Effect of weight loss, with or without exercise, on body composition and sex hormones in postmenopausal women: the SHAPE-2 trial

Abstract

IntroductionPhysical inactivity and overweight are risk factors for postmenopausal breast cancer. The effect of physical activity may be partially mediated by concordant weight loss. We studied the effect on serum sex hormones, which are known to be associated with postmenopausal breast cancer risk, that is attributable to exercise by comparing randomly obtained equivalent weight loss by following a hypocaloric diet only or mainly by exercise.MethodsOverweight, insufficiently active women were randomised to a diet (N = 97), mainly exercise (N = 98) or control group (N = 48). The goal of both interventions was to achieve 5–6 kg of weight loss by following a calorie-restricted diet or an intensive exercise programme combined with only a small caloric restriction. Primary outcomes after 16 weeks were serum sex hormones and sex hormone-binding globulin (SHBG). Body fat and lean mass were measured by dual-energy X-ray absorptiometry.ResultsBoth the diet (−4.9 kg) and mainly exercise (−5.5 kg) groups achieved the target weight loss. Loss of body fat was significantly greater with exercise versus diet (difference −1.4 kg, P < 0.001). In the mainly exercise arm, the reduction in free testosterone was statistically significantly greater than that of the diet arm (treatment effect ratio [TER] 0.92, P = 0.043), and the results were suggestive of a difference for androstenedione (TER 0.90, P = 0.064) and SHBG (TER 1.05, P = 0.070). Compared with the control arm, beneficial effects were seen with both interventions, diet and mainly exercise, respectively, on oestradiol (TER 0.86, P = 0.025; TER 0.83, P = 0.007), free oestradiol (TER 0.80, P = 0.002; TER 0.77, P < 0.001), SHBG (TER 1.14; TER 1.21, both P < 0.001) and free testosterone (TER 0.91, P = 0.069; TER = 0.84, P = 0.001). After adjustment for changes in body fat, intervention effects attenuated or disappeared.ConclusionsWeight loss with both interventions resulted in favourable effects on serum sex hormones, which have been shown to be associated with a decrease in postmenopausal breast cancer risk. Weight loss induced mainly by exercise additionally resulted in maintenance of lean mass, greater fitness, greater fat loss and a larger effect on (some) sex hormones. The greater fat loss likely explains the observed larger effects on sex hormones.Trial registrationClinicalTrials.gov identifier: NCT01511276. Registered on 12 January 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-015-0633-9) contains supplementary material, which is available to authorized users.

Long-term effects of a weight loss intervention with or without exercise component in postmenopausal women: A randomized trial

“…These results are in accordance with the results of a meta-analysis by Gourlan et al and an earlier study of our study group (van Gemert et al, 2015, Gourlan et al, 2011). Gourlan et al summarized the long-term maintenance of interventions promoting physical activity levels in people with overweight and obesity; and they showed that exercise interventions, varying from three weeks to six months, were successful in maintaining physical activity levels after the intervention has ended (Gourlan et al, 2011).…”

“…The primary goal of the SHAPE-2 trial was to study the effects of 5–6 kg weight loss induced by a hypocaloric diet or mainly by exercise on postmenopausal serum sex hormone levels, associated with breast cancer risk(van Gemert et al, 2015, van Gemert et al, 2013). The mainly exercise intervention was combined with a small caloric intake restriction to ensure the intended weight loss in this short time-frame.…”

Effect of Weight Loss with or without Exercise on Inflammatory Markers and Adipokines in Postmenopausal Women: The SHAPE-2 Trial, A Randomized Controlled Trial

“…The results of the SHAPE-2 trial on body composition and fitness are published separately (18). To summarize, both groups attained the weight loss goal.…”

“…The primary outcome was changed in serum sex hormone levels (18). Here, we report on inflammatory markers [highsensitive (hs)CRP, IL6] and adipokines (leptin and adiponectin).…”

A Qualitative Assessment of Breast Cancer Awareness in an Urban Indian City

“…The incidence of breast cancer has increased over the past 30 years due to a variety of factors from improved screening methods, longevity, and exposure to carcinogens to changes in lifestyle [2]. However, the mortality rate is decreasing, reflecting the benefits of early detection, screening and improvements in treatment [3].…”