Aerobic Plus Resistance Training Improves Bone Metabolism and Inflammation in Adolescents who Are Obese

Abstract

Obesity is a worldwide epidemic with a high prevalence of comorbidities, including alterations in bone mineral metabolism. The purpose of this yearlong study was to evaluate the role of 2 types of exercise training (aerobic and aerobic plus resistance exercise) on adipokines parameters and bone metabolism in adolescents who are obese. This was a clinical trial study with interdisciplinary weight loss therapy. Forty-two postpubertal adolescents who are obese were subjected to interdisciplinary weight loss therapy with physical exercise, medical monitoring, nutritional intervention, and psychological intervention. Data were collected from serum analyses of leptin, ghrelin, adiponectin, glucose, and insulin. Anthropometric measurements of body composition, bone mineral density, visceral, and subcutaneous fat were also performed. Statistical tests were applied using repeated-measures analysis of variance. Correlations were established using the Pearson test, and dependencies of variables were established using simple linear regression test. Both training types promoted reductions in body mass index, total central, visceral and subcutaneous fat, insulin concentration, and homeostasis model assessment insulin resistance (HOMA-IR) index, but only aerobic plus resistance training showed statistical improvements in the bone mineral content, adiponectin concentration, and lean tissue. Effective reduction in the visceral/subcutaneous ratio, central/peripheral ratio, and leptin concentration was observed. Insulin and the HOMA-IR index were negative predictors of bone mineral content in the combined training group. Moreover, fat distribution was a negative predictor for bone mineral density in both groups. Aerobic plus resistance training promotes a protective role in bone mineral content associated with an improvement in adiponectin and leptin concentrations, favoring the control of the inflammatory state related to obesity in adolescents. Aerobic plus resistance training combined with interdisciplinary interventions provides important strategies to approach obesity, and these strategies may contribute to clinical practice.

Bone-adiposity cross-talk: implications for pediatric obesity

“…An understanding of the effects of weight loss programs on the bone-adipocyte cross-talk in adolescents is required in order to prescribe effective and safe weight loss programs. Protocols combining nutritional, physical activity and psychological approaches [51][52][53][54], nutritional and physical activity [55,56] or physical intervention alone [41] have been proposed. However, the exact mechanisms for weight loss induced-bone loss remain unknown, and hypotheses have been proposed involving alterations of some bone-regulating hormones.…”

“…Weight loss and associated changes in the VAT/SAT ratio, lean mass and bone quality were made through comparisons of programs involving nutrition plus AT vs. nutrition and AT + RT in obese adolescents [55]. The AT + RT group had higher BMC values than the AT group, who showed a deceased BMC.…”

“…Specifically, a potentially negative correlation with bone density was postulated in obese girls. However, cautious interpretation of results is required because of the unequal baseline values between groups (with the AT + RT group showing lower baseline ghrelin concentrations) [55]. Moreover, in their study total ghrelin was analyzed without subanalysis of the acylated form, which has a major role in appetite regulation [58].…”

Inappropriate Use of Homeostasis Model Assessment Cutoff Values for Diagnosing Insulin Resistance in Pediatric Studies

“…Examples included comparing HOMA in different populations, tracking changes in response to an intervention, and correlating HOMA to other factors, such as body mass index. 24–26 …”

Efectos del entrenamiento contra resistencias o resistance training en diversas patologías

“…Actualmente, el aumento en las tasas de obesidad se ha convertido en un problema de salud pública (25). El menor gasto energético derivado de un menor gasto por actividad física puede explicar el progresivo aumento de los niveles corporales de masa grasa que caracterizan a la obesidad (26), ya que el incremento en las tasas de obesidad podría deberse a la interacción existente entre los niveles corporales de masa grasa y masa magra.…”