Impact of different training modalities on anthropometric outcomes in patients with obesity: A systematic review and network meta‐analysis

Abstract

Summary Obesity management guidelines consistently advise aerobic training for weight loss, whereas recommendations for other training modalities are sparse. This systematic review and network meta‐analysis (NMA) aimed to compare the long‐term effects of different training modalities on anthropometric outcomes in patients with obesity. MEDLINE, Cochrane CENTRAL, and Web of Science were searched to identify the following: (1) randomized controlled trials (RCTs); (2) conducted in adults with a mean body mass index (BMI) ≥30 kg/m2; (3) comparing aerobic, resistance, combined, or high‐intensity interval training head‐to‐head or to control for ≥6 months; and (4) reporting changes in body weight (BW), BMI, waist circumference (WC), fat mass (FM), or fat‐free mass (FFM). Random‐effects NMA models were fitted in a frequentist approach. GRADE framework was used to assess certainty of evidence. Thirty‐two RCTs with 4774 participants with obesity were included in this review. Aerobic training was ranked as best for improving BW, BMI, and WC and combined training for improving FM, as well as equally with resistance training most effective for improving FFM. Low to moderate certainty of evidence supports use of aerobic training to improve anthropometric outcomes in obesity, and its combination with resistance training provides additional benefit for reducing FM and increasing FFM.

Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta‐analysis

“…Our findings that resistance training alone and combined resistance and aerobic exercise can significantly reduce fat mass were in agreement with previous systematic reviews and meta‐analyses 5,7,140 . However, among the interventions investigated in this study, resistance‐based exercise programs combined with caloric restriction were the most effective for reducing body fat percentage and whole‐body fat mass in participants who are overweight or obese.…”

“…Although greater effects were observed when undertaking resistance training or combined resistance and aerobic exercise, as previously reported, 5,7 the result that resistance training can at least help preserve lean mass while undergoing caloric restriction is meaningful for this population. In the systematic review of Weinheimer et al, 149 the authors reported that ~70% of studies only undertaking caloric restriction present reductions ≥1.5 kg of lean mass in middle‐aged and older adults.…”

“…Furthermore, the benefits observed in VAT and SAT could reduce the progression of metabolic syndrome, attenuating the chronic side effects from comorbidities in these age groups. 148 Although greater effects were observed when undertaking resistance training or combined resistance and aerobic exercise, as previously reported, 5,7 the result that resistance training can at least help the investigation of myokines. 154 Several myokines, including myostatin, 155 interleukin 6 (IL-6), 156 and brain-derived neurotrophic factor (BDNF), 157 are produced, expressed, and released by muscle contraction and may account for protection against proinflammatory adipokines under conditions of obesity.…”

Relative Efficacy of Weight Management, Exercise, and Combined Treatment for Muscle Mass and Physical Sarcopenia Indices in Adults with Overweight or Obesity and Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

“…Our findings also indicate that muscle mass can be effectively maintained or muscle mass loss can be prevented by the adjunct therapy of RET in individuals with obesity and OA who are undergoing a dietary weight loss intervention. Finally, a previous NMA indicated that RET and MET are equally ranked as optimal exercise therapies for muscle mass gain in adults with obesity [101], which supports the present study finding that RET and MET combined with diet therapy were ranked as the first two optimal treatments for individuals with obesity and knee or hip OA. We further identified that PMMR plus RET had the highest efficacy for muscle mass gain over a short-term follow-up, and PMMR-DIA plus MET had the strongest long-term effect on muscle mass and walking speed outcomes.…”

“…Our findings indicate that the efficacy of diet therapy for muscle mass can be objectively estimated using percentage LBM or FFM rather than absolute values. Second, previous systemic review studies have indicated that muscle strength training, especially RET, augments muscle mass gain in older people with sarcopenia [99,100], individuals with obesity and OA [101], and older adults with OA [24]. The muscle mass gain caused by exercise may be beneficial for older adults with obesity who are undergoing weight management [31,102].…”