Chiu et al. Health and Quality of Life Outcomes (2017) 15:168
DOI 10.1186/s12955-017-0743-4

RESEARCH

Open Access

Benefits of different intensity of aerobic
exercise in modulating body composition
among obese young adults: a pilot
randomized controlled trial
Chih-Hui Chiu1†, Ming-Chen Ko2†, Long-Shan Wu3, Ding-Peng Yeh4, Nai-Wen Kan4, Po-Fu Lee2,5, Jenn-Woei Hsieh2,
Ching-Yu Tseng2 and Chien-Chang Ho2*

Abstract
Background: The aim of present study was to compare the effects of different aerobic exercise intensities andenergy expenditures on the body composition of sedentary obese college students in Taiwan.
Methods: Forty-eight obese participants [body mass index (BMI) ≥ 27 kg/m2, age 18–26 years] were randomized
into four equal groups (n = 12): light-intensity training group (LITG), 40%–50% heart rate reserve (HRR); middleintensity training group (MITG), 50%–70% HRR; high-intensity training group (HITG), 70%–80% HRR; and control
group (CG). The aerobic exercise training program was conducted for 60 min per day on a treadmill 3 days per
week for 12 weeks. All participant anthropometric data, blood biochemical parameters, and health-related physicalfitness components were measured at baseline and after 12 weeks.
Results: At baseline, the anthropometric indices did not differ significantly among the four groups (p > 0.05). After 12week exercise intervention, the HITG and MITG had significantly more changes in body weight, waist circumference(WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) than the LITG. The changes in BMI and body fat
percentage differed among all four groups (p < 0.05).
Conclusions: A 12-week high-intensity exercise intervention with high energy expenditure can considerably reduce
body weight, body fat, WC, WHR, and WHtR, whereas a light-intensity exercise intervention can significantly reduce
body weight and body fat.
Trial registration: Current Controlled Trials TPECTR09831410900, registered on 24th Dec 2009.
Keywords: Obesity, Aerobic exercise, Exercise intensity, Body composition

Background
The percentage of the population that is obese increased
in both the developed and developing countries [1].
Obesity is defined as a condition of abnormal or excessive body fat (i.e., the accumulation of adipose tissue) tothe extent that health may be impaired [2]. Studies havedemonstrated that obesity is linked to higher risk of developing various chronic diseases, such as cardiovascular* Correspondence: 093703@mail.fju.edu.tw†
Equal contributors
2
Department of Physical Education, Fu Jen Catholic University, New Taipei
City 24205, Taiwan
Full list of author information is available at the end of the article

disease, type 2 diabetes mellitus, and cancers [3, 4]. According to the clinical standards for defining obesity
proposed by Taiwan’s Ministry of Health and Welfare(MOHW), children and adolescents are defined as obese
based on their body mass index (BMI) over age- andsex-specific 95th percentile values; by contrast, adults
with a BMI ≥ 27 kg/m2 are defined as being obese.Nevertheless, the standards for “obesity” in adults are also
diverse among different countries. For example, theWorld Health Organization (WHO)-Asian standard forobesity in adults is a BMI ≥ 25 kg/m2, in contrast to theobesity standard set by the MOHW in Taiwan [5]. The
MOHW’s standard is the more frequently used

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
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Chiu et al. Health and Quality of Life Outcomes (2017) 15:168

anthropometric measure to evaluate the degree of obesity among Taiwanese adults. Based on data from thethree waves of the Nutrition and Health Surveys in
Taiwan (NAHSIT), which occurred in 1993–1966, 2005–
2008, and 2013–2014, Chang et al. [6] noted that theprevalence of adult obesity has drastically increased inrecent decades from 11.8% to 17.9% to 22.1%, respectively. Two earlier surveys were conducted using multiple
stage sampling among Taiwanese college students,
wherein the prevalence of overweight and obesity was
31.4% in men and 16.4% in women [7, 8]. Weight loss is
crucial for improving health and reducing body fat [9].
Thus, considering the public health, weight loss is effective for reducing chronic disease risk [10].
Aerobic exercise increases peak oxygen consumption(VO2 peak), which is closely correlated with total bodyfat percentage (BF%); aerobic exercise is also a powerfulstrategy for weight loss, particularly body fat loss [11,12]. When designing a suitable weight loss program, exercise duration and intensity are generally manipulated.
Moderate aerobic exercise for at least 150 min per week
may improve risk factors for metabolic syndrome likebody composition, insulin resistance and glycatedhaemoglobin (HbA1c) [13]. American College of Sports
Medicine suggested that long-term moderate aerobic
exercise for >150 or 200–300 min per week can significantly reduce body weight when the diet is not controlled [10]. However, when exercise intensities differ,
exercise expenditure is not the only factor responsible
for weight loss [14]. The effects of increasing exercise
intensity on weight loss when exercise duration is kept
constant remain unknown.
High-intensity exercise training may effectively reduce
body and abdominal fat [15]. When energy expenditureis held equal, high-intensity exercise is more beneficial
for improving body composition and reducing abdominal fat than low-intensity exercise [15, 16]. Furthermore, a randomized controlled trial reported that highintensity interval training (which resulted in low energy
expenditure) was found equally effective in reducing
body weight and body fat as was low-intensity endurance exercise training [17]. This finding suggests that ahigher exercise intensity may be more effective in improving body composition. However, long-term evidence from randomized controlled trials on the effect of
exercise duration with different intensities and energy
expenditures on body composition is scant. Furthermore, using a single duration during aerobic exercise
training can increase the appetite of obesity people during the recovery period [18]. Moreover, the effects oflong-term aerobic exercise training on the appetite andweight loss remain unknown. Therefore, in this pilot
randomized controlled trial, we compared the effect ofdifferent aerobic exercise intensities and unequal energy

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expenditures on body composition among sedentaryobese college students in Taiwan.

Material and methods
Study design and participants

We conducted a 12-week randomized controlled trial. A
total of 58 obese sedentary college students (aged 18–
26 years) were recruited using advertisements that wereposted in the Fitness Center of Chung Hua University in
Taiwan. Of these 58 voluntary participants, five did notmeet the inclusion criteria; the remaining 53 were randomly assigned into a light-intensity training group(LITG, n = 13), middle-intensity training group (MITG,
n = 13), high-intensity training group (HITG, n = 13),and control group (CG, n = 14) following initial screening. The inclusion criteria for the recruitment and enrollment of participants were as follows: 1)
BMI ≥ 27 kg/m2, 2) exercise comprising ≤1 session per
week with ≤30 min at moderate-to-vigorous intensity,and 3) a fitness performance level that allowed the completion of the aerobic exercise training in present study.
However, five participants dropped out of the study
because of ill health, lack of availability, and family commitments. Finally, 48 participants (34 men and 14
women)—with 12 in each group—were evaluated further(Fig. 1). To reduce the influence of other confounding
factors, participants with a cardiovascular disease, diabetes, liver dysfunction, renal impairment, a endocrine
disorder, a smoking habit, and weight-loss pill consumption were excluded. The experimental protocol was approved by the institutional review board of Taipei Physical
Education College, and informed consent was obtained
from each participant after fully explaining the study.
Exercise intervention

The exercise programs, comprising three 60-min sessions weekly for 12 weeks, progressing gradually in intensity were conducted at the Fitness Center of Chung
Hua University (Fig. 1). Each session included 10-min
warm-up, cool-down, and stretching periods. The LITG
performed the aerobic exercise for 40%–50% heart rate
reserve (HRR) during weeks 1–12, as determined byusing a walking treadmill exercise test. The MITG performed the aerobic exercise for 40%–50% HRR during
weeks 1–6, increasing to 50%–70% HRR during weeks
7–12. The HITG performed the aerobic exercise for40%–50% HRR during weeks 1–6, increasing to 70%–
80% HRR during weeks 7–12. Heart rate was monitoredcontinuously on a Polar Accurex monitor (Kempele,
Finland) for adjusting workload to achieve the target
heart rate. During the 12-week period, all participants
were asked not to change their dietary habits; moreover,
the CG was asked to not change their exercise habits
and maintain normal activity.

Chiu et al. Health and Quality of Life Outcomes (2017) 15:168

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Fig. 1 Flow chart of participant enrollment and completion of the 12-week aerobic exercise program

Experimental procedure

Age, sex, smoking habit, current alcohol consumption, andfamily history of chronic diseases of all participants were recorded. Systolic and diastolic blood pressure after a resting
period of at least 5 min was obtained from the right arm
through auscultation by using a mercury sphygmomanometer (Baumanometer, Copiague, NY, USA). All participants
were instructed to maintain their typical diet and daily physical activity throughout the study period, and compliancewith this instruction was assessed through a 24-h diet recall
questionnaire and 7-day International Physical Activity
Questionnaire administered at the beginning and end of thestudy. The validity and reliability of these questionnaires
have been described elsewhere [19, 20]. Other than diet andphysical activity, total energy intake or estimated energy expenditure did not change significantly over the study period(data not shown). Participant demographic data, anthropometric measurements, blood biochemical parameters, andhealth-related physical fitness components were assessed atbaseline and Week 12.

Health-related physical fitness assessment

The National Physical Fitness Survey conducted by the
National Council on Physical Fitness and Sports in
Taiwan during 1999–2001 and 2011–2013 included fourmain components of health-related physical fitness:cardiorespiratory endurance, muscle strength and endurance, flexibility, and body composition. These tests havebeen used to estimate the health-related physical fitnessof people aged 20–65 years and can be performed by research assistants who have attended the official training
seminar and passed the certification test on standardized
procedures. In present study, body composition and its related outcomes such as cardiorespiratory endurance were
measured, which are detailed as follows [21–23]:

Chiu et al. Health and Quality of Life Outcomes (2017) 15:168

 Body composition: Body composition wasdetermined using six anthropometric indicesincluding BMI, WC, hip circumference (HC), waistto-hip ratio (WHR), waist-to-height ratio (WHtR),
and BF%. These measurements were performed after
the participants removed their shoes and heavy
clothing. The values of body height and weight wererecorded in meters to the nearest 0.1 cm and 0.1 kg
with a calibrated automatic height and weight scale(model HW686, Taiwan), respectively. BMI was calculated using the following formula: BMI = bodyweight (in kg)/[height (in m)]2. WC was measured
to the nearest 0.1 cm by using a flexible steel tape atthe level midway between the lowest rib margin andthe iliac crest, and HC was measured at the widest
level over the greater trochanters. WHR was calculated as WC divided by HC, and WHtR was calculated as WC divided by height. BF%, fat mass, andfat-free mass was determined through bioelectrical
impedance analysis by using a Body Composition
Analyzer (TANITA Corporation, Japan).
 Cardiorespiratory endurance: Cardiorespiratory
endurance was measured using a standardized 3-minstep test (step height 35 cm; frequency 24 steps/min).
When the exercise was completed, the participants
were immediately seated and their heart rates were
measured for 1 min, starting within 5 s of the end of
the exercise. The sum of the heart rates during therecovery period was compared with the sum of theheart rates during three periods after the test—1–1.5,
2–2.5, and 3–3.5 min [24, 25]. The test was terminated if a subject lost balance, missed the steppingrhythm for three steps, or reported any discomfort
during the test [26]. The cardiorespiratory endurance
index (CEI) was calculated as CEI = [duration of exercise(s) × 100]/[sum of heart rates during the recovery
period/2]. Although maximal exercise testing is asophisticated measure of cardiorespiratory
endurance, generally not feasible or desirable clinically. By contrast, step tests are submaximal exercise
tests requiring minimal equipment. Various step tests(different step heights and stepping rates) estimate
VO2 peak and are reliable and valid measures ofcardiopulmonary fitness [27, 28]. The 3-min step test
used in our study was adapted from the Harvard Step
Test, which assesses cardiorespiratory endurance
based on the speed of heart-rate recovery fromsubmaximal exercise. The CEI of the 3-min step test
was positively correlated (r = 0.50) with VO2 peak inhealthy Taiwanese adults [29].
The content of the measurements was explained toeach participant, and then, they were given a 10-min
warm-up and stretching period to achieve their mostPage 4 of 9favorable performance. These measurements werescheduled in the morning before any other exercise. All
measurements were performed by the same well-trained
investigator. Each measurement was obtained two times,
and the average of the two values for each test was used.
Blood sample analysis

Following a 12-h overnight fasting period, venous blood
samples (15 mL) were obtained from an antecubital veinin the sitting position after a 20-min rest between
07:00 a.m. and 09:00 a.m. at baseline and Week 12. The
blood was immediately transferred into vacutainer tubes(Becton Dickinson, Rutherford, NJ, USA) containing or
not containing 0.1% EDTA as the anticoagulant for estimating the hematological status. Serum or plasma wasseparated through centrifugation at 2500 rpm for
15 min at 4 °C and then stored at −80 °C until analysis.
Hematological entities including fasting glucose, totalcholesterol (TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol (HDL-C),
and triglycerides (TG) were measured using an automated biochemical analyzer. The analytical inter- andintra-assay coefficients of variation obtained in our laboratory were respectively as follows: fasting glucose,
2.4% and 1.6%; TC, 1.3% and 0.7%; LDL-C, 2.2% and1.6%; HDL-C, 4.5% and 1.6%; and TG, 2.1% and 1.3%.
Statistical analysis

All analyses were performed using SAS software package(version 9.12, Statistical Analysis System, SAS Institute Inc.,
Cary, NC, USA). Differences in the participant demographic
data, anthropometric measurement, blood biochemical parameters, and health-related physical fitness components between baseline and Week 12 were analyzed using a paired t
test. Comparisons between the mean values of normally distributed variables between groups of exercise were analyzed
using one-way analysis of variance (ANOVA). When a significant F value (p < 0.05) was noted, Tukey’s post hoc test
was performed to determine the differences between thepairs of means. The relationship between changes in various
anthropometric indices and physical fitness measurements
were examined using Pearson partial correlation coefficients
after adjustment for potential confounders. All data areexpressed as means ± standard errors (SEs) or frequency
percentages (%).We considered a significance level ofp < 0.05 to reject the null hypothesis. Since this is a pilot
study, we did not calculate sample size.

Results
Baseline characteristics of the four groups including thedemographic data, anthropometric measurement, bloodbiochemical parameters, and health-related physical fitness components did not differ significantly (all p > 0.05;
Table 1).

Chiu et al. Health and Quality of Life Outcomes (2017) 15:168

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Table 1 Baseline characteristics of subjects
Characteristic

HITG (n = 12)

MITG (n = 12)

LITG (n = 12)

CG (n = 12)

P-valueAge (years)

21.75 ± 0.74

20.92 ± 0.38

20.67 ± 0.56

20.83 ± 0.71

0.603

Gender (Male %)8/4 (66.67)

9/3 (75.00)

8/4 (66.67)

9/3 (75.00)

0.318

Height (cm)

169.17 ± 2.46

170.09 ± 2.84

168.20 ± 2.57

171.40 ± 2.42

0.840

Body weight (kg)84.38 ± 2.71

92.12 ± 3.89

87.53 ± 4.62

89.83 ± 4.38

0.562

BMI (kg/m2)

29.43 ± 0.56

31.78 ± 0.99

30.70 ± 0.99

30.38 ± 0.86

0.305

WC (cm)97.42 ± 2.08

103.83 ± 2.65

99.38 ± 2.50

98.79 ± 2.86

0.322

HC (cm)109.96 ± 1.66

115.25 ± 1.97

113.58 ± 2.44

111.83 ± 1.69

0.273

WHR

0.89 ± 0.01

0.90 ± 0.01

0.88 ± 0.02

0.88 ± 0.01

0.680

WHtR

0.58 ± 0.01

0.61 ± 0.02

0.59 ± 0.01

0.58 ± 0.01

0.178

Body fat (%)

34.50 ± 1.78

38.55 ± 2.09

39.89 ± 2.40

33.32 ± 1.07

0.054

Fat mass (kg)29.04 ± 1.70

35.35 ± 2.24

35.02 ± 2.97

30.03 ± 1.99

0.115

Fat-free mass (kg)55.34 ± 2.47

56.77 ± 3.34

52.51 ± 3.53

59.80 ± 2.77

0.408

SBP (mmHg)

126.17 ± 2.23

127.75 ± 2.54

119.67 ± 4.24

126.08 ± 1.64

0.203

DBP (mmHg)

75.75 ± 1.87

78.42 ± 2.87

79.25 ± 3.08

83.75 ± 2.59

0.206

Fasting glucose (mg/dL)

89.42 ± 2.53

88.67 ± 2.33

87.83 ± 2.93

86.92 ± 2.77

0.919

TC (mg/dL)

184.67 ± 3.93

185.75 ± 3.67

181.08 ± 4.30

181.50 ± 3.87

0.795

HDL-C (mg/dL)

48.67 ± 2.82

44.42 ± 1.60

47.25 ± 2.67

47.17 ± 1.86

0.619

LDL-C (mg/dL)

116.92 ± 3.06

120.83 ± 3.75

113.67 ± 3.85

111.67 ± 4.12

0.334

TC/HDL-C ratio

3.50 ± 0.16

4.31 ± 0.20

3.83 ± 0.31

3.71 ± 0.25

0.112

TG (mg/dL)

98.50 ± 3.96

114.17 ± 9.94

96.42 ± 11.19

105.67 ± 9.30

0.506

Abbreviations: BMI body mass index, CEI cardiorespiratory endurance index, CG control group, DBP diastolic blood pressure, HC hip circumference, HITG highintensity training group, LITG light-intensity training group, MITG moderate-intensity training group, SBP systolic blood pressure, SE standard error, TG triglycerides,
WC waist circumference, WHR waist-to-hip ratio, WHtR waist-to-height ratio. Data are expressed as mean ± SE. Groups compared using one-way ANOVA with
Tukey’s post hoc comparisons (P-values shown)

The changes in the health-related physical fitness
components including those in body composition andcardiorespiratory fitness among the four groups between
baseline and Week 12 are presented in Table 2. At Week
12, the HITG exhibited significant improvement in bodycomposition in body composition and cardiorespiratory
fitness measurements (p ≤ 0.05). Similarly, the body composition and cardiorespiratory fitness measurements significantly improved in the MITG and LITG; in addition,
no differences in fat-free mass were observed in the MITG
and LITG and no significant differences in HC, fat-freemass, and sit-and-reach test in the LITG. No significant
changes were observed in any of these outcome measurements in the CG.
Table 3 also presents the differences in the changes inhealth-related physical fitness components among thefour groups. ANOVA indicated significant means groupeffects for changes in the body weight, BMI, WC, HC,
WHR, WHtR, %BF, fat mass, and CEI (all p < 0.05);
however, the changes in fat-free mass did not have significant differences in the group effects. Furthermore,post hoc comparisons revealed that the changes in bodyweight, WC, WHR, WHtR, fat mass, and CEI were significantly higher in the HITG and MITG compared with

the LITG and CG; changes in the HITG and MITG did
not differ significantly, whereas those in the LITG and
CG did. In addition, the changes in BMI and BF%
significantly differed among the four groups.
Moreover, pooled partial Pearson correlation analyses(n = 48) were conducted to examine the relationshipamong changes in cardiorespiratory fitness and bodycomposition after adjusting for age and sex (Table 4).
The changes in CEI were negatively associated withchanges in body weight, BMI, WC, HC, WHR, WHtR,%BF, fat mass, and fat-free mass (p < 0.05).

Discussion
In this randomized controlled trial, we examined the effect of aerobic exercise at three intensities on bodyweight and body fat of obese individuals. After a 12week exercise intervention, higher intensity exercise
training (HITG and MITG) led to significantly morechanges in body composition. Body weight, WC, WHR,
and WHtR were significantly improved in the HITG and
MITG compared with those in the LITG and CG. Furthermore, low-intensity exercise intervention without
diet control also improved body composition. This study
emphasizes that regular exercise training is a major

0.58 ± 0.01

34.50 ± 1.78

29.04 ± 1.70

55.34 ± 2.47

56.82 ± 3.12

WHR

WHtR

Percent body fat (%)

Fat mass (kg)Fat-free mass (kg)CEI

64.24 ± 3.26

54.06 ± 2.28

23.60 ± 1.29

30.53 ± 1.60

0.52 ± 0.01

0.81 ± 0.01

109.00 ± 1.77

88.04 ± 1.88

27.08 ± 0.39

77.66 ± 2.33

< 0.0001

0.010< 0.0001< 0.0001< 0.0001< 0.0001

0.004< 0.0001< 0.0001< 0.0001

52.16 ± 1.24

56.77 ± 3.34

35.35 ± 2.24

38.55 ± 2.09

0.61 ± 0.02

0.90 ± 0.01

115.25 ± 1.97

103.83 ± 2.65

31.78 ± 0.99

92.12 ± 3.89

57.04 ± 1.27

56.16 ± 2.94

30.99 ± 2.05

35.64 ± 1.95

0.57 ± 0.01

0.84 ± 0.01

113.92 ± 1.66

95.92 ± 2.18

30.08 ± 0.91

87.15 ± 3.51

Week 12< 0.0001

0.238< 0.0001< 0.0001< 0.0001< 0.0001

0.034< 0.0001< 0.0001< 0.0001

P-value

51.50 ± 1.93

52.51 ± 3.53

35.02 ± 2.97

39.89 ± 2.40

0.59 ± 0.01

0.88 ± 0.02

113.58 ± 2.44

99.38 ± 2.50

30.70 ± 0.99

87.53 ± 4.62

Baseline

LITG (n = 12)

54.69 ± 1.85

52.20 ± 3.48

32.40 ± 2.79

38.19 ± 2.37

0.56 ± 0.01

0.84 ± 0.02

112.21 ± 2.00

94.12 ± 2.36

29.67 ± 0.94

84.60 ± 4.50

Week 12< 0.0001

0.067< 0.0001< 0.0001< 0.0001< 0.0001

0.054< 0.0001< 0.0001< 0.0001

P-value

55.30 ± 1.80

59.80 ± 2.77

30.03 ± 1.99

33.32 ± 1.07

0.58 ± 0.01

0.88 ± 0.01

111.83 ± 1.69

98.79 ± 2.86

30.38 ± 0.86

89.83 ± 4.38

Baseline

CG (n = 12)
Week 1254.78 ± 1.71

60.09 ± 2.78

30.48 ± 2.07

33.54 ± 1.20

0.58 ± 0.01

0.88 ± 0.01

112.67 ± 1.72

99.25 ± 2.81

30.64 ± 0.88

90.57 ± 4.40

0.122

0.500

0.054

0.361

0.282

0.560

0.277

0.298

0.127

0.138

P-value

Abbreviations: BMI body mass index, CEI cardiorespiratory endurance index, CG control group, HC hip circumference, HITG high-intensity training group, LITG light-intensity training group, MITG moderate-intensity
training group, SE standard error, WC waist circumference, WHR waist-to-hip ratio, WHtR waist-to-height ratio. Data are expressed as mean ± SE. Significantly different between baseline and week 12 by paired
t-test (P < 0.05)

109.96 ± 1.66

0.89 ± 0.01

HC (cm)29.43 ± 0.56

97.42 ± 2.08

WC (cm)84.38 ± 2.71

Baseline

P-value

MITG (n = 12)

Week 12HITG (n = 12)

Baseline

BMI (kg/m )2

Body weight (kg)Variables

Table 2 The comparison of body composition and cardiorespiratory fitness measurements following 12-week walking programs

Chiu et al. Health and Quality of Life Outcomes (2017) 15:168
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Chiu et al. Health and Quality of Life Outcomes (2017) 15:168

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Table 3 Changes in body composition and cardiorespiratory fitness measurements following 12-week walking programs
Variables

HITG (n = 12)

MITG (n = 12)

LITG (n = 12)

CG (n = 12)

P-value

Body weight (kg)−6.73 ± 0.67

−4.97 ± 0.46

−2.93 ± 0.19

0.74 ± 0.46

< 0.0001

Tukey’s post hoc test
HITG, MITG > LITG > CG

BMI (kg/m2)−2.34 ± 0.24

−1.70 ± 0.13

−1.04 ± 0.06

0.26 ± 0.16

< 0.0001

HITG > MITG > LITG > CG

WC (cm)−9.38 ± 0.74

−7.92 ± 0.69

−5.25 ± 0.23

0.46 ± 0.42

< 0.0001

HITG, MITG > LITG > CG

HC (cm)−0.96 ± 0.26

−1.33 ± 0.55

−1.38 ± 0.64

0.83 ± 0.73

0.028

MITG, LITG > CG

WHR

−0.08 ± 0.01

−0.06 ± 0.01

−0.04 ± 0.004−0.002 ± 0.004< 0.0001

HITG, MITG > LITG > CG

WHtR

−0.06 ± 0.004−0.05 ± 0.004−0.03 ± 0.001

0.003 ± 0.002< 0.0001

HITG, MITG > LITG > CG

Percent body fat (%)−3.97 ± 0.28

−2.91 ± 0.25

−1.70 ± 0.14

0.23 ± 0.24

< 0.0001

HITG > MITG > LITG > CG

Fat mass (kg)−5.44 ± 0.49

−4.35 ± 0.23

−2.62 ± 0.22

0.45 ± 0.21

< 0.0001

HITG, MITG > LITG > CG

Fat-free mass (kg)−1.29 ± 0.42

−0.61 ± 0.49

−0.31 ± 0.15

0.29 ± 0.42

0.050

HITG > CG

CEI

7.42 ± 0.34

4.88 ± 0.28

3.19 ± 0.16

−0.52 ± 0.31

< 0.0001

HITG, MITG > LITG > CG

Abbreviations: BMI body mass index, CEI cardiorespiratory endurance index, CG control group, HC hip circumference, HITG high-intensity training group, LITG lightintensity training group, MITG moderate-intensity training group, SE standard error, WC waist circumference, WHR waist-to-hip ratio, WHtR waist-to-height ratio.
Data are expressed as mean ± SE. Groups compared using one-way ANOVA with Tukey’s post hoc comparisons (P < 0.05)

factor responsible for improving body composition andpreventing abdominal obesity-related chronic disease inoverweight and obese people.
Our results are consistent with those of previous studies: high-intensity training is more effective in decreasing
BF% [15]. The higher exercise intensity and energy
expenditure may be involved in improving body composition [30, 31]. Compared with low-intensity exercise,high-intensity exercise may reduce body weight andbody fat significantly, when the energy expenditure isequal [15, 16]. The possible explanations for the effect of
exercise intensity on body composition control are thathigh intensity exercise can increase catecholamine andgrowth hormone release [32, 33], postexercise oxygen
consumption [34, 35], and lipoprotein lipase activity[36]. By contrast, higher energy expenditure during exercise can cause greater body fat loss [30, 31]. Taken
Table 4 Correlates of changes in body composition
measurements with change in cardiorespiratory fitness
Variables△ CEIr

P-value△ Body weight (kg)−0.857< 0.0001△ BMI (kg/m2)−0.848< 0.0001△ WC (cm)−0845< 0.0001△ HC (cm)−0.345

0.019

△ WHR

−0.798< 0.0001△ WHtR−0.841< 0.0001△ Percent body fat (%)−0.843< 0.0001△ Fat mass (kg)−0.871< 0.0001△ Fat-free mass (kg)−0.4420.002

Abbreviations: BMI body mass index, CEI cardiorespiratory endurance index, CG
control group, HC hip circumference, HITG high-intensity training group, LITG
light-intensity training group, MITG moderate-intensity training group, WC waist
circumference, WHR waist-to-hip ratio, WHtR waist-to-height ratio. △, change in.
Data are expressed as Pearson correlation coefficients after adjusting for age andgender (P < 0.05). Data derived from pooled groups (N = 48)

together, higher exercise intensity may result in significantly higher long-term reduction in body fat comparedwith lower exercise intensity.
Previous studies examining the effect of exercise training on appetite perceptions during postexercise recovery
have reported inconsistent results [37–42]. The present
study demonstrated that aerobic exercise training may
not affect appetite perceptions when the energy intake is
not controlled. This finding is consistent with recent
studies showing that long-term exercise training may
not affect energy intake and reduce the benefit of weightloss [37, 39]. Studies have also suggested that highintensity exercise results in reducing energy intake after
exercise [41, 42]. No association between energy expenditure during exercise and energy intake or appetite perceptions was reported previously [37, 40, 41]. In present
study, no such association was observed over the study
period: high-intensity exercise training with more energy
expenditure effectively improved body composition. Ourfindings indicate that high-intensity exercise training
with higher energy expenditure is more effective in improving body composition than low-intensity exercise
training, even when the diet is not controlled.
The differences in exercise intensities resulted in significant changes in body weight, WC, WHR, and WHtR
(HITG and MITG > LITG > CG) among our participants.
Thus, intensity may be crucial for reducing abdominal fat
and sequentially reducing WC, WHR, and WHtR. Higher
exercise intensity, but not high energy expenditure, may
significantly reduce whole body fat, abdominal fat, subcutaneous abdominal fat, and abdominal visceral fat compared with lower exercise intensity [15, 16]. By contrast,
energy expenditure during aerobic exercise training is only
associated with visceral fat and not subcutaneous or abdominal fat [31, 43]. Although not statistically significant,the values of reduction in WC, WHR, and WHtR was
higher in the HITG than in the MITG. Thus, exercise

Chiu et al. Health and Quality of Life Outcomes (2017) 15:168

intensity is crucial for modulating abdominal fat. Furthermore, the additional benefit of abdominal fat reduction
may be counteracted if the exercise intensity is higher
than 50%–80% HRR.
The results of present study implicate that low-intensity
exercise can also significantly reduce body weight andbody fat: body weight (−2.9 ± 0.2 kg, p < 0.001) and bodyfat (−1.7% ± 0.1%) decreased significantly in the LITG. Exercise training for 150–250 min per week effectively reduces body weight. Exercise at the similar duration andintensity can also reduce body weight and body fat [44].
These findings are consistent with those of our study, suggesting that three sessions of light-intensity training for
60 min per day effectively reduces body weight and body
fat in sedentary obese people.
The main limitation of the present study was that weonly collected data before and after the exercise intervention. Hence, the speed of weight loss during thestudy is unknown. Additionally, the exercise intervention
was only 12 weeks in duration, and therefore was notsuitable for follow-up examinations. Future researchmust investigate the speed of weight loss (and fluctuations therein) by using a longer exercise intervention
period.

Conclusion
In conclusion, higher exercise intensity and energy expenditure can significantly reduce body weight, body fat,
WC, WHR, and WHtR. Light-intensity exercise training
can also significantly reduce body weight and body fat.
Here, a 12-week aerobic exercise program significantly
modulated the anthropometric indices in obese college
students, even when the diet was not controlled. Accordingly, when prescribing an aerobic exercise training
program for individuals with obesity related issues, aclinical practitioner should take the intensity of the
training into consideration. A high intensity aerobic exercise training program should be prescribed by a clinical practitioner for an obese individual when theindividual’s exercise capacity is high enough to complete
the program.
Abbreviations
ACSM: American College of Sports Medicine; ANOVA: Analysis of variance;
BF%: Body fat percentage; BMI: Body mass index; CEI: Cardiorespiratory
endurance index; CG: Control group; HC: Hip circumference; HDL-C: Highdensity lipoprotein cholesterol; HITG: High-intensity training group;
HRR: Heart rate reserve; IPAQ: International Physical Activity Questionnaire;
LDL-C: Low-density lipoprotein cholesterol; LITG: Light-intensity training
group; MITG: Middle-intensity training group; MOHW: Ministry of Health andWelfare; SE: Standard error; TC: Total cholesterol; TG: Triglycerides;
VO2peak: Peak oxygen consumption; WC: Waist circumference; WHO: World
Health Organization; WHR: Waist-to-hip ratio; WHtR: Waist-to-height ratio
Acknowledgements
The authors acknowledge the college students for participating in this trial.
C-H. Chiu and M-C. Ko contributed equally as first author, and C-C. Ho was
the corresponding author.

Page 8 of 9

Funding
No external funding was sought or obtained for present study, which wasundertaken for a Taipei Physical Education College Doctor in Sport Sciences
dissertation.
Availability of data and materials
All relevant materials are presented in the present manuscript.
Authors’ contributions
HCC participated in the design, conducted the statistical analyses,interpreted the data, and drafted the manuscript. CHC and KMC supervised
the study, assisted in data interpretation, and critically reviewed themanuscript. WLS, YDP, and KNW helped in conducting the study andrevising the manuscript. LPF, HJW, and TCY helped to manage and analyze
the data. All authors read and approved the final manuscript.
Ethics approval and consent to participate
The study was conducted in accordance with the Declaration of Helsinki, andall procedures have been approved by the Institutional Review Board of theTaipei Physical Education College (TPECTR09831410900). Written informed
consent was obtained from each subject after a full explanation of the study.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.

Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.
Author details
1
Department of Exercise Health Science, National Taiwan University of Sport,
Taichung City 40404, Taiwan. 2Department of Physical Education, Fu Jen
Catholic University, New Taipei City 24205, Taiwan. 3Graduate Institute ofSports Training, University of Taipei, Taipei City 11153, Taiwan. 4Center for
General Education, Taipei Medical University, Taipei City 11031, Taiwan.
5
Graduate Institute of Sport Coaching Science, Chinese Culture University,
Taipei City 11114, Taiwan.
Received: 30 December 2016 Accepted: 16 August 2017

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