A Metabolically Healthy Profile Is a Transient Stage When Exercise and Diet Are Not Supervised: Long-Term Effects in the EXERDIET-HTA Study

Abstract

Metabolically unhealthy obesity (MUO) is a regular state in people with primary hypertension (HTN), obesity, and who are physically inactive. To achieve and maintain a metabolically healthy overweight/obese (MHO) state should be a main treatment goal. The aims of the study were (1) to determine differences in metabolic profiles of overweight/obese, physically inactive individuals with HTN following a 16-week (POST) supervised aerobic exercise training (SupExT) intervention with an attentional control (AC) group, and (2) to determine whether the changes observed were maintained following six months (6 M) of unsupervised time. Participants (n = 219) were randomly assigned into AC or SupExT groups. All participants underwent a hypocaloric diet. At POST, all participants received diet and physical activity advice for the following 6 M, with no supervision. All measurements were assessed pre-intervention (PRE), POST, and after 6 M. From PRE to POST, MUO participants became MHO with improved (p < 0.05) total cholesterol (TC, ∆ = −12.1 mg/dL), alanine aminotransferase (∆ = −8.3 U/L), glucose (∆ = −5.5 mg/dL), C-reactive protein (∆ = −1.4 mg/dL), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) compared to unhealthy optimal cut-off values. However, after 6 M, TC, glucose, and SBP returned to unhealthy values (p < 0.05). In a non-physically active population with obesity and HTN, a 16-week SupExT and diet intervention significantly improves cardiometabolic profile from MUO to MHO. However, after 6 M of no supervision, participants returned to MUO. The findings of this study highlight the need for regular, systematic, and supervised diet and exercise programs to avoid subsequent declines in cardiometabolic health.

Impact on Health-Related Quality of Life after Different Aerobic Exercise Programs in Physically Inactive Adults with Overweight/Obesity and Primary Hypertension: Data from the EXERDIET-HTA Study

“…Thus, whereas HEALTHY were classified as normal body composition and BP values, as well as good cardiorespiratory fitness, EXERDIET-HTA individuals showed obesity values in addition to low cardiorespiratory fitness. These results have been previously presented and further explained [ 29 ]. In contrast, analyzing the domains of health-related QoL, EXERDIET-HTA participants showed lower scores in physical function (88.6 vs. 99.2, p < 0.001), general health (63.3 vs. 82.4, p < 0.001), vitality (58.2 vs. 68.7, p < 0.001), social functioning (88.5 vs. 95.2, p = 0.002), and mental health (76.1 vs. 81.8, p = 0.001) in comparison with the HEALTHY population ( Table 1 ).…”

Physical Activity, Sedentary Behavior, and Sleep Quality in Adults with Primary Hypertension and Obesity before and after an Aerobic Exercise Program: EXERDIET-HTA Study

“…After the intervention, the ExT subgroup markedly reduced the sitting time (∆ = −49.0%, from 6.7 to 3.4 h/day, p = 0.01) and increased MVPA, according to self-reported data ( Table 2 ). These results, along with previously published analyses on the same sample showing improvements from unhealthy to healthy physical, clinical, and physiological profile [ 40 , 41 , 42 ]), further support the use of self-reported data from IPAQ questionnaire in parallel to accelerometer-measured data. Further, the benefits of increased PA and decreased SB were also observed after analyzing sleep quality, confirming that longer sleepers generally have better metabolic profiles [ 52 ].…”

“…Previous reports for the EXERDIET-HTA study have already presented the baseline body composition, BP, cardiorespiratory fitness, biochemical profile, and medication intake data of the HEALTHY and HTN groups [ 40 ], as well as changes in these variables elicited by the intervention in the HTN group [ 41 , 42 , 43 ].…”

“…Indeed, HTN participants did not reach 85% sleep efficiency, which is considered to be healthy [ 26 , 37 , 46 ]. The absence of MVPA and bad sleep quality, along with a moderate risk for OSA as shown by the STOP-Bang Questionnaire, could be the key factors explaining the unhealthy status of HTN participants, presenting with physical, clinical, and physiological differences compared with HEALTHY participants [ 40 , 42 ]. In this sense, our results were consistent with previous studies reporting that a high level of exercise was associated with reduced odds of moderate-severe OSA, which in turn was associated with increased all-cause mortality [ 38 , 47 ].…”

Obesity Acceptance: Body Positivity and Clinical Risk Factors

“…It is widely recognized that cardiovascular risk and metabolic complications are due to a constellation of obesity, physical inactivity, and primary HTN [25]. Compared to those with a healthy or normal weight, people with obesity are at especially increased risk for many adverse health outcomes, including high BP, higher levels of low-density lipoprotein cholesterol, lower levels of high-density [7,24,26] (Figure 3).…”