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Effects of clinically significant weight loss with exercise training on insulin resistance and cardiometabolic adaptations
Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Blair SN, Church TS
Obesity 2016 Apr;24(4):812-819
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; 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*

OBJECTIVE: To determine response rates for clinically significant weight loss (CWL) following different aerobic exercise training amounts and whether enhanced cardiometabolic adaptations are observed with CWL compared to modest weight loss (MWL) or neither. METHODS: Participants (n = 330) performed 6 months of aerobic training at 4 kcal per kilogram per week (KKW), 8 KKW, or 12 KKW (50%, 100%, and 150% of recommended levels respectively). Weight loss was categorized as CWL (> 5%) or MWL (3.0% to 4.9%) or neither. RESULTS: The CWL response rate was greater in the 8 KKW group (20.2%, CI 13.0% to 27.5%) compared to 4 KKW (10.3%, CI 4.6% to 16.0%), but not compared to the 12 KKW group (14.6%, CI 7.6% to 21.6%). Reductions in HOMA-IR were observed in participants with CWL (-0.60, CI -0.98 to -0.22) and with MWL (-0.48, CI -0.87 to -0.10), but not those who achieved neither (-0.06, CI -0.22 to 0.10). No changes between groups were observed for cholesterol, fitness, or blood pressure. CONCLUSIONS: Low response rates for CWL were observed following training, even at levels above recommended levels. Achieving MWL with exercise may represent a reasonable initial weight loss target since the improvement in insulin resistance with MWL is similar to what is achieved with CWL.

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