Obesity is an independent risk factor for cardiovascular morbidity and mortality. Large artery compliance is thought to be associated with cardiovascular risk. The effect of weight loss on large artery compliance is not yet clarified.
                To investigate the effect of weight loss, with or without exercise, on vessel wall properties in healthy obese men.
                This was a pair-matched randomized intervention study. All subjects were on an energy-restricted diet. One subject from each pair was also on an exercise programme. Measurements were performed before and at the end of the study period. The study lasted for 3 months.
                The vessel wall properties of the brachial and common carotid artery were assessed using a vessel wall movement detector system in combination with applanation tonometry.
                The mean body mass index was 32.3+/-0.4 kg/m2 and decreased (P < 0.001) to 27.6+/-0.4 kg/mm2 during the study. The mean blood pressure decreased (P < 0.001) by 6%. At operating pressures, carotid artery distensibility was 27.5+/-1.7 x 10(-3)/kPa at the start of the study and 31.1+/-1.8 x 10(-3)/kPa (P < 0.04) at the end of the study. Brachial and carotid artery compliances were 0.11+/-0.01 and 1.35+/-0.08 mm2/kPa at the start of the study and tended to increase to 0.12+/-0.001 (P = 0.06) and 1.48+/-0.08 mm2/kPa (P = 0.057), respectively, at the end of the study. Isobaric compliance did not change. The diet-and-exercise group did not differ statistically from the only-diet group in the effects on weight loss, blood pressure and arterial compliance.
                This study shows that weight loss increased carotid artery distensibility at operating pressures, but not under isobaric conditions. This increase is probably due to the decrease in blood pressure. The addition of exercise did not result in an additional effect within 3 months. To investigate whether prescribing exercise in several short-bouts versus one long-bout per day would enhance exercise adherence, cardiorespiratory fitness, and weight loss in overweight adult females in a behavioral weight control program.
                Randomized controlled trial with subjects randomized to either a short-bout exercise group (SB, n = 28, age = 40.4 +/- 5.9 yrs) or a long-bout exercise group (LB, n = 28, age = 40.9 +/- 7.3 yrs), with subjects followed for a period of 20 weeks. Both groups were instructed to exercise 5 days per week with exercise duration progressing from 20 to 40 min per day. The LB group performed one exercise bout per day, whereas the SB group performed multiple 10 min bouts of exercise per day. The recommended caloric intake for all subjects was 5022-6277 kJ/day (1200-1500 kcal/day), with fat reduced to 20% of caloric intake.
                Fifty-six obese, sedentary females (BMI = 33.9 +/- 4.1 kg/m2).
                Exercise participation was assessed from self-reported diaries and Tri-Trac Accelerometers. Cardiorespiratory fitness was assessed using a submaximal cycle ergometer test.
                Exercising in multiple short-bouts per day improved adherence to exercise: the SB group reported exercising on a greater number of days (mean +/- s.d. = 87.3 +/- 29.5 days vs 69.1 +/- 28.9 days; P < 0.05) and for a greater total duration (223.8 +/- 69.5 min/week vs 188.2 +/- 58.4 min/week; P = 0.08) than the LB group. Predicted VO2Peak increased by 5.6% and 5.0% for the LB and SB groups, respectively (P < 0.05). There was a trend for the weight loss to be greater in the SB group (-8.9 +/- 5.3 kg) compared to the LB group (-6.4 +/- 4.5 kg; P < 0.07).
                These results suggest that short-bouts of exercise may enhance exercise adherence. Short-bouts of exercise may also enhance weight loss and produce similar changes in cardiorespiratory fitness when compared to long-bouts of exercise. Thus, short-bouts of exercise may be preferred when prescribing exercise to obese adults. Exercise should be an integral part of the treatment in non-insulin-dependent (NIDDM) diabetic patients, yet most of these patients' performance is low, mainly because of their obesity and concomitant macrovascular disease. We studied the influence of a moderate exercise training on parameters of glucose control in NIDDM patients. Forty patients aged 56.6 +/- 6.6 years were assigned randomly according to age and sex into exercise and control groups. The exercise group trained for 45 min 3 times weekly for 12 weeks, while the control group did not change their lifestyle. At the end of the study the exercise group had a significant reduction in plasma levels of triglycerides, fructosamine and glycohemoglobin. The improvement in metabolic control persisted significantly in patients who continued to exercise at varying levels at home during 1 year of follow-up. Exercise is the best predictor of long-term weight loss. This study evaluated two strategies for improving exercise adherence and long-term weight loss in obese outpatients. Obese men and women (N = 193) were randomized to 1 of 5 treatment groups for 18 months: standard behavior therapy (SBT); SBT with supervised walks (SW) 3 times per week; SBT + SW with personal trainers (PT), who walked with participants, made phone reminders, and did make-up SW; SBT + SW with monetary incentives (I) for completing SW; and SBT + SW + PT + I. Both PT and I enhanced attendance at SWs, the combination producing the best adherence. Increased walk attendance did not result in higher overall energy expenditure, however, and long-term weight loss was also not improved. Post hoc analyses suggest that the level of exercise needed for successful long-term weight loss is much higher than that usually recommended in behavioral treatment programs. The effects of diet only (DO) and diet combined with either aerobic (DA) or resistance (DR) exercise on subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), lean tissue (LT), and skeletal muscle (SM) tissue were evaluated in 33 obese men (DO, n = 11; DA, n = 11; DR, n = 11). All tissues were measured by using a whole body multislice magnetic resonance imaging (MRI) model. Within each group, significant reductions were observed for body weight, SAT, and VAT (P < 0.05). The reductions in body weight (approximately 10%) and SAT (approximately 25%) and VAT volume (approximately 35%) were not different between groups (P > 0.05). For all treatments, the relative reduction in VAT was greater than in SAT (P < 0.05). For the DA and DR groups only, the reduction in abdominal SAT (approximately 27%) was greater (P < 0.05) than that observed for the gluteal-femoral region (approximately 20%). Conversely, the reduction in VAT was uniform throughout the abdomen regardless of treatment (P > 0.05). MRI-LT and MRI-SM decreased both in the upper and lower body regions for the DO group alone (P < 0.05). Peak O2 uptake (liters) was significantly improved (approximately 14%) in the DA group as was muscular strength (approximately 20%) in the DR group (P < 0.01). These findings indicate that DA and DR result in a greater preservation of MRI-SM, mobilization of SAT from the abdominal region, by comparison with the gluteal-femoral region, and improved functional capacity when compared with DO in obese men. To study the effect of exercise added to an energy-restrictive diet in overweight postmenopausal women.
                In a longitudinal clinical study, 121 healthy, overweight postmenopausal women (age 53.8 +/- 2.5 years, body mass index: 29.7 +/- 3.1 kg/m2) were randomly assigned to 3 groups: controls, a 4,200 kJ/d diet, or a 4,200 kJ/d diet with combined aerobic and anaerobic exercise. Body composition (measured by dual-energy x-ray absorptiometry), fat distribution, resting metabolic rate, blood pressure, serum lipids and lipoproteins, bone mineral densities, and markers of collagen and bone turnover were measured before and after 12 weeks of intervention.
                One hundred eighteen women completed the study. The mean loss of body weight (9.5 kg versus 10.3 kg, NS) was similar in the intervention groups, but compared with the diet-only group, the diet-plus-exercise group lost more fat (7.8 kg versus 9.6 kg, p < 0.001) and no lean tissue mass (1.2 kg versus -0.0 kg, p < 0.001). The resting metabolic rate (per kg wt) was increased in the diet-plus-exercise group compared with the control group (11% versus 4%, p < 0.009). The levels of serum triglycerides, total cholesterol, low-density lipoprotein, and very-low-density lipoprotein decreased, and the ratio of high-density lipoprotein to low-density lipoprotein increased by 20% to 30% in both intervention groups compared with the control group (p < 0.001). The systolic blood pressure dropped, and the waist-to-hip circumference ratio and abdominal-to-total body fat decreased in both intervention groups compared with the control group (10%, p < 0.003, and 3.5%, p < 0.0001). There were no consistent, major differences between the groups in terms of changes in total body, spinal, or forearm bone mineral densities, or in markers of collagen and bone turnover.
                Overweight postmenopausal women benefit from addition of combined aerobic and anaerobic exercise to an energy-restrictive diet. The diet itself has a positive effect on cardiovascular risk factors. The purpose of this study was to determine the effect of intensity controlled exercise on the aerobic capacity of overweight, middle-aged women. Thirty-eight moderately overweight women, ages 35-57, participated in a 16-week dance-exercise program. Random assignment was made to an experimental group (n = 20) in which intensity of exercise was controlled and prescribed, and a control group (n = 18) in which exercise was of an intensity typical to commercial aerobic classes. Prior to the onset of training, and at the completion of 16 weeks, the following fitness tests were administered: Aerobic capacity expressed as VO2 max, body composition analysis, blood chemistry, blood pressure, resting heart rate, muscular endurance, and flexibility. T-tests, ANCOVA, and gain-score analyses were utilized to evaluate data. Both groups showed small changes in weight, percent fat, resting systolic and diastolic blood pressure, resting heart rate, high density lipoprotein-cholesterol (HDL-C), muscular endurance, and flexibility, but these changes were statistically nonsignificant. The VO2 max for the experimental group increased 41%, while the VO2 max for the control group increased 22% (p less than 0.05). The results suggest that the cardiovascular fitness changes for overweight, middle-aged women are greater when exercise intensity and progression are tailored to their age and fitness level. Although aerobic exercise training and diet-induced weight loss each have been shown to individually lower elevated blood pressure (BP), it is currently not known whether their combined use produces an additive antihypertensive effect. In this randomized clinical trial we therefore compared the effect on resting BP of exercise training only and dietary modification only with that of exercise training plus dietary modification in 55 sedentary, overweight patients with high normal BP or stage 1 or 2 hypertension. After baseline testing, patients were randomized to 1 of the following 3 interventions for 12 weeks: exercise training only (aerobic exercise; 30 to 45 minutes; 3 to 5 days/week; 60% to 85% of maximal heart rate), dietary modification only (aimed primarily at weight loss via restriction of energy intake and dietary fat), or exercise training plus dietary modification. Forty-eight patients completed the study. In these patients, exercise training plus dietary modification elicited a greater reduction (p < or = 0.001) in body weight (-7.1 +/- 2.9 vs -1.0 +/- 1.8 kg) than exercise training only, and a greater increase (p < or = 0.05) in maximal oxygen uptake (4.3 +/- 2.6 vs 1.9 +/- 2.0 ml/kg/min) versus dietary modification only. However, the reduction in BP with exercise training plus dietary modification (-12.5 +/- 6.3/7.9 +/- 4.3 mm Hg) did not differ significantly from that with exercise training only (-9.9 +/- 6.4/5.9 +/- 4.6 mm Hg) or dietary modification only (-11.3 +/- 12.1/7.5 +/- 4.3 mm Hg). These data indicate that the antihypertensive effects of exercise training and diet-induced weight loss are not additive. This finding has important public health and clinical implications for the millions of overweight persons with high normal BP or stage 1 or 2 hypertension. To study the impact of diet and exercise and the combination thereof on cardiovascular risk factors, 157 healthy men aged 35-60 years (mean +/- S.D.; 46.2 +/- 5.0) with slightly to moderately raised cardiovascular risk factors, were randomized to 4 groups, diet (D, n = 40), exercise (E, n = 39), diet plus exercise (DE, n = 39), and no active intervention (controls (C, n = 39)), and investigated at baseline and after 6 months. BMI was significantly reduced in Groups E and DE (mean difference and 95% confidence intervals (CI), -0.3 (-0.5, -0.01) and -0.6 (-0.9, -0.3) kg/m2, respectively). Waist circumference was reduced in all 3 intervention groups (D, E, and DE), -1.3 (-2.5, -0.1), -2.2 (-3.2, -1.3) and -3.0 (-3.9, -2.0) cm, but not in the control group. Blood pressure (BP) was reduced in all 3 intervention groups, systolic BP 4-7 mmHg and diastolic BP 2-6 mmHg. Serum cholesterol was reduced in Group DE, -0.45 (-0.77, -0.13) mmol/l. VLDL-cholesterol was reduced in Groups E and DE, -0.14 (-0.26, -0.03) and -0.09 (-0.18, -0.01) mmol/l, whereas LDL-cholesterol was reduced in Groups D and DE -0.30 (-0.54, -0.06) and -0.35 (-0.64, -0.05) mmol/l. In contrast, neither HDL-cholesterol nor serum triglycerides were influenced by the interventions. According to the coronary risk profile derived from the Framingham study, all 3 intervention groups (D, E, and DE) significantly reduced their estimated 10-year risk (-13, -12, and -14%, respectively). We conclude that even with rather moderate changes in diet and exercise, several important cardiovascular risk factors can be affected and that diet and exercise were about equally effective in reducing cardiovascular risk. The purpose of this study was to determine the effects of a resistive training program on the time course of changes in strength, body mass index, lipids, lipoproteins, and apolipoproteins in sedentary obese women. Sixteen sedentary obese women strength trained 3 times . wk-1 for 12 wk performing three sets of six to eight repetitions per set with sets 1 and 2 at 60-70% of one-repetition maximum. During set 3, the subjects used the greatest weight possible so that failure occurred between six to eight repetitions. Six sedentary obese women served as controls. Blood samples for serum total cholesterol (TC), high-density lipoproteins (HDL-C), low-density lipoproteins (LDL-C), triglycerides (TG), TC/HDL-C ratio, apolipoprotein A-I (apo A-I), and apolipoprotein B-100 (apo B-100) were obtained pre, and after 4, 8, and 12 wk of training and approximately 3-4 d following the last training session. A 3-d dietary record was obtained on all subjects pre and post, and subjects were instructed not to alter their diet. The 12 wk of resistive training did not result in a significant change in body weight, BMI, or total kilocalories consumed per day but did show a mean improvement of 58% in muscular strength (P less than 0.05). The training program did not significantly alter the TC, HDL-C, LDL-C, TG, TC/HDL-C ratio, apo A-I, or apo B-100 levels, which suggests that this increase in strength owing to resistive training in the absence of body weight loss did not alter the lipid profiles in these sedentary obese women. Energy restriction is known to induce a decline in fat oxidation during the postdiet period. Reduced fat oxidation may contribute to weight regain.
                The present study investigated the effect of the addition of low-intensity exercise training to energy restriction on postdiet fat oxidation and on the contribution of the sympathetic nervous system to fat oxidation.
                Forty obese men were divided randomly into 2 groups: diet (D) and diet plus exercise (DE). Both groups followed an energy restriction program for 10 wk. Subjects in the DE group also participated in a low-intensity exercise training program [40% maximal oxygen uptake (VO2max)] for 12 wk. Before the intervention and after 12 wk, with subjects at stable body weights, we measured body composition, VO2max, and substrate oxidation at rest, during exercise at 50% VO2max, and during recovery. Measurements were made with and without administration of the beta-adrenergic antagonist propranolol.
                Both interventions led to significant decreases in body weight, fat mass, and fat-free mass (P < 0.001); these decreases did not differ significantly between the D and DE groups. Neither intervention significantly affected VO2max. The effect of the intervention on the respiratory exchange ratio differed significantly between the D and DE groups [two-way analysis of variance (ANOVA), P < 0.05]. The effect on the beta-adrenergic-mediated respiratory exchange ratio tended to be different between the 2 groups (two-way ANOVA, P = 0.09).
                Addition of low-intensity exercise training to energy restriction counteracts the decline in fat oxidation during the postdiet period. The purpose of this study was to investigate the effects of exercise intensity on the body composition of obese subjects during severe caloric restriction. Forty obese subjects (33 women, 7 men; 41 +/- 7.7 years; 106 +/- 26kg; body fat > 25% men, > 30% women) on a commercially prepared OPTIFAST 420kcal/day supplemented fast were randomized into groups that exercised at target heart rates corresponding to 40% and 60% of the heart rate reserve (HRR) at the start of the program. Training volume was similar for both groups at approximately 300kcal per session three times per week for 12 weeks. Body weight, body fat, and lean weight were similar for both exercise intensity groups at week one. Overall, body weight decreased by 15.3 +/- 6.7 kg (p < or = .05), and body fat decreased by 14.9 +/- 5.0 kg (p < or = .05) for the 40 subjects, whereas lean weight remained unchanged. No significant differences in body weight, body fat, or lean weight were observed between the two groups. The results of the current study indicated that while on a supplemented 420-kcal/day fast, exercise at 40% and 60% of the HRR affected body composition similarly when total training volume was held constant at 900kcal/week. Lean weight remained unchanged and accompanied a 14.9 +/- 5.0-kg decrease in body fat, which may have resulted when the volume of exercise (ie, 900kcals/wk) was factored into the exercise prescriptions. These results suggest that exercising at 60% of the HRR offers no advantages for body composition changes over those obtained from exercising at 40% of HRR when the total volume of exercise training is controlled. This study investigated changes in body composition, resting energy expenditure (REE), appetite, and mood in 128 obese women who were randomly assigned to 1 of 4 treatment conditions: diet alone, diet plus aerobic training, diet plus strength training, or diet combined with aerobic and strength training (i.e., combined training). All women received the same 48-week group behavioral program and were prescribed the same diet. Exercising participants were provided 3 supervised exercise sessions per week for the first 28 weeks and 2 sessions weekly thereafter. Participants across the 4 conditions achieved a mean weight loss of 16.5 +/- 6.8 kg at Week 24, which decreased to 15.1 +/- 8.4 kg at Week 48. There were no significant differences among conditions at any time in changes in weight or body composition. Women who received aerobic training displayed significantly smaller reductions in REE at Week 24 than did those who received strength training. There were no other significant differences among conditions at any time on this variable or in changes in appetite and mood. Previous studies have shown that fat metabolism is different in upper body (UB) and lower body (LB) obese women. The present study investigated whether the effect of low-intensity exercise training on fat metabolism is different in UB and LB obese premenopausal women.
                Twenty-one healthy, premenopausal women with either LB obesity (waist-to-hip ratio of < or =0.79; n = 8) or UB obesity (waist-to-hip ratio of > or =0.85; n = 13) participated in the present study. The UB obese women were matched and randomly divided in an exercise training group (UB) and a nonexercising control group (UB-C). Subjects in the UB and LB groups participated in a low-intensity exercise training program (40% VO2max) three times per week for 12 weeks. Before and after the intervention, measurements of fat metabolism at rest and during exercise, body composition, and maximal aerobic capacity were performed.
                Exercise training did not change the respiratory exchange ratio at rest in the UB and LB groups. During exercise, relative fat oxidation increased in the UB group by 19% (p < 0.05), whereas no change in the LB and UB-C groups was found. Plasma free fatty acid oxidation did not change by exercise training, and nonplasma fatty acid oxidation tended to increase in the UB group compared with the UB-C group (p = 0.08).
                Low-intensity exercise training increased the contribution of fat oxidation to total energy expenditure during exercise but not at rest in UB obese women. Exercise training had no significant effect on fat metabolism in the LB obese women. Effects of large (LA; 400 min/wk) and moderate (MA; 200 min/wk) amounts of endurance exercise in combination with weight training (3 d/wk) were compared with the effects of no exercise (C) in 23 obese females after a 12-wk, 3360-kJ/d very-low-energy diet (VLED). The LA group lost 6.5 kg more weight, mainly as fat (6.4 kg), than the C group (P < 0.05). No measurable differences were found among groups for decreases in resting metabolic rate (-729 to -1233 kJ/d; NS) or fat-free mass (-2.9 to -3.9 kg; NS). No improvements in aerobic capacity were achieved with the addition of exercise to a VLED (-0.079 to -0.037 L/min; NS). Strength indexes were improved (+16 to +5 kg; P < 0.05) or maintained with exercise (-3 kg; NS) whereas a loss (-9.3 kg; P < 0.05) or maintenance (+4.5 kg; NS) was found for VLED alone. Large amounts of endurance exercise in combination with weight training added to a VLED appear to improve weight and fat loss compared with a VLED alone. Recommending increased physical activity facilitates long-term weight loss, but the optimal level of physical activity to recommend is unknown.
                The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments.
                Overweight men and women (n = 202) were randomly assigned to either a standard behavior therapy (SBT) for obesity, incorporating an energy expenditure (EE) goal of 1000 kcal/wk, or to a high physical activity (HPA) treatment, in which the goal was an EE of 2500 kcal/wk. To help HPA treatment group participants achieve this high exercise goal, their treatment included encouragement to recruit 1-3 exercise partners into the study, personal counseling from an exercise coach, and small monetary incentives.
                The HPA treatment group reported achieving higher mean (+/- SD) physical activity levels than did the SBT group at 6 mo (EE of 2399 +/- 1571 kcal/wk compared with 1837 +/- 1431 kcal/wk), 12 mo (EE of 2249 +/- 1751 kcal/wk compared with 1565 +/- 1309 kcal/wk), and 18 mo (EE of 2317 +/- 1854 kcal/wk compared with 1629 +/- 1483 kcal/wk) (all P < 0.01). Mean (+/- SEM) cumulative weight losses at 6, 12, and 18 mo in the HPA treatment group were 9.0 +/- 7.1, 8.5 +/- 7.9, and 6.7 +/- 8.1 kg, respectively. In the SBT group, the corresponding weight losses were 8.1 +/- 7.4, 6.1 +/- 8.8, and 4.1 +/- 7.3 kg, respectively. Between-group differences in weight loss were significant at 12 and 18 mo.
                These results suggest that recommendations of higher levels of physical activity (EE of 2500 kcal/wk) promote long-term weight loss better than do conventional recommendations.
The results of this review support the use of exercise as a weight loss intervention, particularly when combined with dietary change. Exercise is associated with improved cardiovascular disease risk factors even if no weight is lost.