OBJECTIVE -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.
RESEARCH DESIGN AND METHODS-A total of 38 premenopausal obese women were randomly assigned to one of three 16-week treatments: DO (n ϭ 13), DA (n ϭ 11), or DR (n ϭ 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.RESULTS -Significant reductions (P Ͻ 0.02) in body weight (ϳ10 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 Յ 0.02). The changes in the body fat and metabolic variables were not different across treatment (P Ͼ 0.05). Visceral fat alone was related to the metabolic risk factors both before and after the treatment.CONCLUSIONS -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.
Diabetes Care 25:431-438, 2002T he prevalence of obesity and associated comorbidities is increasing (1,2), which underscores the importance of developing effective strategies for reducing obesity and the risk of metabolic disease in women. Diet-induced weight loss (3-5) as well as aerobic exercise (6 -8) and resistance exercise (7-9) are effective treatments for reducing metabolic risk factors in women. Although these observations suggest that the combination of diet and exercise would have a greater effect on metabolic risk factors than weight loss alone, the influence of diet and exercise combined in women is unclear. Whereas some studies report greater improvements in the plasma lipid profile in response to the combination of diet and exercise than diet alone (10 -12), others report no treatment differences (13-15). It is also reported that the addition of aerobic (16,17) or resistance (16) exercise does not enhance the reductions in plasma insulin and glucose levels in comparison to diet alone in obese women. These observations do not reflect those in a recent report in obese men wherein a twofold greater improvement in insulin action was observed in response to diet combined with aerobic or resistance exercise than diet alone (18). A rationale that explains the equivocal findings is unknown; however, taken together, these observations suggest that the utility of exercise to enha...