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The independent and combined effects of exercise training and reducing sedentary behavior on cardiometabolic risk factors
Kozey Keadle S, Lyden K, Staudenmayer J, Hickey A, Viskochil R, Braun B, Freedson PS
Physiologie Appliquee Nutrition et Metabolisme [Applied Physiology, Nutrition, & Metabolism] 2014 Jul;39(7):770-780
clinical trial
3/10 [Eligibility criteria: Yes; Random allocation: No; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

This pilot study examined if the combination of exercise training and reducing sedentary time (ST) results in greater changes to health markers than either intervention alone. Fifty-seven overweight/obese participants (19 males/39 females) (mean +/- SD; age 43.6 +/- 9.9 years; body mass index (BMI) 35.1 +/- 4.6 kg/m2) completed the 12-week study and were randomly assigned to (i) EX: exercise 5 days/week for 40 min/session at moderate intensity; (ii) rST: reduce ST and increase nonexercise physical activity; (iii) EX-rST: combination of EX and rST; and (iv) CON: maintain behavior. Fasting lipids, blood pressure (BP), peak oxygen uptake, BMI, and 2-h oral glucose tolerance tests were completed pre- and post-intervention. EX and EX-rST increased peak oxygen uptake by about 10% and decreased systolic BP (both p < 0.001). BMI decreased by -3.3% (95% confidence interval -4.6% to -1.9%) for EX-rST and -2.2% (-3.5% to 0.0%) for EX. EX-rST significantly increased composite insulin-sensitivity index by 17.8% (2.8% to 32.8%) and decreased insulin area under the curve by 19.4% (-31.4% to -7.3%). No other groups improved in insulin action variables. rST group decreased ST by 7% (about 50 min/day); however, BP was the only health-related outcome that improved. EX and EX-rST improved peak oxygen uptake and BMI, providing further evidence that moderate-intensity exercise is beneficial. The within-group analysis provides preliminary evidence that exercising and reducing ST may result in improvements in metabolic biomarkers that are not seen with exercise alone, though between-group differences did not reach statistical significance. Future studies, with larger samples, should examine health-related outcomes resulting from greater reductions in ST over longer intervention periods.

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