Caloric restriction with or without exercise: the fitness versus fatness debate.

UNLABELLED There is a debate over the independent effects of aerobic fitness and body fatness on mortality and disease risks. PURPOSE To determine whether a 25% energy deficit that produces equal change in body fatness leads to greater cardiometabolic benefits when aerobic exercise is included. METHODS Thirty-six overweight participants (16 males/20 females) (39 +/- 1 yr; 82 +/- 2 kg; body mass index = 27.8 +/- 0.3 kg x m2, mean +/- SEM) were randomized to one of three groups (n = 12 for each) for a 6-month intervention: control (CO, weight-maintenance diet), caloric restriction (CR, 25% reduction in energy intake), or caloric restriction plus aerobic exercise (CR + EX, 12.5% reduction in energy intake plus 12.5% increase in exercise energy expenditure). Food was provided during weeks 1-12 and 22-24. Changes in fat mass, visceral fat, VO2peak (graded treadmill test), muscular strength (isokinetic knee extension/flexion), blood lipids, blood pressure, and insulin sensitivity/secretion were compared. RESULTS As expected, VO2peak was significantly improved after 6 months of intervention in CR + EX only (22 +/- 5% vs 7 +/- 5% in CR and -5 +/- 3% in CO), whereas isokinetic muscular strength did not change. There was no difference in the losses of weight, fat mass, or visceral fat and changes in systolic blood pressure (BP) between the intervention groups. However, only CR + EX had a significant decrease in diastolic BP (-5 +/- 3% vs -2 +/- 2% in CR and -1 +/- 2% in CO), in low-density lipoprotein (LDL) cholesterol (-13 +/- 4% vs -6 +/- 3% in CR and 2 +/- 4% in CO), and a significant increase in insulin sensitivity (66 +/- 22% vs 40 +/- 20% in CR and 1 +/- 11% in CO). CONCLUSIONS Despite similar effect on fat losses, combining CR with exercise increased aerobic fitness in parallel with improved insulin sensitivity, LDL cholesterol, and diastolic BP. The results lend support for inclusion of an exercise component in weight loss programs to improve metabolic fitness.

[1]  Corby K. Martin,et al.  Caloric restriction alone and with exercise improves CVD risk in healthy non-obese individuals. , 2009, Atherosclerosis.

[2]  S. Blair,et al.  Does physical activity ameliorate the health hazards of obesity? , 2008, British Journal of Sports Medicine.

[3]  X. Sui,et al.  CARDIORESPIRATORY FITNESS AND ADIPOSITY AS MORTALITY PREDICTORS IN OLDER ADULTS , 2008 .

[4]  Rena R Wing,et al.  Fitness, fatness, and cardiovascular risk factors in type 2 diabetes: look ahead study. , 2007, Medicine and science in sports and exercise.

[5]  Y. Ohashi,et al.  Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. , 2007, Archives of internal medicine.

[6]  Corby K. Martin,et al.  Effect of calorie restriction with or without exercise on body composition and fat distribution. , 2007, The Journal of clinical endocrinology and metabolism.

[7]  S. Klein,et al.  Effect of long-term calorie restriction with adequate protein and micronutrients on thyroid hormones. , 2006, The Journal of clinical endocrinology and metabolism.

[8]  E. Ravussin,et al.  Effect of calorie restriction with or without exercise on insulin sensitivity, beta-cell function, fat cell size, and ectopic lipid in overweight subjects. , 2006, Diabetes care.

[9]  Corby K. Martin,et al.  Effect of 6-month calorie restriction on biomarkers of longevity, metabolic adaptation, and oxidative stress in overweight individuals: a randomized controlled trial. , 2006, JAMA.

[10]  S. Blair,et al.  Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. , 2005, Archives of internal medicine.

[11]  J. Manson,et al.  Adiposity as compared with physical activity in predicting mortality among women. , 2005, The New England journal of medicine.

[12]  D. Seals,et al.  Fatness Is a Better Predictor of Cardiovascular Disease Risk Factor Profile Than Aerobic Fitness in Healthy Men , 2005, Circulation.

[13]  J. Tuomilehto,et al.  Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes. , 2005, Diabetes care.

[14]  D. Seals,et al.  Stiffening our resolve against adult weight gain. , 2005, Hypertension.

[15]  J. Holloszy.  A forty-year memoir of research on the regulation of glucose transport into muscle. , 2003, American journal of physiology. Endocrinology and metabolism.

[16]  E. Benjamin,et al.  Obesity and Systemic Oxidative Stress: Clinical Correlates of Oxidative Stress in The Framingham Study , 2003, Arteriosclerosis, thrombosis, and vascular biology.

[17]  J. Stevens,et al.  Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. , 2002, American journal of epidemiology.

[18]  G. Giacchetti,et al.  Overexpression of the renin-angiotensin system in human visceral adipose tissue in normal and overweight subjects. , 2002, American journal of hypertension.

[19]  G. Bray,et al.  Contributions of total body fat, abdominal subcutaneous adipose tissue compartments, and visceral adipose tissue to the metabolic complications of obesity. , 2001, Metabolism: clinical and experimental.

[20]  J. Wilmore,et al.  Fitness, fatness, and estimated coronary heart disease risk: the HERITAGE Family Study. , 2001, Medicine and science in sports and exercise.

[21]  E. Bruckert,et al.  Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. , 2000, The Journal of clinical endocrinology and metabolism.

[22]  Robert Ross,et al.  Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men , 2000, Annals of Internal Medicine.

[23]  Steven Blair,et al.  Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes , 2000, Annals of Internal Medicine.

[24]  G. Shulman,et al.  On Diabetes: Insulin Resistance Cellular Mechanisms of Insulin Resistance , 2022 .

[25]  J. Kampert,et al.  Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. , 1999, JAMA.

[26]  S. Coppack,et al.  C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? , 1999, Arteriosclerosis, thrombosis, and vascular biology.

[27]  S. Blair,et al.  Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. , 1999, The American journal of clinical nutrition.

[28]  J. Roitman,et al.  ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription , 1998 .

[29]  R. Eckel,et al.  Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. , 1997, Circulation.

[30]  R. Withers,et al.  The effectiveness of exercise training in lowering blood pressure: a meta-analysis of randomised controlled trials of 4 weeks or longer , 1997, Journal of Human Hypertension.

[31]  J. Holloszy.  Mortality rate and longevity of food-restricted exercising male rats: a reevaluation. , 1997, Journal of applied physiology.

[32]  J. Cutler.  High blood pressure and end-organ damage. , 1996, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[33]  P. Thompson,et al.  ACSM's Guidelines for Exercise Testing and Prescription , 1995 .

[34]  R. Bergman,et al.  A comparison between the minimal model and the glucose clamp in the assessment of insulin sensitivity across the spectrum of glucose tolerance. Insulin Resistance Atherosclerosis Study. , 1994, Diabetes.

[35]  Richard M Watanabe,et al.  A Comparison Between the Minimal Model and the Glucose Clamp in the Assessment of Insulin Sensitivity Across the Spectrum of Glucose Tolerance , 1994, Diabetes.

[36]  R N Bergman,et al.  Minimal model analysis of intravenous glucose tolerance test-derived insulin sensitivity in diabetic subjects. , 1990, The Journal of clinical endocrinology and metabolism.

[37]  R. Weindruch,et al.  The retardation of aging in mice by dietary restriction: longevity, cancer, immunity and lifetime energy intake. , 1986, The Journal of nutrition.

[38]  M. Criqui.  Epidemiology of atherosclerosis: an updated overview. , 1986, The American journal of cardiology.

[39]  S. Blair,et al.  Exercise capacity and body composition as predictors of mortality among men with diabetes. , 2004, Diabetes care.

[40]  L. Goodyear,et al.  Exercise, glucose transport, and insulin sensitivity. , 1998, Annual review of medicine.