Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial Copenhagen study of overweight patients with coronary artery disease undergoing low energy diet or interval training: the randomized CUT-IT trial protocol Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Effect of Long-Term Whole Body Vibration Training on Visceral Adipose Tissue: A Preliminary Report Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Six weeks of structured exercise training and hypocaloric diet increases the probability of ovulation after clomiphene citrate in overweight and obese patients with polycystic ovary syndrome: a randomized controlled trial. Effect of caloric restriction with and without exercise training on oxidative stress and endothelial function in obese subjects with type 2 diabetes. The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Effects of an Intervention and Maintenance Weight Loss Diet with and without Exercise on Anthropometric Indices in Overweight and Obese Healthy Women Dietary weight loss and exercise interventions effects on quality of life in overweight/obese postmenopausal women: a randomized controlled trial The effect of almonds on anthropometric measurements and lipid profile in overweight and obese females in a weight reduction program: A randomized controlled clinical trial Better dietary adherence and weight maintenance achieved by a long-term moderate-fat diet. Effect of diet and controlled exercise on weight loss in obese children. A School-Based Program for Overweight and Obese Adolescents: A Randomized Controlled Trial. Design of the SHAPE-2 study: the effect of physical activity, in addition to weight loss, on biomarkers of postmenopausal breast cancer risk Changes in weight loss, body composition and cardiovascular disease risk after altering macronutrient distributions during a regular exercise program in obese women Diet and Exercise Interventions among Overweight and Obese Lactating Women: Randomized Trial of Effects on Cardiovascular Risk Factors Evaluating the Efficacy of the Feeding Exercise Randomized Trial in Overweight and Obese Adolescents. Determinants of high and low attendance to diet and exercise interventions among overweight and obese older adults. Results from the arthritis, diet, and activity promotion trial. Men gain additional psychological benefits by adding exercise to a weight-loss program. Consumption of whole-grain cereals during weight loss: effects on dietary quality, dietary fiber, magnesium, vitamin B-6, and obesity. Cultural factors and patients' adherence to lifestyle measures.
PURPOSE The purpose of this paper is to review the evidence on the role of physical activity in the treatment of adult overweight and obesity . Three specific questions are addressed : ( 1 ) Does exercise alone produce weight loss ? ( 2 ) Does exercise in combination with diet produce greater weight loss than diet only ? and ( 3 ) Does exercise in combination with diet produce better maintenance of weight loss than diet alone ? METHODS The literature initially identified by the Expert Panel on Clinical Guidelines for the Treatment of Obesity , three key meta analyses , and additional literature search es were used to identify r and omized trials related to the three aforementioned topics . These articles were review ed and tabulated . RESULTS Six of 10 r and omized studies found significantly greater weight loss in exercise alone versus no treatment controls . The magnitude of the effect averaged 1 - 2 kg . Only 2 of 13 studies found significant differences in initial weight loss for diet plus exercise versus diet only , although almost all studies pointed in this direction . Six studies were identified with maintenance periods of at least 1 yr . In two of the six there were significant long term differences favoring diet plus exercise , but in every study considered the direction of the difference favored diet plus exercise . Other strong evidence showing benefits of exercise for long-term weight loss comes from correlational analyses which consistently find that those individuals who report the greatest exercise have the best maintenance of weight loss . CONCLUSIONS R and omized trials consistently show benefits of exercise for weight loss , but the effects are often modest . This may result from small sample sizes , short study duration , and poor adherence to the exercise prescriptions . To better define the doses and types of exercise that will promote long-term weight loss , it is necessary to develop better ways to measure exercise and promote adherence to exercise OBJECTIVE The long-term impact of intentional weight loss on cardiovascular events remains unknown . We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus , a trial design ed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention . RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years ( n = 626 ) were r and omized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet , physical activity promotion , and behavioral support ( IG ) or a control group ( CG ) . The primary and secondary outcomes were changes in weight and cardiovascular risk markers , respectively . RESULTS Diet and physical activity changes were in the expected direction , with significant improvements in IG versus CG . After 12 months , IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG ( P < 0.001 ) , a mean difference of −2.5 kg ( 95 % CI −3.1 to −1.9 ) . Weight loss ≥5 % occurred in 33.7 % of IG participants compared with 11.9 % in the CG ( P < 0.001 ) . Compared with the CG , cardiovascular risk factors , including waist circumference , fasting glucose , triglycerides , and HDL cholesterol , significantly improved in IG participants ( P < 0.002 ) . Reductions in insulin resistance , HbA1c , and circulating levels of leptin , interleukin-18 , and MCP-1 were greater in IG than CG participants ( P < 0.05 ) . IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity , along with triglycerides and HDL cholesterol levels compared with their CG counterparts . CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome , as well as in individuals with or at risk for diabetes Background Coronary artery disease ( CAD ) is accountable for more than 7 million deaths each year according to the World Health Organization ( WHO ) . In a European population 80 % of patients diagnosed with CAD are overweight and 31 % are obese . Physical inactivity and overweight are major risk factors in CAD , thus central strategies in secondary prevention are increased physical activity and weight loss . Methods / Design In a r and omized controlled trial 70 participants with stable CAD , age 45–75 , body mass index 28–40 kg/m2 and no diabetes are r and omized ( 1:1 ) to 12 weeks of  intensive exercise or weight loss both succeeded by a 40-week follow-up . The exercise protocol consist of supervised aerobic interval training ( AIT ) at 85 - 90 % of VO2peak 3 times weekly for 12 weeks followed by supervised AIT twice weekly for 40 weeks . In the weight loss arm dieticians instruct the participants in a low energy diet ( 800–1000 kcal/day ) for 12 weeks , followed by 40 weeks of weight maintenance combined with supervised AIT twice weekly . The primary endpoint of the study is change in coronary flow reserve after the first 12 weeks ’ intervention . Secondary endpoints include cardiovascular , metabolic , inflammatory and anthropometric measures . Discussion The study will compare the short and long-term effects of a protocol consisting of AIT alone or a rapid weight loss followed by AIT . Additionally , it will provide new insight in mechanisms behind the benefits of exercise and weight loss . We wish to contribute to the creation of effective secondary prevention and sustainable rehabilitation strategies in the large population of overweight and obese patients diagnosed with CAD.Trial registration Clinical Trials.gov : OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone Aim : To determine the effect of whole body vibration ( WBV ) , combined with caloric restriction , on weight , body composition and metabolic risk factors in overweight and obese adults . Methods : A r and omized , controlled study with a 6-month intervention period and a 6-month ‘ no intervention ’ follow-up . 61 of the 79 participants completed the study . Data were collected at baseline and at 3 , 6 and 12 months in the control group ( CONTROL ) , the diet only group ( DIET ) , the diet plus fitness group ( FITNESS ) and the diet plus WBV group ( VIBRATION ) . Results : Weight decreased significantly in all three intervention groups . Only FITNESS and VIBRATION managed to maintain a weight loss of 5 % or more in the long term . Visceral adipose tissue ( VAT ) changed most in VIBRATION : –47.8 ± 41.2 and –47.7 ± 45.7 cm2 after 6 and 12 months respectively compared to CONTROL ( –3.6 ± 20.5 or + 26.3 ± 30.6 cm2 ) , DIET ( –24.3 ± 29.8 or –7.5 ± 28.3 cm2 ) and FITNESS ( –17.6 ± 36.6 or –1.6 ± 33.3 cm2 ) ( p < 0.001 ) . Conclusions : Combining aerobic exercise or WBV training with caloric restriction can help to achieve a sustained long-term weight loss of 5–10 % . These preliminary data show that WBV training may have the potential to reduce VAT more than aerobic exercise in obese adults , possibly making it a meaningful addition to future weight loss programs BACKGROUND Although the DASH ( Dietary Approaches to Stop Hypertension ) diet has been shown to lower blood pressure ( BP ) in short-term feeding studies , it has not been shown to lower BP among free-living individuals , nor has it been shown to alter cardiovascular biomarkers of risk . OBJECTIVE To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension ( systolic BP , 130 - 159 mm Hg ; or diastolic BP , 85 - 99 mm Hg ) . DESIGN AND SETTING R and omized , controlled trial in a tertiary care medical center with assessment s at baseline and 4 months . Enrollment began October 29 , 2003 , and ended July 28 , 2008 . PARTICIPANTS Overweight or obese , unmedicated out patients with high BP ( N = 144 ) . INTERVENTIONS Usual diet controls , DASH diet alone , and DASH diet plus weight management . OUTCOME MEASURES The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring . Secondary outcomes included pulse wave velocity , flow-mediated dilation of the brachial artery , baroreflex sensitivity , and left ventricular mass . RESULTS Clinic-measured BP was reduced by 16.1/9.9 mm Hg ( DASH plus weight management ) ; 11.2/7.5 mm ( DASH alone ) ; and 3.4/3.8 mm ( usual diet controls ) ( P < .001 ) . A similar pattern was observed for ambulatory BP ( P < .05 ) . Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity , baroreflex sensitivity , and left ventricular mass ( all P < .05 ) . CONCLUSION For overweight or obese persons with above-normal BP , the addition of exercise and weight loss to the DASH diet result ed in even larger BP reductions , greater improvements in vascular and autonomic function , and reduced left ventricular mass . CLINICAL TRIAL REGISTRATION clinical trials.gov Identifier : NCT00571844 BACKGROUND Clomiphene citrate ( CC ) is the first-line therapy for the induction of ovulation in infertile women with polycystic ovary syndrome ( PCOS ) , but ∼20 % of patients are unresponsive . The aim of the current study was to test the hypothesis that a 6-week intervention that consisted of structured exercise training ( SET ) and hypocaloric diet increases the probability of ovulation after CC in overweight and obese CC-resistant PCOS patients . METHODS A cohort of 96 overweight and obese CC-resistant PCOS patients was enrolled consecutively in a three-arm r and omized , parallel , controlled , assessor-blinded clinical trial . The three interventions were : SET plus hypocaloric diet for 6 weeks ( Group A ) ; 2 weeks of observation followed by one cycle of CC therapy ( Group B ) ; and SET plus hypocaloric diet for 6 weeks , with one cycle of CC after the first 2 weeks ( Group C ) . The primary end-point was the ovulation rate . Other reproductive data , as well as anthropometric , hormonal and metabolic data , were also collected and considered as secondary end points . RESULTS After 6 weeks of SET plus hypocaloric diet , the ovulation rate was significantly ( P = 0.008 ) higher in Group C [ 12/32 ( 37.5 % ) ] than in Groups A [ 4/32 ( 12.5 % ) ] and B [ 3/32 ( 9.4 % ) ] with relative risks of 3.9 [ 95 % confidence interval ( CI ) 1.1 - 8.3 ; P = 0.035 ] and 4.0 ( 95 % CI 1.2 - 12.8 ; P = 0.020 ) compared with Groups A and B , respectively . Compared with baseline , in Groups A and C , a significant improvement in clinical and biochemical and rogen and insulin sensitivity indexes was observed . In the same two groups , the insulin sensitivity index was significantly ( P < 0.05 ) better than that in Group B. CONCLUSIONS In overweight and obese CC-resistant PCOS patients , a 6-week intervention of SET and a hypocaloric diet was effective in increasing the probability of ovulation under CC treatment . The study was registered at Clinical trials.gov : NCT0100468 AIM Effects of dietary weight loss on endothelial function , particularly when combined with exercise training , is largely unknown in type 2 diabetes . We sought to determine whether aerobic exercise training provided any additional improvements in endothelial function , oxidative stress or other established markers of cardiovascular risk when combined with an energy-restricted diet in patients with type 2 diabetes . METHODS In a parallel study design , 29 sedentary , overweight and obese patients with type 2 diabetes ( age 52.4 + /- 1.4 years and BMI 34.2 + /- 0.9 kg/m(2 ) ) were r and omized to a 12-week moderate energy-restricted diet ( ~5000 kJ/day and approximately 30 % energy deficit ) with or without aerobic exercise training [ diet only ( D ) , n = 16 and diet plus exercise ( DE ) , n = 13 ] . Body weight , cardiovascular risk markers , malondialdehyde ( MDA , oxidative stress marker ) , 24-h urinary nitrate/nitrite and flow-mediated dilatation ( FMD ) of the brachial artery were measured pre- and postintervention . RESULTS Both interventions reduced body weight ( D 8.9 % , DE 8.5 % , time effect p < 0.001 ) . Significant reductions in body fat , waist circumference , blood pressure , glycated haemoglobin , glucose , insulin resistance , lipids and MDA and increases in urinary nitrite/nitrate were observed in both groups ( time effect p < or = 0.05 ) ; however , these changes were not different between treatments . At baseline , FMD was similar in both groups ( D 2.5 + /- 0.9 % , DE 4.2 + /- 1.2 % ; p = 0.25 ) and did not change after the interventions ( p = 0.59 ) . CONCLUSIONS These results suggest that lifestyle interventions incorporating diet with or without exercise improve glycaemic control , reduce oxidative stress and improve other cardiovascular risk factors but do not improve FMD in obese subjects with type 2 diabetes Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic Background and Aims : There is growing evidence that excess body weight and body fat levels may lead to various diseases . A low-calorie diet has been found to reduce body weight and fat ; however , 95 % of patients regain the weight within a short period of time . The aim of this study was to investigate the effects of a reduced-calorie diet with and without exercise on body composition profile as well as to evaluate maintenance of weight loss 18 weeks after the intervention had concluded . Methods : Two hundred and six overweight and /or obese women were r and omized by a computer to either diet only ( DO ) or diet and exercise ( DE ) for an 18-week intervention period and 18 weeks of maintenance . Statistical significance was set at p < 0.05 . Results : Body mass index ( BMI ) was reduced by 5.1 in the DE group compared to 3.2 in the DO group 18 weeks after the intervention period had ended ; waist circumference ( WC ) was 14.2 cm lower in the exercise group and 8 cm lower in the diet alone group , and body fat was reduced by 15.5 % in the DE group , while no changes were observed in the DO group . Conclusion : A combination of a reduced-calorie diet with exercise may successfully reduce weight , BMI , WC and body fat levels Background Although lifestyle interventions targeting multiple lifestyle behaviors are more effective in preventing unhealthy weight gain and chronic diseases than intervening on a single behavior , few studies have compared individual and combined effects of diet and /or exercise interventions on health-related quality of life ( HRQOL ) . In addition , the mechanisms of how these lifestyle interventions affect HRQOL are unknown . The primary aim of this study was to examine the individual and combined effects of dietary weight loss and /or exercise interventions on HRQOL and psychosocial factors ( depression , anxiety , stress , social support ) . The secondary aim was to investigate predictors of changes in HRQOL . Methods This study was a r and omized controlled trial . Overweight/obese postmenopausal women were r and omly assigned to 12 months of dietary weight loss ( n = 118 ) , moderate-to-vigorous aerobic exercise ( 225 minutes/week , n = 117 ) , combined diet and exercise ( n = 117 ) , or control ( n = 87 ) . Demographic , health and anthropometric information , aerobic fitness , HRQOL ( SF-36 ) , stress ( Perceived Stress Scale ) , depression [ Brief Symptom Inventory (BSI)-18 ] , anxiety ( BSI-18 ) and social support ( Medical Outcome Study Social Support Survey ) were assessed at baseline and 12 months . The 12-month changes in HRQOL and psychosocial factors were compared using analysis of covariance , adjusting for baseline scores . Multiple regression was used to assess predictors of changes in HRQOL . Results Twelve-month changes in HRQOL and psychosocial factors differed by intervention group . The combined diet + exercise group improved 4 aspects of HRQOL ( physical functioning , role-physical , vitality , and mental health ) , and stress ( p ≤ 0.01 vs. controls ) . The diet group increased vitality score ( p < 0.01 vs. control ) , while HRQOL did not change differently in the exercise group compared with controls . However , regardless of intervention group , weight loss predicted increased physical functioning , role-physical , vitality , and mental health , while increased aerobic fitness predicted improved physical functioning . Positive changes in depression , stress , and social support were independently associated with increased HRQOL , after adjusting for changes in weight and aerobic fitness . Conclusions A combined diet and exercise intervention has positive effects on HRQOL and psychological health , which may be greater than that from exercise or diet alone . Improvements in weight , aerobic fitness and psychosocial factors may mediate intervention effects on HRQOL.Trial Registration Clinical Trials , Clinical Trials.gov register , Background : Due to the wholesome benefits of nuts increased consumption of them has been recommended . However , because of nut 's high energy density , the role of them in the treatment of overweight and obesity is vague . This current clinical trial study aims to investigate the effects of a balanced hypocaloric almond-enriched diet ( AED ) ( almond group ) in comparison to a balanced hypocaloric nut-free diet ( NFD ) ( nut-free group ) on body weight and cardiovascular disease risk factors in women with body mass index ( BMI ) > 25 for 3-month . Material s and Methods : A total of 108 overweight and obese women were assigned in our 3-month r and omized controlled trial . The subjects were r and omly divided into two groups regarding a balanced hypocaloric diet with or without almond . The planned reduced calorie diets for both groups were identical except for the almond group who consumed 50 g of almonds daily . Anthropometric and laboratory measurements of the participants who completed the study were made prior to and at the end of the study . Results : A total of 100 subjects completed the study .  Weight , BMI , waist circumference , waist to hip circumference ratio , total cholesterol , and triglyceride , total : High density lipoprotein-cholesterol ( HDL-C ) , fasting blood sugar and diastolic blood pressure decreased significantly in the almond group compared to the nut-free group ( P > 0.001 ) . Greater reduction in low density lipoprotein-cholesterol ( P > 0.002 ) and systolic blood pressure ( P > 0.001 ) and greater increase in HDL-C ( P = 0.001 ) were found in the nut-free group . Conclusion : The balanced hypocaloric AED in comparison to the balanced hypocaloric NFD led to a greater weight-loss and overall better improvements in studied cardiovascular disease risk factors The objective of the present study was to determine the effects of a long-term moderate-fat diet ( 30 % energy from fat ) v. a low-fat one ( 20 % energy from fat ) on metabolic risks . The study was a r and omised , prospect i ve 14-month trial on overweight and obese patients ( eighty-nine overweight and obese men and women ) . The intervention was a moderate-fat diet ( 30 % energy ) or a low-fat diet ( 20 % energy ) . The main outcome measurements were change in body weight , waist circumference , LDL-cholesterol , HDL-cholesterol , total cholesterol , TAG , and systolic and diastolic blood pressure .  Forty-five subjects on the moderate-fat diet and forty-four subjects on the low-fat one were studied . Characteristics of all r and omised participants were similar in both groups . After 7 months , the moderate- and low-fat diets had similar effects on cardiovascular risks . The moderate-fat diet was more successful after 14 months in reducing weight ( -5.0 ( SD 2.5 ) kg in the moderate-fat group v. -1.2 ( SD 1.1 ) kg in the low-fat one ; P < 0.0001 ) , waist circumference ( -5.5 ( SD 2.4 ) cm in the moderate-fat group v. - 2.3 ( SD 1.3 ) cm in the low-fat one ; P < 0.0001 ) , and other cardiovascular risk factors as well ( LDL , TAG , total cholesterol and systolic blood pressure ) . In conclusion , a moderate-fat energy-restricted diet in the long term might have more beneficial effects on weight maintenance and cardiovascular risk factors compared with a low-fat diet . Better dietary adherence with the moderate-fat diet may be the reason for its successful effects The effects of adding exercise to diet for weight control in obese children were evaluated by r and omizing obese girls to one of two groups : diet and diet plus exercise . During the first 6 weeks of the treatment , children exercised in a supervised three times a week exercise program , in which they walked or ran 3 miles . Significant decreases from baseline weight and in percent overweight were observed for both groups during the year of treatment . Significant decreases in percent overweight were observed at 0 to 2 months and then at 2 to 6 months for the children who were exercising , whereas percent overweight in children in the  diet-alone  group decreased only from 0 to 2 months . In addition , a significant improvement in fitness was observed only for children in the diet plus exercise group BACKGROUND Given the dramatic increase in adolescent overweight and obesity , models are needed for implementing weight management treatment through readily accessible venues . We evaluated the acceptability and efficacy of a school-based intervention consisting of school nurse-delivered counseling and an afterschool exercise program in improving diet , activity , and body mass index ( BMI ) among overweight and obese adolescents . METHODS A pair-matched cluster-r and omized controlled school-based trial was conducted in which 8 public high schools were r and omized to either a  12-session school nurse-delivered cognitive-behavioral counseling intervention plus school-based after school exercise program , or 12-session nurse contact with weight management information ( control ) .  Overweight or obese adolescents ( N = 126 ) completed anthropometric and behavioral assessment s at baseline and 8-month follow-up . Main outcome measures included diet , activity , and BMI . Mixed effects regression models were conducted to examine differences at follow-up . RESULTS At follow-up , students in intervention compared with control schools were not different in BMI , percent body fat , and waist circumference . Students reported eating breakfast ( adjusted mean difference 0.81 days ; 95 % confidence interval [ CI ] 0.11 - 1.52 ) on more days/week ; there were no differences in other behaviors targeted by the intervention . CONCLUSIONS While a school-based intervention including counseling and access to an after-school exercise program is theoretically promising with public health potential , it was not effective in reducing BMI or key obesogenic behaviors . Our findings are important in highlighting that interventions targeted at the individual level are not likely to be sufficient in addressing the adolescent obesity epidemic without changes in social norms and the environment Background Physical inactivity and overweight are two known risk factors for postmenopausal breast cancer . Former exercise intervention studies showed that physical activity influences sex hormone levels , known to be related to postmenopausal breast cancer , mainly when concordant loss of body weight was achieved . The question remains whether there is an additional beneficial effect of physical activity when weight loss is reached . The aim of this study is to investigate the effect attributable to exercise on postmenopausal breast cancer risk biomarkers , when equivalent weight loss is achieved compared with diet-induced weight loss . Design The SHAPE-2 study is a three-armed , multicentre trial . 243 sedentary , postmenopausal women who are overweight or obese ( BMI 25–35 kg/m2 ) are enrolled . After a 4 - 6 week run-in period , wherein a baseline diet is prescribed , women are r and omly allocated to ( 1 ) a diet group , ( 2 ) an exercise group or ( 3 ) a control group . The aim of both intervention groups is to lose an amount of 5–6 kg body weight in 10–14 weeks . The diet group follows an energy restricted diet and maintains the habitual physical activity level . The exercise group participates in a 16-week endurance and strength training programme of 4 hours per week . Furthermore , they are prescribed a moderate caloric restriction . The control group is asked to maintain body weight and continue the run-in baseline diet . Measurements include blood sampling , question naires , anthropometrics ( weight , height , waist and hip circumference ) , maximal cycle exercise test ( VO2peak ) , DEXA-scan ( body composition ) and abdominal MRI ( subcutaneous and visceral fat ) . Primary outcomes are serum levels of oestradiol , oestrone , testosterone and sex hormone binding globulin ( SHBG ) . Discussion This study will give insight in the potential attributable effect of physical activity on breast cancer risk biomarkers and whether this effect is mediated by changes in body composition , in postmenopausal women . Eventually this may lead to the design of specific lifestyle guidelines for prevention of breast cancer . Trial registration The SHAPE-2 study is registered in the register of clinical trials.gov , Identifier : NCT01511276 Background This study 's purpose investigated the impact of different macronutrient distributions and varying caloric intakes along with regular exercise for metabolic and physiological changes related to weight loss . Methods One hundred forty-one sedentary , obese women ( 38.7 ± 8.0 yrs , 163.3 ± 6.9 cm , 93.2 ± 16.5 kg , 35.0 ± 6.2 kg•m-2 , 44.8 ± 4.2 % fat ) were r and omized to either no diet + no exercise control group ( CON ) a no diet + exercise control ( ND ) , or one of four diet + exercise groups ( high-energy diet [ HED ] , very low carbohydrate , high protein diet [ VLCHP ] , low carbohydrate , moderate protein diet [ LCMP ] and high carbohydrate , low protein [ HCLP ] ) in addition to beginning a 3x•week-1 supervised resistance training program . After 0 , 1 , 10 and 14 weeks , all participants completed testing sessions which included anthropometric , body composition , energy expenditure , fasting blood sample s , aerobic and muscular fitness assessment s. Data were analyzed using repeated measures ANOVA with an alpha of 0.05 with LSD post-hoc analysis when appropriate . Results All dieting groups exhibited adequate compliance to their prescribed diet regimen as energy and macronutrient amounts and distributions were close to prescribed amounts . Those groups that followed a diet and exercise program reported significantly greater anthropometric ( waist circumference and body mass ) and body composition via DXA ( fat mass and % fat ) changes . Caloric restriction initially reduced energy expenditure , but successfully returned to baseline values after 10 weeks of dieting and exercising . Significant fitness improvements ( aerobic capacity and maximal strength ) occurred in all exercising groups . No significant changes occurred in lipid panel constituents , but serum insulin and HOMA-IR values decreased in the VLCHP group . Significant reductions in serum leptin occurred in all caloric restriction + exercise groups after 14 weeks , which were unchanged in other non-diet/non-exercise groups . Conclusions Overall and over the entire test period , all diet groups which restricted their caloric intake and exercised experienced similar responses to each other . Regular exercise and modest caloric restriction successfully promoted anthropometric and body composition improvements along with various markers of muscular fitness . Significant increases in relative energy expenditure and reductions in circulating leptin were found in response to all exercise and diet groups . Macronutrient distribution may impact circulating levels of insulin and overall ability to improve strength levels in obese women who follow regular exercise Objective To examine the effects of Diet ( D ) and Exercise ( E ) interventions on cardiovascular fitness , waist circumference , blood lipids , glucose metabolism , inflammation markers , insulin-like growth factor 1 ( IGF-1 ) and blood pressure in overweight and obese lactating women . Methods At 10–14 wk postpartum , 68 Swedish women with a self-reported pre-pregnancy BMI of 25–35 kg/m2 were r and omized to a 12-wk behavior modification treatment with D , E , both or control using a 2 × 2 factorial design . The goal of D treatment was to reduce body weight by 0.5 kg/wk , accomplished by decreasing energy intake by 500 kcal/d and monitoring weight loss through self-weighing . The goal of E treatment was to perform 4 45-min walks per wk at 60–70 % of max heart-rate using a heart-rate monitor . Effects were measured 12 wk and 1 y after r and omization . General Linear Modeling was used to study main and interaction effects adjusted for baseline values of dependent variable . Results There was a significant main effect of the D treatment , decreasing waist circumference ( P = 0.001 ) , total cholesterol ( P = 0.007 ) , LDL-cholesterol ( P = 0.003 ) and fasting insulin ( P = 0.042 ) , at the end of the 12-wk treatment . The decreased waist circumference ( P<0.001 ) and insulin ( P = 0.024 ) was sustained and HDL-cholesterol increased ( P = 0.005 ) at the 1-y follow-up . No effects from the E treatment or any interaction effects were observed . Conclusions Dietary behavior modification that produced sustained weight loss among overweight and obese lactating women also improved risk factors for cardiovascular disease and type 2 diabetes . This intervention may not only reduce weight-related risks with future pregnancies but also long-term risk for metabolic disease . Trial registration Clinical Trials.gov BACKGROUND The Feeding Exercise Trial in Adolescents ( FETA ) aim ed to evaluate whether a community-based , parents-involving , combined physical activity and nutritional education program was effective in improving adiposity profiles in overweight and obese adolescents . METHODS A total of 181 overweight and obese adolescents aged 13 - 15 years old were r and omized in the three study groups ( " Diet & Activity , " " Activity , " and Control ) . The Activity intervention included a 45-minute , 3-day per week supervised training program , while the Diet & Activity intervention included a supplementary 15 minutes of group-based sessions attended by the parents . The intervention lasted 3 months and the participants were followed for another 3 months after the intervention . The participants were assessed for anthropometric measures and activity and fulfilled the modified version of the question naire " Family Eating and Activity Habits Question naire " ( FEAHQ ) . RESULTS Both " Activity " only and " Diet & Activity " groups reduced significantly ( p < 0.001 ) their mean body mass index ( BMI ) ( -1.1 , 95 % CI -1.3 , -0.8 , and -1.4 , 95 % CI -1.7 , -1.2 , respectively ) , waist circumference , systolic and diastolic blood pressure , pulses per minute , and 50 m sprint run test at 3 months , while greater reductions in BMI were observed at 6 months ( -2.3 , 95 % CI -2.6 , -2.0 , and -3.1 , 95 % CI -3.3 , -2.8 ) . Significant changes in the total FEAHQ score were achieved only in the " Diet & Activity " group both at 3 months and at 6 months . CONCLUSIONS FETA result ed in significant effects on improving adiposity profiles in overweight and obese adolescents , as well as family activity and feeding habits , maintained at 3 months follow-up BACKGROUND Determinants of adherence to lifestyle regimens are ill understood . Attendance to intervention sessions is crucial for patients to acquire knowledge and skills regarding the core elements of an intervention . Therefore , we explored demographic , health-related , and social determinants of high and low attendance to diet and exercise sessions  among overweight and obese patients with knee osteoarthritis ( > or = 60 years ; N = 206 ) . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month r and omized controlled trial on the effectiveness of dietary weight loss and exercise interventions . We conducted chi-square and t-tests , and logistic regression analyses on categories of short- and long-term attendance to intervention sessions . RESULTS Over the 18-month duration of the study , 60.7 % ( + /- 28.5 ) of diet sessions , and 53.2 % ( + /- 29.0 ) of exercise sessions were attended . Not being married , low social participation , and single intervention r and omization predicted high attendance to diet sessions  during months 1 - 4 . Exercising at home , and single intervention r and omization predicted high attendance to exercise sessions during months 5 - 18 . High attendance to sessions early in the intervention was a significant determinant of high session attendance thereafter . CONCLUSIONS Offering people a choice where to exercise , and stimulating early intervention session attendance can be effective in improving long-term attendance to both interventions . Several determinants we found may be amenable to change to enhance intervention adherence of future r and omized controlled trials involving dietary weight loss and /or physical exercise OBJECTIVE Adding exercise to a comprehensive weight-loss program might not only attenuate any psychological distress associated with weight-loss attempts but also may provide psychological benefits . This study examined whether a diet-plus-exercise weight-loss program improved psychological outcomes more than a diet-only weight-loss program or an assessment -only control group . RESEARCH METHODS AND PROCEDURES This study was part of a larger 1-year r and omized weight-loss trial examining the effects of  diet and exercise on cardiovascular disease risk factors in 264 overweight adults . Psychological measures specific to weight control ( e.g. , cognitive restraint , disinhibition , hunger , and body dissatisfaction ) as well as traditional measures of psychological distress ( e.g. , symptoms of depression , anxiety , and stress ) were obtained at baseline and 1 year . RESULTS Men and women in either weight-loss program reported greater restraint , less disinhibition , and less hunger at 1 year than those in no program . Men in the diet-plus-exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet-only program . Women in the diet-plus-exercise program did not experience additional psychological benefits specific to weight control than those in the diet-only program , despite increases in aerobic capacity . DISCUSSION The pattern seen for overweight men in the diet-plus-exercise program at 1 year-greater restraint , less disinhibition , and less hunger-is similar to the pattern seen in successful weight maintainers . These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss , especially for overweight women OBJECTIVE While various weight-management approaches produce weight loss , they may differ in dietary quality . We monitored changes in nutrient intakes in overweight and obese subjects on three different weight-management programs . DESIGN R and omized clinical trial ( pilot study ) with two 12-week phases : phase 1 , weekly counseling ; phase 2 , monitoring only . SUBJECTS/ SETTING One hundred eighty nonsmoking , sedentary overweight and obese adults began this outpatient study ; 134 ( body mass index [ calculated as kg/m(2)]=30.9+/-2.4 ; age=42.3+/-1.2 years ) were used in analyses . INTERVENTION Twenty-four weeks of exercise only ( control group ) , hypocaloric diet plus exercise , or hypocaloric diet with fiber-rich whole-grain cereals plus exercise . MAIN OUTCOME MEASURES At weeks 0 , 12 , and 24 , diet quality was assessed by 3-day food records and body weight was measured . STATISTICAL ANALYSES PERFORMED Three-way analysis of variance with repeated measures . RESULTS The hypocaloric diet with fiber-rich whole-grain cereals plus exercise decreased energy intake more than exercise only ( P=0.032 ) . By week 12 , the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise decreased total fat more than exercise only , which was sustained in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise at 24 weeks ( P<0.001 ) . At weeks 12 and 24 , the hypocaloric diet with fiber-rich whole-grain cereals plus exercise reduced saturated fat intake more than exercise only . The hypocaloric diet with fiber-rich whole-grain cereals plus exercise increased total fiber , insoluble fiber ( both P<0.001 ) , magnesium ( P=0.004 ) , and vitamin B-6 ( P=0.002 ) intakes more than the hypocaloric diet plus exercise and exercise only . Calcium and vitamin E intakes were inadequate in all groups . Weight loss was similar in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise . CONCLUSIONS Weight-reduction strategies may be associated with reduced intake of micronutrients , such as calcium and vitamin E. However , a hypocaloric diet with fiber-rich whole-grain cereal is effective for improving or maintaining other aspects of dietary quality during weight loss BACKGROUND Non-adherence to preventive and therapeutic lifestyle recommendations among patients at high risk of cardiovascular disease is more prevalent and varied than previously thought . The problem needs to be addressed by those who are involved in the care of these patients . AIM To measure adherence and barriers of complying with lifestyle recommendations among patients with high cardiovascular risk factors . DESIGN OF STUDY Prospect i ve study . SETTING Six family- practice health centres in Kuwait . METHOD Data are from 334 Kuwaiti adult males and females with hypertension , type 2 diabetes , or both , who completed a routine clinic visit in one of six family practice centres . Trained staff used a structured question naire to obtain a detailed medical history regarding exercise habits and barriers to compliance with diet and exercise programmes . Clinical criteria assessed were height , weight , and the control of blood pressure and blood sugar . RESULTS From the study sample , 63.5 % of patients reported that they were not adhering to any diet regimen , 64.4 % were not participating in regular exercise , and 90.4 % were overweight and obese . The main barriers to adherence to diet were unwillingness ( 48.6 % ) , difficulty adhering to a diet different from that of the rest of the family ( 30.2 % ) , and social gatherings ( 13.7 % ) . The main barriers to adherence to exercise were lack of time ( 39.0 % ) , coexisting diseases ( 35.6 % ) , and adverse weather conditions ( 27.8 % ) . Factors interfering with adherence to lifestyle measures among the total sample were traditional Kuwaiti food , which is high in fat and calories ( 79.9 % ) , stress ( 70.7 % ) , a high consumption of fast food ( 54.5 % ) , high frequency of social gatherings ( 59.6 % ) , abundance of maids ( 54.1 % ) , and excessive use of cars ( 83.8 % ) . CONCLUSION The majority of individuals in the sample were overweight , did not engage in recommended levels of physical activity , and did not follow dietary recommendations . Additional cultural and demographic variables need to be considered to improve adherence to lifestyle measures
Results from the network meta-analyses confirmed these findings .
Conclusions Moderate- quality evidence from the present network meta- analysis suggests that D + E can be highly recommended for long-term obesity management .
Furthermore , the evidence suggests a moderate superiority of D over E with respect to anthropometric outcomes .
Background The aim of this meta- analysis was to compare the long-term efficacy of diet plus exercise ( D + E ) vs. diet ( D ) , D + E vs. exercise ( E ) and D vs. E on anthropometric outcomes and cardiovascular risk factors in overweight and obese participants .