SummaryArterial stiffness is improved by weight loss. However, no data exist on the impact of aerobic exercise levels on arterial stiffness during weight maintenance. Adults who were  overweight or with obesity (N = 39) participated in a 10‐week weight loss program. Participants who achieved ≥7% weight loss were randomized to aerobic training at the minimum physical activity guidelines (PA‐REC, 550 MET min/week) or weight maintenance guidelines (WM‐REC, 970 MET min/week) for 18 additional weeks. Arterial stiffness (carotid‐to‐femoral pulse wave velocity [cfPWV], augmentation index normalized for 75 beats/min [AIX75]) and blood pressure [aortic and brachial]) were assessed at baseline, the end of the weight loss phase (week 10), and follow‐up (week 28). There was a reduction in cfPWV in participants who met the weight loss goal (−0.34 m/s, p = .02) and approached significance for the entire sample (p = .051). Similarly, there were reductions in AIX75, brachial blood pressure, and aortic blood pressure (p < .05) in the full sample. In the weight maintenance phase, no differences were observed between the PA‐REC and the WM‐REC groups for change in arterial stiffness or blood pressure (p > .05). However, changes in cfPWV were independently associated with changes in LDL (r2: 0.45, p = .004) and exercise intensity (r2: 0.17, p = .033). Aerobic exercise level at the minimum physical activity guidelines or weight maintenance guidelines does not affect the change in PWV or the change in cfPWV after clinically significant weight loss. However, interventions which limit increases in LDL cholesterol and promote high‐intensity aerobic exercise may prevent increases in stiffness during weight maintenance.

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PURPOSE:It has been suggested that cardiorespiratory fitness (CRF) is associated with favorable health outcomes independent of comorbidities, including obesity. However, relatively few studies have assessed the association between CRF and mortality risk in obese women. Thus, in the present work we aimed to assess the relationship between CRF and risk of mortality among obese women. METHODS: Female (N=39,556) US Veterans completed a symptom-limited exercise treadmill test (ETT) between 1999-2020 using the Bruce Protocol. Of those 28,681 were classified as obese based on body mass index (BMI) ≥30.0 kg/m 2 criteria. We established four CRF categories based on age-specific quartiles of peak metabolic equivalents (METs) achieved: Least-Fit (n=8,005), 475), 905) and 296). Multivariate Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for death events across CRF categories. RESULTS: During the follow-up period (median=8.0 years), 1,174 women died (48.1 events/10,000 person-years of observation). Body weight in those within the Least-Fit CRF category was significantly higher when compared to women in the High-Fit category (90±17 vs. 78±11 kg, p<0.001). After adjustments for age, race, hypertension, diabetes, smoking status, major adverse cardiovascular event, breast or lung cancer and heart failure, mortality risk was 18% lower for each 1-MET increase in exercise capacity (HR: 0.82, 95% CI: 0.79-0.84). When CRF categories were considered, comparisons to the Least-Fit category (referent) revealed a progressive decline in risk with higher CRF status. Specifically, mortality risk was 32% lower for Low-Fit women (HR: 0.68, 95% CI: 0.62-0.76), 55% lower (HR: 0.45, 95% CI: 0.38-0.53) for Moderate-Fit, and 68% lower (HR: 0.32, 95% CI: 0.26-0.41) for those in the High-Fit category. CONCLUSIONS: In obese women, CRF was inversely associated with mortality risk and followed a dose-response pattern. These findings support the concept that adequate physical activity that leads to increased CRF is protective against premature mortality in obese women.

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