The Effect of Resistance Training in Healthy Adults on Body Fat Percentage, Fat Mass and Visceral Fat: A Systematic Review and Meta-Analysis

Optimal strategies for exercise intervention in older people diabetic patients: The impacts of intensity, form, and frequency on glycemic control: An exercise prescription for older people with diabetes

OBJECTIVE

This study aims to investigate the optimal exercise intensity, type, and weekly duration for improving glycated haemoglobin (HbA1c) and fasting blood glucose (FBG) levels in older people individuals with diabetes.

MATERIALS AND METHODS

PubMed, EMBASE, Web of Science and other databases were searched to identify randomised controlled trials (RCTs) starting from January 2000 to February 2024 that reported improved effects on fasting glucose and glycated haemoglobin after different exercises in middle-aged and elderly diabetic patients. Meta-analyses Review Manager V.5.3 was used.

RESULTS

Meta-analysis showed that moderate- and high-intensity exercise had a significant effect on HbA1c levels, with a mean difference (MD) of -0.34 (95 % CI: -0.44 ∼ -0.24, p < 0.01) for moderate-intensity exercise and -0.54 (95 % CI: -0.78 ∼ -0.3, p < 0.001) for high-intensity exercise.. Both moderate-intensity and high-intensity exercise demonstrated statistical significance in lowering fasting blood glucose levels (p < 0.001). Additionally, there was no significant difference between aerobic and resistance exercise forms (p= 0.72). Furthermore, for reducing HbA1c levels, engageing in weekly exercise for at least 2.5 hours showed a MD of-0.44(95 % CI:-0.63∼0.25;p<0.001).

CONCLUSIONS

In summary, in terms of exercise intensity, medium and high-intensity exercise can significantly reduce HbA1c and FBG levels in middle-aged and older people diabetic patients; in terms of exercise form, the effects of different exercise forms within medium and high-intensity on HbA1c and FBG are not statistically significant; and in terms of exercise time, in moderate-intensity aerobic exercise, older people exercising for more than 2.5 h per week are more beneficial.

Effect of different forms of high-intensity interval training on V̇O2max, strength, flexibility, and body fat percentage among middle-aged males

BACKGROUND

High-intensity interval training (HIIT) has become a popular exercise approach due to its potential to elicit significant physiological adaptations. However, limited research has compared the effects of different HIIT modalities on fitness parameters in middle-aged males. This study aimed to determine the effect of different HIIT on V̇O2max, strength, flexibility, and body fat percentage among middle-aged males.

METHODS

Thirty sedentary males aged 40-50 years were randomly assigned to HIIT-Weight Training Circuit (WTC), HIIT-Shuttle Run (SR), or HIIT-Bodyweight Exercise (BWE) groups. Training consisted of 20 sessions over 5 weeks of 4×4 minutes at 90-95% HRmax with 3 minutes recovery at 70% HRmax between intervals. Outcome measures including V̇O2max, strength, flexibility, and body fat percentage were assessed pre- and postintervention.

RESULTS

The result for the Two-Way Mixed ANOVA indicated there was no significant interaction effect between the three training groups. There was no significant main effect for the three training groups, whereas there was a significant effect for the repeated measure time existed. A significant improvement in V̇O2max, strength, flexibility has been shown between post-test and pre-test for the HIIT-SR, HIIT-WTC, and HIIT-BWE group. Whereas A significant decrease has been shown between post and pretest for all the groups in body fat percentage.

CONCLUSIONS

This research findings suggested that different forms of HIIT can elicit differential adaptation in middle-aged males. Incorporating different form of HIIT as HITT-SR, HITT-WTC, and HITT-BWE into exercise program may be an effective way to systematically improve V̇O2max, strength, flexibility, and body composition in middle-age male population. These findings provide guidance on HIIT prescription according to fitness goals.

Impact of Resistance Training on Body Composition and Physical Function in Individuals with Down Syndrome: A Meta-Analysis

Objectives: Down syndrome (DS) is associated with challenges like increased fat mass and reduced muscle tone. This study aims to analyze the impact of resistance training on improving muscle strength and physical function in individuals with DS. Methods: We conducted a comprehensive search of PubMed, Scopus, Google Scholar, Cochrane Library, and China National Knowledge Infrastructure for studies published up to August 2023. Standardized mean differences and 95% confidence intervals were used to evaluate the efficacy of resistance training. Results: Eight randomized controlled trials (RCTs), including 127 participants with DS, met the inclusion criteria. Resistance training significantly improved muscle strength in the knee extensors (SMD: 1.009, 95% CI: 0.505-1.513), knee flexors (SMD: 1.133, 95% CI: 0.106 to 2.16), and upper limbs (SMD: 0.748, 95% CI: 0.152-1.343). The SMD for upper limb function was 0.385 (95% CI: 0.004-0.765), showing a small improvement. For walking ability, the SMD was 0.259 (95% CI: -0.171-0.690), and for stair climbing ability, the SMD was 0.257 (95% CI: -0.189-0.703), both indicating no significant changes. Improvements in upper limb physical function were significant, but no notable improvements were seen in lower limb functions. Conclusions: Resistance training for more than four weeks enhances muscle strength in individuals with DS, with greater gains seen in younger participants. While improvements were noted in upper limb physical function, lower limb function remained largely unchanged. These findings suggest that resistance training is a valuable exercise for improving muscle strength and physical function in individuals with DS.

The utility-and limitations-of the rodent synergist ablation model in examining mechanisms of skeletal muscle hypertrophy

In this issue, Burke et al. discuss the utility of the rodent synergist ablation (SA) model for examining mechanisms associated with skeletal muscle hypertrophy. In this invited perspective, we aim to complement their original perspective by discussing limitations to the model along with alternative mechanical overload models that have strengths and limitations.

Stopgap Measures for Obesity Prior to Surgery

PURPOSE OF REVIEW

The data on preventive measures for managing obesity prior to surgery is limited. This review highlights the role of stopgap measures for managing obesity before surgery.

RECENT FINDINGS

Body weight regulation to achieve sustainable weight loss is a gradual process. Regular aerobic exercises, transformative yoga and restrained eating can contribute to a calorie deficit. Behavioural strategies aim to raise awareness, set goals, manage stress, and support adherence to healthier lifestyles. Pharmacotherapy can be adjunctive in inducing weight loss but could be better at maintaining weight. Intragastric balloon and endoscopic sleeve gastroplasty are restrictive procedures for patients before surgery. Obesity is a multifaceted chronic disease with adverse health consequences. There is a need to identify contributors to weight gain and treatment should target the cause of obesity. Utilize stop-gap measures and monitor progress for step-up or more intensive treatment. Structured weight loss needs lifelong commitment.

Comparative effects of 8-week combined resistance exercise training and alternate-day calorie restriction on soluble epidermal growth factor receptor (sEGFR) and adipsin in obese men

This study investigated the combined effects of resistance exercise training (RET) and alternate-day calorie restriction (ADCR) on body composition, insulin resistance (IR), insulin resistance-related biomarkers (adipokine adipsin and hepatokine soluble EFGR), and weight loss in obese men. The findings revealed that RET + ADCR induced the greatest reductions in body weight, body fat percentage, and waist-to-hip ratio (WHR) compared to RET and ADCR alone (p < 0.05). Additionally, RET + ADCR resulted in the most significant improvements in IR, as measured by HOMA-IR, and in circulating levels of adipsin and soluble EFGR (p < 0.05). These findings suggest that combining RET and ADCR may be a more effective strategy for improving metabolic health, including body composition, IR, and metabolic tissues' functions, in obese men than either intervention alone.

The Effect of Creatine Supplementation on Resistance Training-Based Changes to Body Composition: A Systematic Review and Meta-analysis

ABSTRACT

Desai, I, Wewege, MA, Jones, MD, Clifford, BK, Pandit, A, Kaakoush, NO, Simar, D, and Hagstrom, AD. The effect of creatine supplementation on resistance training-based changes to body composition: A systematic review and meta-analysis. J Strength Cond Res XX(X): 000-000, 2024-The purpose of this review was to determine the added effect of creatine supplementation on changes in body composition with resistance training in adults younger than 50 years. The review protocol was preregistered on the Open Science Framework (osf.io/x48a6/). Our primary outcome was lean body mass (LBM); secondary outcomes were body fat percentage (%) and body fat mass (kg). We performed a random-effects meta-analysis in R using the metafor package. Subgroup analyses were conducted to examine the effects of training status and use of a carbohydrate drink with creatine. We conducted a meta-regression to examine the moderating effect of total training volume. Statistical significance was set at p < 0.05. One thousand six hundred ninety-four records were screened, and 67 full-text articles were assessed for eligibility. Twelve studies were included in the meta-analysis. Fifty-two percentages of the studies had low risk, 41% some concerns, and 7% high risk of bias. Compared with resistance training (RT) alone, creatine supplementation increased LBM by 1.14 kg (95% CI 0.69 to 1.59), and reduced body fat percentage by -0.88% (95% CI -1.66 to -0.11) and body fat mass by -0.73 kg (95% CI -1.34 to -0.11). There were no differences between training status or carbohydrate subgroups. Training volume was not associated with effect size in all outcomes; 7 g or 0.3 g/kg of body mass of creatine per day is likely to increase LBM by 1 kg and reduce fat mass by 0.7 kg more than RT alone. Concurrent carbohydrate ingestion did not enhance the hypertrophy benefits of creatine.

Heavy resistance training at retirement age induces 4-year lasting beneficial effects in muscle strength: a long-term follow-up of an RCT

Objectives

Muscle function and size decline with age, but long-term effects of resistance training in older adults are largely unknown. Here, we explored the long-lasting (3 years) effects of 1 year of supervised resistance training with heavy loads.

Methods

The LIve active Successful Ageing (LISA) study was a parallel group randomised controlled trial at a university hospital in Denmark. Older adults (n=451) at retirement age were randomised to 1 year of heavy resistance training (HRT), moderate-intensity training (MIT) or a non-exercising control group (CON). Primary outcome measure was leg extensor power. Secondary outcomes included maximal isometric quadriceps torque (isometric leg strength) and body composition (dual-energy X-ray absorptiometry (DXA)). Participants completed test procedures at baseline, following the 1-year intervention, and 2 and 4 years post study start.

Results

At the 4-year assessment, 369 participants attended (mean age=71 years, 61% women). The main finding was that across all four time points, there was a significant group×time interaction in isometric leg strength (F6,1049=8.607, p<0.001,η 2 =0.05). Individuals in HRT maintained baseline performance in isometric leg strength (Baseline: 149.7±51.5 Nm, 4 years: 151.5±51.1 Nm, t(1050)=1.005, p=1.00) while participants in CON and MIT decreased.

Conclusion

In well-functioning older adults at retirement age, 1 year of HRT may induce long-lasting beneficial effects by preserving muscle function.

Trial registration number

NCT02123641.

Strategies for Improving Firefighter Health On-Shift: A Review

The fire service suffers from high rates of cardiovascular disease and poor overall health, and firefighters often suffer fatal and non-fatal injuries while on the job. Most fatal injuries result from sudden cardiac death, while non-fatal injuries are to the musculoskeletal system. Previous works suggest a mechanistic link between several health and performance variables and injury risk. In addition, studies have suggested physical activity and nutrition can improve overall health and occupational performance. This review offers practical applications for exercise via feasible training modalities as well as nutritional recommendations that can positively impact performance on the job. Time-efficient training modalities like high-intensity interval training and feasible modalities such as resistance training offer numerous benefits for firefighters. Also, modifying and supplementing the diet and can be advantageous for health and body composition in the fire service. Firefighters have various schedules, making it difficult for planned exercise and eating while on shift. The practical training and nutritional aspects discussed in this review can be implemented on-shift to improve the overall health and performance in firefighters.

Association of fat-to-muscle mass ratio with physical activity and dietary protein, carbohydrate, sodium, and fiber intake in a cross-sectional study

Higher fat-to-muscle mass ratio (FMR) is reported to be a risk factor for various diseases, including type 2 diabetes and cardiovascular diseases, and mortality. Although this association suggests that reducing FMR may help to prevent certain diseases and mortality, the relationship between FMR and lifestyle factors is unclear. Therefore, we performed a cross-sectional study with the aim to elucidate this relationship. This cross-sectional study included 1518 healthy Japanese adults aged 30 to 64 years. We measured FMR in the whole body, arms, legs, and trunk and assessed various lifestyle factors. Then, we performed forced entry multiple regression analyses for FMR with the following variables: sex, age, physical activity, dietary intake, sleep quality, cigarette smoking, stress levels, and body mass index. As a result, whole-body and regional FMRs were correlated with female sex (β = 0.71); age (β = 0.06); physical activity (β = - 0.07); dietary intake of protein (β = - 0.12), carbohydrate (β = 0.04), sodium (β = 0.13), and fiber (β = - 0.16); and body mass index (β = 0.70). The results suggest that in the Japanese middle-aged population, low FMR is associated with certain lifestyle factors, i.e. higher physical activity and a diet with higher protein and fiber and lower carbohydrate and sodium, independent of age, sex, and body mass index.

A Mobile Health Resistance Training Intervention Using Outdoor Gym Equipment: Process Evaluation of the Ecofit Effectiveness Randomized Controlled Trial

BACKGROUND

Few mobile health resistance-based physical activity interventions have targeted community-dwelling adults. "Ecofit" is a multicomponent intervention that promotes resistance and aerobic activities using smartphone technology, outdoor gyms, and social support. This study evaluated process evaluation outcomes of the ecofit randomized controlled trial: (1) the acceptability and usability of the ecofit smartphone app and app user workouts; (2) perceptions of factors influencing outdoor gym use; and (3) the fidelity, reach, recruitment, and dose received of the ecofit program.

METHODS

Process data were collected through program evaluation surveys at 3 months, and app usage data were collected via the intervention platform for up to 3 months. Data were analyzed using descriptive statistics.

RESULTS

The survey was completed by 57% (n = 69) of eligible participants. The majority (93%) believed the app provided them with sufficient information to perform muscle-strengthening activities. Approximately half (51%) agreed that the goal-setting function encouraged them to complete their workouts, and 42% agreed that the self-assessment helped them monitor progress. "Proximity" to outdoor gyms emerged as the most important factor for choosing locations to workout (mean = 5.5, SD = 1.1). Participants logged a median of 5.5 (interquartile range = 19) workouts and 1 (interquartile range = 1) upper- and lower-body muscular fitness self-assessment.

CONCLUSIONS

The ecofit app provided participants with sufficient skills to perform unsupervised resistance training exercises using mobile health. Only half of the participants regarded self-assessments and goal setting as useful, suggesting a need for modifications to how these are implemented. Mobile health remains a promising delivery platform to promote unsupervised resistance training, although more research is needed to improve uptake.

Different resistance training volumes on strength, functional fitness, and body composition of older people: A systematic review with meta-analysis

Aging causes several changes in the body, reducing strength and muscle mass, which leads to a decline in function. Resistance training (RT) is used to counteract these changes. However, there is still ongoing debate about the optimal volume of RT in the context of aging. We systematically reviewed articles that assessed the impact of different volumes of RT on muscular strength, functional fitness, and body composition of older people. We conducted a systematic search in the PubMed/MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, LILACS, PEDro, and Google Scholar databases, using keywords related to the older population and various RT volumes. We performed meta-analyses for each outcome separately using intervention time in weeks for subgroup analyses. We employed random effects models for all meta-analyses and expressed the results as standardized mean differences (Hedges' g). We included 31 studies, encompassing a total of 1.744 participants. The sample size ranged from 18 to 376, with an average size of 56 participants. Participants' ages ranged from 60 to 83 years. On average, HV-RT (High-Volume Resistance Training) induced significant adaptations in muscle strength of the upper limbs (g = 0.36; 95 % CI = 0.11-0.61) and lower limbs (g = 0.41; 95 % CI = 0.23-0.59), with superiority more pronounced after 12 weeks of training. Regarding functional fitness, there was a tendency favoring HV-RT (g = 0.41; 95 % CI = 0.23-0.59). Thus, HV-RT outperforms LV-RT (Low-Volume Resistance Training) in enhancing muscle strength, particularly in longer interventions with independent older adults.

Moderators of Resistance Training Effects in Healthy Young Women: A Systematic Review and Meta-analysis

ABSTRACT

Molinari, T, Radaelli, R, Rech, A, Brusco, CM, Markarian, AM, and Lopez, P. Moderators of resistance training effects in healthy young women: A systematic review and meta-analysis. J Strength Cond Res 38(4): 804-814, 2024-To systematically review and analyze the effects of resistance-based exercise programs and potential moderators of change in body fat percentage, whole-body fat and lean mass, muscle hypertrophy, muscle strength, and muscle power/rapid force in healthy young women (between 18 and 35 years). A systematic search was undertaken in 7 databases from inception to May 2022. Eligible randomized controlled trials examined the effects of resistance-based exercise programs on outcomes of interest in healthy young women. Meta-analysis was undertaken with a 3-level mixed-effects model. Associations between standardized mean difference (SMD) and potential moderators (number of sessions, weekly volume, and intensity) were tested by meta-regression models. Statistical significance was set at an α level of 0.05, whereas an α level of 0.05-0.10 was also considered for potential moderators of resistance training effects. Forty articles ( n = 1,312) were included. Resistance-based exercise programs resulted in a significant improvement of 0.4 SMD (95% confidence intervals [95% CI]: 0.2 to 0.5, p < 0.001) in lean mass/muscle hypertrophy and 1.2 SMD (95% CI: 0.9 to 1.5, p < 0.001) in muscle strength. A higher number of sessions was associated with changes in lean mass/muscle hypertrophy ( β = 0.01 ± 0.00, p = 0.009), whereas a higher weekly volume approached statistical significance to moderate changes in muscle strength ( β = 0.01 ± 0.01, p = 0.053). Body fat percentage (-0.4 SMD, 95% CI: -0.6 to -0.1, p = 0.006) and muscle power/rapid force (0.6 SMD, 95% CI: 0.2 to 1.1, p = 0.011) were significantly improved. In conclusion, a higher resistance training volume was associated with greater improvements in lean mass/muscle hypertrophy, muscle strength, and body fat percentage, whereas muscle power/rapid force improvements were observed irrespective of prescription characteristics. These findings may help in designing resistance training programs for muscle hypertrophy, strength and power, and body fat percentage in healthy women.

The associations of "weekend warrior" and regularly active physical activity with abdominal and general adiposity in US adults

OBJECTIVE

This study examined the association between physical activity patterns and abdominal and general adiposity.

METHODS

Data were extracted among 20- to 59-year-old participants in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Abdominal and general adiposity was assessed by dual-energy x-ray absorptiometry (DXA) and anthropometric measures. DXA-measured indicators were further normalized into z scores. Physical activity levels were collected by questionnaire and classified as inactive, "weekend warrior" (WW), and regularly active (RA). Survey linear regression models were used to assess associations between physical activity patterns and adiposity indicators.

RESULTS

Among 9629 participants, 772 (8.2%) reported the WW pattern and 3277 (36.9%) reported the RA pattern. Compared with inactive, both WW and RA had lower DXA-measured abdominal adiposity (WW: β: -0.24, 95% CI: -0.38 to -0.10; RA: -0.18, 95% CI: -0.29 to -0.07), waist circumference (WW: β: -1.94, 95% CI: -3.16 to -0.73; RA: -1.31, 95% CI: -2.32 to -0.29), whole-body fat mass (WW: β: -0.16, 95% CI: -0.25 to -0.08; RA: -0.11, 95% CI: -0.18 to -0.04), and BMI (WW: β: -0.78, 95% CI: -1.27 to -0.28; RA: -0.47, 95% CI: -0.89 to -0.04).

CONCLUSIONS

The WW pattern was associated with similarly lower abdominal and general adiposity to the RA pattern versus the inactive pattern.

Effect of resistance training volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females: Systematic review and meta-analysis of randomized controlled trials

PURPOSE

This meta-analytical study aimed to explore the effects of resistance training (RT) volume on body adiposity, metabolic risk, and inflammation in postmenopausal and older females.

METHODS

A systematic search was performed for randomized controlled trials in PubMed, Scopus, Web of Science, and SciELO. Randomized controlled trials with postmenopausal and older females that compared RT effects on body adiposity, metabolic risk, and inflammation with a control group (CG) were included. Independent reviewers selected the studies, extracted the data, and performed the risk of bias and certainty of the evidence (Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)) evaluations. Total body and abdominal adiposity, blood lipids, glucose, and C-reactive protein were included for meta-analysis. A random-effects model, standardized mean difference (Hedges' g), and 95% confidence interval (95%CI) were used for meta-analysis.

RESULTS

Twenty randomized controlled trials (overall risk of bias: some concerns; GRADE: low to very low) with overweight/obese postmenopausal and older females were included. RT groups were divided into low-volume RT (LVRT, ∼44 sets/week) and high-volume RT (HVRT, ∼77 sets/week). Both RT groups presented improved body adiposity, metabolic risk, and inflammation when compared to CG. However, HVRT demonstrated higher effect sizes than LVRT for glucose (HVRT = -1.19; 95%CI: -1.63 to -0.74; LVRT = -0.78; 95%CI:-1.15 to -0.41) and C-reactive protein (HVRT = -1.00; 95%CI: -1.32 to -0.67; LVRT = -0.34; 95%CI, -0.63 to -0.04)) when compared to CG.

CONCLUSION

Compared to CG, HVRT protocols elicit greater improvements in metabolic risk and inflammation outcomes than LVRT in overweight/obese postmenopausal and older females.

Is dancing an effective intervention for fat loss? A systematic review and meta-analysis of dance interventions on body composition

OBJECTIVE

The systematic review aimed to review the research on the effects of dance interventions, relative to normal lifestyles, on body composition in people with overweight and obesity.

METHODS

7 databases were searched from their inception to 3 July 2023 for studies with dance interventions and normal lifestyles groups. Only studies investigating dance interventions in people with overweight and obesity(body mass index (BMI)>24kg/m2 and percent fat mass (Fat(%)) abnormal(male>20%, female>25%)) were included in the meta-analysis. There were no restrictions on dance forms.

RESULTS

654 studies were identified from the databases, and 10 studies were evaluated to be eligible. The meta-analysis revealed that compared to normal lifestyles dance had meaningful improvements in body mass(BM), BMI, waist circumference(WC), Fat(%), and fat mass(Fat(kg)). No significant differences were found in the waist-to-hip ratio(WHR).

CONCLUSIONS

Dance is effective on fat loss in people with overweight and obesity, and has a significant improvement on body composition and morphology. For its high efficiency and greater sense of enjoyment, dance can be a beneficial exercise intervention for fat loss.

Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association

Resistance training not only can improve or maintain muscle mass and strength, but also has favorable physiological and clinical effects on cardiovascular disease and risk factors. This scientific statement is an update of the previous (2007) American Heart Association scientific statement regarding resistance training and cardiovascular disease. Since 2007, accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease. This scientific statement summarizes the benefits of resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors. We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations. Because less than one-third of US adults report participating in the recommended 2 days per week of resistance training activities, this scientific statement provides practical strategies for the promotion and prescription of resistance training.

Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis

The combination of resistance exercise and creatine supplementation has been shown to decrease body fat percentage in adults ≥ 50 years of age. However, the effect on adults < 50 years of age is currently unknown. To address this limitation, we systematically reviewed the literature and performed several meta-analyses comparing studies that included resistance exercise and creatine supplementation to resistance exercise and placebo on fat mass and body fat percentage Twelve studies were included, involving 266 participants. Adults (<50 years of age) who supplemented with creatine and performed resistance exercise experienced a very small, yet significant reduction in body fat percentage (-1.19%, p = 0.006); however, no difference was found in absolute fat mass (-0.18 kg, p = 0.76). Collectively, in adults < 50 years of age, the combination of resistance exercise and creatine supplementation produces a very small reduction in body fat percentage without a corresponding decrease in absolute fat mass.

Effects of physical training programs on female tennis players' performance: a systematic review and meta-analysis

Background: Tennis is among the world's most popular and well-studied sports. Physical training has commonly been used as an intervention among athletes. However, a comprehensive review of the literature on the effects of physical training programs on female tennis players' performance is lacking. Therefore, this systematic review and meta-analysis aimed to determine the effects of physical training on performance outcomes in female tennis players. Methods: A comprehensive search was conducted on Web of Science, PubMed, SPORTDicus, Scopus, and CNKI from inception until July 2023 to select relevant articles from the accessible literature. Only controlled trials were included if they examined the effects of physical training on at least one measure of tennis-specific performance in female tennis players. The Cochrane RoB tool was employed to assess the risk of bias. The CERT scale was used to examine the quality of program information. The GRADE approach was adopted to evaluate the overall quality of the evidence. The Comprehensive Meta-Analysis software was used for the meta-analysis. Results: Nine studies were selected for the systematic review and seven for the meta-analysis, totaling 222 individuals. The study's exercise programs lasted 6-36 weeks, with training sessions ranging from 30 to 80 min, conducted one to five times per week. Muscle power (ES = 0.72; p = 0.003), muscle strength (ES = 0.65; p = 0.002), agility (ES = 0.69; p = 0.002), serve velocity (ES = 0.72; p = 0.013), and serve accuracy (ES = 1.14; p = 0.002) demonstrated significant improvement following physical training, while no notable changes in linear sprint speed (ES = 0.63; p = 0.07) were detected. Conclusion: Although research on physical training in sports is diversified, studies on training interventions among female tennis players are scarce. This review found that existing training programs yield some favorable outcomes for female tennis players. However, further research with high methodological quality is warranted on the tailoring of specific training programs for female tennis players. There should be more consistent measuring and reporting of data to facilitate meaningful data pooling for future meta-analyses.

The Effect of Exercise on Quality of Life in Type 2 Diabetes: A Systematic Review and Meta-analysis

BACKGROUND

Exercise is a proven therapy for managing cardiometabolic risk factors in type 2 diabetes (T2D). However, its effects on patient-reported outcome measures such as quality of life (QoL) in people with T2D remain unclear. Consequently, the primary aim of this study was to determine the effect of regular exercise on QoL in adults with T2D. A secondary aim was to determine the effect of different exercise modalities on QoL. The third aim was to determine whether improvements in QoL were associated with improvements in gly'cated hemoglobin (A1C).

METHODS

Relevant databases were searched to May 2022. Eligible studies included randomized trials involving ≥2 wk of aerobic and/or resistance exercise and assessed QoL using a purpose-specific tool. Mean differences and 95% confidence intervals (CI) were calculated as standardized mean difference (SMD) or weighted mean difference. A regression analysis was undertaken to examine the interaction between change in QoL with change in A1C.

RESULTS

Of the 12,642 studies retrieved, 29 were included involving 2354 participants. Exercise improved QoL when compared with control (SMD, 0.384; 95% CI, 0.257 to 0.512; P < 0.001). Aerobic exercise, alone (SMD, 0.475; 95% CI, 0.295 to 0.655; P < 0.001) or in combination with resistance training (SMD, 0.363; 95% CI, 0.179 to 0.548; P < 0.001) improved QoL, whereas resistance training alone did not. Physical components of health-related QoL (HRQoL) improved with all exercise modalities, but mental components of HRQoL remained unchanged. Exercise improved A1C (mean difference, -0.509%; 95% CI, -0.806% to -0.212%; P = 0.001), and this change was associated with improvements in HRQoL ( β = -0.305, SE = 0.140, Z = -2.18, P = 0.030).

CONCLUSIONS

These results provide robust evidence that regular aerobic exercise alone or in combination with resistance training is effective for improving QoL in adults with T2D. Such improvements seem to be mediated by improvements in physical components of HRQoL and are associated with improved blood glucose control. Further studies should be undertaken to determine the relative importance of exercise duration, intensity, and frequency on patient-reported outcomes such as QoL.

Physical activity planning interventions, body fat and energy-dense food intake in dyads: ripple, spillover, or compensatory effects?

OBJECTIVES

It is unclear if planning to change one behavior may prompt changes in other health behaviors or health outcomes. This study tested if physical activity (PA) planning interventions may result in (i) a body fat reduction in target persons and their dyadic partners (a ripple effect), (ii) a decrease in energy-dense food intake (a spillover effect), or an increase in energy-dense food intake (a compensatory effect).

METHOD

N = 320 adult-adult dyads were assigned to an individual ('I-for-me'), dyadic ('we-for-me'), or collaborative ('we-for-us') PA planning intervention or a control condition. Body fat and energy-dense food intake were measured at baseline and at the 36-week follow-up.

RESULTS

No Time x Condition effects were found for target persons' body fat. There was a reduction in body fat among partners participating in any PA planning intervention, compared to the control condition. Across conditions, target persons and partners reduced energy-dense food intake over time. The reduction was smaller among target persons assigned to the individual PA planning condition compared to the control condition.

CONCLUSIONS

PA planning interventions delivered to dyads may result in a ripple effect involving body fat reduction among partners. Among target persons, the individual PA planning may activate compensatory changes in energy-dense food intake.

The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis

Introduction

We conducted a systematic review and meta-analysis to investigate the effect of exercise training on body composition outcomes in postmenopausal women.

Methods

PubMed, Web of Science, CINAHL, and Medline were searched to identify the randomized controlled trials which evaluated effect of exercise training versus control in postmenopausal women. Standardized mean differences (SMD), weighted mean differences (WMD) and 95% confidence intervals (95% CIs) were calculated using random effects model.

Results

One hundred and one studies involving 5,697 postmenopausal women were included in the meta-analysis. Results indicated that exercise training effectively increased muscle mass/ volume, muscle and fiber cross-sectional area and fat-free mass, and decreased fat mass, body fat percentage, waist circumference and visceral fat. Furthermore, subgroup analyses results revealed that aerobic and combined training had greater beneficial effects on fat mass outcomes, whereas resistance and combined training had greater beneficial effects on muscle mass outcomes.

Discussion

Overall, our results revealed that exercise training is effective for improving body composition in postmenopausal women. To be specific, aerobic training is effective on fat loss, whereas resistance training is effective on muscle gain. However, combination of aerobic and resistance trainings may be considered a viable strategy to improve body composition in postmenopausal women.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42021283425.

The effects of resistance training on myostatin and follistatin in adults: A systematic review and meta-analysis

INTRODUCTION AND AIM

Myostatin and follistatin are the main hormones for regulating muscle mass, and previous research suggests they are modulated by resistance training. We therefore performed a systematic review and meta-analysis to investigate the impact of resistance training on circulating myostatin and follistatin in adults.

METHODS

A search was conducted in PubMed and Web of science from inception until October 2022 to identify original studies investigating the effects of resistance training compared with controls that did not exercise. Standardized mean differences and 95% confidence intervals (CIs) were calculated using random effects models.

RESULTS

A total 26 randomized studies, including 36 interventions, and involving 768 participants (aged ∼18 to 82 years), were included in the meta-analysis. Resistance training effectively decreased myostatin [-1.31 (95% CI -1.74 to -0.88, p=0.001, 26 studies] and increased follistatin [2.04 (95% CI: 1.51 to 2.52), p=0.001, 14 studies]. Subgroup analyses revealed a significant decrease in myostatin and increase in follistatin regardless of age.

CONCLUSION

Resistance training in adults is effective for reducing myostatin and increasing follistatin which may contribute to the beneficial effects of resistance training on muscle mass and metabolic outcomes.

Impacto de los diferentes tipos de entrenamiento físico sobre la composición corporal en mujeres adultas con obesidad: una revisión bibliográfica

Introducción: La obesidad sigue siendo uno de los problemas más grandes de salud pública en todo el mundo. Se conoce que está asociada con una gran variedad de enfermedades; en mujeres obesas, aún se desconoce la forma idónea para realizar una adecuada prescripción física. Objetivo: revisar los tipos de entrenamientos físicos de ensayos controlados aleatorizados publicados en la base de datos PubMed entre los años 2015 a 2022 sobre los cambios en la composición corporal en mujeres adultas de 18 a 65 años con obesidad. Metodología: se utilizó a modo de filtro la “Herramienta de Evaluación de Calidad Validada para Estudios Cuantitativos”. Resultados: la búsqueda arrojó 586 artículos, de los cuales el 93.85% fueron eliminados; 6.14% pasaron por un filtro que dejó un total de 1.7%. Conclusión: en mujeres adultas con obesidad, se ha demostrado que todos los tipos de entrenamiento físico sirven para generar cambios en la composición corporal. Introduction: Obesity continues to be one of the biggest public health problems worldwide. It is known to be associated with a wide variety of diseases; in obese women, the ideal way to carry out an adequate physical prescription is still unknown. Objective: to review the types of physical training in randomized controlled trials published in the PubMed database between 2015 and 2022 on changes in body composition in adult women aged 18 to 65 with obesity. Methodology: the "Validated Quality Assessment Tool for Quantitative Studies" was used as a filter. Outcomes: the search yielded 586 articles, of which 93.85% were eliminated; 6.14% went through a filter that left a total of 1.7%. Conclusion: in adult women with obesity, it has been shown that all types of physical training serve to generate changes in body composition.

High-Intensity Interval Training Ameliorates Molecular Changes in the Hippocampus of Male Rats with the Diabetic Brain: the Role of Adiponectin

Alzheimer's disease (AD) is closely related to type 2 diabetes (T2D). This study investigated the impact of high-intensity interval training (HIIT) on diabetes-induced disturbances in AD-related factors (including AMP-activated protein kinase (AMPK), glycogen synthase kinase-3β (GSK3β), and tau protein) in the hippocampus, with the main focus on adiponectin signaling.In total, 28 male Wistar rats at the age of 8 weeks were randomly assigned to four groups (n = 7 in each group): control (Con), type 2 diabetes (T2D), HIIT (Ex), and type 2 diabetes + HIIT (T2D + Ex). T2D was induced by a high-fat diet plus a single dose of streptozotocin (STZ). Rats in Ex and T2D + Ex groups performed 8 weeks of HIIT (running at 8-95% of V_max, 4-10 intervals). Insulin and adiponectin levels in serum and hippocampus were measured along with hippocampal expression of insulin and adiponectin receptors, phosphorylated AMPK, dephosphorylated GSK3β, and phosphorylated tau. Homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for insulin resistance beta (HOMA-β), and quantitative insulin sensitivity check index (QUICKI) were calculated to assess insulin resistance and sensitivity. T2D decreased insulin and adiponectin levels in serum and hippocampus, as well as the hippocampal levels of insulin and adiponectin receptors and AMPK, but increased GSK3β and tau in the hippocampus. HIIT reversed diabetes-induced impairments and consequently decreased tau accumulation in the hippocampus of diabetic rats. HOMA-IR, HOMA-β, and QUICKI were improved in Ex and T2D + Ex groups. Overall, our results confirmed that T2D has undesirable effects on the levels of some Alzheimer's-related factors in the hippocampus, and HIIT could ameliorate these impairments in the hippocampus.

mHealth to Support Outdoor Gym Resistance Training: The ecofit Effectiveness RCT

INTRODUCTION

In Australia, 45% of adults meet the aerobic recommendations, and only 9%-30% meet the resistance training guidelines. Given the lack of at-scale community-based interventions promoting resistance training, the aim of this study was to assess the impact of an innovative mHealth intervention on upper- and lower-body muscular fitness, cardiorespiratory fitness, physical activity, and social-cognitive mediators among a sample of community-dwelling adults.

STUDY DESIGN

Researchers evaluated the community-based ecofit intervention using a cluster RCT from September 2019 to March 2022 in 2 regional municipalities of New South Wales, Australia.

SETTING/PARTICIPANTS

Researchers recruited a sample of 245 participants (72% female, aged 53.4±13.9 years) who were randomized to the ecofit intervention group (n=122) or waitlist control (n=123) group.

INTERVENTION

The intervention group received access to a smartphone application with standardized workouts tailored to 12 outdoor gym locations and an introductory session. Participants were encouraged to perform at least 2 ecofit workouts per week.

MAIN OUTCOME MEASURES

Primary and secondary outcomes were assessed at baseline, 3 months, and 9 months. The coprimary muscular fitness outcomes were evaluated using the 90-degree push-up and the 60-second sit-to-stand test. Intervention effects were estimated using linear mixed models accounting for group-level clustering (participants could enroll in groups of up to 4). Statistical analysis was conducted in April 2022.

RESULTS

Statistically significant improvements were observed in upper (1.4 repetitions, 95% CI=0.3, 2.6, p=0.018) and lower (2.6 repetitions, 95% CI=0.4, 4.8, p=0.020) body muscular fitness at 9 months but not at 3 months. Increases in self-reported resistance training, resistance training self-efficacy, and implementation intention for resistance training were statistically significant at 3 and 9 months.

CONCLUSION

This study has shown that a mHealth intervention promoting resistance training using the built environment can improve muscular fitness, physical activity behavior, and related cognitions in a community sample of adults.

TRIAL REGISTRATION

This trial was preregistered with the Australian and New Zealand Clinical Trial Registry (ACTRN12619000868189).

Effects of resistance training on body recomposition, muscular strength, and phase angle in older women with different fat mass levels

AIMS

The concomitant increase in skeletal muscle mass (SMM) and decrease in fat mass has been termed body recomposition. This study aimed to analyze the influence of pre-training levels of fat mass on body recomposition, muscular strength, and (phase angle) PhA after 24 weeks of resistance training (RT) in older women.

METHODS

Data from 99 older women (68.6 ± 5.7 years, 65.7 ± 8.6 kg, 155.1 ± 5.8 cm, 27.2 ± 3.1 kg/m²) was retrospectively analyzed. Participants were separated into tertiles according to the amount of fat mass at baseline as follows: low fat mass (L-FM, n = 33), moderate fat mass (M-FM, n = 33), and high fat mass (H-FM, n = 33). The participants underwent a RT program consisting of eight exercises, three sets per exercise, with a load between 8 and 15 RM, performed three times per week for 24 weeks. The SMM and fat mass were evaluated by dual-energy X-ray absorptiometry (DXA). Body recomposition was determined by the composite Z-score of changes in SMM and fat mass. One repetition maximum (1RM) tests in chest press, knee extension, and preacher curl were assessed to verify muscular strength. Bioimpedance was used to determine phase angle.

RESULTS

Results indicated that after the RT period, a greater positive body recomposition was observed in the L-FM group than in M-FM and H-FM groups. Moreover, all groups increased muscular strength and phase angle with no significant difference among groups (P > 0.05).

CONCLUSION

The present study results suggest that the initial amount of fat mass influences the body recomposition induced by RT in older women, with those with lower pre-training fat mass levels presenting higher levels of body recomposition. However, improvements in muscular strength and phase angle are not dependent on the amount of initial fat mass in older women.

Resistance Training for Patients with Cancer: A Conceptual Framework for Maximizing Strength, Power, Functional Mobility, and Body Composition to Optimize Health and Outcomes

There are many benefits to the addition of exercise to cancer treatment and survivorship, particularly with resistance training regimens that target hypertrophy, bone mineral density, strength, functional mobility, and body composition. These goals are best achieved through a series of individualized high-intensity compound movements that mirror functional mobility patterns and sufficiently stress the musculoskeletal system. As a result of adequate stress, the body will engage compensatory cellular mechanisms that improve the structural integrity of bones and muscles, stimulate metabolism and the immune system, optimize functional performance, and minimize mechanical injury risk. The current evidence suggests that application of the above exercise principles, practiced in a safe environment under expert observation, may offer patients with cancer an effective means of improving overall health and cancer-specific outcomes. The following article poses several important questions certified exercise specialists and physicians should consider when prescribing resistance exercise for patients with cancer.

Jump rope training effects on health- and sport-related physical fitness in young participants: A systematic review with meta-analysis

The aim of this systematic review with meta-analysis was to assess the available body of published peer-reviewed articles related on the effects of jump rope training (JRT) compared with active/passive controls on health- and sport-related physical fitness outcomes. Searches were conducted in three databases, including studies that satisfied the following criteria: i) healthy participants; ii) a JRT programprogramme; iii) active or traditional control group; iv) at least one measure related to health- and sport-related physical fitness; v) multi-arm trials. The random-effects model was used for the meta-analyses. Twenty-one moderate-high quality (i.e., PEDro scale) studies were meta-analysed, involving 1,021 participants (male, 50.4%). Eighteen studies included participants with a mean age <18 years old. The duration of the JRT interventions ranged from 6 to 40 weeks. Meta-analyses revealed improvements (i.e., p = 0.048 to <0.001; ES = 0.23-1.19; I² = 0.0-76.9%) in resting heart rate, body mass index, fat mass, cardiorespiratory endurance, lower- and upper-body maximal strength, jumping, range of motion, and sprinting. No significant JRT effects were noted for systolic-diastolic blood pressure, waist-hip circumference, bone or lean mass, or muscle endurance. In conclusion, JRT, when compared to active and passive controls, provides a range of small-moderate benefits that span health- and sport-related physical fitness outcomes.

Effects of whole-body electromyostimulation training on upper limb muscles strength and body composition in moderately trained males: A randomized controlled study

Resistance training has been known to have a positive effect on muscle performance in exercisers. Whole-body electromyostimulation (WB-EMS) is advertised as a smooth, time-efficient, and highly individualized resistance training technology. The purpose of this study is to evaluate the effects of WB-EMS training on maximum isometric elbow muscle strength and body composition in moderately trained males in comparison to traditional resistance training. The study was a randomized controlled single-blind trial. Twenty, moderately trained, male participants (25.15 ± 3.84, years) were randomly assigned to the following groups: a WB-EMS training group (n = 11) and a traditional resistance training group (the control group [CG]: n = 9). Both training intervention programs consisted of 18 training sessions for six consecutive weeks. All subjects performed dynamic movements with the WB-EMS or external weights (CG). The primary outcome variables included maximum isometric elbow flexor strength (MIEFS), maximum isometric elbow extensor strength (MIEES) and surface electromyography amplitude (sEMG_RMS). Secondary outcomes involved lean body mass, body fat content, arm fat mass, and arm lean mass. ANOVAs, Friedman test and post hoc t-tests were used (P = 0.05) to analyze the variables development after the 6-week intervention between the groups. Significant time × group interactions for MIEFS (η² = 0.296, P _Bonferroni = 0.013) were observed, the increase in the WB-EMS group were significantly superior to the CG [23.49 ± 6.48% vs. 17.01 ± 4.36%; MD (95% CI) = 6.48 (1.16, 11.80); d = 1.173, P = 0.020]. There were no significant differences were observed between interventions regarding MIEES, sEMG_RMS and body composition. These findings indicate that in moderately trained males the effects of WB-EMS were similar to a traditional resistance training, with the only exception of a significantly greater increase in elbow flexor strength. WB-EMS can be considered as an effective exercise addition for moderately trained males.

Benefits of Exercise in Multidisciplinary Treatment of Binge Eating Disorder in Adolescents with Obesity

Obesity in childhood and adolescence represents a serious health problem worldwide. Similarly, eating disorders (EDs) are complex diseases that affect adolescents with an increasing prevalence and are an alarming health concern to both physical and mental health. Traditionally, obesity and EDs, particularly binge eating disorder (BED), have been considered separate conditions, but there is emerging evidence such as etiology, comorbidities, risk factors, psychosocial impairment, and prevention approaches, highlighting important overlaps among these conditions. In youth, the two conditions share risk factors and consequences at both the physical and psychological levels, requiring special care. Exercise, useful as strategy to prevent and treat overweight conditions, may have beneficial effects on BED symptoms, suggesting that it may be considered as one of the key factors in the treatment of individuals affected by obesity with BED. The purpose of this narrative review is to examine the bidirectional impact of obesity and BED in adolescents, in terms of risk factors, etiology and comorbid conditions. Specifically, we focused on the benefits of physical activity (PA) in the multidisciplinary treatment of subjects affected by obesity with BED. Even though additional research is needed to reach conclusions about the role of exercise in the treatment of obesity and comorbid BED, especially in adolescents, promising results have already suggested that closely monitored exercise is safe and, paired with cognitive behavioral therapy, may provide multiple benefits on both the physical and psychological levels. Tailored and integrated treatments for weight management and eating disorders are important to promptly and effectively treat obese subjects that have BED.

Acute and Chronic Physical Activity Increases Creative Ideation Performance: A Systematic Review and Multilevel Meta-analysis

BACKGROUND

Physical activity is a health-relevant lifestyle factor associated with various benefits on physical and mental health. Several meta-analyses indicated effects of acute and chronic physical activities on elementary cognitive functions such as executive control processes, memory, and attention. Meta-analytic evidence on the effects of physical activity on creative idea generation, which involves a conglomerate of these elementary cognitive functions, is largely missing.

OBJECTIVE

A twofold approach was used to evaluate (1) if there is an association between habitual physical activity and creative ideation and (2) if physical activity interventions (acute and chronic) enhance creative ideation performance.

METHODS

Multilevel meta-analytic methods were applied to (1) evaluate the cross-sectional association between creative ideation performance and measures of habitual physical activity and (2) the effect of physical activity on creative ideation performance. Indicators of creative ideation (fluency, flexibility, originality, elaboration, or composite score), creativity domain (verbal, figural), population (adults, children), gender, study quality, and publication year served as moderator variables for both meta-analyses. Analyses of intervention studies additionally examined the moderator variables study design (between, within), time of measurement (during, after), and implementation of intervention (acute, chronic).

RESULTS

The applied meta-analytic multilevel analysis indicated a medium effect for cross-sectional studies (r = 0.22, SE = 0.06, p = 0.002, 95% CI [0.10-0.34]) based on 17 effects sizes from seven studies. The pooled effects of 28 intervention studies, providing 115 effect sizes, indicated a medium effect size of Hedges' g = 0.47 (SE = 0.09, p < 0.001, 95% CI [0.30-0.65]). Furthermore, a stronger effect was observed for chronic interventions of several days or weeks in comparison with acute interventions of one single bout.

CONCLUSION

This study adds important new meta-analytic evidence on the beneficial role of physical activity beyond mental and physical health outcomes: Physical activity has a positive impact on creative ideation, which expands the literature on the role of physical activity in more elementary cognitive functions such as executive control, memory, and attention. Moderator analyses suggested that chronic interventions showed stronger effects than single bouts of physical activity. Rigorously conducted randomized controlled intervention studies and more cross-sectional studies are needed to broaden the evidence in this nascent field of research.

Accuracy of body composition measurement techniques across the age span

This study investigated the acceptable accuracy of common body composition techniques compared with the reference 4-compartment (4C-R) model, which has not been investigated in a sample with diverse characteristics, including age and sex. Techniques included components of the 4C-R model [dual-energy X-ray absorptiometry, air displacement plethysmography, deuterium dilution (DD)] and surrogate compartment models, which utilised bioelectrical impedance spectroscopy (BIS) rather than DD. Men and women (sex = 1:1, 18-85 years, n = 90) completed body composition testing under best-practice guidance. For measurement of individuals, only the reference 3-compartment (3C-R) equation met acceptable error limits (<5% error among individuals) within the a priori cut-point (80%) for fat-free mass (FFM; CV = 0.52%) and fat mass (FM; CV = 1.61%). However, all investigated techniques reached equivalency to the 4C-R model for FFM on average (CV = 0.52-4.31%), but for FM only the 3C and 4C equations that included quantification of total body water (TBW) by DD or BIS reached equivalency overall (CV = 1.61-6.68%). Sex and age minimally influenced accuracy. Only the 3C-R or 4C-R equations are supported for acceptable individual accuracy for both FFM and FM. For group estimates any investigated technique could be used with acceptable accuracy for FFM; however, for FM, inclusion of TBW measurement within a compartment model is necessary. Novelty: Only the referent 3C and 4C models (including deuterium dilution) provide accurate body composition results that are acceptable for measurement of individuals in the general population. For group estimates of lean mass in the general population, compartments models that include TBW must be used for accurate measurement.

Does a Hypertrophying Muscle Fibre Reprogramme its Metabolism Similar to a Cancer Cell?

In 1924, Otto Warburg asked "How does the metabolism of a growing tissue differ from that of a non-growing tissue?" Currently, we know that proliferating healthy and cancer cells reprogramme their metabolism. This typically includes increased glucose uptake, glycolytic flux and lactate synthesis. A key function of this reprogramming is to channel glycolytic intermediates and other metabolites into anabolic reactions such as nucleotide-RNA/DNA synthesis, amino acid-protein synthesis and the synthesis of, for example, acetyl and methyl groups for epigenetic modification. In this review, we discuss evidence that a hypertrophying muscle similarly takes up more glucose and reprogrammes its metabolism to channel energy metabolites into anabolic pathways. We specifically discuss the functions of the cancer-associated enzymes phosphoglycerate dehydrogenase and pyruvate kinase muscle 2 in skeletal muscle. In addition, we ask whether increased glucose uptake by a hypertrophying muscle explains why muscularity is often negatively associated with type 2 diabetes mellitus and obesity.