This review explores the role of physical activity (PA) and exercise training (ET) in the prevention of weight gain, initial weight loss, weight maintenance, and the obesity paradox. In particular, we will focus the discussion on the expected initial weight loss from different ET programs, and explore intensity/volume relationships. Based on the present literature, unless the overall volume of aerobic ET is very high, clinically significant weight loss is unlikely to occur. Also, ET also has an important role in weight regain after initial weight loss. Overall, aerobic ET programs consistent with public health recommendations may promote up to modest weight loss (~2 kg), however the weight loss on an individual level is highly heterogeneous. Clinicians should educate their patients on reasonable expectations of weight loss based on their physical activity program and emphasize that numerous health benefits occur from PA programs in the absence of weight loss.

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The metabolic syndrome is a complex clustering of metabolic defects associated with physical inactivity, abdominal adiposity, and aging. Purpose To examine the effects of exercise training intensity on abdominal visceral fat (AVF) and body composition in obese women with the metabolic syndrome. Methods Twenty-seven middle-aged, obese women (mean ± SD; age: 51 ± 9 years and body mass index: 34 ± 6 kg/m2) with the metabolic syndrome completed one-of-three 16-week aerobic exercise interventions: (i) No Exercise Training (Control): Seven participants maintained their existing levels of physical activity, (ii) Low-Intensity Exercise Training (LIET): eleven participants exercised 5 days · week-1 at an intensity ≤ lactate threshold (LT) (iii) High-Intensity Exercise Training (HIET): nine participants exercised 3 days · week-1 at an intensity > LT and 2 days ·week-1 ≤ LT. Exercise time was adjusted to maintain caloric expenditure (400 kcal·session-1). Single-slice computed tomography scans obtained at the L4-L5 disc-space and mid-thigh were used to determine abdominal fat and thigh muscle cross-sectional areas. Percent body fat was assessed by air displacement plethysmography. Results HIET significantly reduced total abdominal fat (p<0.001), abdominal subcutaneous fat (p=0.034) and AVF (p=0.010). There were no significant changes observed in any of these parameters within the Control or LIET conditions. Conclusions The present data indicate that body composition changes are affected by intensity of exercise training with HIET more effective for reducing total abdominal fat, subcutaneous abdominal fat and AVF in obese women with the metabolic syndrome.

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